Novel Echocardiographic Biomarkers in the Management of Atrial Fibrillation

Purpose of Review: Atrial fibrillation (AF) is the most common arrhythmia in adults. The number of patients with AF is anticipated to increase annually, mainly due to the aging population alongside improved arrhythmia detection. AF is associated with a significantly elevated risk of hospitalization, stroke, thromboembolism, heart failure, and all-cause mortality. Echocardiography is one of the key components of routine assessment and management of AF. Therefore, the aim of this review is to briefly summarize current knowledge on “novel” echocardiographic parameters that may be of value in the management of AF patients. Recent Findings: Novel echocardiographic biomarkers and their clinical application related to the management of AF have been taken into consideration. Both standard parameters such as atrial size and volume but also novels like atrial strain and tissue Doppler techniques have been analyzed. Summary: A number of novel echocardiographic parameters have been proven to enable early detection of left atrial dysfunction along with increased diagnosis accuracy. This concerns particularly experienced echocardiographers. Hence, these techniques might improve the prediction of stroke and thromboembolic events among AF patients and need to be further developed and disseminated. Nonetheless, even the standard imaging parameters could be of significant value and should not be discontinued in everyday clinical practice. © 2019, The Author(s)

Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Communication management in local government unit controversy around the local government press

Prasa samorządowa, mimo pojawiających się kontrowersji wokół jej edycji, może pełnić społecznie ważną rolę jako podmiot rynku medialnego wypełniający większość funkcji prasy lokalnej (poza kontrolną). Właściwie realizując zadania komunikacyjne nie tylko dostarcza mieszkańcom wiarygodnych, rzetelnych i sprawdzonych informacji, ale może również występować jako czynnik sprzyjający partycypacji obywatelskiej. Podejmując tematykę lokalną i sublokalną w sposób atrakcyjny czytelniczo, lecz pozbawiony elementów charakterystycznych dla tabloidów, bezceremonialnie rywalizujących o pozyskanie uwagi odbiorców, prasa samorządowa powinna się przyczyniać do aktywizacji i integracji mieszkańców.Binding regulations in Poland allow and partly oblige self-governments to undertake communication activities in the scope of information and promotion. For executing these tasks self-governments can undertake cooperation with external entities based on media relations activity or by disclosing advertising content. Independently self-government can act as an entity on media market directly editing self-governmental press or commissioning publishing to the entities which are supervised by the self-government

Social communication of local government in creating civic society

Komunikacja to kluczowa forma aktywizacji życia społecznego. Dzięki przekazowi informacji od nadawcy poprzez kanał dystrybucji do poszczególnych kategorii odbiorców możliwe jest właściwe zaspakajanie potrzeb wspólnoty samorzą-dowej, a także integrowanie społeczności lokalnych. Partycypacja obywatelska w sprawowaniu władzy także nie zaistnieje w pełni bez wiedzy samych zaintereso-wanych o życiu miasta – ważnych wydarzeniach, planach rozwoju, przedsięwzięciach kulturalnych, sportowych, rekreacyjnych, inwestycjach, przeznaczeniu nakładów budżetowych itd. Z kolei badanie skuteczność podejmowanych działań pozwala na wzbogacanie strategii komunikacyjnej. Strategii, która zapewnić ma odpowiednie warunki do prowadzenia debaty publicznej, a także realizacji celów z zakresu marketingu terytorialnego.Communication is a key form of activating social life. With the transfer of information from the sender through a distribution channel to each category of recipients it can be appropriate to satisfy the needs of local community, as well as the integration of local communities. Citizen participation in the exercise of power will not also fully arise without the knowledge of the interested parties about the life of the city – the important events, development plans, cultural, sports, leisure events, investments, allocation of budgetary outlays and so on. On the other hand, the study of the effectiveness of the actions allows the enrichment of communication strategy. Strategy, which seeks to ensure the right conditions for public debate, as well as the objectives in the field of territorial marketing

Local government as a factor of local and regional development

Aktywizacja obywatelska, integracja społeczna i wyzwalanie przedsiębiorczości prowadzone z udziałem samorządu stanowiły ważny element w budowie społeczeństwa obywatelskiego. Niekwestionowanym wkładem samorządu w rozwój gospodarczy okazało się także pozyskiwanie funduszy unijnych i wykonywanie działań inwestycyjnych przy wykorzystaniu środków zewnętrznych wspartym świadomą oraz długookresową polityką inwestycyjną z zaangażowaniem budżetów poszczególnych gmin. Dlatego realizacja ustawowych kompetencji przyznanych samorządom wraz z rozpoczęciem okresu transformacji ustrojowej przyczyniła się do rozwoju lokalnego oraz regionalnego w całym kraju.Civic activation, social integration and entrepreneurship run with self-government participation were important element in building civic society. Indisputable input of self-government in economic development was obtaining EU funds and running investment activities based on external funding supported with aware and long-term investment policy with engagement of individual municipality budgets. That is why realization of competences given to self-government along with the beginning of transformation period contributed to local and regional development in the entire country

Fractal analysis of the medical insurance market: Theoretical and practical aspects

The latest experience obviously reflects that social-economic systems increasingly demonstrate an unforecastable behaviour. Financial markets are characterised by extremely guick change and crisis phenomena. Use of traditional modelling methods (in particular, the effective market hypothesis) provides no opportunity to obtain efficient forecasts about state and development of financial markets. One of promising methods in researching and modelling financial markets is the fractal analysis. Various natural and social phenomena posess fractality properties, namely there are similar structures on different scales. Generality of the fractal analysis methods allows their applying to study systems of any nature – from physical to economic and social ones. Fractality attributes of time series provide its dynamics pre-forecast and assess the time series predictability. The fractal analysis consists in establishing the extent of time series similarity to the fractal ones and defining a relation between the trend line and fractal dimension. The Hurst exponent assessment (persistence or anti-persistence of time series) predicts the further process development on the preliminary data basis. The fractal analysis efficiency during the unstable market periods is applicable for studying different social-economic systems (in particular, the Ukrainian medical insurance market). The research object is time series of gross insurance rewards on the Ukrainian medical insurance market. The research topic is the time series fractal analysis. The paper deals with peculiarities of the time series fractal analysis, the R/S analysis for time series of gross insurance rewards on the Ukrainian medical insurance market (via the MS Excel software). The Statistica 10.0.228.2 application generated the ARIMA model to predict dynamics of the gross insurance rewards on the Ukrainian medical insurance market. The obtained results may be used to conduct the R/S analysis of financial time series. In particular, that concerns those time series that describe the insurance market. Also, dynamics of the financial time series may be forecasted via these results as wel