[Short-term prognosis and treatment of patients hospitalized for acute heart failure in a regional hospital without a cardiocentre]. / Krátkodobá prognóza a lécba pacientu hospitalizovaných pro akutní srdecní selhání v regionální nemocnici bez kardiocentra.

BACKGROUND: Heart failure is a syndrome with increasing prevalence and poor prognosis. The aim of the article is to describe the characteristics, etiology, treatment and short-term prognosis of consecutive patients hospitalized for acute heart failure (AHF) in a regional hospital without Cardiocentre. PATIENTS AND METHODS: From 1/2007 to 5/2009 in total 752 patients were hospitalized in Hospital in Frýdek-Místek with diagnosis of AHF, 18% of them were in that period re-hospitalized. Data collection was performed by doctors using the National registry of acute heart failure AHEAD. Systematic sorting of patients with heart failure was made on the basis of guidelines for the diagnosis and treatment of acute heart failure (2005). Statistical analysis was performed at the Institute of Biostatistics and Analyses Masaryk University in Brno. RESULTS: AHF was a reason of 9% of all hospital admissions. This represents approximately 250 hospitalizations due to AHF per 100 000 inhabitants/year. A median of hospital stay was 6.5 days. Patients with de-novo AHF formed 40.8% of all hospitalizations. The most common syndromes of AHF were acute decompensated heart failure (57.7%) and pulmonary oedema (19.8%). According to laboratory tests the incidence of renal insufficiency was in 35.6% of patients, anemia in 39.9%, blood glucose on admission above 10 mmol/l in 29.5% and hyponatremia < 135 mmol/l in 19.1%. During hospitalization, there was a significant increase in the treatment of heart failure. Diuretics were receiving 91% of discharged patients, ACE inhibitors and/or AT2 blockers 85.7% and beta-blockers 69.6% of patients. A total of 30% of discharged patients were not self-sufficient. The total 30-day mortality was 16.8%. Using univariante logistic regression factors most affecting the 30-day mortality were identified: cardiogenic shock, female gender, age over 70 years, acute coronary syndrome, hypotension on admission, atrial fibrillation, renal insufficiency, chronic obstructive pulmonary disease, anemia, hyperglycemia, hyperkalemia, and hyponatremia. CONCLUSION: The paper provides an overview and characteristics of consecutive patients hospitalized in the regional hospital. We identified factors pointing to the adverse short-term prognosis. The work draws attention to social problems, up to 30% of patients hospitalized for acute heart failure were not self-sufficient at discharged.

[Cost of acute heart failure related readmissions]. / Náklady na rehospitalizaci pacientu s akutním srdecním selháním.

AIM OF STUDY: To assess direct in-patient cost and length of stay in the intensive care unit (ICU) and the standard cardiology unit in acute heart failure (AHF) readmissions. RESULTS: Out of 1 759 patients hospitalized with acute heart failure, 223 patients were readmitted to Faculty Hospital Brno-Bohunice (Czech Republic) during study period (61.4% male; mean age 71.2 years) with mean total cost CZK 85 120 (Euro 3 095) per length of stay 9.2 days and interventions. Comparing to the first hospitalization of study cohort (223 pts.) the decrease was recorded in mean room rate, length of stay and need of ICU stay (from 48% to 42% pts.), nevertheless ICU stay increased (from 3.7 days to 4.1 days). The growth of mean cost was recorded in both procedures in angiology (the decrease in number of coronary angiography which is cheaper was more remarkable than PCI decrease in readmitted patients) and arrhythmology (including device: pacemaker, ICD, CRT) which made 57.5% of total readmission costs. CONCLUSION: The difference in mean in-patient cost between the first and second hospitalization was 18%. The antiarrhytmic procedures had the most significant impact on total readmission cost and its variability, butwe assume that these procedures will reduce within next readmissions and their impact will weaken as in angiology procedures.

[The prevalence of anemia and its impact on hospitalization mortality in patients with acute heart failure]. / Prevalence anémie a vliv na hospitalizacní mortalitu pacientu prijatých pro akutní srdecní selhání.

AIM OF STUDY: To evaluate the influence of entry hemoglobin level on the hospitalization mortality of the patients admitted with AHF caused by 4 major etiologies--acute coronary syndrome with ST elevation (STEMI, n = 325) and without ST elevation (nonSTEMI, n = 210), decompensated chronic ischaemic heart disease (IHD, n = 206) and dilated cardiomyopathy (CMP, n = 88). RESULTS: We analyzed 1,253 consecutive 1st-time hospitalizations of AHF patients of whom 1,212 had their entry hemoglobin known. Out of these, 829 subjects were of STEMI (1), nonSTEMI (2), IHD (3) and CMP (4) etiology and were included in further analyses. We devided these patients into subgroups according to hemoglobin levels: I--no anemia, II--minor and III--severe anemia. The hospitalization mortality in subgroups (I-II-III) of each etiology was 16.9-24.5-35.3% (1); 12.4-9.8-35.7% (2); 9.0-9.7-18.2% (3); 1.5-21.4-33.3% (4); all etiologies together 12.4-15.0-28.8%, total rate 14.1%. Univariate analysis (chi2) showed significant differencies in hospitalization mortality depending on etiology and hemoglobin level but not type of failure (de novo/decompensation). Other parametres (comorbidities, laboratory and hemodynamic values, medication at entry) had a very variable impact on mortality throughout etiologies and hemoglobin subgroups. CONCLUSION: The presence of anemia increases hospitalization mortality of patients with acute heart failure. The relation between hemoglobin level and mortality seems to be linear, we did not observe "U shape" type of relation. It is necessary to distinguish etiologies of AHF as well as consider effects of laboratory and anamnestic variables when interpreting the results.

[Acute embolization into the veins in the splanchnic bed--an overview of current methods of diagnosis and therapies]. / Akutní embolizace do tepen splanchnického reciste--prehled soucasných diagnostických prístupu a terapie.

Acute mesentery artery embolization is a rare diagnosis. In case of late recognition the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Unfortunately, the symptoms do not often correlate with clinical findings. Plain X-ray of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the occluded artery. Papaverin vasodilatation and intravenous anticoagulation are also justifiable, catheter aspiration and stent implantation have also been challenged. Our review is to provide a detailed up-to-date information about the issue and is an extensive follow-up of our recently published case report [Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis. Vnitr Lék 2008; 54(9): 871-875].

[Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis]. / Embolizace vetví a. mesenterica superior jako komplikace direktní angioplastiky resená lokální trombolýzou.

Acute mesentery artery embolization is a rare complication of invasive catheterizations. The incidence is unknown. In case of late diagnosis the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Plain X-Rays of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the artery with embolus. We report a case of a man who was admitted with an acute myocardial infarction who underwent primary angioplasty with implantation ofa bare-metal stent. After the procedure he developed severe and progressive abdominal pain as a result of acute superior mesentery artery embolization. In this patient we performed a local thrombolysis with rt-PA (alteplase) with a great technical success and immediate pain relief, with no need of surgical revision. Our approach was concordant to recommendations cited in this article.