• MeSH
• chlorid sodný MeSH
• hypertenze * diagnóza   farmakoterapie   epidemiologie   MeSH
• kuchyňská sůl škodlivé účinky   MeSH
• lidé MeSH
• sodík dietní * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Background: Atrial fibrillation (AF) is associated with high risk of stroke preventable by timely initiation of anticoagulation. Currently available screening tools based on ECG are not optimal due to inconvenience and high costs. Aim of this study was to study the diagnostic value of apelin for AF in patients with high risk of stroke. Methods: We designed a multicenter, matched-cohort study. The population consisted of three study groups: a healthy control group (34 patients) and two matched groups of 60 patients with high risk of stroke (AF and non-AF group). Apelin levels were examined from peripheral blood. Results: Apelin was significantly lower in AF group compared to non-AF group (0.694 ± 0.148 vs. 0.975 ± 0.458 ng/ml, p = 0.001) and control group (0.982 ± 0.060 ng/ml, p < 0.001), respectively. Receiver operating characteristic (ROC) analysis of apelin as a predictor of AF scored area under the curve (AUC) of 0.658. Apelin's concentration of 0.969 [ng/ml] had sensitivity = 0.966 and specificity = 0.467. Logistic regression based on manual feature selection showed that only apelin and NT-proBNP were independent predictors of AF. Logistic regression based on selection from bivariate analysis showed that only apelin was an independent predictor of AF. A logistic regression model using repeated stratified K-Fold cross-validation strategy scored an AUC of 0.725 ± 0.131. Conclusions: Our results suggest that apelin might be used to rule out AF in patients with high risk of stroke.

• Publikační typ
• časopisecké články MeSH

Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. Methods: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models. Findings: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05). Interpretation: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.

• Publikační typ
• časopisecké články MeSH

Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35-1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04-1.06), and significantly lower with private (OR = .92, 95%CI = .91-.93) or public (OR = .83, 95%CI = .82-84) funding compared to hybrid sources.Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150-390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

• Publikační typ
• časopisecké články MeSH

AIMS: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature of programmes, and to compare these by European region (geoscheme) and with other high-income countries. METHODS: A survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using global burden of disease study ischaemic heart disease incidence estimates. Four high-income countries were selected for comparison (N = 790 programmes) to European data, and multilevel analyses were performed. RESULTS: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8% country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey. Programme volumes (median 300) were greatest in western European countries, but overall were higher than in other high-income countries (P < 0.001). Across all Europe, there was on average only 1 CR spot per 7 IHD patients, with an unmet regional need of 3,449,460 spots annually. Most programmes were funded by social security (n = 25, 59.5%; with significant regional variation, P < 0.001), but in 72 (16.0%) patients paid some or all of the programme costs (or ∼18.5% of the ∼€150.0/programme) out of pocket. Guideline-indicated conditions were accepted in 70% or more of programmes (lower for stable coronary disease), with no regional variation. Programmes had a multidisciplinary team of 6.5 ± 3.0 staff (number and type varied regionally; and European programmes had more staff than other high-income countries), offering 8.5 ± 1.5/10 core components (consistent with other high-income countries) over 24.8 ± 26.0 hours (regional differences, P < 0.05). CONCLUSION: European cardiac rehabilitation capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally.

• MeSH
• disparity zdravotní péče ekonomika   MeSH
• dostupnost zdravotnických služeb ekonomika   MeSH
• integrované poskytování zdravotní péče ekonomika   MeSH
• kardiovaskulární rehabilitace ekonomika   MeSH
• lidé MeSH
• náklady na zdravotní péči * MeSH
• nemoci srdce diagnóza   ekonomika   epidemiologie   rehabilitace   MeSH
• příjem * MeSH
• průřezové studie MeSH
• průzkumy zdravotní péče MeSH
• sociální zabezpečení ekonomika   MeSH
• výdaje na zdravotnictví MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) ekonomika   MeSH
• zdravotnické služby - potřeby a požadavky ekonomika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Evropa MeSH

V práci autori predkladajú návrh praktického postupu pri vykonávaní ambulantnej komplexnej kardiovaskulárnej rehabilitácie (AKKVR). Vychádzajú pritom z aktuálnej situácie v mortalite a morbidite na kardiovaskulárne ochorenia u nás i vo svete. Zdôrazňujú, že situáciu sa nepodarí zlepšiť len podporou invazívnych revaskularizačných postupov a farmakoterapiou, resp. že napriek úspešným intervenčným a kardiochirurgickým výkonom sa ich efekt stráca, ak nie sú sprevádzané liečebnými zmenami životného štýlu. AKKVR sa v tomto návrhu nechápe len ako pravidelný, kontrolovaný fyzický tréning, ale jej súčasťou má byť aj edukácia pacienta, nácvik relaxácie a spôsobov zvládania stresu, zmeny v chovaní a sociálnej podpore pacienta. Predpokladá sa aj záverečné preverenie znalostí pacienta a určenie úrovne jeho fyzickej zdatnosti a následné intermitentné pokračovanie kontaktov s pacientom s prechodom do tréningu v domácom prostredí. Ťažiskom práce sú konkrétne požiadavky na personálne, priestorové a prístrojové vybavenia Stacionára pre AKKVR, ktorý má nadväzovať na činnosť kardiologickej ambulancie. Ďalej sú to praktické postupy pri odosielaní pacientov do stacionára, indikácie a kontraindikácie, stratifikácia pacientov, určovanie tréningovej záťaže na začiatku a v priebehu jedného cyklu AKKVR v trvaní 3 mesiacov, základné zložky AKKVR počas jedného cyklu, aeróbny a silový tréning z hľadiska postupného zvyšovanie záťaže, prechod do domáceho tréningu. V závere sa podčiarkujú podmienky, ktorých splnenie je nevyhnutné k tomu, aby sa dosiahla účinná implementácia AKKVR do systému zdravotníckej starostlivosti.

Authors have proposed a concept of guidelines for applying the ambulatory complex cardiovascular rehabilitation (ACCVR) into the clinical practice in Slovakia. As a background they have used an actual cardiovascular mortality and morbidity data from home country and abroad as well. They emphasize the non-optimal situation in this aspect which may not be solved by the increasing supporting the invasive revascularization methods and by the intensifying pharmacotherapy only, because the favourable effects of these procedures is timely missing if it is not accompanied by the therapeutic lifestyle changes. In this proposal the ACCVR is considered not as a regular, controlled physical training only, but there is included patient´s education, relaxation, stress management, behavioral changes and possible social support too. At the end of one 3 months lasting cycle of ACCVR there is subsumed a final test oriented on patient´s education and physical fitness levels and the continuing long-term contacts with him during following home-based training. Main parts of the concept are the concrete conditions which should by fulfilled as for as a personal, space and device equipment needed for accreditation so called cardiology stationary for ACCVR activities (in connection with cardiology department for out patients). Moreover, there are also included practical guidelines how to do patient´s stratification, how to send the patients to stationary, indications and contraindications, establishing of the training heart rate and training load, the composition of one cycle 3 months lasting, application of the progressive aerobic and resistance training and how to continue in home-based training. At the end the authors have proposed conditions which are needed to fulfil for a successful implementation of ACCVR into the health care system.

• MeSH
• kardiovaskulární nemoci mortalita   terapie   MeSH
• kardiovaskulární rehabilitace * metody   využití   MeSH
• lidé MeSH
• relaxace MeSH
• rizikové faktory MeSH
• sekundární prevence MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• tělesná výchova metody   MeSH
• vzdělávání pacientů jako téma MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Slovenská republika MeSH

Sympatolytiká, ktoré zasahujú na centrálnej úrovni, v regulačných centrách artériového tlaku v mozgovom kmeni a CNS, nielen účinne znižujú krvný tlak, ale aj redukujú prejavy nadmernej aktivity sympatika a zlepšujú inzulínovú senzitivitu. Do programu TEMPO sme zaradili 1 079 pacientov liečených pre artériovú hypertenziu a metabolický syndróm s cieľom zistiť, ako sa zmení pod vplyvom liečby prípravkom Tenaxum® ich vnímanie stresu a či tieto zmeny súvisia so zmenami krvného tlaku. Liečba prípravkom Tenaxum® v trvaní 3 mesiacov bola spojená nielen s výrazným poklesom systolického a diastolického tlaku, srdcovej frekvencie, ale aj so signifikantnou redukciou bodového skóre dotazníka na nadmerný stres. To znamená, že prejavy stresu sa zmiernili spolu s poklesom týchto parametrov. Je pozoruhodné, že medzi zmenami v bodovom skóre na začiatku a konci programu a zmenami v hodnotách systolického tlaku a srdcovej frekvencie sme zistili pozitívnu koreláciu.

Sympatolytics, which intervene on central level in regulation centres of arterial pressure in brain stem and CNS, not only effectively lower blood pressure but they also reduce manifestations of sympatholytic excessive activity and improve insulin sensitivity. To the programme TEMPO we assigned 1 079 patients treated for arterial hypertension and metabolic syndrome with the aim to find out how they will change stress perception under the treatment by preparation Tenaxum® and if these changes are associated with blood pressure changes. The treatment by preparation Tenaxum® in the period of 3 months was associated not only with a significant decrease of systolic and diastolic pressure, heart frequency but also with a significant reduction of a point score questionnaire for excessive stress. It means that stress manifestations were alleviated together with the drop of these parameters. It is remarkable that between changes in the point score at the beginning and at the end of the programme and changes in the values of systolic pressure and heart frequency we detected a positive reaction.

Cieľom práce bolo prezentovať výsledky merania krvného tlaku, podielu kostrového svalstva, celkového a viscerálneho tuku, získané v rámci mesiaca MOST 2008 počas preventívnych vyšetrení na území Slovenska. Krvný tlak sme vyšetrili u 562 konzekutívnych osôb, bioimpedančne sme stanovili podiel kostrového svalstva, celkového a viscerálneho tuku u 238 osôb. U oboch pohlaví sme s narastajúcim vekom pozorovali postupné zvyšovanie systolického krvného tlaku, diastolický tlak sa vo vyššom veku už nezvyšoval. U žien sa s pribúdajúcim vekom zvyšovala telesná hmotnosť, BMI, celkový i viscerálny tuk a klesal podiel svalovej hmoty. U mužov bol zistený nárast priemernej hmotnosti a BMI pri prechode do strednej vekovej skupiny, s pribúdajúcim vekom podiel celkového tuku kontinuálne rástol a podiel svalovej hmoty postupne klesal. Evidentne sa zvyšovala priemerná hodnota viscerálneho tuku, už v strednom veku presiahla normu a vo vyššom veku bola výrazne zvýšená. Vzhľadom na vysoké kardiometabolické riziko nemožno považovať postupné zvyšovanie hmotnosti, celkového a hlavne viscerálneho tuku v rámci postupného starnutia za veku primerané. Alarmujúci je najmä výrazný nárast vnútrobrušného tuku u mužov už v strednom veku a jeho postupné zvyšovanie na hodnoty signalizujúce vysoké riziko diabetu 2. typu.

The aim of the study was to present results of blood pressure measurement, portion of skeletal musculature, whole and visceral fat that were gained within the month of MOST 2008 during preventive examinations in the area of Slovakia. Blood pressure was measured in 562 consecutive persons; the portion of skeletal musculature and whole and visceral fat was determined bioimpendantly in 238 persons. We observed in both sexes age induced gradual increasing of systolic blood pressure while diastolic pressure did not increase with age. Body weight, BMI, whole and visceral fat of women increased with age and portion of skeletal musculature decreased. In middle age men we observed increase of average body weight and BMI, while with growing age the portion of whole fat continually increased and portion of portion of musculature gradually decreased. Apparently, the average value of visceral fat increased, at middle age it was higher than standard value and at higher age it was markedly increased. Regarding cardiometabolic risk, gradual increasing of body weight, whole and visceral fat with age is not appropriate. Significant increase of intra abdominal fat in middle age men and its gradual increasing up to value of high risk of type 2 diabetes are alarming.

Pokroky v zobrazovacích a iných neinvazívnych metódach na vyšetrenie vlastností cievnej steny a cievneho prietoku umožňujú posunúť sa v diagnostickom procese od rizikových faktorov k diagnostike tzv. predklinickej (subklinickej) aterosklerózy, teda k rozpoznaniu choroby ešte pred objavením sa klinických príznakov. V článku sa opisujú a diskutujú hlavne metódy na rozpoznanie endoteliálnej dysfunkcie, stupňa tuhosti veľkých tepien, začínajúcich aterosklerotických zmien na koronárnych a periférnych tepnách, pričom dôraz sa kladie na diferenciáciu plakov v zmysle ich stability, resp. vulnerability. V blízkej budúcnosti sa očakáva, že prevenciu vaskulárnych príhod výrazne zlepší možnosť neinvazívnej diagnostiky aterosklerózy u asymptomatických osôb, avšak na plnú akceptáciu jednotlivých diagnostických postupov sú potrebné veľké randomizované štúdie na posúdenie ich efektivity a ekonomických vplyvov.

Progress of imaging and other non-invasive methods for investigation of vessel wall and vascular flow characteristics enables to move in diagnostic process from risk factors to diagnostics of s.c. preclinical atherosclerosis, i. e. to detection of a disease before clinical symptoms appear. The author describes and discusses methods for detection of endothelial dysfunction, stage of toughness of major arteries, incipient atherosclerotic changes on coronary and peripheral arteries. Plaque differentiation in the sense of its stability or vulnerability is emphasized. It is expected that prevention of vascular incidences will be significantly improved by non-invasive diagnostics of atherosclerosis in asymptomatic patients. However, great randomized studies are needed to assess its effectiveness and financial impact.

Esenciálna hypertenzia je preventabilná, civilizačná choroba, ktorej rozsah a dopad sa dajú priaznivo ovplyvniť primárnou i sekundárnou prevenciou. Keď vynecháme z uhla pohľadu enormný potenciál metód verejného zdravotníctva, založených na kultivácii spôsobu života populácie, vrátane stravovacích a pohybových návykov, do popredia sa dostávajú aktivity zdravotníckej starostlivosti a hlavne efektivita praktických lekárov na poli manažmentu hypertenzie. Tento článok je zameraný na aktuálne problémy hypertenzie, s ktorými sa praktickí lekári denne stretávajú, z hľadiska prirodzeného vývoja hodnôt TK s narastajúcim vekom, z hľadiska vzniku a vývoja hypertenzie z normálnych a hraničných hodnôt, dosahovania cieľových hodnôt pri liečbe hypertenzie a zlepšenia jej efektivity.

Essential hypertension is a preventable, civilization disease scale and impact of which can be favorably affected by primary and secondary prevention. Besides enormous potential of public health methods based on cultivation of ways of lives of the population eating and physical habits including, dominant role is attributed to health care activities and effectiveness of general practitioners in the field of hypertension management. The article presents current problems of hypertension the GPs come to the contact at their everyday practice from the aspect of natural development of BP values with the age, onset and development of hypertension from normal values to bordering values, achievement of targeting values and improvement of therapy effectiveness.