SCD in the world, Europe, Bosnia and Herzegovina and Mostar.

UNLABELLED Sudden cardiac death (SCD) is "a natural death due to cardiac causes, heralded by abrupt loss of consciousness within 1 hour of the onset of acute symptoms". Annual incidence is 0.36-1.28/1000 inhabitants. More than 1000 sudden deaths occur each day is in USA, and 100,000 people annually dead in the United Kingdom. Epidemiology differs greatly in 100-fold between young and old, and between developing and developed worlds. SCD is one of the leading causes of death and accounts for over 50% of the cardiac deaths. New data show that SCD is not nearly as sudden in most cases as the term may suggest. Warning symptoms that precede the sudden cardiac death are present for a surprisingly long time in many patients. Coronary artery disease (CAD) is the most common cause of death in the developed world. The major causes are inherited arrythmogenic right ventricular cardiomyopathy (ARVC), hypertrophic cardiomyopathy (HCM), anomalous coronary arteries and hereditary channelopathies (e.g., Long QT syndrome, LQTS). Prevalence is 3-4 fold higher in men, reflecting that of CAD. In adults, the incidence of CAD-related SCD varies with geography and age. The incidence of SCD increases with congestive heart failure (CHF), stroke, cancer and metabolic syndrome, particularly in the developed world. Coronary thrombi and plaque rupture or erosion are found in two thirds of SCD. In women over 50, rupture accounted for 80% of coronary thrombi. In Europe SCD accounts for 200,000 dead in 1 year. In FBiH rate of SCD fluctuates around 0.62/1000 inhabitants, in HNK it is 0.78/1000 and in Mostar 0.54/1000. A wide range of cardiac etiology and development of various management procedures in the primary and secondary preventive pharmacotherapy, device therapy, lifestyle changes and genetic profiling have had a major impact on the prediction and prevention of SCD. Improved resuscitation and defibrillation techniques together with advances in implantable pacemaker and defibrillator technology (AED) have all improved treatment outcome. Education of the Red Cross, Police, Army, Civic Protection members, public, patients and relatives to recognize and respond to symptoms of heart disease holds promise for reducing mortality attributed to sudden death. Developing a better understanding of the circumstances of sudden cardiac death and preventive measures and proper reactions to the impending events. Training in cardio-pulmonary resuscitation with public access defibrillation programs is necessary in fighting sudden death. Systematic screening of young athletes and implantation of implantable cardioverter defibrillators should prevent SCD. CONCLUSION SCD remains one of the major public health problems in the world and is most commonly caused by CAD. Risk stratification is effective for groups, but difficult in case of individuals. There is a need for major improvements in prevention, risk protection, resuscitation and therapy

Left bundle branch block (LBBB) in patients with heart failure (HF) in Mostar region of Bosnia and Herzegovina.

UNLABELLED WORK GOAL: to determine the influence of Left branch block Hissa (LBBB) on: (a) the degree of heart weakness according to NYHA classification; (b) structural remodelling based on echocardiographic, and (c) functional remodelling based on EFLV i FS (echo), comparing patients with heart failure (HF) and the left branch block Hissa (LBBB) on EKG with heart failure with heart failure (HF) without the left branch block Hissa (LBBB). METHODS AND WORK We selected group of So hospital patients with heart weakness of NYHA class II-IV with and 50 without the left branch block Hissa on EKG (LBBB). RESULTS There was a clinical and echocardiographic evaluation of all patients and we determined their correlation related to the sex, NYHA class, structural and functional remodelling of heart cavities, EFLV, FS and survival and the number of hospitalisation in the last three years. The results where shown in a form of a table SAS 9.13 was used for statistic analysis. DISCUSSION AND CONCLUSION LBBB is an important component of electric heart remodeling in patients with heart failure and represent an important clinic data in evaluation of patients and therapeutic approach. Because all our variables were expressed as a frequencies, chi square and Fisher exact test were used to test for potential differences. It particularly stressed the correlation of LBBB with echocardiographic movability parameters of i.v. septum and left atrium dimension (p < 0.001) while septum fibrosis (p < 0.001), paradoxal septum movability (p = 0.193) and EFLV (p < 0.001) point to a close correlation with LBBB. Other analysed parameters showed no correlation with LBBB

Analizing Recent Trends in Coronary Heart Disease (CHD) Deaths Among the Elderly in the United States Using Data From Official Statistical Sources

Total mortality rates and coronary heart disease (CHD) mortality ratesare declining in the USA. Accordingly, the oldest individuals (85+years) comprise the fastest growing segment of the population. Howdo these declines in mortality apply to and re-apportion other age groups?We examined trends in CHD mortality for the USA population over 25 yearsof age, focusing on changes occurring among individuals 65-74 and 75-84years of age

Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry

To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5 with acute HF and 59.5 with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, reninangiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0 of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4 of the cases, respectively. About 30 of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues. This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written

European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions

AIMS: The European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT-R) was set up with the aim of describing the clinical epidemiology and the 1-year outcomes of patients with heart failure (HF) with the added intention of comparing differences between participating countries. METHODS AND RESULTS: The ESC-HF-LT-R is a prospective, observational registry contributed to by 211 cardiology centres in 21 European and/or Mediterranean countries, all being member countries of the ESC. Between May 2011 and April 2013 it collected data on 12 440 patients, 40.5% of them hospitalized with acute HF (AHF) and 59.5% outpatients with chronic HF (CHF). The all-cause 1-year mortality rate was 23.6% for AHF and 6.4% for CHF. The combined endpoint of mortality or HF hospitalization within 1 year had a rate of 36% for AHF and 14.5% for CHF. All-cause mortality rates in the different regions ranged from 21.6% to 36.5% in patients with AHF, and from 6.9% to 15.6% in those with CHF. These differences in mortality between regions are thought reflect differences in the characteristics and/or management of these patients. CONCLUSION: The ESC-HF-LT-R shows that 1-year all-cause mortality of patients with AHF is still high while the mortality of CHF is lower. This registry provides the opportunity to evaluate the management and outcomes of patients with HF and identify areas for improvement

Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry.

AIMS: To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. METHODS AND RESULTS: The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues. CONCLUSION: This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN