Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology.

Episodes of worsening symptoms and signs characterize the clinical course of patients with chronic heart failure (HF). These events are associated with poorer quality of life, increased risks of hospitalization and death and are a major burden on healthcare resources. They usually require diuretic therapy, either administered intravenously or by escalation of oral doses or with combinations of different diuretic classes. Additional treatments may also have a major role, including initiation of guideline-recommended medical therapy (GRMT). Hospital admission is often necessary but treatment in the emergency service or in outpatient clinics or by primary care physicians has become increasingly used. Prevention of first and recurring episodes of worsening HF is an essential component of HF treatment and this may be achieved through early and rapid administration of GRMT. The aim of the present clinical consensus statement by the Heart Failure Association of the European Society of Cardiology is to provide an update on the definition, clinical characteristics, management and prevention of worsening HF in clinical practice.

Optimizing outcomes in heart failure: 2022 and beyond.

Although the development of therapies and tools for the improved management of heart failure (HF) continues apace, day-to-day management in clinical practice is often far from ideal. A Cardiovascular Round Table workshop was convened by the European Society of Cardiology (ESC) to identify barriers to the optimal implementation of therapies and guidelines and to consider mitigation strategies to improve patient outcomes in the future. Key challenges identified included the complexity of HF itself and its treatment, financial constraints and the perception of HF treatments as costly, failure to meet the needs of patients, suboptimal outpatient management, and the fragmented nature of healthcare systems. It was discussed that ongoing initiatives may help to address some of these barriers, such as changes incorporated into the 2021 ESC HF guideline, ESC Heart Failure Association quality indicators, quality improvement registries (e.g. EuroHeart), new ESC guidelines for patients, and the universal definition of HF. Additional priority action points discussed to promote further improvements included revised definitions of HF 'phenotypes' based on trial data, the development of implementation strategies, improved affordability, greater regulator/payer involvement, increased patient education, further development of patient-reported outcomes, better incorporation of guidelines into primary care systems, and targeted education for primary care practitioners. Finally, it was concluded that overarching changes are needed to improve current HF care models, such as the development of a standardized pathway, with a common adaptable digital backbone, decision-making support, and data integration, to ensure that the model 'learns' as the management of HF continues to evolve.

Assessment of Clinical Indicators Registered on Admission to the Hospital Related to Mortality Risk in Cancer Patients with COVID-19.

BACKGROUND: Oncology patients are a particularly vulnerable group to the severe course of COVID-19 due to, e.g., the suppression of the immune system. The study aimed to find links between parameters registered on admission to the hospital and the risk of later death in cancer patients with COVID-19. METHODS: The study included patients with a reported history of malignant tumor (n = 151) and a control group with no history of cancer (n = 151) hospitalized due to COVID-19 between March 2020 and August 2021. The variables registered on admission were divided into categories for which we calculated the multivariate Cox proportional hazards models. RESULTS: Multivariate Cox proportional hazards models were successfully obtained for the following categories: Patient data, Comorbidities, Signs recorded on admission, Medications used before hospitalization and Laboratory results recorded on admission. With the models developed for oncology patients, we identified the following variables that registered on patients' admission were linked to significantly increased risk of death. They are: male sex, presence of metastases in neoplastic disease, impaired consciousness (somnolence or confusion), wheezes/rhonchi, the levels of white blood cells and neutrophils. CONCLUSION: Early identification of the indicators of a poorer prognosis may serve clinicians in better tailoring surveillance or treatment among cancer patients with COVID-19.

Impact of ferric carboxymaltose for iron deficiency at discharge after heart failure hospitalization: a European multinational economic evaluation.

AIMS: Iron deficiency (ID) is comorbid in up to 50% patients with heart failure (HF) and exacerbates disease burden. Ferric carboxymaltose (FCM) reduced HF hospitalizations and improved quality of life when used to treat ID at discharge in patients hospitalized for acute HF with left ventricular ejection fraction <50% in the AFFIRM-AHF trial. We quantified the effect of FCM on burden of disease and the wider pharmacoeconomic implications in France, Germany, Poland, Spain and Sweden. METHODS AND RESULTS: The per country eligible population was calculated, aligning with the 2021 European Society of Cardiology (ESC) HF guidelines and the AFFIRM-AHF trial. Changes in burden of disease with FCM versus standard of care (SoC) were represented by disability-adjusted life years (DALYs), hospitalization episodes and bed days, using AFFIRM-AHF data. A Markov model was adapted to each country to estimate cost-effectiveness and combined with epidemiology data to calculate the impact on healthcare budgets. Between 335 (Sweden) and 13 237 (Germany) DALYs were predicted to be avoided with FCM use annually. Fewer hospitalizations and shorter lengths of stay associated with FCM compared to SoC were projected to result in substantial annual savings in bed days, from 5215 in Sweden to 205 630 in Germany. In all countries, FCM was predicted to be dominant (cost saving with gains in quality-adjusted life years), resulting in net savings to healthcare budgets within 1 year. CONCLUSIONS: This comprehensive evaluation of FCM therapy highlights the potential benefits that could be realized through implementation of the ESC HF guideline recommendations regarding ID treatment.

Clinical and economic impact of ferric carboxymaltose treatment for iron deficiency in patients stabilized following acute heart failure: a multinational study.

OBJECTIVE: To estimate clinical events and evaluate the financial implications of introducing ferric carboxymaltose (FCM) to treat iron deficiency (ID) at discharge in patients hospitalized for acute heart failure (AHF) with left ventricular ejection fraction (LVEF) <50% in the UK, Switzerland and Italy. METHODS: A decision analytic cost-offset model was developed to evaluate the costs associated with introducing FCM for all eligible patients in three countries compared to a world without FCM, over a five-year time horizon. Data from AFFIRM-AHF clinical trial were used to model clinical outcomes, using an established cohort state-transition Markov model. Country-specific prevalence estimates were derived using data from real-world studies to extrapolate number of events and consequent cost totals to the population at risk on a national scale. RESULTS: The cost-offset modeling demonstrated that FCM is projected to be a cost-saving intervention in all three country settings over a five-year time horizon. Savings were driven primarily by reduced hospitalizations and avoided cardiovascular deaths, with net cost savings of -£14,008,238, -CHF25,456,455 and -€105,295,146 incurred to the UK, Switzerland and Italy, respectively. LIMITATIONS: Although AFFIRM-AHF was a multinational trial, efficacy data per country was not sufficiently large to enable country-specific analysis, therefore overall clinical parameters have been assumed to apply to all countries. CONCLUSIONS: This study provides further evidence of the potential cost savings achievable by treating ID with FCM at discharge in patients hospitalized for AHF with LVEF <50%. The value of FCM treatment within the healthcare systems of the UK, Switzerland and Italy was demonstrated even within a limited time frame of one year, with consistent cost savings indicated over a longer term.

Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis utilising AFFIRM-AHF.

AIMS: Iron deficiency is common in patients with heart failure (HF). In AFFIRM-AHF, ferric carboxymaltose (FCM) reduced the risk of hospitalisations for HF (HHF) and improved quality of life vs. placebo in iron-deficient patients with a recent episode of acute HF. The objective of this study was to estimate the cost-effectiveness of FCM compared with placebo in iron-deficient patients with left ventricular ejection fraction <50%, stabilised after an episode of acute HF, using data from the AFFIRM-AHF trial from Italian, UK, US and Swiss payer perspectives. METHODS AND RESULTS: A lifetime Markov model was built to characterise outcomes in patients according to the AFFIRM-AHF trial. Health states were defined using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Subsequent HHF were incorporated using a negative binomial regression model with cardiovascular and all-cause mortality incorporated via parametric survival analysis. Direct healthcare costs (2020 GBP/USD/EUR/CHF) and utility values were sourced from published literature and AFFIRM-AHF. Modelled outcomes indicated that treatment with FCM was dominant (cost saving with additional health gains) in the UK, USA and Switzerland, and highly cost-effective in Italy [incremental cost-effectiveness ratio (ICER) EUR 1269 per quality-adjusted life-year (QALY)]. Results were driven by reduced costs for HHF events combined with QALY gains of 0.43-0.44, attributable to increased time in higher KCCQ states (representing better functional outcomes). Sensitivity and subgroup analyses demonstrated data robustness, with the ICER remaining dominant or highly cost-effective under a wide range of scenarios, including increasing treatment costs and various patient subgroups, despite a moderate increase in costs for de novo HF and smaller QALY gains for ischaemic aetiology. CONCLUSION: Ferric carboxymaltose is estimated to be a highly cost-effective treatment across countries (Italy, UK, USA and Switzerland) representing different healthcare systems.

The Heart Failure Association Atlas: Heart Failure Epidemiology and Management Statistics 2019.

AIMS: The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) developed the HFA Atlas to provide a contemporary description of heart failure (HF) epidemiology, resources, reimbursement of guideline-directed medical therapy (GDMT) and activities of the National Heart Failure Societies (NHFS) in ESC member countries. METHODS AND RESULTS: The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness of source data varied across countries. The median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from ≤2 in Italy and Denmark to >6 in Germany. The median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people, ranging from ≤12 in Greece and Spain to >30 in Lithuania and Germany. The median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people annually, ranging from <1000 in Latvia and North Macedonia to >6000 in Romania, Germany and Norway. The median length of hospital stay for an admission with HF was 8.50 (IQR 7.38-10) days. Diagnostic and management resources for HF varied, with high-income ESC member countries having substantially more resources compared with middle-income countries. The median number of hospitals with dedicated HF centres was 1.16 (IQR 0.51-2.97) per million people, ranging from <0.10 in Russian Federation and Ukraine to >7 in Norway and Italy. Nearly all countries reported full or partial reimbursement of standard GDMT, except ivabradine and sacubitril/valsartan. Almost all countries reported having NHFS or working groups and nearly half had HF patient organizations. CONCLUSIONS: The first report from the HFA Atlas has shown considerable heterogeneity in HF disease burden, the resources available for its management and data quality across ESC member countries. The findings emphasize the need for a systematic approach to the capture of HF statistics so that inequalities and improvements in care may be quantified and addressed.

Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation.

PURPOSE: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence increases with age. The elderly population is commonly affected by frailty syndrome (FS). FS syndrome along with anxiety and depressive symptoms are prevalent among elderly patients with AF. It is unclear whether depression contributes to AF or vice versa. The purpose of this study was to assess correlations between FS and the occurrence of anxiety and depression symptoms in a group of elderly patients with AF. PATIENTS AND METHODS: This cross-sectional study included 100 elderly patients (69 females, 31 males, mean age: 70.27 years) with AF. Standardized research instruments were used including the Tilburg Frailty Indicator (TFI) to assess FS, and two questionnaires to assess depression including the Geriatric Depression Scale (GDS), and the Hospital Anxiety Depression Scale (HADS). RESULTS: Mild FS was found in 38% and moderate FS in 29% of patients. Based on GDS scores, depression symptoms were found in 51% of patients' sample. Based on HADS scores, 20% of patients were found to have anxiety symptoms, and 28% revealed depression symptoms. Single-factor analysis demonstrated a significant positive correlation between HADS anxiety symptoms (r=0.492), HADS depression symptoms (r=0.696), and GDS score (r=0.673) on the one hand, and overall TFI frailty score on the other. Multiple-factor analysis identified overall GDS score, education, and lack of bleeding as significant independent predictors of TFI scores (p<0.05). CONCLUSION: FS is common in the population of elderly patients with AF. We found evidence for the association between symptoms of anxiety and depression and the incidence of FS in this group of patients. Due to the risk of consequences which may in part be irreversible, screening for FS is recommended.

Cardiovascular stress biomarker assessment of middle-aged non-athlete marathon runners.

BACKGROUND: Cardiovascular safety of marathon running in recreational runners remains unclear. We set up this study to comprehensively evaluate the effects of a marathon run on the profile of cardiovascular stress biomarkers in connection with transthoracic echocardiography. DESIGN AND METHODS: Thirty-three healthy male amateur runners, aged ≥50 years (mean age 57 ± 7) were enrolled. Venous blood samples were obtained before the marathon, just after the race, 2-4 and seven days after the marathon. Using novel single molecule counting technology we measured: plasma concentrations of high-sensitivity cardiac troponin I (hs-cTnI) and endothelin-1. N-terminal pro B-type natriuretic peptide was measured using electrochemiluminescence. Each participant had transthoracic echocardiography before and immediately after the race. RESULTS: We observed a sharp rise in the levels of all biomarkers after the race (all p < 0.01), which subsequently normalized after 2-4 days and stayed within normal range after seven days. Runners with intensive training programmes (>169 km/month, a median for the studied group) had lower hs-cTnI leak after the race (median 15.11 ng/ml and 31.2 ng/ml, respectively; p < 0.05). Neither transthoracic echocardiography measures of ventricles nor strain rates changed after the run. We observed a decrease in the left atrial volume index and increase in the maximal right atrial volumes (all p < 0.05). Changes in Doppler indices of diastolic function suggestive of alteration in left ventricular relaxation were observed. CONCLUSIONS: Marathon run is associated with sharp and significant rises in the biomarkers of cardiovascular stress. The profile of these changes, however, along with echocardiographic parameters, does not suggest irreversible myocardial damage.

Serial assessment of spot urine sodium predicts effectiveness of decongestion and outcome in patients with acute heart failure.

AIMS: The clinical significance of the measurement of urine sodium concentration (UNa+ ) in response to loop diuretic administration in patients with acute heart failure (AHF) is still unsettled. We studied the association of serial measurements of spot UNa+ during the first 48 h of AHF treatment with the indices of decongestion, renal function, and prognosis. METHODS AND RESULTS: We enrolled 111 AHF patients, all of whom received intravenous furosemide on admission. The mean spot UNa+ significantly increased in the 6 h sample (P < 0.05 vs. baseline) and returned to baseline values in the 24 and 48 h samples. Based on the increase or decrease/no change of UNa+ in the 6 and 48 h samples vs. baseline, patients were divided into two groups at each time point, respectively. Patients did not differ in baseline clinical and laboratory characteristics. Patients with a decrease/no change of UNa+ in the 6 and 48 h samples had a lower weight loss during hospitalization. Patients with a decrease/no change of UNa+ in the 48 h sample had a poorer diuretic response and a significant increase in the urinary levels of the tubular biomarkers: kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin. Low UNa+ and decrease/no change in UNa+ in the 6 and 48 h samples were independent predictors of higher risk of all-cause mortality during 1-year follow-up (all P < 0.05). CONCLUSION: In AHF, low spot UNa+ and lack to increase UNa+ in response to intravenous diuretics are associated with poor diuretic response, markers of tubular injury and high risk of 1-year mortality.

Assessment of baroreflex sensitivity has no prognostic value in contemporary, optimally managed patients with mild-to-moderate heart failure with reduced ejection fraction: a retrospective analysis of 5-year survival.

OBJECTIVES: We evaluated the prognostic value of cardiac baroreflex sensitivity (BRS) in contemporary, optimally treated patients with mild-to-moderate heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: Data from 97 patients with HFrEF (left ventricular ejection fraction 32 ± 6%, all receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-blocker, 85% receiving aldosterone antagonist) were analysed retrospectively. All patients underwent standard clinical assessment, cardiopulmonary exercise testing and BRS evaluation with three methods: the phenylephrine (BRS-Phe), the sequence (BRS-Seq) and the controlled breathing (BRS-CtrBr) method. Data on 5-year all-cause mortality and appropriate and documented implantable cardioverter-defibrillator (ICD) discharges were collected. During a mean follow-up of 53 ± 15 months, the composite endpoint of all-cause death and appropriate and documented ICD discharge occurred in 31 (32%) patients. BRS measures assessed using all three methods were not related to survival in univariate Cox proportional hazards analyses (all P >0.25). There were also no differences in survival between low vs. preserved BRS groups, irrespective of the method used for BRS assessment (all P ≥0.15). BRS-Phe correlated with several clinically important variables (including left ventricular ejection fraction: rS = 0.27, and peak oxygen consumption: rS = 0.32, both P < 0.05), while clinical associations of BRS-Seq and BRS-CtrBr were sparse. CONCLUSIONS: Assessment of cardiac BRS provides no prognostic information in the contemporary mild-to-moderate HFrEF population receiving optimal management.

Differences of psychological features in patients with heart failure with regard to gender and aetiology - Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study.

OBJECTIVE: Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology. METHODS: 758 patients with HFrEF (mean age - 64±11years, men - 79%, NYHA class III-IV - 40%, ischemic aetiology - 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF. RESULTS: There were differences in the CISS and BDI score between the genders - women had higher CISS (emotion- and avoidance-oriented) and BDI (general score - 14.2±8.7 vs 12.3±8.6, P<0.05; subscale - somatic score - 7.3±3.7 vs 6.1±3.7, P<0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status. CONCLUSIONS: There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.

Sexual dimorphism in socioeconomic differences regarding the risk factors, symptomatology and management of patients with stable coronary artery disease in Poland.

BACKGROUND: Relationships between socioeconomic status (SES) and the risk factors, applied treatment and outcomes of patients with coronary artery disease (CAD) have been demonstrated in Western European countries, however analogous evidence is missing from Eastern and Central European countries. The aim of the study was to investigate SES gradients regarding the risk factors, symptoms and management of patients with stable CAD in Poland, separately in men and women. METHODS: We analyzed the data of 2,593 participants of the RECENT study. SES was assessed based on the level of education attainment: university, secondary school or primary school. RESULTS: Socioeconomic differences in risk profile were most markedly seen in women: lower the education, higher body mass index (p < 0.01), systolic and diastolic blood pressure (p < 0.05), resting heart rate (p < 0.01), and greater prevalence of heart failure (p < 0.05) and dyslipidemia (p < 0.05). Importantly, smoking habit was the most frequent in women who graduated from univer-sity (p < 0.01). In men, socioeconomic gradients were only seen within resting heart rate (p < 0.01), LDL cholesterol level (p < 0.05) and smoking habit (p < 0.05). In both genders, better education was associated with less severe symptoms of angina and more frequent use of statins (p < 0.05). CONCLUSIONS: SES stratified based on education level differentiates patients with stable CAD in Poland regarding their risk profile, symptom control and the use of statins. Sexual dimorphism is found mainly within SES gradients regarding the prevalence of risk factors.

Safety and efficacy assessment of carotid artery stenting in a high-risk population in a single-centre registry.

INTRODUCTION: Ischaemic stroke is the primary cause of long-term disability and the third most common cause of death. Internal carotid artery stenosis is an important risk factor for stroke and transient ischaemic attack (TIA). European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines allow carotid artery stenting (CAS) as an alternative to endarterectomy in centres with low rates of death or stroke. AIM: To assess the safety and efficacy of CAS in a single-centre observation. MATERIAL AND METHODS: We performed a retrospective analysis of all patients treated with CAS between March 2008 and July 2012. Clinical data and outcomes in both asymptomatic and symptomatic patients were analysed. RESULTS: A total of 214 consecutive patients were included in the registry. Symptomatic patients accounted for 57% of the study group and were more likely to have a history of stroke and/or TIA that occurred more than 6 months before the procedure (50% vs. 8%, p < 0.001). Asymptomatic patients were more likely to have a history of coronary artery disease (88% vs. 61%, p < 0.001), and the rates of previous acute coronary syndrome and revascularisation were also higher in this group (58% vs. 41% and 71% vs. 52%, respectively, both p < 0.05). The symptomatic group had higher incidence of stroke in periprocedural and 30-day observation (4% vs. 0%, p < 0.05). There was no difference in incidence of adverse events in long-term observation. CONCLUSIONS: Carotid artery stenting is a safe and efficacious procedure. Every centre performing CAS should monitor the rate of periprocedural complications.

[Arterial baroreflex--physiological role and assessment of functioning]. / Odruch z baroreceptorów tetniczych--znaczenie fizjologiczne i ocena funkcjonowania.

Arterial baroreflex is one of the key mechanisms responsible for the homeostasis maintenance within the cardiovascular system. Through the modulation of sympathetic and parasympathetic drive within the autonomic nervous system, baroreflex enables to stabilize arterial blood pressure and maintain perfusion within critical organs (e.g. brain, heart). This review provides the physiological background of the baroreflex functioning and describes the methodology for assessing the arterial baroreflex sensitivity (BRS). Decreased BRS reflects autonomic imbalance and predicts unfavorable outcome in cardiovascular diseases accompanied by the autonomic dysfunction, such as arterial hypertension and heart failure. BRS assessment methods can be divided into those that are performed in resting conditions (the measurements of spontaneous BRS, e.g. the sequence or spectral analysis method) and methods with the application of the external stimuli, which may be either non-invasive (e.g. the controlled breathing method) or invasive (e.g. the phenylephrine method).

[Coping styles in patients with systolic heart failure]. / Style radzenia sobie ze stresem u mezczyzn z lagodna skurczowa niewydolnoscia serca.

INTRODUCTION: Inadequate coping with stress, in the course of severe disease (e.g. heart failure, HF), promotes the development of depressive symptoms and disadvantageous behaviours (e.g. non-compliance). METHOD: We examined coping styles in men with systolic HF (n=46, age: 60+/-12 years), and related them to clinical status and depressive symptoms. Patients filled-in Coping Inventory for Stressful Situations (CISS) distinguishing: task-oriented (ZA), emotional (EM) and avoidance (UN) styles of coping. Style 'UN' has two subtypes: engaging in alternative activities (ACZ) or seeking for social contacts (PKT). RESULTS: 59% of patients showed a tendency towards all 3 styles of coping. There were the following prevalences of domination of particular coping styles: ZA (35%), UN (28%), EM (7%). 30% of cases did not show domination of any style. The higher tendency to EM style was accompanied by the greater severity of depressive symptoms, both affective-cognitive and somatic ones (p<0.05). CONCLUSIONS: Assessment of coping styles may be helpful in educational programs or psychotherapy addressed to patients with HF experiencing psychological burden due to chronic physical illness.

[Assessment of severity of depressive symptoms using the Polish version IA of Beck Depression Inventory in healthy men, inhabitants of Wroclaw]. / Ocena nasilenia objawów depresyjnych z zastosowaniem polskiej wersji IA Inwentarza Depresji Becka u zdrowych mezczyzn, mieszkanców Wroclawia.

BACKGROUND: Aging is accompanied by progression of depressive symptoms, which significantly impair the prognosis and quality of life of elderly men. Currently, there are no Polish reference values reflecting age-related changes in the intensity of depressive symptoms in healthy men. AIM: An assessment of the severity of depressive symptoms in a population of healthy Polish men, and an evaluation of the effects of age and education on the analyzed variables. METHODS: We examined 341 healthy men, inhabitants of Wroclaw, aged 32-79, without any significant medical history. The intensity of depressive symptoms was assessed using the Polish version IA of Beck Depression Inventory (BDI). RESULTS: We observed an increase in the severity of depressive symptoms in the subsequent age categories in the examined men, in all the analyzed symptoms (32-45, 46-55, 56-65, 66-79 years--4.1 +/- 4.4, 8.2 +/- 4.2, 10.4+/- 3.6, 13.4 +/- 3.4 points, respectively, r = 0.65, p < 0.0001), and in cognitive-affective symptoms (respectively--2.8 +/- 3.1, 5.0 +/- 2.8, 5.8 +/- 2.5, 7.3 +/- 2.6 points, r = 0.5 1, p < 0.0001) as well as in somatic symptoms related to mood changes (respectively - 1.3 +/- 1.5, 3.2 +/- 2.0, 4.6 +/- 1.5, 6.1 +/- 1.7 points r = 0.73, p < 0.0001). Mild (BDI > or = 10 and <20 points) and moderate depression (BDI > or = 20 and < 30 points) were found in 12.6% and 0%, 34.5% and 0.8%, 50.0% and 2.9%, 80.0% and 2.9% of men aged 32-45, 46-55, 56-65, 66-79 years, respectively (p < 0.0001). There were differences in the intensity of depressive symptoms in the examined men (p > 0.2). CONCLUSIONS: In Poland, male aging is accompanied by an increase in the severity of depressive symptoms. Age, but not education, constitutes a major determinant of these symptoms. The presented data may be used as reference values for BDI scores of healthy Polish men in subsequent age categories.

Costs of management of patients with coronary artery disease in Poland: the multicenter RECENT study.

INTRODUCTION: Treatment of coronary artery disease (CAD) generates the major part of public health expenditure in the developed countries. OBJECTIVES: The aim of the study was to estimate costs associated with the diagnosis and treatment of patients with CAD in Poland. PATIENTS AND METHODS: Costs were estimated in a representative sample of 2593 patients with CAD receiving general practitioner (n = 1977) or specialist care (n = 616) in 2005 (the multicenter RECENT study). Data from the National Health Fund, Social Insurance Institution, Central Statistical Office, and current literature were used. RESULTS: The total annual cost of CAD reached €2254.17 per patient, with 48% accounting for direct medical costs (drugs, medical consultations, laboratory tests, diagnostic procedures, invasive treatment, hospitalizations, emergency care) and 52% for indirect costs (related to absence at work and disability). Eighty-one percent of total direct medical costs were covered by the public payer (including 30% of pharmacological treatment costs). Direct medical costs covered by the public payer were higher in men and in patients with more severe angina symptoms (both P <0.05). In the model based on the lowest prevalence of CAD (estimated based on the real population of patients treated in 2005), direct medical costs covered by the public payer reached €617.6 million, i.e., around 7% of the total public health expenditure in Poland in 2005. CONCLUSIONS: Modern management of CAD imposes enormous economic burden on the public health system in Poland. There is a need to develop and implement strategies that would optimize health care costs associated with the treatment of CAD.

[Assessment of chemoreflex involved in reflex cardio-respiratory control]. / Metody oceny wrailiwosci chemoreceptorów uczestniczacych w odruchowej regulacji ukladu krazenia i oddychania.

Impaired chemosensitivity is an important element of the pathogenesis and the course of various cardiovascular diseases. Our paper presents the assessment of the sensitivity of the central (located on the ventrolateral medullary surface, sensitive to hypercapnea and acidosis) and peripheral (located in the carotid and aortic bodies, sensitive to hypoxia) chemoreceptors, pointing out a physiological and clinical aspects of their application.

[Assessment of the functioning of autonomic nervous system in the context of cardiorespiratory reflex control]. / Ocena aktywnosci autonomicznego ukladu nerwowego zwiazanej z odruchowa regulacja ukladu sercowo-naczyniowego i oddychania.

Derangements within autonomic nervous system take part in the natural history of cardiovascular disease. Current paper presents three categories of methods measuring autonomic status: direct methods (e.g. laboratory tests measuring circulating catecholamine levels or based on isotopes, microneurography), indirect methods applied at rest (e.g. analysis of heart rate variability, spectral and sequence methods of arterial baroreflex sensitivity assessment) and indirect methods, associated with the exposure to physiological stimuli (e.g. Ewing's battery, central and peripheral chemoreceptor sensitivity assessment, invasive methods of arterial baroreflex sensitivity assessment). This review provides an insight into the physiology of reflex regulatory mechanisms within cardiorespiratory system, including their complex and unstable nature.