Reduction of Long‐Term Care Dependence After an 8‐Year Primary Care Prevention Program for Stroke and Dementia: The INVADE Trial

Bickel, Horst; Ander, Karl‐Heinz-H.; Brönner, Monika; Etgen, Thorleif; Gnahn, Hans; Gotzler, Othmar; Poppert, Holger; Pürner, Klaus; Sander, Dirk; Förstl, Hans

doi:10.1161/jaha.112.000786

Cited by 18 publications

(14 citation statements)

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“…GPs also took fasting blood samples that were analyzed in a central laboratory with regard to total cholesterol, low-and high-density lipoprotein (LDL, HDL) cholesterol, triglycerides, serum glucose, glycosylated hemoglobin A 1c (HbA 1c ), creatinine, homocysteine and high-sensitivity C-reactive protein (hsCRP). A detailed description of the INVADE trial and the baseline examination is published [25].…”

Section: Methodsmentioning

confidence: 99%

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Smoking increases the risk of delirium for older inpatients: a prospective population-based study

Heßler

Brönner

Etgen

et al. 2015

General Hospital Psychiatry

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Section: Methodsmentioning

confidence: 99%

“…To this purpose, we analyzed data of almost 4000 individuals older than 54 years who were prospectively observed for an average of 6 years over the course of the INVADE trial (Intervention Project on Cerebrovascular Disease and Dementia in the District of Ebersberg [25]). …”

Section: Introductionmentioning

confidence: 99%

Smoking increases the risk of delirium for older inpatients: a prospective population-based study

Heßler

Brönner

Etgen

et al. 2015

General Hospital Psychiatry

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“…This hypothesis is currently being addressed in the ongoing INVADE (Prevention of Stroke and Dementia in Primary Care) study, 19 in which PESP was determined in a general population sample of 1,900 patients aged ≥65 years, who are now followed up for cardiovascular events. of post-MI mortality by LVEF and PESP (see Figure 2C) suggests that this might be the case.…”

Section: Future Directionsmentioning

confidence: 99%

Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

Steger

Sinnecker

Barthel

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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In 1885, Oscar Langendorff was the first person to describe the increase in contractility ('Pulsverstärkung') that follows an extrasystole.1 Langendorff experimented with spontaneously beating isolated frog hearts. He recorded the heartbeats by using a lever that transferred the contractile movements of the heart to a rotating drum. Electrical stimulation resulted in premature contractions that were followed by compensatory pauses. In these experiments, he noticed that myocardial contractility during the first post-ectopic beats was typically stronger compared with the normal beats (see Figure 1A). Decades later, this phenomenon was termed postextrasystolic potentiation (PESP).2 PESP is present at the level of the myocardium, independently of pre-or afterload conditions. 3 The driving force behind the augmented post-extrasystolic contractility is augmented calcium release from the intracellular stores during the post-extrasystolic action potential. 4,5 Historically, PESP has been studied intensively with regard to two possible clinical applications (reviewed in Cooper 3 ):• PESP was induced during contrast ventriculography with the aim of identifying ischaemic but viable myocardial regions that might benefit from revascularisation.• PESP was elicited by paired pacing with the aim of augmenting myocardial contractility in heart failure patients.Besides these now widely abandoned applications, several studies have documented an interesting relationship between PESP and myocardial dysfunction. Post-extrasystolic Potentiation and HeartDisease: A Forgotten Association?PESP can be measured as post-extrasystolic augmentation of the maximum left-ventricular pressure rise (LV dP/dt) or as systolic blood pressure potentiation. The parameter that is most closely related to myocardial contractility is LV dP/dt. At the level of LV dP/dt, PESP was observed both in healthy people and in heart failure patients. 6However, potentiation of LV dP/dt was typically more pronounced in failing than in healthy hearts. 7-10 At the level of blood pressure, it has to be taken into account that systolic blood pressure is not only determined by cardiac output, but also by vascular factors, such as peripheral vascular resistance. When PESP was measured at the level of maximum systolic blood pressure (or maximum LV pressure, which are roughly equivalent in the absence of aortic stenosis), the typical finding in healthy probands was that the first post-ectopic heartbeat elicited a lower pulse wave than the regular ones. By contrast, in heart failure patients, PESP of systolic blood pressure could generally be observed. [6][7][8][9][10] In a series of 100 consecutive patients with coronary artery disease, the pattern of post-extrasystolic blood pressure potentiation was associated with an increased prevalence of congestive heart failure and cardiomegaly as well as with higher left-ventricular end-diastolic pressure, lower cardiac output and lower left-ventricular ejection fraction (LVEF). 11At the cellular level, PESP of contractility is caused ...

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“…Die erste, 8-jährige Phase des Modellvorhabens wurde 2012 evaluiert [16]. Dabei zeigte sich, dass unter den knapp 4000 eingeschriebenen Teilnehmern sämtliche objektiv messbaren Risikofaktoren (Blutdruck, Blutfette, Blutzucker, glykosyliertes Hämoglobin, Homocystein und Body-Mass-Index) signifikant reduziert werden konnten.…”

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Prävention von Schlaganfall und Demenz in der Hausarztpraxis: Evaluation des Projektes INVADE

Bickel

Block

Gotzler

et al. 2020

Dtsch Med Wochenschr

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Zusammenfassung Einleitung Schlaganfall und Demenz haben zahlreiche modifizierbare Risikofaktoren gemeinsam. Im hausärztlichen Präventionsprojekt INVADE (INterventionsprojekt VAskuläre Hirnerkrankungen und Demenz im Landkreis Ebersberg) wurden diese vaskulären Risikofaktoren systematisch erfasst und evidenzbasiert behandelt. Methoden Alle über 50-jährigen Versicherten der AOK Bayern mit Wohnsitz im oberbayerischen Landkreis Ebersberg erhielten das Angebot zur Teilnahme an INVADE, rund 1 Drittel schrieb sich in das Programm ein. Durch hausärztliche Untersuchungen, Selbstauskünfte der Versicherten, Laboranalysen und eine Duplexsonografie der extrakraniellen Halsgefäße wurden individuelle Risikoprofile erstellt, aus denen sich die Interventionsmaßnahmen ableiteten. In jedem Quartal dokumentierten die Hausärzte Behandlung und Gesundheitszustand der Teilnehmer, nach jeweils 2 Jahren wurde das gesamte Untersuchungsprogramm wiederholt. Der Erfolg der Intervention wurde am Landkreis Dachau bemessen, wo die Versicherten die übliche hausärztliche Versorgung erhielten. Als Endpunkte wurden administrative Daten der Kranken- und Pflegekasse für den Zeitraum von 2013 bis 2016 verwendet. Primäre Endpunkte bestanden in der Mortalität und im Eintritt von Pflegebedürftigkeit, sekundäre Endpunkte in den stationären Behandlungen infolge von zerebrovaskulären Erkrankungen. Ergebnisse Der Vergleich zwischen den Versicherten im Landkreis Ebersberg (n = 10 663) und im Landkreis Dachau (n = 13 225) fiel sowohl in den primären klinischen Endpunkten als auch im kombinierten sekundären Endpunkt zugunsten des Präventionsprogramms aus. Mortalitätsrisiko (HR = 0,90; 95 %-Konfidenzintervall: 0,84–0,97), Pflegebedürftigkeitsrisiko (HR = 0,88; 95 %-KI 0,81–0,96) und die Wahrscheinlichkeit einer stationären Behandlung aufgrund zerebrovaskulärer Erkrankungen (OR = 0,87; 95 %-KI 0,77–0,97) waren signifikant reduziert. Diskussion Die Ergebnisse stützen die Annahme, dass durch eine intensivierte hausärztliche Identifikation und Behandlung vaskulärer Risikofaktoren das Auftreten von zerebrovaskulären Erkrankungen und Demenzen gesenkt werden kann und sich damit Lebenserwartung und von Pflegebedürftigkeit freie Lebenserwartung erhöhen lassen. Registrierung clinicaltrials.gov, NCT1107548, Registrierungsdatum: 21.04.2010, drks.de, DRKS00 011348, Registrierungsdatum: 29.12.2016

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Reduction of Long‐Term Care Dependence After an 8‐Year Primary Care Prevention Program for Stroke and Dementia: The INVADE Trial

Abstract: Background--Stroke and dementia are the major causes for long-term care (LTC) dependence in old age. This intervention trial compared a multidomain prevention program for stroke and dementia with usual medical care in reducing the need for LTC.

Cited by 18 publications

References 50 publications

Smoking increases the risk of delirium for older inpatients: a prospective population-based study

Smoking increases the risk of delirium for older inpatients: a prospective population-based study

Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

Prävention von Schlaganfall und Demenz in der Hausarztpraxis: Evaluation des Projektes INVADE

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