Klug entscheiden in der Kardiologie

© Sergey Nivens - stock.adobe.com

 

Positiv-Empfehlungen

aerzteblatt.de vom 19. April 2024

Bei Patientinnen und Patienten mit neu diagnostiziertem Vorhofflimmern (AF, < 12 Monaten) und kardiovaskulärem Risiko (CHA2DS2Vasc ≥ 2) soll eine antiarrhythmische Therapie erfolgen.

 
Negativ-Empfehlungen

aerzteblatt vom 19. April 2024

Bei älteren Menschen mit permanentem Vorhofflimmern sollte keine Therapie mit Antiarrhythmika erfolgen.

 

Literaturnachweise 2024

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Negativ-Empfehlungen

Deutsches Ärzteblatt | Jg. 120 | Heft 17 | 28. April 2023

Bei Patienten mit akutem Koronarsyndrom und Vorhofflimmern mit CHA2DS2-VASc-Score ≥ 1 bei Männern beziehungsweise ≥ 2 bei Frauen – und damit der Notwendigkeit zur Antikoagulation – soll nicht, wie lange Zeit praktiziert, eine 12-monatige Tripletherapie ..

 

Bei Patienten mit Verdacht auf ein akutes Koronarsyndrom, bei denen eine früh-invasive Behandlung mittels perkutaner Konorarintervention oder aortokoronarer Bypassoperation geplant ist, soll keine Vorbehandlung mit einem P2Y12-Rezeptorantagonisten ...

 

Literaturnachweise 2023

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2. https://dgim.de/veroeffentlichungen/klug-entscheiden/ (last accessed 13 April 2023).
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8. Felber J, Bläker H, Fischbach W, et al.: Aktualisierte S2k-Leitlinie Zöliakie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 2022; 60: 790–856. CrossRef MEDLINE
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12. Fischbach W, Bornschein J, Hoffmann JC, et al.: Aktualisierte S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Juli 2022 – AWMF-Registernummer: 021 – 001. https://register.awmf.org/assets/guidelines/021-001l_S2k_Helicobacter-pylori-gastroduodenale-Ulkuskrankheit_2022-07_1.pdf (last accessed 13 April 2023).
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21. Scally B, Emberson JR, Spata E, et al.: Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials. Lancet Gastroenterol Hepatol 2018; 3: 231–41. CrossRef MEDLINE
22. Wang X, Tian HJ, Yang HK, et al.: Meta-analysis: Cyclooxygenase-2 inhibitors are no better than nonselective nonsteroidal anti-inflammatory drugs with proton pump inhibitors in regard to gastrointestinal adverse events in osteoarthritis and rheumatoid arthritis. Eur J Gastroenterol Hepatol 2011; 23: 876–80. CrossRef MEDLINE
23. Rane PP, Guha S, Chatterjee S, et al.: Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US. Res Social Adm Pharm 2017; 13: 358–63. CrossRef MEDLINE
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25. Haastrup PF, Thompson W, Søndergaard J, et al.: Side Effects of Long-Term Proton Pump Inhibitor Use: A Review. Basic Clin Pharmacol Toxicol 2018; 123: 114–21. CrossRef MEDLINE
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27. Beschluss der Bundesärztekammer über die Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten, Gesamtnovelle 2020. Dtsch Arztebl 2020; 117 (40): A-1883/B-1603. VOLLTEXT
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33. Tobberup R, Thoresen L, Falkmer UG, et al.: Effects of current parenteral nutrition treatment on health-related quality of life, physical function nutritional status, survival and adverse events exclusively in patients with advanced cancer: A systematic literature review. Crit Rev Oncol Hematol 2019; 139: 96–107. CrossRef MEDLINE
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39. Bouleuc C, Anota A, Cornet C, et al.: Impact on Health-related Quality of Life of Parenteral Nutrition for Patients with Advanced Cancer Cachexia: results from a Randomized Controlled Trial. Oncologist 2020; 25: e843–51. CrossRef MEDLINE PubMed Central
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43. Thiele H, Bauersachs J, Mehilli J, et al.: Kommentar zu den 2020er-Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management des akuten Koronarsyndroms bei Patienten ohne persistierende ST-Strecken-Hebung. Kardiologe 2021; 15: 19–31. CrossRef
44. Hindricks G, Potpara T, Dagres N, et al.: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC); Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42: 373–498 CrossRef MEDLINE
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Positiv-Empfehlungen

Deutsches Ärzteblatt | Jg. 113 | Heft 27–28 | 11. Juli 2016

Bei Patienten mit Vorhofflimmern und dadurch erhöhtem Schlaganfall-Risiko (CHA2DS2- VASc-Score Frauen > 1, Männer >= 1) soll eine unbefristete Blutverdünnung (orale Antikoagulation) durchgeführt werden.

 

Bei Patienten mit koronarer Herzkrankheit soll die LDL-Cholesterin- Serumkonzentration mit einem Statin auf Werte unter 70 mg/dL (1,8 mmol/L) gesenkt bzw. eine mindestens 50 %ige Reduktion des LDL-Cholesterin-Ausgangswertes erreicht werden.

 

Bei Patienten mit akutem Herzinfarkt soll nach perkutaner Koronarintervention (PCI) für 12 Monate neben ASS einer der beiden Thrombozyten-ADP-Rezeptorantagonisten (Prasugrel oder Ticagrelor) verordnet werden, falls nicht ein exzessives Blutungsrisiko vorliegt!

 

Patienten mit stabiler Herzinsuffizienz (NYHA I–III) sollen in ärztlicher Absprache ein regelmäßiges Belastungstraining durchführen, um damit ihre körperliche Leistungsfähigkeit und Lebensqualität zu verbessern sowie ihre kardialen Symptome zu vermindern.

 

Verschreibung von Mineralokortikoidrezeptor- Antagonisten bei Patienten mit chronischer systolischer Herzinsuffizienz

 
Negativ-Empfehlungen

Deutsches Ärzteblatt | Jg. 113 | Heft 27–28 | 11. Juli 2016

Bei Patienten mit Vorhofflimmern und dennoch nur geringem Schlaganfall-Risiko (CHA2DS2- VASc-Score = 0) soll eine Blutverdünnung nicht durchgeführt werden.

 

Bei asymptomatischen Personen mit niedrigem Risiko für das Vorliegen einer koronaren Herzkrankheit soll KEINE „Vorsorge“-Computertomographie der Herzkranzgefäße (Koronar- CTA) durchgeführt werden!

 

Nach unkomplizierter perkutaner Koronarintervention (PCI) soll KEINE routinemäßige „Kontroll-Koronarangiographie“ durchgeführt werden.

 

Bei asymptomatischen Patienten ohne Nachweis einer myokardialen Ischämie respektive ohne Nachweis eines hämodynamisch signifikanten Stenosegrades soll auf eine Behandlung von Koronarstenosen mittels perkutaner Koronarintervention verzichtet werden.

 

Innerhalb der ersten 40 Tage nach Herzinfarkt soll KEINE primärpräventive ICD-Implantation durchgeführt werden.

 

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