Essential tremor has been associated with cognitive impairment. Mild action tremor labelled physiological tremor is present in all humans. Tremor increases with age. It is unknown if mild action tremor is associated with cognitive performance in older people. To test the hypothesis that mild—mostly non-pathological—action tremor is associated with reduced cognitive performance in community-dwelling older adults. The Cooperative Health Research in the Region of Augsburg (KORA)-Age study assessed health-related parameters including cognition in individuals between 65 and 93 years of age. We measured tremor using semi-quantitative ratings of Archimedes-spiral drawings. Participants taking Parkinson medication, with a self-reported neurologic disease or with a spiral rating > 5 indicating certainly pathologic tremor were excluded. The modified Telephone Interview for Cognitive Status (TICS-m) was used to measure cognition. We analyzed the association between tremor and cognition using multivariable adjusted regression models in the whole population and after exclusion of participants with a spiral rating > 3. We employed stepwise backward variable selection to build a final regression model. Tremor severity was associated with cognitive performance. Age, sex, Parkinson score, frailty, tremor score, physical activity, sleep-duration and previous stroke entered the final statistical model. Judged by the differences of adjusted r-squared between models, age was the most important predictor of cognition followed by sex, Parkinson score, frailty, and tremor severity. Sensitivity analyses excluding participants with likely pathological tremors did not attenuate the association between tremor severity and cognitive performance. Even mild action tremor severity is associated with reduced cognitive performance in older people. We hypothesize that aging-related brain changes are a common cause of cognitive impairment and tremor.

Das European Society of Cardiology(ESC)-Statement stellt einen Meilenstein für die Weiterentwicklung der psychokardiologischen Versorgung in Europa dar. Die verfügbare Evidenz für die Bedeutung psychosozialer Faktoren in der Herzmedizin wird umfassend dargestellt, und praxisnahe Handlungsempfehlungen werden abgeleitet. Das Konsensuspapier hebt das enge bidirektionale Zusammenspiel zwischen psychischer Gesundheit und kardiovaskulärer Erkrankungen hervor und formuliert Empfehlungen für eine interdisziplinäre und interprofessionelle Regelversorgung mit einem Psycho-Kardio-Team als Schlüsselbestandteil. Gefordert wird ein psychosoziales Screening sowohl im Erstkontakt als auch im Verlauf sowie eine stärkere Fokussierung auf betreuende An- und Zugehörige, die in die Versorgung der Patienten mit einbezogen werden sollten. Besondere Aufmerksamkeit widmet das Statement der erheblich reduzierten Lebenserwartung von Patienten mit schweren psychischen Erkrankungen (z. B. Psychosen, bipolare Störungen) und fordert hier verstärkte Anstrengungen in Prävention und Therapie. Auch wird auf die besonderen Anforderungen der psychokardiologischen Versorgung verschiedener vulnerabler Patientengruppen wie ältere und gebrechliche Menschen, onkologische Patienten als auch Migranten und Flüchtlinge eingegangen. Das ESC-Statement verortet psychische Gesundheit von einem „additiven“ Aspekt der Herzmedizin zu einem integralen Bestandteil kardiovaskulärer Versorgung.

BACKGROUND:Bystanders may critically influence prehospital delay during acute myocardial infarction (AMI), but existing evidence is limited and largely outdated. This study aimed to examine the association between bystander presence and type on prehospital delay in AMI across two culturally distinct cities with attention to gender differences. METHODS:This cross-sectional observational study included 907 patients with confirmed AMI from the Munich Examination of Delay in Patients Experiencing AMI (MEDEA) study (n=614) and the multicentre MEDEA FAR-EAST study in Shanghai (n=293). The primary outcome was prehospital delay time, analysed by bystander presence and type. Multivariable logistic regression identified independent predictors of prehospital delay related to bystander type. RESULTS:Overall, 216 (24%) patients were women (median age 62 (IQR 54-72) years) and 636 (70%) patients experienced AMI with bystanders, resulting in shorter delays than those without (180 min vs 213 min; p=0.023). Non-family bystanders consistently facilitated the most rapid responses (128 min). Women suffering from AMI all alone delayed by 254 min (IQR 130-725) compared with 166 min (IQR 67-979) in women living alone but being supported by a bystander. Patients in Shanghai experienced shorter delays than those in Munich (150 min vs 203 min; p<0.001). CONCLUSIONS:Non-family bystanders were associated with markedly shorter prehospital delay but their effectiveness differed by sex and cultural context. These findings support a paradigm shift in public health strategies: alongside patient education, community-wide first-aid training and targeted interventions that enable non-family bystanders to act promptly are critical to improving outcomes.

BACKGROUND:Psychosocial risk factors are well established in the development of cardiovascular disease. However, their role in the onset and progression of atrial fibrillation (AF) has not yet been systematically summarised. OBJECTIVE:To present the current evidence on psychosocial risk factors associated with the development and course of AF. METHODS:A scoping review of epidemiological and population-based studies as well as relevant meta-analyses was conducted. Studies addressing psychosocial risk factors, including social, occupational, and psychological stressors, sleep disturbances, depression, anxiety disorders, and stress-related disorders were included. RESULTS:Consistent associations were reported particularly for depression, insomnia, and work-related stress. For depression, risk increases ranging from 15% to 58% were reported. Large population-based cohort studies consistently demonstrated risk increases of 26% to 36% for insomnia. In addition, associations were observed for adverse childhood experiences, anxiety disorders, and post-traumatic stress disorder. Evidence regarding loneliness and social isolation was inconsistent. Proposed underlying mechanisms include autonomic, endocrine, and inflammatory pathways. CONCLUSION:Available evidence suggests that psychosocial factors make a relevant contribution to the development and maintenance of AF. Consideration of psychosocial stressors may complement current approaches to AF risk stratification and prevention. The existing evidence supports a stronger integration of psychosocial risk factors into future epidemiological research and clinical care concepts.

Recent PET studies suggest a link between amygdala activity and cardiovascular disease. Altered amygdala volumes are associated with increased stressor-evoked cardiovascular reactivity, which potentially increases the risk for cardiovascular disease. Therefore, we investigated the association between amygdala volume and MRI-based markers of cardiovascular disease in order to evaluate morphological alterations of the amygdala in persons with early, clinically inapparent signs of cardiovascular complications. 400 subjects underwent a comprehensive 3-T MRI to estimate amygdala volume and imaging-based markers of cardiovascular disease, specifically carotid plaque presence and grading, media wall thickening, left ventricular myocardial mass, myocardial late gadolinium enhancement, and left ventricular function. Amygdala volume was automatically segmented based on FLAIR images and corrected for total intracranial volume. Logistic and linear regression analyses of amygdala volume and cardiovascular parameters were conducted while controlling for age, gender and cardiovascular risk factors. Among 339 included subjects (mean age: 56.3 ± 9.1, 57

Der negative Einfluss psychischer Faktoren auf die Entstehung oder den Verlauf von Herz-Kreislauf-Erkrankungen wird im „ESC 2025 Clinical Consensus Statement on mental health and cardiovascular disease“ (ESC-CCS-2025) mit insgesamt 687 Referenzen eindrucksvoll belegt. Insbesondere chronischer Stress, eine Depression, eine Angsterkrankung oder eine posttraumatische Belastungsstörung können das kardiovaskuläre Risiko bis auf das Doppelte erhöhen und führen oft auch zu einem ungesunden Lebensstil (Rauchen, ungesunde Ernährung, Bewegungsmangel, Adipositas). Umgekehrt können Herz-Kreislauf-Erkrankungen wegen ihrer oft existenziellen Bedrohlichkeit sekundär zu psychischen Belastungen führen. Auf der Basis dieses breiten Wissens wird der Leser inspiriert, dieses Wissen unmittelbar soweit wie möglich anzuwenden. Da diesem Plädoyer einige Hindernisse im Weg stehen, werden mit den ACTIVE-Prinzipien Regeln aufgestellt, wie Strukturen verbessert oder geschaffen werden können, um die Diagnostik und Therapie von psychischen Belastungen bzw. Erkrankungen bei kardiovaskulären Patienten zu verbessern. Hierzu wird die Schaffung eines Psycho-Kardio-Teams („Psycho-Cardio team“) sowie der Ausbau eines gestuften Versorgungsmodells vorgeschlagen. Es wird betont, dass auch die pflegenden Angehörigen der Patienten ebenfalls in seelische Not geraten können und oft einer Betreuung bedürfen. Andererseits wird die Lage von Patienten mit einer primären, schweren psychischen Erkrankung beleuchtet, deren kardiovaskuläre Betreuung oft durch Stigmatisierung und kardiovaskuläre Unterversorgung gekennzeichnet ist. Das ESC-CCS-2025 ist unserer Ansicht nach ein Meilenstein der Psychokardiologie, der uns alle auffordert, dieses Wissen umzusetzen und hierzu handlungsfähige Strukturen zu schaffen oder zu erweitern.

The negative impact of psychological factors on the development and course of cardiovascular disease is impressively documented in the European Society of Cardiology (ESC) 2025 Clinical Consensus Statement on mental health and cardiovascular disease (ESC-CCS-2025), which cites a total of 687 references. In particular, chronic stress, depression, anxiety disorders, and post-traumatic stress disorder can increase the cardiovascular risk by up to twofold, and these factors are often associated with an unhealthy lifestyle (smoking, unhealthy diet, physical inactivity, obesity). Conversely, due to their often existentially threatening nature, cardiovascular diseases can secondarily lead to significant psychological distress. Based on this broad body of evidence, readers are encouraged to apply this knowledge in clinical practice as directly and extensively as possible. As there are several barriers to implementing these recommendations, the ACTIVE principles propose guidance on how structures can be improved or newly created in order to enhance the diagnosis and treatment of psychological distress and mental disorders in patients with cardiovascular disease. To this end, establishment of a "Psycho-Cardio team" and expansion of a stepped-care model are recommended. The statement also emphasizes that caregiving relatives of patients may themselves experience severe emotional distress and often require support. Furthermore, the situation of patients with a primary, severe mental disorder is highlighted, as their cardiovascular care is frequently characterized by stigma and undertreatment. In our view, the ESC-CCS-2025 represents a milestone in psychocardiology, calling on all of us to translate this knowledge into practice and to create or expand effective structures of care.

Psychosoziale Risikofaktoren sind für die Entstehung kardiovaskulärer Erkrankungen gut etabliert. Ihre Bedeutung für Vorhofflimmern (VHF) wurde bislang jedoch nicht systematisch zusammengefasst. Darstellung der aktuellen Evidenz zu psychosozialen Risikofaktoren für die Entstehung und den Verlauf von Vorhofflimmern. Es wurde ein Scoping Review epidemiologischer und populationsbasierter Studien sowie relevanter Metaanalysen durchgeführt. Berücksichtigt wurden Arbeiten zu psychosozialen Risikofaktoren, einschließlich sozialer, beruflicher und psychischer Belastungsfaktoren, Schlafstörungen sowie Depressionen, Angst- und Belastungsstörungen. Konsistente Zusammenhänge wurden insbesondere für Depression, Insomnie und arbeitsbezogenen Stress berichtet. Für Depression wurden Risikoerhöhungen zwischen 15 und 58

OBJECTIVE:Inflammation contributes to the bidirectional relationship between depression and coronary artery disease (CAD). However, the impact of group psychotherapy on inflammatory levels in CAD patients with comorbid depression has not been elucidated. METHODS:A total of 337 patients (average age 59.2 years ±9.4, 80.4% male) from the SPIRR-CAD trial provided results of questionnaires and inflammatory data at baseline (T0) and the 18-month follow-up (T3) of a group psychotherapy program, with a maximum of 25 sessions vs. usual care. RESULTS:At baseline, inflammatory parameters were elevated for high-sensitivity C-reactive protein (hsCRP) in 41.2%, tumor necrosis factor-α (TNF-α) in 33.2% and interleukin-6 (IL-6) in 21.1% of all patients. From T0 to T3, prevalences of elevated hsCRP (p = .027), TNF-α (p = .013) and depression scores (measured with the Hamilton Depression Rating-Scale; (p = .002) significantly decreased in all patients. Additionally, an inflammatory factors score (IFS), calculated from the inflammatory parameters showed a significant decrease between T0 and T3 (p = .046) in all patients. A blockwise multivariate logistic regression analysis revealed a 4.59-fold higher chance of IFS reduction (or stable low values) for patients with a higher number (10-25) of group psychotherapy sessions (OR = 4.59, 95% CI: 1.39-15.1, p = .012) compared to patients with 1-9 sessions, even after adjusting for comorbidities or pharmacological antidepressant treatment. CONCLUSION:This analysis demonstrates a significant impact of group psychotherapy sessions on IFS changes in CAD patients with persistently elevated depression scores. Beyond the influence of the absence of diabetes mellitus, a higher number of group psychotherapy sessions reduces the risk of inflammatory burden.

Background: Leptin, an adipokine suspected to play a role in coronary artery disease (CAD), may also be associated with deteriorated mental health. We investigated the prospective impact of recurrent depressed mood (RDM) on heightened plasma leptin levels in CAD patients. Methods: Derived from the randomized SPIRR-CAD trial, plasma leptin were measured by the Human Leptin DuoSet ELISA at baseline in 539 patients (including 115 (21.3 %) women and 424 (78.7 %) men) and in 373 participants after 18-months follow up (T-3). RDM was based on the clinical course from baseline to follow-up assessed by the Hamilton Depression Rating Scale (HAM-D). Multivariate binary logistic regression models identified predictors for heightened leptin at T-3. Results: At baseline, highest leptin level (3rd tertile) was associated with type 2 diabetes (p = 0.009), heart failure symptoms (NYHA III) (p < 0.001), female sex and BMI >= 30 (p < 0.001) but not with age and depression. At study endpoint (T-3), RDM was associated with a substantially increased risk of experiencing the highest plasma leptin level (OR 2.92 (95 % CI 1.27-6.75)) followed by increased NT-proBNP (the most prominent indicator of CHF) with an OR of 2.73 (1.22-6.11) - both after adjustment for concurrent factors including weight gain (diff BMI T3T1) over the study period - the latter accounting for an OR of 1.41 (1.17-1.70). Limitations: Findings are limited to people of Caucasian ancestry which prevents being generalized to other ethnicities. Although relying upon a prospective design, reverse causality cannot be excluded but is unlikely. Conclusions: In CAD patients, RDM is a significant predictor of heightened leptin -a finding opening room for a new pathway of the psychobiological underpinning of depression on CAD risk.

Bei bis zu einem Drittel der ICD(implantierbarer Kardioverter-Defibrillator)-Patienten kommt es in den letzten 24 h vor dem Tod zu Schockentladungen, die keinerlei therapeutischen Nutzen mehr haben. Selbst bei Patienten, die eine Patientenverfügung (DNR[„do not resuscitate“]-Direktive) besitzen, ist bei über 50

Up to one third of patients with an implantable cardioverter defibrillator (ICD) experience shock discharges in the last 24 h before death, which no longer have any therapeutic benefit. Even in patients who have a living will (do not resuscitate, DNR, directive), the shock function of the ICD is activated in over 50% of those affected 24 h before death. A significant subgroup of ICD wearers must therefore experience painful, significantly stressful and unnecessary ICD shocks at the hour of their death. All available position papers on this topic call for patients to be informed about this issue in good time; however, in reality such a conversation almost never takes place. This paper outlines the legal basis that helps doctors to deactivate the ICD in the final stage of life and the specific conditions that must be met. This paper advocates repeatedly addressing the issue during the course of the illness and to involve relatives. The actual conversation about deactivation at the end of life should be proactively initiated by the responsible attending physician and should take the form of a structured, patient-centered dialogue in the spirit of good dialogue.

BACKGROUND:To examine sex-specific risk factors of elevated fatigue symptoms over 7 years in a large community cohort. METHODS:Data were drawn from 1700 adults (52.3 % women; mean age = 49.6 ± 9.4 years) participating in the KORA F4 study and its 7-year follow-up (FF4) in Augsburg, Germany. Fatigue symptoms (0-12) were assessed at both time points using four items from the Depression and Exhaustion Scale. Sex-stratified generalized estimating equation (GEE) models examined associations with sociodemographic, behavioural, medical (BMI, medical illness, hemoglobin, C-reactive protein, thyroid-stimulating hormone [TSH], Epstein-Barr virus), psychological (depression, anxiety, childhood trauma), and bodily distress factors (somatization, self-rated health, pain, sleep complaints). RESULTS:Women reported significantly higher fatigue levels than men at both assessments. Cross-sectionally, higher baseline fatigue was associated with physical inactivity, medical illness, and multiple psychological and bodily distress factors. Several associations differed descriptively by sex: psychological distress and medical utilization showed stronger links in women, whereas sociodemographic factors and selected biomarkers were more relevant in men. Longitudinally, fatigue levels were stable over the follow-up, with baseline fatigue emerging as the main predictor of subsequent fatigue (men: OR = 1.65[1.55-1.77]; women: OR = 1.72 [1.59-1.86]). Physical inactivity and somatization predicted fatigue in both sexes. Depression symptoms, childhood trauma, and lower TSH predicted fatigue only in women, whereas sleep complaints were uniquely predictive in men. Medical measures showed limited value. CONCLUSION:Baseline fatigue was linked to behavioural, medical, and psychosocial risk profiles, while longitudinal analyses revealed distress and prior fatigue as the key predictors of elevated fatigue symptoms over time.

Psychosoziale Faktoren gewinnen evidenzbasiert als Risikofaktoren für kardiovaskuläre Erkrankungen zunehmend an Bedeutung, indem sie ihre Entstehung fördern und zur Progression beitragen. Umgekehrt können kardiovaskuläre Erkrankungen die seelische Gesundheit der Patienten negativ beeinflussen. Aufgrund dieser Erkenntnisse wird auch in den Leitlinien und Positionspapieren zur Diagnostik und Therapie verschiedener Herzerkrankungen das Screening auf psychosoziale Risikofaktoren gefordert. Dieses Positionspapier stellt den aktuellen Stand des Wissens hierzu dar und geht auch auf die aktuellen psychokardiologischen Herausforderungen wie die COVID-19-Pandemie und Belastung durch psychische Traumata ein. Als psychophysiologische Grundlagen zur Vermittlung zwischen seelischen und somatischen Prozessen am Herzen werden die zentralen Vermittlungswege des autonomen, endokrinen und immunologischen Systems sowie deren Pathologie erläutert. Neben Screeninginstrumenten und diagnostischen Verfahren werden multimodale Therapiekonzepte bestehend aus Psychoedukation, Sport- und Bewegungstherapie, Stressmanagement, Psychotherapie und Pharmakotherapie aufgezeichnet. Die wichtigsten Informationen sind in Kernaussagen zusammengefasst. Die psychokardiologische Grundversorgung kann durch Hausärzte, Kardiologen und Internisten erfolgen; bei schwerwiegenden psychischen Störungen sollte im Rahmen der interdisziplinären Versorgung eine fachspezifische Mitbehandlung erfolgen.