Sex-specific relationships of inflammatory biomarkers with blood pressure in older adults.

Emerging evidence indicates an association between blood pressure and inflammation, yet this relationship remains unclear in older adults, despite the elevated prevalence of hypertension. We investigated the association between blood pressure, high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and white blood cell (WBC) count in a cohort of 3571 older adults aged 65 and above, and 587 middle-aged participants (55-59 years old). In women aged 65 and above, the relationship between inflammatory markers and blood pressure was consistent, with hs-CRP and WBC emerging as predictors of high blood pressure. For hs-CRP, the adjusted odds ratio (OR) was 1.5 (95% CI, 1.07 to 2.10, P = 0.02), and for WBC, the adjusted OR was 1.41 (95% CI, 1.02 to 1.94, P = 0.04), comparing the highest to the lowest quartiles. In men, only the WBC count was significantly associated with an increased OR for high BP (adjusted OR 1.49, 95% CI, 1.09 to 2.02, P = 0.01) across quartiles. Across the entire study population, in a fully adjusted model, all inflammatory markers were modestly associated with blood pressure levels, while the effect of being over 65 years was the most significant predictor of high blood pressure (OR 1.84, 95% CI, 1.50 to 2.25, P < 0.001). The link between key inflammation markers and blood pressure in older adults varies by sex and biomarker type and may differ from the relationship observed in younger individuals. These relationships are likely to be affected by factors linked to age.

Baseline characteristics, reperfusion treatment secondary prevention and outcome after acute ischemic stroke in three different socioeconomic environments in Europe.

INTRODUCTION: The differences in vascular risk factors' and stroke burden across Europe are notable, however there is limited understanding of the influence of socioeconomic environment on the quality of secondary prevention and outcome after acute ischemic stroke. PATIENTS AND METHODS: In this observational multicenter cohort study, we analyzed baseline characteristics, reperfusion treatment, outcome and secondary prevention in patients with acute ischemic stroke from three tertiary-care teaching hospitals with similar service population size in different socioeconomic environments: Bern/CH/n = 293 (high-income), Gdansk/PL/n = 140 (high-income), and Lutsk/UA/n = 188 (lower-middle-income). RESULTS: We analyzed 621 patients (43.2% women, median age = 71.4 years), admitted between 07 and 12/2019. Significant differences were observed in median BMI (CH = 26/PL = 27.7/UA = 27.8), stroke severity [(median NIHSS CH = 4(0-40)/PL = 11(0-33)/UA = 7(1-30)], initial neuroimaging (CT:CH = 21.6%/PL = 50.7%/UA = 71.3%), conservative treatment (CH = 34.1%/PL = 38.6%/UA = 95.2%) (each p < 0.001), in arterial hypertension (CH = 63.8%/PL = 72.6%/UA = 87.2%), atrial fibrillation (CH = 28.3%/PL = 41.4%/UA = 39.4%), hyperlipidemia (CH = 84.9%/PL = 76.4%/UA = 17%) (each p < 0.001) and active smoking (CH = 32.2%/PL = 27.3%/UA = 10.2%) (p < 0.007). Three-months favorable outcome (mRS = 0-2) was seen in CH = 63.1%/PL = 50%/UA = 59% (unadjusted-p = 0.01/adjusted-p CH-PL/CH-UA = 0.601/0.981), excellent outcome (mRS = 0-1) in CH = 48.5%/PL = 32.1%/UA = 27% (unadjusted-p < 0.001/adjusted-p CH-PL/CH-UA = 0.201/0.08 and adjusted-OR CH-UA = 2.09). Three-months mortality was similar between groups (CH = 17.2%/PL = 15.7%/UA = 4.8%) (unadjusted-p = 0.71/adjusted-p CH-PL/CH-UA = 0.087/0.24). Three-months recurrent stroke/TIA occurred in CH = 3.1%/PL = 10.7%/UA = 3.1%, adjusted-p/OR CH-PL = 0.04/0.32). Three-months follow-up medication intake rates were the same for antihypertensives. Statin/OAC intake was lowest in UA = 67.1%/25.5% (CH = 87.3%/39.2%/unadjusted-p < 0.001/adjusted-p CH-UA = 0.02/0.012/adjusted-OR CH-UA = 2.33/2.18). Oral intake of antidiabetics was lowest in CH = 10.8% (PL = 15.7%/UA = 16.1%/unadjusted-p = 0.245/adjusted-p CH-PL/CH-UA = 0.061/0.002/adjusted-OR CH-UA = 0.25). Smoking rates decreased in all groups during follow-up. DISCUSSION AND CONCLUSION: Substantial differences in presentation, treatment and secondary prevention measures, are linked to a twofold difference in adjusted 3-months excellent outcome between Switzerland and Ukraine. This underscores the importance of socioeconomic factors that influence stroke outcomes, emphasizing the necessity for targeted interventions to address disparities in treatment and secondary prevention strategies.

Effectiveness of antazoline versus amiodarone, flecainide and propafenone in restoring sinus rhythm at the emergency department.

PURPOSE: Little is known about the effectiveness of pharmacological cardioversion (PCV) with antazoline in comparison to flecainide. The aim of this study was to compare the effectiveness of antazoline in restoring sinus rhythm (SR) versus amiodarone, flecainide and propafenone in a group of emergency department (ED) patients. MATERIALS/METHODS: This was a single-centre retrospective analysis of patient records from an ED in a large hospital in Poland. We analysed a total of 1878 patient records, divided based on the anti-arrhythmic drug (AAD) administered during PCV: antazoline (n â€‹= â€‹1080), antazoline â€‹+ â€‹ß-blocker (n â€‹= â€‹479), amiodarone (n â€‹= â€‹129), flecainide (n â€‹= â€‹102), propafenone (n â€‹= â€‹88). Of the patients, 63.5 â€‹% were female (median 65 years, [19-100]). RESULTS: The percentage of successful PCV was significantly higher in the antazoline group (84.3 â€‹%) than in the antazoline â€‹+ â€‹ß-blocker (75.8 â€‹%, p â€‹= â€‹0.0001), propafenone (75.6 â€‹%, p â€‹= â€‹0.0364) and amiodarone (68.8 â€‹%, p â€‹< â€‹0.0001) groups. Post-hoc analysis revealed that patients who received PCV with antazoline, antazoline â€‹+ â€‹ß-blocker, flecainide and propafenone had significantly shorter time to SR than those who received amiodarone (p â€‹< â€‹0.0001). Univariate regression analysis revealed that patients who underwent PCV with antazoline were almost twice as likely to return to SR compared to the other groups (p â€‹< â€‹0.0001, OR 1.81, 95 â€‹% CI 1.44-2.27). CONCLUSIONS: This is the first study comparing the effectiveness of antazoline in PCV versus flecainide in addition to the previously studied amiodarone and propafenone. Our results indicate that antazoline is more effective in restoring SR than amiodarone, flecainide and propafenone. In addition, antazoline restored SR significantly faster than amiodarone or propafenone.

Is the 2016 ESC diagnostic algorithm useful for assessing the prevalence of chronic heart failure in population-based studies?

BACKGROUND: Chronic heart failure (CHF) is a major healthcare problem. However, there are no epidemiological studies assessing the prevalence of CHF in the general population with diagnosis based on algorithms recommended for clinical practice. AIM: The aim of the HF-Pomorskie survey was to assess the prevalence of three basic components of the 2016 ESC diagnostic algorithm for CHF (symptoms, N-terminal pro B-type natriuretic peptide [NT-proBNP], and abnormalities on echocardiography) and to determine whether this algorithm may be applicable to studies in general population samples. METHODS: The study was performed in a representative sample of 313 adults (170 women and 143 men) aged between 20 and 90 years (mean 55.2 years [15.3]) in Northern Poland. A questionnaire to determine New York Heart Association [NYHA] class, laboratory tests including NT-proBNP, as well as transthoracic echocardiography and spirometry examinations were performed in all subjects. RESULTS: Dyspnea (NYHA class II-IV) was reported by 13.7% of recruited participants. Dyspnea and elevated levels of NT-proBNP (>125 pg/ml) were found in 7.7% of all examined subjects, while dyspnea, elevated NT-proBNP levels accompanied by systolic or diastolic abnormalities on echocardiography occurred in 4.8%. In the group without dyspnea (86.3% of all examined subjects), every sixth subject had an elevated level of NT-proBNP. On the other hand, 5.8% of studied subjects reported a previous diagnosis of CHF, which was confirmed using the current ESC algorithm in 78% of them. CONCLUSIONS: The prevalence of CHF assessed by the 2016 ESC diagnostic algorithm in the representative sample of adults was equal to 4.8%. The clinical algorithm for the diagnosis of CHF is fully applicable to the representative surveys in the general population. However, due to logistic and economic factors, echocardiography examination and NT-proBNP determination can be limited to patients reporting dyspnea or previous diagnosis of CHF.

Evaluation of Conventional Cardiovascular Risk Factors and Ordinal Coronary Artery Calcium Scoring in a Lung Cancer Screening Cohort.

(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50-79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.

Does atrial fibrillation still increase the risk of death? One-year follow-up results of the NOMED-AF study.

INTRODUCTION: Although atrial fibrillation (AF) is a well­known risk factor for ischemic stroke and hospitalization, its effect on mortality has not been clearly established. OBJECTIVES: We aimed to assess whether AF is an independent risk factor for death. A secondary objective was to evaluate the role of oral anticoagulation in the prevention of stroke and death in 1­year follow­up of patients included in the NOMED­AF (Noninvasive Monitoring for Early Detection of Atrial Fibrillation) study. PATIENTS AND METHODS: The NOMED­AF study included 3014 patients. The participants underwent continuous long­term electrocardiographic monitoring using a wearable vest for up to 30 days. The present analysis involved 2795 patients who completed the 1­year follow­up. The median (interquartile range) follow­up time was 365 (365-365) days. AF was diagnosed in 617 participants. RESULTS: Independent risk factors for death in the patients who completed the 1­year follow­up were AF, age equal to or above 65 years, and chronic kidney disease. The individuals with diagnosed AF had an almost 2­fold higher risk of death (odds ratio [OR], 1.7; 95% CI, 1.18-2.44; P <0.001) and a 2.5­fold higher risk of stroke (OR, 2.53; 95% CI, 1.41-4.44; P <0.001), as compared with those without an AF diagnosis. The participants with AF who received oral anticoagulants had an almost 5­fold lower risk of death than those who were not on anticoagulation (2.9% vs 14.2%, respectively; P <0.001). CONCLUSIONS: AF is an independent risk factor for death and cardiovascular hospitalization. The risk of death and stroke in patients with AF is significantly higher than in the patients without this arrhythmia. Oral anticoagulation in patients with AF significantly reduces the rates of death and stroke; however, its use is suboptimal in this group of patients.

Identifying associations between the social network index, its components, and the prevalence of cardiovascular diseases in Polish adults. Results of the cross-sectional WOBASZ II study.

BACKGROUND: Psychosocial risk factors are important determinants of cardiovascular diseases (CVDs): people involved in positive relationships live longer than those with low social support (SS). AIMS: Our study aimed to evaluate the association between SS, components of the social network, and CVDs. METHODS: A cross-sectional population-based survey WOBASZ II conducted in the years 2013-2014 included a sample of 6043 individuals, aged 20 and over, who completed the Berkman-Syme questionnaire to assess SS using the social network index (SNI). RESULTS: Higher percentage of low SS was observed in women (52.15%) compared to men (45.4%) (P <0.001). People with a low SNI had a worse CVD risk factor profile. None of the analyzed social contacts (with children, relatives, or friends), regardless of how satisfactory they were, was associated with CVDs in men. In women, satisfying contact with children or relatives appeared to be associated with better cardiovascular health. Furthermore, active participation in organized social activity increased the chance of arrhythmia in both sexes: 1.50 (1.04-2.15); P = 0.029 in men; 1.47 (1.11-1.95); P = 0.007 in women. Although a low SNI was associated with analyzed CVDs in the univariate analysis, it was not confirmed in the fully adjusted model. CONCLUSIONS: More women had low SS compared to men. People with low SS had a worse CVD risk factor profile. There was a significant independent relationship between different components of the SNI, such as social contacts and CVDs in women and active participation in organized social activity and arrhythmia in both sexes.

Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence in the Polish population aged ≥ 65.

Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p < 0.001), p = 0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p = 0.027) and LDL < 100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p = 0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p < 0.001), LDL < 100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p = 0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p = 0.031) and HbA1c ≤ 6.5 (OR 0.46, 95%CI: 0.25-0.85, p = 0.013) were associated with silent AF prevalence. Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤ 6.5 being additional independent predictors for silent AF.Trial registration: NCT03243474.

Concordance/discordance between serum apolipoprotein B, low density lipoprotein cholesterol and non-high density lipoprotein cholesterol in NATPOL 2011 participants - An epidemiological perspective.

BACKGROUND: The study compared the distribution of serum LDL-C, non-HDL-C, and apolipoprotein B (apoB) among participants of the NATPOL 2011 survey and analysed concordance/discordance of results in the context of the risk for atherosclerotic cardiovascular disease (ASCVD). METHODS: Serum levels of apoB, LDL-C, non-HDL-C and small dense LDL-C were measured/calculated in 2067-2098 survey participants. The results were compared between women and men, age groups and in relation to body mass index (BMI), fasting glucose and TG levels, and the presence of CVD. Percentile distribution of lipid levels and concordance/discordance analysis were based on medians and ESC/EAS 2019 target thresholds for ASCVD risk and on comparison of measured apoB levels and levels calculated from linear regression equations with serum LDL- C and non-HDL-C as independent variables. RESULTS: Serum apoB, LDL-C and non-HDL-C were similarly related to sex, age, BMI, visceral obesity, cardiovascular disease, and fasting glucose and triglyceride levels. Serum apoB, LDL-C and non-HDL-C very high- and moderate- target thresholds were exceeded in 83%, 99% and 96.9% and in 41%, 75% and 63.7% of subjects, respectively. The incidence of the discordances between the results depended on the dividing values used and ranged from 0.2% to 45.2% of the respondents. Subjects with high apoB / low LDL-C/non-HDL-C discordance had features of metabolic syndrome. CONCLUSIONS: Diagnostic discordances between apoB and LDL-C/non-HDL-C indicate limitations of serum LDL-C/non-HDL-C in ASCVD risk management. Due to the high apoB/low LDL-C/non-HDL-C discordance, obese/metabolic syndrome patients may benefit from replacing LDL-C/non-HDL-C by apoB in ASCVD risk assessment and lipid-lowering therapy.

The effectiveness of atrial fibrillation identification using noninvasive long-term electrocardiographic monitoring system (NOMED-AF TECH).

INTRODUCTION: Although it is well­known that longer electrocardiographic (ECG) monitoring allows for detection of paroxysmal silent atrial fibrillation (SAF), it is still unknown how long the ECG monitoring should last to increase the probability of SAF diagnosis. OBJECTIVES: Our aim was to analyze ECG acquisition parameters and timing to detect SAF during the Noninvasive Monitoring for Early Detection of Atrial Fibrillation study. PATIENTS AND METHODS: The protocol assumed up to 30 days of ECG telemonitoring of each participant in order to reveal AF / atrial flutter (AFL) episodes lasting at least 30 seconds. SAF was defined as AF detected and confirmed by cardiologists in asymptomatic individuals. The ECG signal analysis was based on the results of 2974 participants (98.67%). AF/AFL episodes were registered and confirmed by cardiologists in 515 individuals, that is, 75.7% of all patients (n = 680) in whom AF/AFL diagnosis was established. RESULTS: The median monitoring time to detect the first SAF episode was 6 days (interquartile range [IQR], 1-13). Fifty percent of the patients with this type of arrhythmia were identified by 6th day (IQR, 1-13) of the monitoring, and 75% by the 13th day of the study. Paroxysmal AF was registered on average on 4th day (IQR, 1-10). CONCLUSIONS: The ECG monitoring time to detect the first episode of SAF in at least 75% of patients at risk of this arrhythmia was 14 days. Detection of 1 patient with de novo AF, SAF, or de novo SAF, required monitoring of, respectively, 17, 11, and 23 patients.

Dietary Antioxidants, Quality of Nutrition and Cardiovascular Characteristics among Omnivores, Flexitarians and Vegetarians in Poland-The Results of Multicenter National Representative Survey WOBASZ.

Several reports have shown that more plant-based dietary patterns provide a higher intake of antioxidants compared to diets rich in meat and animal products. Data on the intake of key nutrients in cardiovascular disease (CVD) prevention in relation to particular diets in countries of Central and Eastern Europe are scarce. The aim of this study was to assess quality of nutrition and CVD characteristics in a representative sample of Polish adults following different dietary patterns. Special regard was paid to the intake of natural antioxidants. The study comprised 13,318 (7159 females) randomly selected adults aged ≥ 20 years participating in the National Multicentre Health Surveys WOBASZ and WOBASZ II. The subjects were categorized into groups of omnivores (92.4%), flexitarians (7.4%) and vegetarians (0.16%) according to type of diet using the Food Frequency Questionnaire and 24 h dietary recall. The obtained results showed that neither flexitarians nor vegetarians represented better dietary habits or lifestyle behaviors compared to omnivores. Flexitarians had significantly lower daily energy intake than omnivores, but their diet was rich in total fat (above 30% of daily energy consumption) and low in fiber. Omnivores declared a higher consumption of fresh vegetables (p < 0.001), fresh fruit (p < 0.01), coffee (p < 0.01) and tea (p < 0.05, in women only) than flexitarians. Omnivores had significantly higher intake of natural antioxidants (vitamin C, E, zinc in both genders and vitamin A in men) as compared with flexitarians. Among women, the highest adherence to the intake of recommended amounts of antioxidant nutrients was noted among omnivores. Among men, vegetarians had the highest proportion of meeting the guidelines for vitamin A (77.8%), E (66.7%) and C (66.7%), while the lowest proportions were found in flexitarians (69.9%, 39.5% and 32.4%, respectively). The groups did not differ in terms of smoking and physical activity level. There were no significant differences in the analyzed CVD characteristics between omnivores and flexitarians. In women, vegetarians had substantially lower BMI than omnivores (p < 0.05) and flexitarians (p < 0.05) and a lower mean serum glucose compared with omnivores (p < 0.01) and flexitarians (p < 0.05). Vegetarians had lower prevalence of hypertension and obesity than meat eaters. In conclusion, the results of the current research showed an inappropriate intake of several nutrients, including highly potent antioxidants, irrespective of the dietary regimen. Flexitarians did not have a more favorable CVD profile than omnivores. Taking into account the growing popularity of diets with reduced animal products, there is a need to elaborate strategies providing Polish adults with guidance regarding properly balanced nutrition.

The national burden of frailty and disproportionate distribution of its components-the predominance of slow gait speed: a 2018-19 face-to-face epidemiologic assessment representative of population of older Poles.

BACKGROUND: The prevalence of frailty and its components may be affected by age, diseases and geriatric deficits. However, the current operational definition of frailty assigns equal weight to the five components of frailty. AIMS: To perform a population-based assessment of physical frailty, its prevalence, and distribution of its components across different age, disease and deficit spectrum. METHODS: From 2018 to 2019, we conducted a face-to-face cross-sectional assessment of a representative sample of older Poles. We obtained data on frailty components, chronic disease burden, and prevalence of particular diseases and geriatric deficits. We calculated weighted population estimates, representative of 8.5 million older Poles, of prevalence of frailty and its components across the disease burden, associated with the particular diseases and the geriatric deficits present. RESULTS: Of 10,635 screened persons ≥ 60 years, 5987 entered the face-to-face assessment. Data of 5410 have been used for the present analysis. Seventy-two percent of the population are burdened with at least one frailty component. The estimated weighted population prevalence (95% CI) of frailty was 15.9% (14.6-17.1%), and of pre-frailty 55.8% (53.3-58.2%). Slow gait speed predominated across disease burden, specific diseases, geriatric deficits and the age spectrum. Overall, the prevalence of slow gait speed was 56.3% (52.7-60.0%), followed by weakness 26.9% (25.4-28.4%), exhaustion 19.2% (17.6-20.8%), low physical activity 16.5% (14.8-18.3%), and weight loss 9.4% (8.4-10.3%). CONCLUSIONS: Slow gait speed predominates among the components of frailty in older Poles. This may affect the component-tailored preventive and therapeutic actions to tackle frailty.

Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: A subanalysis of the COV-HF-SIRIO 6 study.

BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. METHODS: The present research is a subanalysis of a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). RESULTS: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). CONCLUSIONS: A greater reduction in hospital admissions in 2020 vs. 2019, higher rates of patients brought by ambulance together with lower rates of self-referrals and higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths were observed in cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones.

Managed Care after Acute Myocardial Infarction (MC-AMI) - Poland's nationwide program of comprehensive post-MI care improves prognosis in 2-year follow-up. A single high-volume center intention-to-treat analysis.

BACKGROUND: Managed Care in Acute Myocardial Infarction (MC-AMI) is a program introduced in Poland aimed at comprehensive, scheduled, and supervised care for AMI patients to improve longterm prognosis. AIMS: Our study aimed to compare 24-month mortality and the incidence of major cardiovascular events (MACE: a composite of death, recurrent MI, and hospitalization for heart failure) in a cohort of AMI patients treated in the MC-AMI era (intention-to-treat analysis) vs. similar population treated before the MC-AMI era. METHODS: We analyzed 2323 consecutive patients with AMI: 1261 patients enrolled in the MC-AMI era (study group) and 1062 patients treated 12 months before the MC-AMI era (control group). In the study group, 57% of patients participated in MC-AMI while 43% of patients remained under standard care. The patients were followed up for 24 months. Mortality and MACE were recorded. RESULTS: Treatment in the MC-AMI era was related to a 30% reduction in all-cause mortality and a 14% reduction of MACE although it was not related to the reduction of hospitalization for heart failure (HF) or AMI in 24 months. The 24-month survival rate was the highest in MC-AMI enrolled patients while patients treated in the MC-AMI era but not enrolled had a similar prognosis to those treated before the MC-AMI era. Multivariable Cox regression analysis revealed the MC-AMI era to be inversely associated with mortality in 24-month follow-up (hazard ratio [HR], 0.49; 95% confidence interval [Cl], 0.38-0.65; P <0.001). CONCLUSIONS: AMI treatment in the MC-AMI era reduces 24-month mortality and MACE. Moreover, AMI treatment in MC-AMI is inversely related to mortality, MACE, and hospitalization for HF. The effect is pronounced in patients enrolled in MC-AMI.

Prevalence of atrial fibrillation in the 65 or over Polish population. Report of cross-sectional NOMED-AF study.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by an increased risk of thromboembolic complications that can be markedly reduced with anticoagulation. There is a paucity of studies assessing the total prevalence of AF in national populations. AIMS: To assess the nationwide prevalence of AF in a population of adults ≥65 old and to determine the impact of duration of electrocardiogram (ECG) monitoring on the number of newly detected AF episodes. METHODS: The NOMED-AF study (ClinicalTrials.gov; NCT: 0324347) was a cross-sectional study performed on a nationally representative random sample of 3014 Polish citizens 65 years or older. Final estimates were adjusted to the national population. All participants underwent up to 30 days of continuous ECG monitoring. Total AF prevalence was diagnosed based on the patient's medical records or the presence of AF in ECG monitoring. RESULTS: The prevalence of AF in the Polish population ≥65 years was estimated as 19.2% (95% confidence interval [CI], 17.9%-20.6%). This included 4.1% (95% CI, 3.5%-4.8%) newly diagnosed cases and 15.1% (95% CI, 13.9%-16.3%) previously diagnosed cases and consisted of 10.8% (95% CI, 9.8%-11.9%) paroxysmal AF and 8.4% (95% CI, 7.5%-9.4%) persistent/permanent AF. The incidence of all paroxysmal AF events as a function of ECG monitoring duration increased from 1.9% (95% CI, 1.4%-2.6%) at 24 hours to 6.2% (95% CI, 5.3%-7.2%) at 4 weeks. CONCLUSIONS: The prevalence of AF in elderly adults is higher than estimated based on medical records only. Four weeks of monitoring compared to 24-hour ECG Holter allow detection of 7-fold more cases of previously undiagnosed paroxysmal AF.

The Prevalence of Anticitrullinated Protein Antibodies in Older Poles-Results from a Population-Based PolSenior Study.

Little is known about the occurrence of antibodies in older subjects. We analyzed the prevalence of anticitrullinated protein antibodies (anti-CCP) in a representative cohort of Polish older adults, participants of PolSenior substudy. Randomly selected 1537 serum samples of community-dwelling participants aged 65 and over. Questionnaires were completed by qualified interviewers and laboratory assessments served as a database for this analysis. The frequency of anti-CCP seropositivity (N = 50) was estimated at 3.25% (95% CI: 2.45-4.30%), being higher among women-4.05% (2.83-5.73%) than men-2.41% (1.48-3.86%). The frequency of anti-CCP seropositivity was decreasing with age from 4.29% in aged 65-74 years and 4.07% in 70-84 years to 1.50% in aged 85 years or above (p < 0.05). Hypoalbuminemia, inflammatory status (C-reactive protein >10 mg/dL or interleukin-6 ≥10 pg/mL), and female gender were associated with increased, while age ≥85 years with decreased risk of seropositivity. Multivariable logistic regression revealed that hypoalbuminemia, inflammatory status, and age ≥85 years were independently associated factors of anti-CCP seropositivity. The decreased frequency of anti-CCP seropositivity in the oldest old suggests shorter survival of the seropositive individuals who developed rheumatoid arthritis. It seems that low symptomatic RA remains frequently undiagnosed in older subjects.

Obesity in Caucasian Seniors on the Rise: Is It Truly Harmful? Results of the PolSenior2 Study.

Obesity is associated with an increased risk of morbidity and mortality; however, data suggest that in old age, obesity is not detrimental. The study's objective was to verify whether obesity frequency still increases in Polish Caucasian seniors and to verify the "obesity paradox". Five thousand and fifty-seven community-dwelling individuals aged ≥ 65 years completed a detailed medical questionnaire, underwent measurements of the body mass index (BMI) and the waist circumference (WC), and an evaluation of physical and cognitive performances. Over a decade, general obesity increased by 2.1%, mostly due to a 3.9% increase in men. Abdominal obesity increased by 1.0%, mainly due to males, in whom it increased by 3.9%. Obesity increased the risk of several aging-related diseases, but this effect was less pronounced in the oldest-old. Obesity did not adversely affect the physical and cognitive functioning or mortality. Through a multivariable analysis, the BMI and WC remained the independent predictors of the Katz Activities of Daily Living score (p < 0.001 and p < 0.05, respectively) and Mini-Mental State Examination score (both p < 0.001). The Kaplan−Meier survival curves revealed that overweight and obesity classes 1 and 2 were associated with the lowest mortality. Through a multivariable analysis, overweight, class 1 obesity, and abdominal obesity remained the independent predictors of a decreased mortality (all p < 0.001). In conclusion, we found that overweight and obesity are not detrimental in seniors, including the oldest-old. We suggest that the anthropometric values defining obesity should be modified for age-advanced people.

Polypharmacy among elderly patients in Poland: prevalence, predisposing factors, and management strategies.

INTRODUCTION: The world's elderly population is growing dramatically. Pharmacotherapy in seniors is particularly challenging due to changes in metabolism, multimorbidity, and a great interest in nonprescription drugs. OBJECTIVES: We aimed to provide up­to­datedata on pharmacotherapy in the geriatric population of Poland, to determine factors predisposing to polypharmacy and excessive polypharmacy, and to identify seniors who are most likely to require multidisciplinary interventions in the field of pharmacotherapy. PATIENTS AND METHODS: We analyzed the use of all prescription and nonprescription drugs taken within 2 weeks preceding the study in a representative national sample of 3014 home­dwelling seniors aged over 65 years. The variables of age, sex, place of residence, level of education, and multimorbidity were considered. Poststratification was used to balance the sample structure to match the Polish population of 2017. RESULTS: Consumption of at least 1 drug was reported by 90.7% of the participants, and the mean number of drugs used was 5.01 (95% CI, 4.87-5.15). At least 1 nonprescription drug was used by 44.2% of the respondents, with a mean number of 0.52 (95% CI, 0.49-0.55). More than 5 drugs were taken by 53.5% of the entire population, while the use of more than 10 drugs was reported by 8.7% of the respondents, with multimorbidity as the most predisposing factor. Single­pill combinations accounted for 27.2% of medications. CONCLUSIONS: The high prevalence of polypharmacy resulting from multimorbidity confirms the need for the implementation of combined medical and pharmaceutical care of the geriatric patients.