BACKGROUND: Physical activity is pivotal in managing heart failure with reduced ejection fraction, and walking integrated into daily life is an especially suitable form of physical activity. This study aimed to determine whether a 6-month lifestyle walking intervention combining self-monitoring and regular telephone counseling improves functional capacity assessed by the 6-minute walk test (6MWT) in patients with stable heart failure with reduced ejection fraction compared with usual care. METHODS: The WATCHFUL trial (Pedometer-Based Walking Intervention in Patients With Chronic Heart Failure With Reduced Ejection Fraction) was a 6-month multicenter, parallel-group randomized controlled trial recruiting patients with heart failure with reduced ejection fraction from 6 cardiovascular centers in the Czech Republic. Eligible participants were ≥18 years of age, had left ventricular ejection fraction <40%, and had New York Heart Association class II or III symptoms on guidelines-recommended medication. Individuals exceeding 450 meters on the baseline 6MWT were excluded. Patients in the intervention group were equipped with a Garmin vívofit activity tracker and received monthly telephone counseling from research nurses who encouraged them to use behavior change techniques such as self-monitoring, goal-setting, and action planning to increase their daily step count. The patients in the control group continued usual care. The primary outcome was the between-group difference in the distance walked during the 6MWT at 6 months. Secondary outcomes included daily step count and minutes of moderate to vigorous physical activity as measured by the hip-worn Actigraph wGT3X-BT accelerometer, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity C-reactive protein biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score. The primary analysis was conducted by intention to treat. RESULTS: Of 218 screened patients, 202 were randomized (mean age, 65 years; 22.8% female; 90.6% New York Heart Association class II; median left ventricular ejection fraction, 32.5%; median 6MWT, 385 meters; average 5071 steps/day; average 10.9 minutes of moderate to vigorous physical activity per day). At 6 months, no between-group differences were detected in the 6MWT (mean 7.4 meters [95% CI, -8.0 to 22.7]; P=0.345, n=186). The intervention group increased their average daily step count by 1420 (95% CI, 749 to 2091) and daily minutes of moderate to vigorous physical activity by 8.2 (95% CI, 3.0 to 13.3) over the control group. No between-group differences were detected for any other secondary outcomes. CONCLUSIONS: Whereas the lifestyle intervention in patients with heart failure with reduced ejection fraction improved daily steps by about 25%, it failed to demonstrate a corresponding improvement in functional capacity. Further research is needed to understand the lack of association between increased physical activity and functional outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03041610.
- MeSH
- chůze MeSH
- dysfunkce levé srdeční komory * MeSH
- funkce levé komory srdeční MeSH
- kvalita života MeSH
- lidé MeSH
- senioři MeSH
- srdeční selhání * terapie farmakoterapie MeSH
- tepový objem MeSH
- životní styl MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
AIM: Understanding cardiac electronic device infective endocarditis epidemiology is essential for the management of this serious complication. Only monocentric and limited data have been published regarding patients in the Czech republic so far. The aim of this study was to describe the current profile, microbiology and clinical characteristics of this population. PATIENTS AND METHODS: National data from the prospective ESC-EORP EURO-ENDO registry were collected. 57 consecutive patients with a diagnosis of cardiac device-related infective endocarditis (CDRIE) from 11 Czech centres were included. RESULTS: Staphylococcus spp. was responsible for 43.9% of isolates, whereas Culture negative endocarditis was documented in 26.3% episodes. The most frequent complications under therapy were acute renal failure (17.5%), septic shock and heart failure (both 10.5%). Extraction of device was performed in 75.4% of all patients, and the 1-year mortality was 22.5%. CONCLUSIONS: The high proportion of culture-negative endocarditis is alarming and warrants further investigation. Cardiac device related infective endocarditis is a serious complication with a high 1-year mortality in a highly polymorbid spectrum of patients.
- MeSH
- bakteriální endokarditida * epidemiologie etiologie MeSH
- defibrilátory implantabilní * škodlivé účinky MeSH
- endokarditida * komplikace etiologie MeSH
- lidé MeSH
- prospektivní studie MeSH
- registrace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
INTRODUCTION: Data describing contemporary profile of infective endocarditis (IE) in the Czech Republic are lacking. The aim of this study was to describe the current profile and outcomes of IE patients. METHODS: Prospectively collected data on consecutive patients admitted for IE diagnosis between April 2016 and March 2018 to 11 main tertiary care cardiac centers in the Czech Republic were used for this analysis. RESULTS: Among 208 patients, 88 patients (42.3 %) had native valve IE (NVIE), 56 patients (26.9 %) had prosthetic valve IE (PVIE), and 57 patients (27.4 %) had intracardiac device-related IE (CDRIE). The mean age was 61.66±15.54 years. Staphylococcus aureus was the most common etiological agent of IE (27.4 %), whereas Culture negative IE was present in 26.4 % patients. Surgery was performed during hospitalization in 112 (53.8 %) patients. In-hospital death occurred in 21.2 % patients, while 1-year mortality was 40.3 %. In patients, who had an indication for surgery, but the procedure was not performed, mortality was significantly higher (p=0.002). CONCLUSION: High proportion of culture negative IE and IE related to artificial intra-cardiac materials calls for action. Furthermore, we show that cardiac surgery should be more often contemplated, especially in the presence of risk factors as septic shock and congestive heart failure (Tab. 6, Fig. 1, Ref. 32).
- MeSH
- bakteriální endokarditida * diagnóza epidemiologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- prospektivní studie MeSH
- registrace MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
AIMS: A reduction of habitual physical activity due to prolonged COVID-19 quarantine can have serious consequences for patients with cardiovascular diseases, such as heart failure. This study aimed to explore the effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients. METHODS AND RESULTS: We analysed the daily number of steps in 26 heart failure patients during a 6-week period that included 3 weeks immediately preceding the onset of the quarantine and the first 3 weeks of the quarantine. The daily number of steps was assessed using a wrist-worn accelerometer worn by the patients as part of an ongoing randomized controlled trial. Multilevel modelling was used to explore the effect of the quarantine on the daily step count adjusted for weather conditions. As compared with the 3 weeks before the onset of the quarantine, the step count was significantly lower during each of the first 3 weeks of the quarantine (P < 0.05). When the daily step count was averaged across the 3 weeks before and during the quarantine, the decrease amounted to 1134 (SE 189) steps per day (P < 0.001), which translated to a 16.2% decrease. CONCLUSIONS: The introduction of the nationwide quarantine due to COVID-19 had a detrimental effect on the level of habitual physical activity in heart failure patients, leading to an abrupt decrease of daily step count that lasted for at least the 3-week study period. Staying active and maintaining sufficient levels of physical activity during the COVID-19 pandemic are essential despite the unfavourable circumstances of quarantine.
- MeSH
- akcelerometrie metody MeSH
- časové faktory MeSH
- COVID-19 MeSH
- cvičení fyziologie MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- karanténa * MeSH
- kohortové studie MeSH
- koronavirové infekce epidemiologie prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- pandemie prevence a kontrola statistika a číselné údaje MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- senioři MeSH
- srdeční selhání patofyziologie rehabilitace MeSH
- tělesná výkonnost fyziologie MeSH
- test chůzí statistika a číselné údaje MeSH
- virová pneumonie epidemiologie prevence a kontrola MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
Cíl: Staphylococcus aureus (SA), který je hlavní příčinou infekční endokarditidy (IE), vykazuje v posledních letech zvýšenou prevalenci. Současná data týkající se dlouhodobého prospěchu operace srdce u pacientů s IE způsobenou SA a IE nezpůsobenou SA jsou vzácná. Metodika: Cílem této studie bylo porovnat krátkodobé a dlouhodobé riziko úmrtí u chirurgických a nechirurgických pacientů s IE způsobenou SA a s IE nezpůsobenou SA. Provedli jsme retrospektivní přehled po sobě jdoucích dospělých pacientů s levostrannou IE, kteří byli v období 15 let přijati do Fakultní nemocnice Univerzity Karlovy v Hradci Králové (mezi lety 1998 a 2006) a do Institutu klinické a experimentální medicíny v Praze (mezi lety 2009 a 2016). Výsledky: Ve skupině 196 pacientů (155 mužů; medián věku 64 let) bylo identifikováno celkem 206 epizod levostranné IE. Septický šok (OR 10,1), indikace k hemodialýze (OR 7,8) a mozková příhoda (OR 8,0) byly spojeny s vyšší nemocniční úmrtností, zatímco operace srdce v době epizody IE způsobené S. aureus byla spojena s nižší nemocniční úmrtností (OR 0,022). Chirurgicky léčení pacienti s infekcí SA dokonce měli 4,25× nižší riziko šestiměsíční mortality než chirurgicky léčení pacienti bez infekce SA. Konzervativní léčba v době epizody IE byla škodlivým faktorem, který významně ovlivňoval dlouhodobé výsledky (OR 2,028). Závěry: Příznivý vliv operace srdce byl prokázán ve všech částech studie: nemocniční úmrtnost, šestiměsíční mortalita a dlouhodobé přežití. Individuální stratifikace rizika směrem ke konzervativní či chirurgické léčbě je nezbytná u všech epizod IE, zejména u pacientů s infekcí SA.
Purpose: Staphylococcus aureus (SA), which is the leading cause of infective endocarditis (IE), has increased in prevalence over recent years. Contemporary data on the long-term benefits of cardiac surgery among patients with SA and non-SA IE are sparse. Methods: The aim of the present study was to compare short-term and long-term mortality risk among surgical and non-surgical patients with SA and non-SA IE. We carried out a retrospective survey of consecutive left-sided IE adult patients, admitted over a 15-year period to the University Hospital Hradec Kralove, Charles University, Czech Republic (between 1998 and 2006), and to the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (between 2009 and 2016). Results: In a group of 196 patients (155 males; median age 64 years), a total of 206 left-sided IE episodes were identified. Septic shock (OR 10.1), indication for haemodialysis (OR 7.8), and stroke (OR 8.0) were associated with a higher in-hospital mortality, while cardiac surgery at the time of S. aureus IE episode was associated with a lower in-hospital mortality (OR 0.022). Surgically treated patients with SA had a 4.25-fold lower risk of 6-month mortality than surgically treated patients without SA infection. Conservative treatment at the time of the IE episode was a detrimental factor that significantly affected long-term outcomes (OR 2.028). Conclusions: A favourable impact of cardiac surgery was shown across all segments of the study: in-hospital mortality, 6-month mortality, and long-term survival. Individual risk stratification towards conservative or surgical treatment is fundamental for all IE episodes, particularly in patients with SA infection.
- MeSH
- analýza přežití MeSH
- bakteriální endokarditida * chirurgie etiologie komplikace mikrobiologie MeSH
- demografie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mortalita v nemocnicích MeSH
- mortalita MeSH
- multivariační analýza MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stafylokokové infekce * chirurgie MeSH
- Staphylococcus aureus patogenita MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
Metody: Byly analyzovány výsledky klinických a laboratorních vyšetření a data z pacientského dotazníku. Součástí bylo subjektivní hodnocení adherence (A) pacientem a lékařem. Referenční metodou pro průkaz NA bylo vyšetření sérových hladin léků (SHL). Výsledky: Bylo zařazeno 81 pacientů. Stanovením SHL byla NA zjištěna u 25 %. Všichni pacienti uvedli, že léky užívají správně, vynechání některé dávky v týdnu připustilo 18 % A a 25 % NA (p = 0,53). Lékař předpokládal NA správně u 40 % NA a chybně u 10 % A. Byl trend k častější NA u žen (p = 0,055), méně častá byla u pacientů z vesnice nebo malého města (p = 0,031). NA měli vyšší systolický (137 ± 13 vs. 124 ± 15 mmHg, p = 0,001) i diastolický (83 ± 11 vs. 75 ± 9 mmHg, p = 0,002) krevní tlak. Byl trend k vyšší tepové frekvenci u NA (83 ± 18 vs. 73 ± 13, p = 0,052), v podskupině léčených betablokátory byl rozdíl signifikantní (94 ± 19 vs. 73±12, p < 0,001). Adherentní nesignifikantně lépe hodnotili svůj zdravotní stav (p = 0,052). V ostatních parametrech nebyl nalezen rozdíl. Závěr: NA můžeme předpokládat u léčených pacientů s přetrvávajícím vyšším TK a u pacientů s vyšší TF při léčbě betablokátory. NA lze potvrdit stanovením SHL.
Methods: Routine examination results, patient questionnaires as well as adherence (A) assessment by both the patient and physician were analyzed. Serum drug levels (SDLs) were used as a reference method. Results: Eighty-one patients were enrolled. Using SDL, non-adherence was shown in 25 %. All patients reported to have taken their drugs properly. Omission of a dose a week was admitted by 18 % of A and 25 % of NA patients (p = 0.53). The physician correctly assumed NA in 40 % of NA patients, but incorrectly in 10 % of A. There was a trend among women to be more non-adherent (p = 0.055) while in patients from a village or small town lower NA (p = 0.031) was observed. The systolic (137 ± 13 vs. 124 ± 15 mm Hg, p = 0.001) and diastolic (83 ± 11 vs. 75 ± 9 mm Hg, p = 0.002) blood pressure values were higher in NA. There was a trend towards a higher heart rate (83 ± 18 vs. 73 ± 13, p = 0.052) in NA, with a significant difference in patients treated with beta-blockers (94 ± 19 vs. 73 ± 12, p < 0.001). Adherent patients rated their health status better (p = 0.052). No differences were found in the other parameters. Conclusion: NA may be predicted in persistent high blood pressure and in high heart rate despite beta-blockers. NA can be confirmed by SDL assessment.
- MeSH
- adherence k farmakoterapii * MeSH
- antihypertenziva krev MeSH
- chromatografie kapalinová MeSH
- chronická nemoc * MeSH
- farmakovigilance MeSH
- hmotnostní spektrometrie MeSH
- interpretace statistických dat MeSH
- krevní tlak účinky léků MeSH
- lidé MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- průzkumy a dotazníky MeSH
- srdeční selhání * diagnóza MeSH
- Check Tag
- lidé MeSH
PURPOSE: Early identification of specific patient subgroups at high risk of developing life–threatening infective endocarditis (IE) complications is of paramount importance. Better stratifi cation may allow more intensive treat-ment of these patients and positively infl uences clinical outcomes.METHODS: We carried out a retrospective survey of consecutive left–sided IE adult patients, admitted over a 15–year period to two main tertiary care centres in the Czech Republic. RESULTS: Among a group of 196 patients (155 males; median age 64 years), a total of 206 left–sided IE episodes were identified. Perivalvular extension of infection was most frequently seen in prosthetic aortic valve endocarditis (OR 6.706, p < 0.0001). Valve prolapse/perforation during IE episodes was signifi cantly associated with mitral valve IE (OR 2.136, p = 0.026) and vegetation length (OR 1.055, p = 0.009). Septic shock was sig-nifi cantly related to two main risk factors: S. aureus infection (OR 8.459, p = < 0.0001) and smoking (OR 8.403, p = 0.001). Mitral valve IE with a vegetation length ≥13 mm was the strongest risk factor for this complication (OR 3.24, p = 0.001), followed by S. aureus infection (OR 3.59, p = 0.002). Finally, septic shock (OR 6.000, p = 0.001) represented the most important risk factor of in–hospital mortality. CONCLUSIONS: This study provides the most detailed profile of complication predictors related to left–sided IE in Central Europe. Early individual stratification of IE related occurrence of complications might help to decrease extremely high morbidity and mortality of this disease (Tab. 5, Ref. 37).
- MeSH
- bakteriální endokarditida * epidemiologie mikrobiologie mortalita MeSH
- chirurgická náhrada chlopně metody MeSH
- kouření škodlivé účinky MeSH
- pooperační komplikace epidemiologie etiologie mortalita MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- Staphylococcus aureus izolace a purifikace patogenita MeSH
BACKGROUND: The aim of our study was to evaluate the prevalence of drug non-adherence in stable chronic heart failure (CHF) patients using serum drug levels (SDL) assessment. METHODS: CHF patients were prospectively enrolled during scheduled outpatient visit. Except standard procedures an unanticipated blood sampling for the SDL assessment was obtained. Analysis was focused on the prescribed heart failure and antihypertensive medication and was performed by liquid chromatography coupled with mass spectrometry. The patient was labelled as non-adherent if at least one of drugs assessed was not found in the serum. In the first half of patients multiple SDL have been evaluated during the follow-up. RESULTS: Eighty one patients were enrolled. The non-adherence was proven in twenty of them (25%). In the subgroup of thirty eight patients with multiple SDL evaluation the non-adherence raised significantly with increasing number of visits assessed together (21% for single visit, 29% for two of three visits assessed together and 34% for all three visits evaluated together, all p < 0.001). CONCLUSION: The non-adherence was proven in significant part of stable CHF patients using SDL assessment. This method seems to be reliable and effective and should be a part of clinical assessment in selected patients with CHF.
- MeSH
- adherence k farmakoterapii psychologie statistika a číselné údaje MeSH
- antihypertenziva krev terapeutické užití MeSH
- chromatografie kapalinová MeSH
- chronická nemoc * psychologie MeSH
- hmotnostní spektrometrie MeSH
- kardiotonika krev terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- srdeční selhání farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
