[FG] Müller Christian

Imported from Grants Tool 4702918

Imported from Grants Tool 4701193

No Description available

Insights from the prospective BASEL VIII and Swiss Secondary Prevention and Rehabilitation Study

No Description available

No Description available

Worldwide, over 300 million major operations are performed annually. Despite advances in many fields of medicine, there is still a relevant risk of death related to these operations. Depending on how sick the patient was prior to the operation and the type of the operation needed, between 1% and 10% of patients die within 30 days of an operation. Cardiac complications, including a heart attack, occurring either during or immediately after these operations seem to be important contributors to many of these deaths.Most heart attacks occurring during or immediately after an operation do not cause symptoms such as chest pain, as the patients is receiving high doses of anesthetic drugs at this time. Accordingly, these heart attacks are very often missed in clinical routine. Therefore, it is largely unknown how often these heart attacks occur and for how many of the perioperative deaths these heart attacks are responsible for.Also, it is unknown, why these heart attacks occur during or immediately after an operation and how these patients should be treated.Aims: To find out, how common cardiac complications including heart attacks are during or immediately after an operation, for how many of the perioperative deaths these heart attacks are responsible for,why these heart attacks occur, how these patients should be treated.Methodology: 3460 consecutive patients undergoing a major operation will be included into this pragmatic prospective observational multicentre study at the University Hospital Basel, the Cantonal Hospital Aarau, and other hospitals in Switzerland. The study will be conducted by an interdisciplinary team of cardiology, anaesthesiology, and surgery. Patients will receive measurements of a novel blood tests that allows the rapid detection of dying heart muscle cells, and therefore heart attacks. prior to the operation, as well as after the operation. The type and the most likely cause of these heart attacks will then by examined by experienced physicians. We will contact all patients after hospital discharge and check whether they are fine or whether a complications or even death may have occurred. We will then try to develop tools that allow a more precise assessment of the risk in the individual patient developing such a cardiac complication and/or death.Potential Significance: Our large interdisciplinary multicentre project will provide novel and unique insights on heart attacks occurring during or immediately after an operation. These insights will empower physicians and patients to make better assessment of the risk-benefit ratio of a planned operation. E.g. patients being told that a planned operation carries with it for them a high risk of developing a heart attack may ultimately decide against an operation and chose a conservative treatment option.

Syncope is frequent and represents 1-2% of all Emergency Department (ED) visits. The ED-evaluation of patients with syncope is challenging, generally time and resource consuming. In the first phase of BASEL IX, which was mainly conducted in EDs in Switzerland, several important insights and novel diagnostic algorithms emerged. However, numerous important questions remain regarding these algorithms, particularly the need to be validated in a large prospective validation cohort before they can be recommended for widespread clinical use. Aims: The aim of the current application is to extend the work in the ongoing and highly successful BASEL IX (BAsel Syncope EvaLuation Study) in order to test the generalizability of the initial findings and to provide additional insights for diagnosis and risk stratification.Methodology: BASEL IX is a large ongoing prospective international diagnostic study enrolling unselected patients presenting with syncope to the ED in thirteen hospitals in eight countries on three continents. It is conducted by a dynamic network of academic, clinical and industry collaborators experienced in the field of syncope and cardiac biomarkers. In the new application period (BASEL IX Validation) we will enroll 2'000 additional patients. It is our primary objective to validate the diagnostic performance of the recently developed algorithm implementing the combination of a low ED-probability and a low plasma level of midregional pro A-type natriuretic peptide (MRproANP) against a gold standard diagnosis adjudicated centrally by two independent cardiologists according to the latest European Society of Cardiology (ESC) guidelines using all information becoming available during clinical work-up including 1-year follow-up. Secondary objectives include the evaluation of a) age-, circadian, and sex-optimized cut-off levels for MR-proANP and ED clinical judgment to derivate and validate personalized diagnostic algorithms b) other biochemical signatures including other natriuretic peptides (e.g. B-type natriuretic peptide and NT-proBNP) c) electrocardiographic signatures to improve the early diagnosis of cardiac syncope. As the main causes of cardiac syncope are arrhythmic disorders, ECG-signals may provide incremental value in diagnosing cardiac syncope. The latter includes the attempt to incorporate an ECG-marker into our algorithm combining clinical judgement and a cardiac biomarker to further improve its accuracy, efficacy and safety d) the prevalence of pulmonary embolism as the cause of syncope among patients presenting to the ED and e) the best clinical use of implantable loop recorders in the management of patients with unexplained syncope.Potential significance: This study will provide insights that will contribute to improvements in diagnosis and risk stratification of cardiac syncope and will therefore have important clinical and economic implications on patient management in Switzerland and worldwide.