Rehospitalizacje w niewydolności serca z upośledzoną funkcją lewej komory — strategie zapobiegania

   Niewydolność serca (HF) w krajach rozwiniętych dotyczy ponad 10% populacji powyżej 70. roku życia, stanowiąc tym samym ważny problem za­równo zdrowotny, społeczny, jak i ekonomiczny. Szacuje się, że obecnie w Polsce na HF cier­pi 600 000–700 000 osób. Mimo postępu, jaki się dokonał w ostatnich 30 latach w zakresie farmakoterapii niewydolności serca z istotnie upośledzoną funkcją skurczową lewej komo­ry (HFrEF) (wdrożenie inhibitorów konwertazy angiotensyny [ACEI], blokerów receptora an­giotensyny II [ARB], antagonistów receptora mineralokortykoidowgo [MRA] oraz iwabrady­ny) rokowanie pacjentów z tej grupy pozostaje niekorzystne. Jednym z głównych czynników istotnie zwiększających współczynnik śmier­telności w tej grupie chorych jest wysoki odse­tek ponownych hospitalizacji (w ciągu roku dla ostrej HF — 43,9%; dla przewlekłej HF — 31,9%). Tym samym HF stanowi również wiodącą przy­czynę rehospitalizacji pacjentów powyżej 65. roku życia. W sytuacji nadmiernego obciążenia oddziałów kardiologicznych i niedostatecznego finansowania hospitalizacji pacjentów z HF ist­nieje bardzo duże niebezpieczeństwo skracania okresu pobytu w szpitalu poniżej bezpieczne­go minimum. Przy czym powszechny i wczesny dostęp do kardiologa wciąż stanowi problem dla wielu pacjentów z HF. W efekcie wczesne rehospitalizacje są w wielu przypadkach wyni­kiem nieoptymalnego wyrównania w trakcie ho­spitalizacji, utrudnionego wczesnego dostępu do specjalisty po wypisaniu ze szpitala, a także braku sprecyzowanego planu dalszej opieki ambulatoryjnej zarówno w zakresie terminu naj­bliższej wizyty, jak i eskalacji farmakoterapii. Świadomość problemów codziennej opieki nad pacjentem z HFrEF oraz czynników ryzyka reho­spitalizacji i gorszego rokowania może stanowić nieocenioną pomoc w wyłonieniu z szerokiej grupy chorych z HFrEF tych, którzy wymagają wzmożonej czujności i częstszych kontroli w po­radni specjalistycznej

Atrial expression of the CCN1 and CCN2 proteins in chronic heart failure

Previous studies have reported the upregulation of CCN proteins early after acute heart injury. The aim of the present work was to evaluate the expression of the CCN1 and CCN2 proteins and their regulation by angiotensin II in the atrial myocardium of a chronically failing heart. Male adult mice were subjected to ligation of the left coronary artery to produce myocardial infarction (the MI group), and 16 of them were treated for 12 weeks with the AT1 receptor antagonist telmisartan (the MI-Tel group). Sham-operated mice served as controls. The expression of proteins was evaluated by immunohistochemistry 12 weeks after the operation. In shamoperated mice, stainings for CCN1 and CCN2 proteins were positive within atrial cardiomyocytes. CCN1-positive reaction revealed diffused cytoplasmic localization, while CCN2 was present mainly within the perinuclear cytoplasm. CCN1 was upregulated in the MI group, while CCN2 remained at basal level. Telmisartan prevented the upregulation of CCN1 and decreased CCN2 level. We compared the experimental data with the expression of CCN1 and CCN2 proteins in human right atrial appendages. We found an inverse, but not significant, relation between the level of either protein and the left ventricular ejection fraction. This suggests a similar atrial regulation of CCN1 and CCN2 expression also in humans. We conclude that in the murine atria, CCN1 and CCN2 proteins are expressed constitutively. In chronic heart failure, CCN proteins tend to be upregulated, which may be related to the action of angiotensin II

Treatment goal attainment for secondary prevention in coronary patients with or without diabetes mellitus : Polish multicenter study POLASPIRE

Introduction: Cardiovascular disease is still a leading cause of death in Poland and across Europe. The aim of this study was to assess the attainment of the main treatment goals for secondary cardiovascular prevention in coronary patients with or without diabetes mellitus (DM) in Poland. Material and methods: The study group included 1026 patients (65.5 ±9 y.o.; males: 72%) included at least 6 months after the index hospitalisation for myocardial infarction, unstable angina, elective percutaneous coronary intervention or coronary artery bypass surgery. The target and treatment goals were defined according to the 2016 European Society of Cardiology guidelines on cardiovascular prevention. Results: Patients with DM (n = 332; 32%) were slightly older compared to non-diabetic (n = 694) individuals (67.2 ±7 vs. 64.6 ±9 years old; p < 0.0001). The DM goal was achieved in 196 patients (60%). The rate of primary (LDL: 51% vs. 35%; p < 0.0001) and secondary (non-HDL: 56% vs. 48%; p < 0.02) goal attainment was higher in DM(+) compared to DM(–) patients. The rate of target blood pressure was lower in DM(+) than in normoglycemic patients (52% vs. 61% at < 140/90 mm Hg, p < 0.01. As expected, goal achievement of normal weight (9.5% vs. 19%; p < 0.0001) and waist circumference (7% vs. 15%; p < 0.001) was lower in diabetic patients and the rate of regular physical activity was similar (DM+ 12% vs. DM– 14%; p = ns). Finally, there was no difference in active smokers (DM+ 23% vs. DM– 22%; p = ns). Conclusions: Great majority of Polish patients in secondary prevention do not achieve treatment goals. Although lipid goals attainment is better in DM and the rate of smokers is similar, the management of all risk factors needs to be improved

Secondary prevention of coronary artery disease in Poland : results from the POLASPIRE survey

Background: The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD. Methods: Fourteen departments of cardiology participated in the study. Patients (aged <= 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after the hospitalization. Results: Overall, 947 patients were examined 6-18 months after lwspitalization. The proportion of patients with high blood pressure (>= 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C >= 1.8 mmol/L) 62%, and with high fasting glucose (>= 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of atients taking an antiplatelet agent 6-18 months after hospitalization was 93%, beta-blacker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure < 140190 mmHg, LDL-C < 1.8 mmoIlL and glucose < 7.0 mmoilL, body mass index < 25 kg/m(2)), while 179% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled. Conclusions: The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational

Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey

Background: The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD.Methods: Fourteen departments of cardiology participated in the study. Patients (aged ≤ 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after the hospitalization.Results: Overall, 947 patients were examined 6–18 months after hospitalization. The proportion of patientswith high blood pressure (≥ 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C ≥ 1.8 mmol/L) 62%, and with high fasting glucose (≥ 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of patients taking an antiplatelet agent 6–18 months after hospitalization was 93%, beta-blocker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure &lt; 140/90 mmHg, LDL-C &lt; 1.8 mmol/L and glucose &lt; 7.0 mmol/L, body mass index &lt; 25 kg/m2), while 17.9% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled.Conclusions: The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational

Smoking cessation in patients with established coronary artery disease: data from the POLASPIRE survey

Background: Smoking cessation in patients with coronary artery disease (CAD) is related to decreased risk of cardiovascular events. Aims: To evaluate factors related to persistent smoking in patients with established coronary artery disease. Methods: Patients aged 80 years or younger and hospitalized for acute coronary syndrome or a myocardial revascularization procedure were interviewed 6 to 18 months after the recruiting event. Medical history, smoking behavior, and exposure to environmental smoke were assessed during the interview. Self­­reported smoking status was validated by carbon monoxide in exhaled air measurement. Persistent smoking was defined as smoking at the time of interview among those who smoked during the month prior to the recruiting event. Results: We analyzed the data of 1034 patients, including 764 (73.9%) who reported smoking at any time in the past and 296 (28.6%) who smoked within 1 month before the recruiting hospitalization. At the time of the interview, the overall smoking rate was 17.2%, whereas 54.7% of patients were persistent smokers. Secondhand smoke exposure and duration of smoking were associated with lower likelihood whereas older age, high socioeconomic status, cardiac rehabilitation following a cardiovascular event, and consultation with a cardiologist were associated with higher likelihood of smoking cessation. Conclusions: Over half of all smokers hospitalized for CAD are still smoking 6 to 18 months after discharge. Older age, secondhand smoking, low socioeconomic status, lack of consultation with a cardiologist, and cardiac rehabilitation following hospitalization were related to persistent smoking. Our findings may help develop strategies aimed at assisting smoking cessation in patients with CAD