Der Internist
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In August 2021, an update of the European Society of Cardiology-Heart Failure Association guideline for the diagnosis and treatment of heart failure was released. To review the changes implied by current guidelines regarding the diagnosis and treatment of patients with heart failure and preserved left ventricular ejection fraction (HFpEF). The diagnosis of HFpEF requires the combined presence of clinical signs, left ventricular ejection fraction ≥ 50%, elevated natriuretic peptides, and elevated left ventricular filling pressure. ⋯ It is expected that this finding will become part of updated treatment recommendations in the near future. Although challenging, the early diagnosis of HFpEF is key to averting the poor prognosis associated with this frequent condition. Multidisciplinary care and innovative pharmacologic and non-pharmacologic therapies, however, can improve quality of life, exercise tolerance, and prognosis.
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Mobile health (mHealth) for the detection of atrial fibrillation is an innovative domestic monitoring of the heart rhythm. The use of mHealth in the context of atrial fibrillation increases the availability of diagnostic technologies and facilitates the integration into telemedical treatment concepts as well as the active participation of patients in the treatment process. The detection of atrial fibrillation with mHealth applications is usually based on electrocardiography (ECG) or by detection of the pulse wave using photoplethysmography (PPG). ⋯ Nevertheless, at present mHealth is only integrated to a limited extent into the reality of patient care. Adequate reimbursement and medical remuneration as well as opportunities to derive information and qualification are prerequisites in order to be able to guarantee a comprehensive implementation in the future. The Digital Health Care Act passed in 2019, regulates the reimbursement of digital healthcare applications but issues of primary preventive applications have not yet been included.
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Telemedicine has the potential to solve many current and especially future challenges in medical care. Using the example of heart failure (HF), the transition of telemedicine from clinical studies to standard care is presented. In patients with chronic HF, randomized controlled trials have shown that telemedicine-based care leads to a reduction in mortality and cardiovascular morbidity. ⋯ The indications are assessed by the primary treating physician (PBA), who works together with a telemedicine center (TMZ) managed through cardiology that receives daily telemetric data and notifies the PBA of abnormal findings. Alternatively, a cardiologist PBA with an associated TMZ infrastructure can also provide telemedical care. In the future, advanced technologies such as artificial intelligence or mobile communication standard 5G will help to make telemedicine both widely available and usable for alternative sensor technology.
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Many cases of Clostridium perfringens sepsis prove to be fatal. We present a case of C. perfringens sepsis with a liver abscess as the focus of infection, which was successfully treated by an interdisciplinary intensive medical care management. ⋯ Hemodialysis with high cut-off filters was started because of acute kidney failure in the Acute Kidney Injury Network (AKIN) stage III, hemolysis and rhabdomyolysis. Therapeutic plasma exchange was performed due to sepsis and acute liver failure.
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Management of patients with respiratory disorders, such as asthma or chronic obstructive pulmonary disease (COPD), became challenging during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic due to infection prevention measures. To maintain care, a remote monitoring program was initiated, comprising a smartphone app and a Bluetooth spirometry device. ⋯ App-based remote monitoring was successfully implemented in routine care during the SARS-CoV‑2 pandemic and demonstrated potential for improvements in care. Patient-relevant experience was positive in all dimensions and remote monitoring was well accepted. Physicians who participated in the program also expressed positive experiences, as demonstrated by a high level of interaction with the platform and positive evaluations of effects from the program.