Ute Amann

Physical activity, muscular strength and polypharmacy among older multimorbid persons: Results from the KORA‐Age Study

The purpose of this study was to examine whether physical activity (PA) and muscular strength (MS) are related to polypharmacy. Our cross‐sectional analysis was based on 711 patients with multimorbidity (MMB), aged 65‐94 years, who participated in the KORA‐Age study. Participants underwent a face‐to‐face interview and extensive physical examinations including anthropometric measurements, registration of chronic diseases, determination of health‐related behaviors (smoking, alcohol intake, physical activity, etc.), collection of blood samples and measurement of hand‐grip strength. PPha was defined as the use of >4 drugs and MMB as having ≥2 of 13 chronic diseases. Prevalence of PPha was 44.6% (n=317), and a significant difference was found in the number of drugs used between participants with and without PPha (7.2±2.1 vs 2.5±1.2, P<.001). Patients in the lower compared to the upper tertile of physical activity had a significantly increased odds to be on PPha (OR: 1.64, 95% CI: 1.05‐2.56, P=.031) after controlling for age, gender, BMI, family status, education, alcohol intake, smoking habits, number of diseases, hs‐CRP, and telomere length. On the contrary, no significant association between muscular strength and PPha was found (OR: 1.04, 95% CI: 0.66‐1.63, P=.873) after multivariable adjustment. Among older persons with MMB, lower levels of physical activity, but not low muscular strength, are associated with higher odds of PPha. Increasing the levels of physical activity appears to be highly recommended in order to potentially reduce the risk of PPha among multimorbid persons aged 65 and older.

Medication use in long-term survivors from the MONICA/KORA Myocardial Infarction Registry

BACKGROUNDnPrior studies reported high guideline adherence for secondary prevention medications (SPM) at hospital discharge in patients with acute myocardial infarction (AMI). Less is known about medication use in long-term AMI survivors.nnnMETHODSnOf the 2077 registered persons with an AMI between 2000 and 2008 who responded to a postal follow-up survey in 2011, 1311 men and 356 women, aged between 34.4 and 84.9years, reported medication intake 7days prior to the survey. These study participants also had their current health condition and comorbidities assessed. Information regarding index AMI was selected from the population-based MONICA/KORA MI registry. Multivariable logistic regression models were conducted to identify factors associated with SPM use (all 4 drug classes).nnnRESULTSnThe median time between index AMI and the follow-up survey was 6.1years (IQR: 3.9). At follow-up, a total of 10,422 medications were reported and polypharmacy was observed in 73.8%. Regarding SPM, the proportion of patients taking antiplatelet agents, beta-blockers, statins, and renin-angiotensin-aldosteron system blockers were 90.9%, 86.7%, 85.4%, and 79.3% respectively. Factors associated with SPM use were hypertension (odds ratio [OR] 1.48, p=0.006), SPM prescription at hospital discharge (OR 2.68, p<0.0001), revascularization therapy at index AMI (OR 2.46, p>0.0001), number of medications taken at follow-up (OR 1.48, p<0.0001), and several comorbidities such as lung disorders (OR 0.17; p<0.0001), depression (OR 0.53, p=0.001), neurological disorders (without stroke) (OR 0.34, p=0.002), and cancer (OR 0.45, p=0.005).nnnCONCLUSIONnSPM use several years after AMI was high and associated with treatment at index AMI and patients comorbidities.

Factors Associated With Emergency Services Use by Patients With Recurrent Myocardial Infarction: From the Monitoring Trends and Determinants in Cardiovascular Disease/Cooperative Health Research in the Region of Augsburg Myocardial Infarction Registry.

Background: Although emergency medical services (EMS) use is the recommended mode of transport in case of acute coronary symptoms, many people fail to use this service. Objective: The objective of this study was to determine factors associated with EMS use in a population-based sample of German patients with recurrent acute myocardial infarction (AMI). Methods: The sample consisted of 998 persons with a first and recurrent AMI, recruited from 1985 to 2011. Logistic regression modeling adjusted for sociodemographic, situational, and clinical variables, previous diseases, and presenting AMI symptoms was applied. Results: Emergency medical services was used by 48.8% of the patients at first, and 62.6% at recurrent AMI. In first AMI, higher age, history of hyperlipidemia, ST-segment elevation AMI, more than 4 presenting symptoms, symptom onset in daytime, and later year of AMI were significantly related with EMS use. Pain in the upper abdomen and pain between the shoulder blades were significantly less common in EMS users. In recurrent AMI, EMS use at first AMI, presence of any other symptom except chest pain, ST-segment elevation myocardial infarction, and later year of AMI were significantly related with EMS use. Significant predictors of EMS use in recurrent AMI in patients who failed to use EMS at first AMI were unmarried, experience of any symptom except chest symptoms at reinfarction, bundle branch block (first AMI), any in-hospital complication (first AMI), longer duration between first and recurrent AMI, and later year of reinfarction. Conclusions: Patients with AMI and their significant others may profit by education about the benefits of EMS use.

Neuropathic pain is not adequately treated in the older general population: Results from the KORA F4 survey

We evaluated the pharmacological treatment of distal sensorimotor polyneuropathy (DSPN) among older subjects from the general population.

Muscular Strength is Independently Associated with Cystatin C: The KORA-Age Study

The purpose of this study was to investigate if there is a link between muscular strength (MS) and markers of chronic kidney disease (CKD) among older adults. The cross-sectional analysis based on 1041 men and women, aged 65-94 years, who participated in the KORA-Age study. Participants underwent an interview and extensive examinations including anthropometric measurements, diseases and drug intake registration, determination of health-related behaviors, collection of blood samples for measurements of cystatin C and maximal muscle strength evaluation. One-Way ANOVA revealed significant differences in both mean cystatin C (1.16±0.37 vs. 1.03±0.29 vs. 0.93±0.24u2009mg/L, p<0.001) and mean eGFRcysC (63.61±18.61 vs. 72.14±18.92 vs. 79.87±18.19u2009ml/min/1.73u2009m2, p<0.05) across thirds of maximal muscular strength (from lowest to highest). MS in the lowest third was significantly associated with increased odds of having elevated cystatin C (OR: 1.70, 95% CI: 1.01-2.85, p=0.043) after controlling for age, gender, fat mass, fat-free mass, alcohol intake, smoking status, number of regularly used medications, multimorbidity status, hs-CRP, telomere length and levels of physical activity. Lower levels of MS are independently associated with higher concentrations of cystatin C and lower eGFRcysC in older individuals. Increasing the levels of muscular strength may be useful to prevent the age-related CKD disease of older adults.

Association of serum potassium concentration with mortality and ventricular arrhythmias in patients with acute myocardial infarction: A systematic review and meta-analysis:

Background Challenging clinical practice guidelines that recommend serum potassium concentration between 4.0–5.0u2009mEq/L or ≥4.5u2009mEq/L in patients with acute myocardial infarction, recent studies found increased mortality risks in patients with a serum potassium concentration of ≥4.5u2009mEq/L. Studies investigating consequences of hypokalemia after acute myocardial infarction revealed conflicting results. Therefore, the aim of this systematic review and meta-analysis was to combine evidence from previous studies on the association of serum potassium concentration with both short and long-term mortality as well as the occurrence of ventricular arrhythmias. Design Systematic review and meta-analysis. Methods A structured search of MEDLINE and EMBASE databases yielded 23 articles published between 1990 and January 2017 that met the inclusion criteria. Study selection, data extraction and quality assessment were carried out by three reviewers. Random effects models were used to pool estimates across the included studies and sensitivity analyses were performed when possible. Results Twelve studies were included in the meta-analysis. Both pooled results from six studies investigating short-term mortality and from five studies examining long-term mortality revealed significantly increased risks in patients with serum potassium concentrations of <3.5u2009mEq/L, 4.5–<5.0u2009mEq/L and ≥5.0u2009mEq/L after acute myocardial infarction. In addition, a serum potassium concentration of <3.5u2009mEq/L was significantly associated with the occurrence of ventricular arrhythmias. Conclusions Mortality, both short and long term, and the occurrence of ventricular arrhythmias in patients with acute myocardial infarction seem to be negatively associated with hypokalemic serum potassium concentration. There is evidence for adverse consequences of serum potassium concentrations of ≥4.5u2009mEq/L. Due to the heterogeneity among existing studies, further research is necessary to confirm the need to change clinical practice guidelines.

Peripheral arterial disease is associated with higher mortality in patients with incident acute myocardial infarction

BACKGROUNDnLittle data is available on short- and long-term survival in patients with peripheral arterial disease (PAD) after acute myocardial infarction (AMI). We aimed to examine the association of PAD and 28-day case fatality as well as long-term mortality in a population-based sample of patients with incident AMI.nnnMETHODSnIn this secondary analysis of data from the German MONICA/KORA Myocardial Infarction Registry 4307 patients aged 28-74years with incident AMI with and without history of PAD (information derived from medical chart) were included. Data were collected between 2000 and 2008. Patients were followed-up until December 2011. Associations between PAD and 28-day case fatality were examined via multivariable logistic regression models, between PAD and long-term mortality with Cox proportional hazards regression models, respectively.nnnRESULTSnFrom 303 (8.9%) patients with PAD, 22 (7.3%) died within 28-days post-AMI in contrast to 96 (2.9%) of patients without PAD. However, the fully adjusted model (OR 1.55, 95% CI 0.89-2.70) revealed no significant association. Long-term follow-up (median 5.7years) yielded 100 (32.4%) versus 483 (14.4%) cases of deaths among patients with and without PAD, respectively. This association was significant (fully adjusted model: HR 1.70, 95% CI 1.35-2.13), persisted up to 11years after AMI and was present in all subgroups according to age, sex and history of diabetes. The highest long-term mortality risk was found for patients younger than 63years with PAD (HR 2.19; 95% CI 1.41-3.39).nnnCONCLUSIONnAMI patients with PAD differ considerably from their counterparts without PAD in terms of long-term survival.

Determinants of adherence and effects on health-related quality of life after myocardial infarction: a prospective cohort study

BackgroundAdherence to recommendations and medication is deemed to be important for effectiveness of case management interventions. Thus, reasons for non-adherence and effects on health-related quality of life (HRQoL) should be fully understood. The objective of this research was to identify determinants of non-adherence to medication and recommendations, and to test whether increased adherence improved HRQoL in patients after myocardial infarction (MI) in a case management intervention.MethodsData were obtained from the intervention group of the KORINNA study, a randomized controlled trail of a nurse-led case management intervention with targeted recommendations in the elderly after MI in Germany. Reasons for non-adherence were described. Logistic mixed effects models and OLS (ordinary least squares) were used to analyze the effect of recommendations on the probability of adherence and the association between adherence and HRQoL.ResultsOne hundred and twenty-seven patients with 965 contacts were included. Frequent reasons for non-adherence to medication and recommendations were “forgotten” (22%; 11%), “reluctant” (18%; 18%), “side effects” (38%; 7%), “the problem disappeared” (6%; 13%), and “barriers” (0%; 13%). The probability of adherence was lowest for disease and self-management (38%) and highest for visits to the doctor (61%). Only if patients diverging from prescribed medication because of side effects were also considered as adherent, 3-year medication adherence was associated with a significant gain of 0.34 quality-adjusted life years (QALYs).ConclusionsMost important determinants of non-adherence to medication were side effects, and to recommendations reluctance. Recommended improvements in disease and self-management were least likely adhered. Medication adherence was associated with HRQoL.Trial registrationCurrent Controlled Trials ISRCTN02893746, retrospectively registered, date assigned 27/03/2009.

Association between admission anemia and long-term mortality in patients with acute myocardial infarction: results from the MONICA/KORA myocardial infarction registry

BackgroundPrevious studies have shown that the presence of anemia is associated with increased short- and long-term outcomes in patients with acute myocardial infarction (AMI). This study aims at examining the impact of admission anemia on long-term, all-cause mortality following AMI in patients recruited from a population-based registry. Contrary to most prior studies, we distinguished between patients with mild and moderate to severe anemia.MethodsThis prospective study was conducted in 2011 patients consecutively hospitalized for AMI that occurred between January 2005 and December 2008. Patients who survived more than 28xa0days after AMIxa0were followed up until December 2011. Hemoglobin (Hb) concentration was measured at hospital admission and classified according to the World Health Organization (WHO). Mild anemia was defined as Hb concentration of 11 to <u200912xa0g/dL in women and 11 to <u200913xa0g/dL in men; moderate to severe anemia as Hb concentration of <u200911xa0g/dL. Adjusted Cox regression models were calculated to compare survival in patients with and without anemia.ResultsMild anemia and moderate to severe anemia was found in 183 (9.1%) and 100 (5%) patients, respectively. All-cause mortality after a median follow-up time of 4.2xa0years was 11.9%. Thexa0Cox regression analysis showed significantly increased mortality risks in both patients with mild (HR 1.74, 95% CI 1.23–2.45) and moderate to severe anemia (HR 2.05, 95% CI 1.37–3.05) compared to patients without anemia.ConclusionThis study shows that anemia adversely affects long-term survival following AMI. However, further studies are needed to confirm that anemia can solely explain worse long-term outcomes after AMI.