Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients - the role of sarcopenia and frailty assessment.

BACKGROUND: COVID-19 has affected older persons the most. The propensity to have severe COVID-19 or die of the infection was especially prevalent among older subjects with multimorbidity, frailty and sarcopenia. The aim of our study was to check which of the simple clinical biomarkers, including the assessment of muscle and frailty, would associate with the survival and the length of hospital stay in older patients with COVID-19. An additional aim was to report the influence of chronic diseases, chronic medication use, and COVID-19 signs and symptoms on the aforementioned outcome measures. METHODS: The CRACoV study was a prospective single-center (University Hospital in Krakow, Krakow, Poland) observational study of clinical outcomes in symptomatic COVID-19 patients that required hospital treatment. We analysed data of persons aged ≥ 65 years. We assessed muscular parameters in accordance with EWGSOP2, frailty with the Rockwood Clinical Frailty Scale. We used the data of the initial and 3-month assessment. Demographic characteristics, past medical history, and baseline laboratory values were gathered as a part of routine care. We calculated sex and age, and additionally number-of-diseases adjusted odds ratios of mortality associated with studied factors and betas of the relation with these factors and the length of hospital stay. RESULTS: The mean (standard deviation, SD) age of 163 participants (44.8% women, 14.8% died) was 71.8 (5.6) years, age range 65-89 years. One score greater SARC-F was associated with 34% (p = 0.003) greater risk of death, and 16.8 h longer hospital stay (p = 0.01). One score greater Rockwood was associated with 86% (p = 0.002) greater risk of death, but was unrelated to the length of hospital stay. Hand grip strength and dynapenia were unrelated to mortality, but dynapenia was related to longer hospital stay. Probable sarcopenia was associated with 441% (p = 0.01) greater risk of death. CONCLUSIONS: In conclusion, the patient assessment with SARC-F and the Rockwood Clinical Frailty Scale may significantly improve the prediction of outcomes in older patients with COVID-19 and by extension might be of use in other acute severe infections. This, however, requires further research to confirm.

New insights on the link between body composition, nutritional status and physical performance in elderly outpatients.

OBJECTIVES: The aim of the study was to assess the relationship between body composition, nutritional status and physical ability in elderly outpatients. METHOD: . In this cross-sectional study, demographic data and medical history were collected from patients aged ≥60 years followed in the Geriatric Outpatient Clinic from October 2010 to February 2014. Body composition was examined using a dual-energy X-ray absorptiometry. Physical performance was assessed by gait speed (GS), Timed Up&Go Test (TUG), Six Minute Walk Test (6MWT). The nutritional status was evaluated using the Mini Nutritional Assessment (MNA) and serum albumin level. RESULTS: Mean age (± SD) of 76 patients (64.47% men) was 71.93 ± 8.88 yrs. The most common diseases were: hypertension (89.47%), coronary heart disease (81.58%) and chronic heart failure (68.4%). In multiple regression analyses, the factors significantly affecting GS were: age (B = - 0.017, p ≤0.0001), good nutritional status (B = 0.038, p <0.01) and percent of lower extremity fat (B = - 0.009, p <0.05). Longer TUG time was associated with poorer nutritional status (B = -0.031, p <0.01), older age (B = 0.01, p <0.01) and a higher number of comorbidities (B = 0.034, p <0.05). 6MWT was influenced negatively by age (B = -3.805, p <0.01) and percent of lower extremity fat (B = -2.474, p <0.05). CONCLUSIONS: Age and nutritional status remain a strong determinant of physical fitness deterioration. Different measures of physical performance are influenced by different elements of body composition - no single element of body composition was found determining the deterioration of all assessed parameters of physical fitness. Identifying the relationship between body composition, nutritional status and physical performance can help elucidate the causes of disability and target preventive measures.

Teledentistry and oral health in older adults - aspects for implementation of the "Patient centric solution for smart and sustainable healthcare (ACESO)" project.

P u r p o s e: Oral health and diseases are significant components of general health. However, oral health-care remains at the lowest of older patients' priorities. The inability to obtain dental care can result in progression of dental disease, leading to a diminished quality of life and overall health. Teledentistry (TD) provides an opportunity to improve the quality of oral health services. The aim of our narrative review was to analyze the usefulness of teledentistry as a part of telemedicine to improve oral health in the elderly. Materials/Methods: The PubMed database search was done for: teledentistry, oral health, oral- health related diseases, elderly, older adults. R e s u l t s: The applicability of TD has been demonstrated from children to older adults. Older adults have many obstacles in getting oral health care, including low income, lack health insurance, frailty, anxiety, depression, mobility problems or other handicaps. Available data suggests that the usefulness of TD in the provision of oral care in elderly people living in residential aged care facilities. Moreover, TD procedures were found to be as accurate as traditional face-to-face dental examinations, they was cost-effective and well accepted among patients and caregivers. C o n c l u s i o n s: TD might be a very useful tool for professional education, improving access and patient satisfaction of dental care. However, such TD modes would be difficult to widely implementation in community-dwelling older people who cannot access dental care. The ongoing "Patient centric solution for smart and sustainable healthcare (ACESO)" project will add to the intelligent oral health solutions.

SARC-F as a case-finding tool for sarcopenia according to the EWGSOP2. National validation and comparison with other diagnostic standards.

BACKGROUND: Sarcopenia is a potentially reversible condition, which requires proper screening and diagnosis. AIMS: To validate a Polish version of sarcopenia screening questionnaire (SARC-F), and assess its clinical performance. METHODS: Cross-sectional validation study in community-dwelling subjects ≥ 65 years of age. Diagnosis of sarcopenia was based on the 2018 2nd European Working Group on Sarcopenia in Older People (EWGSOP2) consensus. Hand grip and 4-m gait speed were measured, and the Polish version of SARC-F was administered. RESULTS: The mean (SD) age of 73 participants (21.9% men) was 77.8 (7.3) years. Seventeen participants (23.3%) fulfilled the EWGSOP2 criteria of sarcopenia, and 9 (12.3%) criteria for severe sarcopenia. Fourteen (19.2%) participants fulfilled the SARC-F criteria for clinical suspicion of sarcopenia. The Cronbach's alpha coefficient for internal was 0.84. With EWGSOP2 sarcopenia as a gold standard, the sensitivity of SARC-F was 35.3% (95% CI 14.2-61.7, p = 0.33), specificity was 85.7% (95% CI 73.8-93.6, p < 0.0001). The corresponding positive and negative predictive values were 42.9% (p = 0.79) and 81.4% (p < 0.0001), respectively. The probability of false-positive result was 14.3% (95% CI 6.4-26.2, p < 0.0001) and the probability of false-negative result was 64.7% (95% CI 38.3-85.8, p = 0.33). Overall the predictive power of SARC-F was low (c-statistic 0.64). DISCUSSION: SARC-F is currently recommended for sarcopenia case finding in general population of older adults. However, its sensitivity is low, despite high specificity. CONCLUSIONS: At present SARC-F is better suited to rule out sarcopenia then to case-finding. Further refinement of screening for sarcopenia with the use of SARC-F seems needed.

Post-occlusive reactive hyperemic response of skin microcirculation among extremely obese patients in the short and long term after bariatric surgery.

OBJECTIVE: To assess changes of post-occlusive reactive hyperemic response in skin microcirculation among extremely obese patients 10 days and 6 months after bariatric surgery for patients with and without hypertension. METHODS: Skin blood flow was measured using PeriFlux laser Doppler fluxmetry. Data were analyzed in the entire group and two subgroups: with and without hypertension. RESULTS: Data from 88 patients (mean age 42.1 ± 11.2 years, 40.5% men) were analyzed. Six months after bariatric surgery, the time to reach peak flows had been shortened (2.4 ± 1.7 vs 2.1 ± 1.0 seconds, P < .05) and the area of hyperemia had increased (1027 ± 791 vs 1386 ± 699 AU*s, P < .05). The total power of post-occlusive reactive hyperemic after occlusion had been augmented mainly with power intensification of endothelial and myogenic origin. Post-occlusive reactive hyperemic parameters had changed mainly in the subgroup with hypertension. Variations of anthropometric parameters, metabolic characteristic, and adipokines mainly influenced on studied hyperemic flow parameters variations after the intervention in multiple regression analysis. CONCLUSION: Cutaneous post-occlusive reactive hyperemic reactivity in time and frequency domains improved 6 months after bariatric surgery, and improvements in microvascular function were observed mainly in patients with hypertension. Variations of anthropometric parameters, metabolic characteristics, and adipokines had influence on hyperemic flow reactivity.

The prevalence and determinants of multimorbidity in hospitalized patients with heart failure.

OBJECTIVE: The aim of this study was to assess the prevalence of multimorbidity and co-existed diseases in hospitalized patients with heart failure (HF) in relation to age and gender. METHODS: The nationwide cross-sectional survey had been conducted in Poland (April-November 2013), in 260 randomly selected hospital wards. A trained nurse contacted with one physician, drawn from the list of all doctors working in the selected hospital's wards, who completed the study questionnaires regarding to clinical characteristics of the last five HF patients, who were discharged from an internal or cardiology ward. RESULTS: Mean age ± SD of the patients was 72.1 ± 10.1 years, 50% were female but the women were significantly older than men. Criterion of multimorbidity met almost 100% of the HF patients. There were no significant differences in the number of co-existed cardiovascular (CV) and non-CV diseases according to gender, but different clinical profile of HF men and women was observed. Women more frequently had thyroid disease, peripheral artery disease and cognitive impairment, whereas men was characterized by higher prevalence of cardiac, pulmonary and hepatic diseases. The co-morbidity significantly increased with age, notably due to increasing prevalence of non-CV diseases. Diabetes, chronic kidney disease, hypercholesterolemia and anemia were the most common non-CV diseases. Among HF patients, 83% suffered from three or more co-morbidities. CONCLUSIONS: The study confirms, that multimorbidity is a considerable problem in patients with HF. Besides age, multimorbidity pattern is strongly dependent on gender. The multidisciplinary approach is warranted in particular in elderly subjects who su er from HF.

Fatigue after COVID-19 in non-hospitalized patients according to sex.

BACKGROUND: Limited evidence exists on sex differences in post-COVID fatigue among non-hospitalized patients. Therefore, aim of the study was to evaluate the course of chronic fatigue symptoms in non-hospitalized subjects with the SARS-CoV-2 infection, according to sex. METHODS: Patients and staff from the University Hospital in Krakow anonymously and retrospectively completed neuropsychological questionnaire that included eight symptoms of chronic fatigue syndrome. The presence of these symptoms was assessed before COVID-19 and 0-4, 4-12, and >12 weeks postinfection. The inclusion criteria were as follows: age 18 or more years, >12 weeks since the onset of the SARS-CoV-2 infection, and diagnosis confirmed by the RT-PCR from anasopharyngeal swab. RESULTS: We included 303 patients (79.53% women, 47.52% medical personnel) assessed retrospectively after a median of 30 (interquartile range: 23-35) weeks since the onset of symptoms. A higher prevalence of at least one chronic fatigue symptom was found in females in all time intervals after the onset of COVID-19 compared to males (p < .036). Women, compared to men, more often experienced persistent fatigue, not caused by effort and persisting after rest (for <4 weeks, odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.13-4.73; for 4-12 weeks, OR = 1.95, 95% CI: 1.06-3.61), non-restorative sleep (for <4 weeks, OR = 2.17, 95% CI: 1.23-3.81; for >12 weeks, OR = 1.95, 95% CI: 1.03-3.71), and sore throat (for <4 weeks, OR = 1.97, 95% CI: 1.03-3.78; for 4-12 weeks, OR = 2.76, 95% CI: 1.05-7.27). Sex differences in headache, arthralgia, and prolonged postexercise fatigue were observed only during the first 4 weeks (OR = 2.59, 95% CI: 1.45-4.60, OR = 2.97, 95% CI: 1.02-8.64, and OR = 1.87, 95% CI: 1.01-3.51, respectively). There were no differences between women and men in myalgia and self-reported lymph node enlargement. CONCLUSIONS: The course of post-COVID fatigue differs significantly between sexes in non-hospitalized individuals with COVID-19, with women more often suffering from persistent fatigue, not caused by effort and persisting after rest, non-restorative sleep, and sore throat.

Access to selected diagnostic procedures in the management of heart failure patients in Poland - POLKARD 2005.

BACKGROUND: Polish heart failure surveys from 1999 and 2005 indicated that non-invasive and invasive diagnostic procedures in heart failure patients are underused, mostly due to limited availability. AIM: To assess the access to procedures used for the diagnosis and treatment of heart failure in randomly selected outpatient clinics and hospital wards in Poland. METHODS: The study was undertaken in 2005, as a part of the National Project of Prevention and Treatment of Cardiovascular Diseases - POLKARD. The data on non-interventional and interventional procedures were collected from 400 primary care units, 396 secondary outpatient clinics and 259 hospitals, and included cardiology or internal medicine departments. Additionally, the last five patients with diagnosed heart failures were identified, who visited outpatient clinics or were discharged from the hospitals, and their medical records of diagnostic procedures were analysed. RESULTS: Echocardiography was not available in approximately 10% of hospital wards and 13-37% of outpatient clinics, both primary and secondary. Generally, the waiting time for echocardiography in Poland varied from region to region. A one-month waiting time was declared by more than 50% of secondary outpatient clinics and only 11-18% of primary care units, regardless of the community size. On the first day of hospital admission, echocardiography was performed in approximately 10% of patients of internal medicine wards and up to 36% of patients in cardiology departments. The assessment of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) was generally performed only in a few hospitals, usually in cardiology departments. In primary care units, it was practically not available. Percutaneous coronary interventions, pacemaker or cardioverter-defibrillator implantations were available in approximately 20% of city hospitals, 30-40% of province hospitals, and 60-70% of clinical wards of medical universities. CONCLUSIONS: These data show limited availability of echocardiography in primary care units. It is necessary to continue actions for better accessibility and frequency of performing interventional procedures in patients with heart failure in Poland.

The relationship between malnutrition risk and inflammatory biomarkers in outpatient geriatric population.

PURPOSE: Malnutrition is an underestimated, but significant problem among older persons. It is described as a consequence of genetic and environmental factors, lack of physical activity, and co-morbidities. However, a key role of a geriatrician is to further explore the multidimensional complexity of this issue. The aim of this study was to identify the relationship between nutritional status and different factors, particularly focusing on inflammatory biomarkers. METHODS: Nutritional status was assessed using Mini-Nutritional-Assessment with a score below 24 (out of 30) defined as malnutrition. Different serum biomarkers of inflammation were measured, such as High-Sensitivity-C-Reactive-Protein (hsCRP), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-18(IL-18), osteoprotegerin(OPG), and Soluble-Receptor-For-TNF-alfa(sTNFRII). Medical history, mental status (Mini-Mental-State-Examination, Geriatric-Depression-Scale) and activities of daily living (using Instrumental-Activities-of-Daily-Living-Scale) were used in the evaluation. The relationship between nutritional status and the factors listed was assessed. RESULTS: The mean age of 76 examined persons (40.8% female) from the outpatient clinic was 71 years. Malnutrition risk was recognized in 29%. The following factors significant in univariate regression were used in stepwise regression analysis: age, sex, mental status (MMSE, GDS), valve disease, number of diseases, IADL. Stepwise regression revealed that the risk of malnutrition was increased by the presence of valve disease, number of diseases, and female sex. Factors that increased the risk of malnutrition were: logsTNFRII (OR = 3.09; 95% CI 1.07-8.96), IL-8 (OR = 1.09; 95% CI 1.00-1.18), and OPG (OR = 1.27; 95% CI 1.02-1.57). Risk of malnutrition was negatively associated with Il-18(OR = 0.995; 95% CI 0.991-0.999). CONCLUSIONS: Chronic inflammation and immunologic process are likely contributors to the complex etiopathogenesis of malnutrition in older persons.

Is the Clock Drawing Test useful in the screening assessment of aged patients with chronic heart failure?

PURPOSE: Cognitive impairment is one of the most common geriatric deficits in old patients with heart failure (HF), but there has been a lack of study on the utility of the Clock Drawing Test (CDT) when used with this group of patients. The aim of the study was to assess the usefulness of the CDT in the geriatric assessment of aged outpatients with chronic HF. PATIENTS AND METHODS: A cross-sectional analysis of the results of the comprehensive geriatric assessment (CGA), including the CDT, of 92 aged outpatients with heart failure was conducted. RESULTS: We found a high prevalence of five examined geriatric problems. The majority of the patients presented signs of cognitive deterioration of different patterns and severity on the Clock Drawing Test. All the CDT scoring systems correlated significantly with the Mini-Mental Test Examination results. CONCLUSIONS: It seems reasonable to perform the routine CGA with the CDT examination in all aged heart failure patients.

Should malnutrition risk be assessed in older patients with elevated levels of NT-proBNP?

Introduction An inverse relationship between natriuretic peptides (N­terminal fragment of the prohormone brain natriuretic peptide [NT­proBNP]) and body mass index (BMI) among healthy people and patients with chronic heart failure (CHF) was observed. Objectives The aim of the study was to assess the relationship between nutritional status and NT­proBNP concentrations in older persons. Patients and methods NT­proBNP concentrations, medical histories, and malnutrition risk using Mini Nutritional Assessment were evaluated. Body composition was measured with dual energy X­ray absorptiometry. The relationship of nutritional status with NT­proBNP concentrations (in tertiles) was assessed. Results The mean (SD) age of 106 participants was 72.16 (9.38) years. Heart failure was diagnosed in 72.6% of patients. The risk of malnutrition was recognized in 28.3%, and the percentage of patients at risk increased in subsequent NT­proBNP tertiles: from 16.7% in the first tertile to 48.6% in the third tertile (P = 0.005). The risk of malnutrition was associated with an increase in NT­proBNP concentrations per tertile (odds ratio [OR], 2.30; 95% CI, 1.30-4.07; P = 0.004). Based on a multivariable logistic model, the NT­proBNP concentration in the third tertile was associated with an over 9­fold higher risk of malnutrition (OR, 9.80; 95% CI, 2.00-48.17; P = 0.005) as compared with the lowest concentration. Among patients with CHF, the relationship between NT­proBNP and nutritional status was even stronger. Conclusions High NT­proBNP levels contribute to increased risk of malnutrition in older patients with heart failure. In patients with elevated NT­proBNP levels, the risk of malnutrition should be assessed.

Chronic heart failure management in primary healthcare in Poland: Results of a nationwide cross-sectional study.

BACKGROUND: Organizational and educational activities in primary care in Poland have been introduced to improve the chronic heart failure (CHF) management. OBJECTIVES: To assess the use of diagnostic procedures, pharmacotherapy and referrals of CHF in primary care in Poland. METHODS: The cross-sectional survey was conducted in 2013, involving 390 primary care centres randomly selected from a national database. Trained nurses contacted primary care physicians who retrospectively filled out the study questionnaires on the previous year's CHF management in the last five patients who had recently visited their office. The data on diagnostic and treatment procedures were collected. RESULTS: The mean age ± SD of the 2006 patients was 72 ± 11 years, 45% were female, and 56% had left ventricular ejection fraction <50%. The percentage of the CHF patients diagnosed based on echocardiography was 67% and significantly increased during the last decade. Echocardiography was still less frequently performed in older patients (≥80 years) than in the younger ones (respectively 50% versus 72%, Ρ <0.001) and in women than in men (62% versus 71%, P <0.001). The percentage of the patients treated with ß-blocker alone was 88%, but those with a combination of angiotensin inhibition 71%. The decade before, these percentages were 68% and 57%, respectively. Moreover, an age-related gap observed in the use of the above-mentioned therapy has disappeared. CONCLUSION: The use of echocardiography in CHF diagnostics has significantly improved in primary care in Poland but a noticeable inequality in the geriatric patients and women remains. Most CHF patients received drug classes in accordance with guidelines.

Quality of care of hospitalised patients with heart failure in Poland in 2013: results of the second nationwide survey.

BACKGROUND: Optimal management of heart failure (HF) patients is crucial to reduce both mortality and the number of hospital admissions, at the same time improving patients' quality of life. AIM: The aim of the study was to assess the quality of care of hospitalised patients with HF in Poland in 2013 and compare it with the results of a similar survey performed in 2005. METHODS: The presented study was conducted from April to November 2013 in a sample of 260 hospital wards in Poland, recruited by stratified proportional sampling. Similarly to the first study edition in 2005, a trained nurse contacted physicians, who filled out the study questionnaires on the last five patients with HF, who had been discharged from an internal or cardiological ward. HF did not have to be a major cause of hospital admission. RESULTS: The mean age of the 1300 hospitalised patients was 72.1 years, an increase of 2.3 years since the 2005 survey. The proportion of patients classified as New York Heart Association IV decreased from 28.5% in 2005 to 22.1% in 2013. In comparison with 2005, more patients had concomitant disorders such as hypertension (79.5% vs. 71.0%), diabetes (46.2% vs. 33.2%), and chronic renal failure (33.4% vs. 19.4%). Access to echocardiography has improved in recent years: it was available for 98.9% of the surveyed hospital wards (93% in 2005) and it was performed during the hospitalisation in 60.2% of the patients (58.8% in 2005). In 2013 N-terminal pro-B-type natriuretic peptide was accessible for 80.8% of hospital wards (12.8% in 2005) and the test was performed in 31.3% of the hospitalised patients (3.3% in 2005). Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) were administered in 68.9% of HF discharged patients, beta-blockers in 84.8%, mineralocorticoid receptor antagonist (MRA) in 57.9%, diuretics in 85.9%, and digoxin in 23%. The respective numbers in 2005 were 85.9%, 76.0%, 65.4%, 88.9%, and 38.4%. The decrease in prescription of ACEI or ARB resulted from lesser usage of these drugs in internal medicine wards (from 84.3% in 2005 to 55.6% in 2013). CONCLUSIONS: In comparison to the analogous project run in 2005, an improvement in some areas of HF treatment was observed in Polish hospitals, such as accessibility to echocardiography and natriuretic peptide measurement as well as beta-blocker and MRA use. At the same time, a meaningful decrease in ACEIs or ARBs usage in internal wards was observed, which might be the result of the ageing of the HF population and an increased number of comorbidities.

Knowledge about heart failure in primary care: need for strengthening of continuing medical education.

BACKGROUND: Heart failure (HF) is a common complication of cardiovascular diseases, and patients with HF remain largely under the care of primary care physicians (GPs). Therefore, the goal of the study presented was to assess the GPs' knowledge of chronic HF guidelines in regards to their professional experience. METHODS AND RESULTS: In 2008, during a nationwide educational project on HF management, 15 courses for GPs were conducted. Before the training, physicians filled out a standardized questionnaire about the diagnosis and treatment of HF. The answers were assessed in a three age-group of respondents: 24-39 years (n = 142), 40-55 years (n = 316), 56 years and above (n = 156). Of 614 physicians, 97% indicated echocardiography as obligatory diagnostic procedure in HF diagnosis. The oldest GPs more frequently pointed to the role of chest X-ray (63%, p < 0.001) and electrocardiography (32%, p < 0.001) in exclusion of systolic HF. There was a significant reverse relationship between physicians' age and their declarations in prescription of angiotensin II receptor blockers (p = 0.007; contingency coefficient, Cc= 0.13) and b-blockers (p = 0.01; Cc = 0.12) in patients with advanced HF (NYHA III-IV), and positive relation between application of spironolactone (p = 0.007; Cc = 0.13) and digitalis (p < 0.001; Cc = 0.16) in patients of NYHA class I-II. The new generation b-blockers (bisoprolol, carvedilol, nebivolol) were more frequently prescribed by the youngest physicians (respectively: 98%, 96%, 58%) compared to the oldest group (respectively: 88%, 87%, 50%; p < 0.05). CONCLUSIONS: The study revealed age of GPs to be inversely related to their knowledge of HF guidelines and potential therapeutic decisions in management of HF patients and support of the need of continuing medical education.

The costs of heart failure in Poland from the public payer's perspective. Polish programme assessing diagnostic procedures, treatment and costs in patients with heart failure in randomly selected outpatient clinics and hospitals at different levels of care: POLKARD.

BACKGROUND: Heart failure (HF) is a chronic disease of great clinical and economic significance for both the healthcare system and patients themselves. AIM: To determine the consumption of medical resources for treatment and care of HF patients and to estimate the related costs. METHODS: The study involved 400 primary care practices and 396 specialist outpatient clinics, as well as 259 hospitals at all reference levels. The sample was representative and supplemented with patient interview data. Based on the consumption of particular resources and the unit costs of services in 2011, costs of care for HF patients in Poland were estimated. Separate analyses were conducted depending on the stage of the disease (according to NYHA classification I-IV). The public payer's perspective and a one year time horizon were adopted. RESULTS: Direct annual costs of an HF patient's treatment in Poland may range between PLN 3,373.23 and 7,739.49 (2011), the main cost item being hospitalisation. The total costs for the healthcare system could be as high as PLN 1,703 million, which is 3.16% of the National Health Fund's budget (Ex. rate from 05.03.2012: 1 EUR = 4.14 PLN). CONCLUSIONS: The costs of treating heart failure in Poland are high; proper allocation of resources to diagnostic procedures and treatment may contribute to rationalisation of the relevant expenditure.

Age-related gap in the management of heart failure patients. The National Project of Prevention and Treatment of Cardiovascular Diseases--POLKARD.

BACKGROUND: Heart failure (HF) is strongly associated with aging. It affects 10-12% of patients older than 80 years, with five-year overall mortality after first hospitalization for HF being as high as 81%. The main objective of this study was to assess the diagnosis and treatment of HF in hospitalized octogenarians compared to younger subjects. METHODS: The survey was performed among a random sample of all Polish hospitals and in all academic centers, as part of the National Project of Prevention and Treatment of Cardiovascular Diseases in Poland -- POLKARD. Using a questionnaire-based method, hospital documentation of the last five patients with diagnosed HF was reviewed. Eventually, in 2005, HF patients of 259 internal medicine and cardiology hospital wards, including 260 very elderly patients, were selected to the study. RESULTS: The mean age of the 1,289 studied patients was 69.8 ± 11.4 years (age range: 26-96 years), 57.8% were males, and 80.1% were in NYHA class III or IV. Echocardiography was performed in 41.7% of octogenarians in comparison with 58.7% of those categorized as younger elderly, i.e. 60-79 years, and 75.2% of patients aged below 60 years (p < 0.0001). The most prescribed drugs in very elderly patients were diuretics (86.9%, p = 0.005) and ACE-I (81.9%), while only 61.5% used beta-blockers (p < 0.0001). In stepwise logistic regression analysis, hypertension, history of myocardial infarction and admission to cardiology ward were positively associated with beta-blocker and ACE-I (or ARB) therapy, while older age and pulmonary diseases (COPD or asthma) were related to their non-prescription. CONCLUSIONS: Despite significant progress in HF management, there is still a need for an improvement in the medical care of very elderly patients. The major obstacles seem to be advanced age and the presence of coexistent pulmonary diseases. Therefore, the participation of geriatricians and pulmonologists should be recommended in caring for octogenarians with HF.

Epidemiology and management of coexisting heart failure and atrial fibrillation in an outpatient setting.

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia complicating heart failure (HF). The coexistence of these diseases may be partially explained by the presence of common risk factors. Although the effect of AF on the prognosis in HF is still debatable, it is associated with specific complications and affects therapy. OBJECTIVES: The aim of this analysis was to evaluate epidemiology and management of coexisting HF and AF among Polish outpatients. PATIENTS AND METHODS: The present study was performed within the framework of the Polish National Cardiovascular Disease Prevention and Treatment Program, POLKARD 2003-2005, and included patients with HF treated in a representative number of 400 outpatient clinics. Data was collected using questionnaires and included demographic characteristics as well as information about coexisting diseases and treatment, provided by patients and physicians on the basis of the available medical records. RESULTS: The study involved 3682 patients with HF (mean age 67.1 ±11.7 years; 58% of patients were men). AF was present in 38% of the patients. The prevalence of arrhythmia increased with the New York Heart Association class. We observed significant differences between the subgroups of patients with AF and those with sinus rhythm in terms of demographic parameters, risk factors, concomitant diseases, and therapy. Although the use of angiotensin-converting enzyme inhibitors and ß-blockers was significantly lower in the subgroup with AF, a multivariable analysis showed that it was associated with specific demographic characteristics and comorbidities rather than with arrythmia itself. Specialty patient care was associated with increased use of therapy aimed to improve the prognosis of HF patients. CONCLUSIONS: Patients with AF constitute a particular subgroup within the population of patients with HF. A specific distribution of risk factors with a significant effect of noncardiac diseases may confound HF therapy in this patient group. Specialty care may be able to optimize treatment in patients with coexisting HF and AF.

Characteristics of the heart failure population in Poland: ZOPAN, a multicentre national programme.

BACKGROUND: It is difficult to define the optimal management of elderly heart failure (HF) patients with complex comorbidities. Thus, comprehensive characterisation of HF patients constitutes a crucial pre-condition for the successful management of this fragile population. AIM: To analyse the 'real life' HF patients, including the evaluation of their health conditions, management and their use of public health resources. METHODS AND RESULTS: We examined 822 consecutive patients diagnosed with HF in NYHA classes II-IV in primary care practices. The mean age was 68.5 years, and 56% were male. Only 23% of the patients who were of pre-retirement age remained professionally active. Ischaemic or hypertension aetiology was found in 90% of participants. Nearly all patients had multiple comorbidities. Most patients received converting enzyme inhibitors (88%) and beta-blockers (77%), 60% of them both, although dosing was frequently inadequate. During the six months preceding the study, 31% had cardiovascular hospitalisation and 66% required unscheduled surgery visits. CONCLUSIONS: The real life HF population differs from trial populations. Most of the real life patients who had not yet reached retirement age were professionally inactive, mainly due to a disability caused by cardiovascular conditions. Moreover, extremely few participants were free from any comorbidity. Compared to 20th century Polish data, there has been an improvement in the overall quality of HF-recommended pharmacotherapy. It must be stressed, however, that the percentage of those on optimal dosage remains unsatisfactory.

Heart failure management in Poland: The National Cardiovascular Disease Prevention and Treatment Program POLKARD, edition 2003-2005.

BACKGROUND: The aim of this study was to assess actual management of heart failure (HF) in Poland, both in outpatient clinics and hospitals. METHODS AND RESULTS: The survey was undertaken between April 21 2005 and December 31 2005 in 796 outpatient departments and 258 internal medicine and cardiology hospital wards chosen at random. In total 3980 HF outpatients and 1294 inpatients were included. Trained nurses performed the questionnaire-based assessment of diagnostic procedures and pharmacotherapy. Heart failure was diagnosed among general practitioners' (GPs) outpatients most frequently, basing on symptoms (64.0%), ECG (47.0%) and chest X-ray (29.9%), while specialists based their diagnosis on symptoms (52.2%) and echocardiography (37.7%). Most HF outpatients and hospital patients were treated with ACE-I (88.3% and 81%, respectively), beta-blockers (68.3% vs. 84.7%) and diuretics (74.4% vs. 90.3%). Spironolactone accounted for 48.3% vs. 56.3% of the patients, while digitalis glycosides 39.2% and 27.4%, respectively. AT-1 blockers were used very rarely (3.5% vs. 2.5%). CONCLUSIONS: GPs in Poland tend to diagnose HF on clinical grounds while specialists use more diagnostic investigations. Specialists provide higher quality HF care than GPs, both in outpatient clinics and hospitals. Significant progress in HF management has occurred in Poland since previous studies. (Cardiol J 2007; 14: 552-560).