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Summary Although Czech women are solidly represented in the Czech Ministry of Foreign Affairs, only a fraction of this 14 per cent make it to the highest positions. This underrepresentation is in stark contrast with Nordic countries, where women make up almost half of the top diplomats. Based on semi-structured interviews with top diplomats conducted in the period 2018-2021, this study aims to identify how Czech female diplomats assess their own gender and professional identity, and to what extent they apply these identities strategically in order to advance their careers. The research enriches concepts on femininities by adding a type of ‘principled feminist’ and further develops career strategies in a specific historical and cultural context. The analysis shows that conservative personal gender ideologies of top Czech female diplomats and their related career strategies present one of the major obstacles to the increased representation of women in top diplomatic positions.

While female representation in the top diplomatic circles was almost nonexistent during the Czechoslovak era, the number of female diplomats in the Czech Republic has steadily increased since the fall of the state-socialist regime. Women are currently solidly represented in the Czech Ministry of Foreign Affairs (MFA), but very few (14%) reach highest diplomatic positions. This study examines the main challenges that influence the careers of top diplomats using quantitative and qualitative data, including official statistics and documents of the Czech MFA and interviews with top diplomats and officials. The results indicate that work-family conflicts are the main challenge for all diplomats. However, women are apparently affected more disproportionately because of the existing “double burden” and a specific “concept of motherhood” vested in a deeply essentialist understanding of gender roles. These barriers have origins at the personal, institutional, and state levels that are strongly interrelated and historically and politically path dependent.

Background The PRAGUE-17 trial demonstrated that left atrial appendage closure (LAAC) was non-inferior to non-warfarin oral anticoagulants (NOAC) for preventing major neurological, cardiovascular or bleeding events in high-risk patients with atrial fibrillation (AF). Objective To assess the pre-specified long-term (4-year) outcomes in PRAGUE-17. Methods PRAGUE-17 was a randomized non-inferiority trial comparing percutaneous LAAC (Watchman or Amulet) with NOACs (95% apixaban) in non-valvular AF patients with a history of cardioembolism, clinically-relevant bleeding, or both CHA2DS2-VASc > 3 and HASBLED > 2. The primary endpoint was a composite of cardioembolic events (stroke, transient ischemic attack, or systemic embolism), cardiovascular death, clinically-relevant bleeding, or procedure/device-related complications (LAAC group only). The primary analysis was modified intention-to-treat (mITT). Results We randomized 402 AF patients (201 per group, age 73.3±7.0 years, 65.7% male, CHA2DS2-VASc 4.7 + 1.5, HASBLED 3.1 + 0.9). After 3.5 years median follow-up (1,354 patients-years), LAAC was non-inferior to NOAC for the primary endpoint by mITT (subdistribution hazard ratio[sHR] 0.81, 95% CI 0.56-1.18; p=0.27; p for non-inferiority=0.006). For the components of the composite endpoint, the corresponding sHRs (and 95% CIs) were 0.68 (0.39-1.20; p=0.19) for cardiovascular death, 1.14 (0.56-2.30; p=0.72) for all-stroke/TIA, 0.75 (0.44-1.27; p=0.28) for clinically-relevant bleeding, and 0.55 (0.31-0.97; p=0.039) for non-procedural clinically-relevant bleeding. The primary endpoint outcomes were similar in the per-protocol [sHR 0.80 (95% CI 0.54-1.18), p=0.25] and on-treatment [sHR 0.82 (95% CI 0.56-1.20), p=0.30] analyses. Conclusion In long-term follow-up of PRAGUE-17, LAAC remains non-inferior to NOACs for preventing major cardiovascular, neurological or bleeding events. Furthermore, non-procedural bleeding was significantly reduced with LAAC.

The care of patients with diabetic foot syndrome (DFS) requires interdisciplinary cooperation, and therefore interdisciplinary recommendations focused on the diagnosis and treatment and prevention of DFS are in place. We also need these recommendations because DFS has its own specifics that affect its diagnosis, therapy, but also the prognosis of patients. These include, for example, the different course of infection and PAD in patients with diabetes, the diagnosis of neuropathic Charcot osteoarthropathy, and the frequent association with end stage kidney disease, which worsens the course of SDN and increases its risk. Last but not least, the specifics of DFS include the issue of amputations with a significantly worse prognosis than in people without diabetes. The creation of an interdisciplinary team in foot clinics, providing comprehensive care for patients with DFS according to the recommended procedure, is associated with improved prognosis of patients with DFS, especially the reduction of amputations.

Purpose Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. Methods Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. Results Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. Conclusion The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally.

Introduction The randomized PRAGUE-17 trial demonstrated non-inferiority of LAAC to NOAC for the prevention of major cardiovascular or cerebrovascular events. However, the LAA is an important source of natriuretic peptides and plays a role in left atrial reservoir function. Changes of HF biomarkers after LAAC compared to NOAC has not been studied. The aim of the study was to compare the changes in concentrations of heart failure (HF) biomarkers between left atrial appendage closure (LAAC) and non-vitamin K anticoagulants (NOAC) patients. Methods Of 402 patients randomized in the PRAGUE-17 trial, biomarkers were analyzed in 144 patients (73 in the NOAC and 71 in the LAAC group). Both groups had similar baseline characteristics. Serum concentration of NT-proBNP, NT-proANP, Galectin-3, and GDF-15 were measured at baseline (before the procedure in the LAAC group), at the 6-month (and at 24-month for NT-proBNP) follow-up timepoint. Results There were no significant differences in baseline, 6-month, and delta (δ = baseline - 6-month) concentrations of NT-proANP between the groups (NOAC: baseline 2.6 (0.5; 4.9), 6-month 3.1 (1.8; 4.8), p=0.068; LAAC: baseline 3.3 (1.1; 4.6), 6-month 2.6 (0.9; 5.3), p=0.51; p value for δ in concentrations between groups = 0.42). Similarly, there were no significant differences in baseline, 6-month, 24-monht and delta concentrations of NT-proBNP between the groups (NOAC: baseline 461.0 (113.5; 1342.0), 6-month 440.0 (120.5; 1291.5), 24-month 798 (274; 2236), p = 0.39; LAAC: baseline 421.0 (100.0; 1320.0), 6-month 601.0 (145.0; 1230.0), 24-month 855 (410; 1367), p=0.28; p value for δ in concentrations between groups = 0.73 at 6 months, and 0.58 at 24 months). Finally, no significant differences were present in baseline, 6-month, and δ concentrations of Galectin-3 and GDF-15 between the two groups. Conclusion LAAC did not significantly influence the levels of HF biomarkers 6 months after the procedure. This article is protected by copyright. All rights reserved.

Aims A retrospective nationwide observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018. Methods and results Prevalence of heart failure (HF) patients increased from 176 496 (1679.4 per 100 000 population) in 2012 to 285 745 (2689.0 per 100 000 population) patients in 2018 (mean age 74.4 ± 12.8 years). In the last years, a stable incidence of HF patients was observed (544 per 100 000 population in 2016 vs. 551 per 100 000 population in 2018; P = 0.310). Mortality rate decreased from 20.55% in 2012 to 15.89% in 2018. The number of hospitalized patients remained similar (318.2 per 100 000 population in 2012 vs. 311.8 per 100 000 population in 2018; P = 0.479). The most used drugs were diuretics (173 295; 60.6%) and beta‐blockers (178 823; 62.6%), followed by angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (angiotensin‐converting enzyme inhibitors 120.581; 42.2%; angiotensin II receptor blockers 47 216; 16.5%). Even though the whole number of implanted devices in HF patients increased steadily (from 25 205 in 2012 to 45 363 in 2018), the prevalence of all devices (pacemakers and defibrillators) in the HF patients remained about the same (14.3% in 2012; 15.9% in 2018). Conclusions The study included all patients with HF in the Czech Republic. These are the first nationwide data of HF epidemiology in the Eastern bloc. The incidence of HF remains stable in the last years. Due to aging of the population, the prevalence of HF significantly increased in the last 6 years. Despite a continuous increase in the prevalence of HF and a suboptimal utilization of its pharmacological therapy, mortality decreased, and the number of hospitalized patients remained the same.

Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are chronic pulmonary conditions. In this review we focus on neuropsychological aspects of CF and PCD in children. Since studies conducted on children with asthma, sleep disturbed breathing (SBD), and studies on animal models describe specific cognitive impairments and suggest that intermittent hypoxia might be the pathophysiological mechanism. Main question of this systematic review is following: “Is neuropsychological functioning of children with CF and PCD specific?”. The database MedlineComplete was searched during September 2021 for each condition using specified key word combinations. We included studies in English, dealing only with pediatric population and papers published in academic journals within the last 10 years (2011-2021). We excluded case reports and studies using non-valid psychological methods or focusing on specific socio-economic populations. Applying these criteria, we acquired 5 studies in CF and 3 studies in PCD, out of them one study examined the association between cognitive impairment and oxygen desaturation levels. Five studies were scored high, and three studies were scored moderate level of evidence according to PRISMA and COCHRANE quality criteria. It can be concluded that the overall IQ of CF and PCD pediatric patients remains intact. However, impairments in specific cognitive functions, e.g., attention, memory or executive function have been described. Number of studies exploring neuropsychological functioning, especially in association with somatic aspects, in CF and PCD patients is not robust and further investigation is needed.

Background: Currently, most available data on the medication adherence of patients with chronic heart failure are based on indirect methods. We examined the level of adherence to medical therapy using a direct method - serum drug level testing. Methods: We carried out a prospective single-centre registry of patients with chronic heart failure (LEVEL-CHF registry), in whom we analysed serum levels of the medications prescribed for the treatment of heart failure: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists. We labelled a patient as non-adherent if at least one serum level of a prescribed drug was unmeasurable (below the detection limit). Patients with all tested drugs identifiable in serum were labelled as adherent. We enrolled 274 patients (208 men and 66 women) mean age 62 years. Results: 82.5% of patients were adherent and 17.5% non-adherent to prescribed medications. 3.6% were completely non-adherent without any detectable drugs in serum. Patients aged

COVID-19 significantly influences the overall patient status and, in severe symptomatology, the ability to move and the low oxygenation of the tissue for the ventilated patient in Intensive Care Units (ICU). There is a higher risk for Pressure injuries (PIs) development.The nationwide analyses of the National health register aimed to compare the prevalence of PIs reported before the pandemic COVID-19 started and during the pandemic in 2020.A retrospective, nationwide cross-sectional analysis of data regarding the STROBE checklist collected by the National Health Information System (NHIS), focusing on the PIs reporting based on the International Classification of Diseases (ICD-10) diagnoses L89.0-L89.9 for PIs in 2020. The data from the pandemic period of COVID-19 in 2020 were compared to the prevalence of PI cases in the period 2010-2019 in the Czech Republic in all hospitalized patients.The total number of admissions for L89 in 2020 was 14,441, of which 1509 (10.4%) also had COVID-19. In the ICU were 4386 admissions, 12.1% of which also had COVID-19. A higher proportion of PIs is observed in patients hospitalized with COVID-19 than in patients without COVID-19 (2.62% vs 0.81%, respectively 1.05% vs 0.46% when standardized to the 2013 ESP = European Standard Population). In patients hospitalized in ICU, 3.68% with COVID-19 had PIs vs 1.42% without COVID-19 had PIs (1.97% vs 0.81% using the 2013 ESP).The national health registers analyses have proven that the prevalence of PIs was higher among patients hospitalized with the SARS-CoV-2 infection.

The study aims to follow up on the analysis of Pressure injuries (PIs) prevalence conducted between 2007 and 2014 and after the new methodological requirements for PIs surveillance establishment at the national level. A retrospective, nationwide cross-sectional analysis of data regarding the STROBE checklist was collected by the National Health Information System (NHIS). The International Classification of Diseases (ICD-10) diagnoses L89.0-L89.9 for PIs were used in the period 2010-2019. A total of 264 442 records of patients with diagnoses of L89.0-L89.9 were identified from 2010 to 2019 (26 444 patients per year on average). The numbers are increasing every year, and there is a 40% increase between 2010 and 2019. When comparing recorded PIs, the percentage of PIs occurrence in category I decreased, and the number of PIs in category IV increased in the second analysed period. Still, in absolute numbers, there is an increase across all categories. The age of patients with recorded PIs also rose slightly in the second analysed period. We have proven the PIs prevalence increase in an ageing population.

Introduction/Background* The impact of lymph node (LN) micrometastases (MIC) in cervical cancer patients remains a controversial topic given their low incidence and good prognosis of patients managed by primary surgery. We aim to evaluate the prognostic significance of MIC and isolated tumour cells (ITC) in a large cohort of patients from the SCCAN retrospetive study (Surveillance in Cervical CANcer). SCCAN study analysed data from more than 4300 patients with early stage cervical cancer treated by primary surgery at 20 large tertiary institutions from Europe, North America, South America and Australia. Methodology In this SCCAN sub-study, we included patients with early stage cervical cancer (T1a1 LVSI+ – T2b) treated between 2007 and 2016 with at least 1-year follow-up data availability, who underwent primary surgery including sentinel lymph node (SLN) biopsy and in whom SLNs were processed by pathological ultrastaging protocol. Result(s)* Out of 969 included patients with at least 1 SLN detected, 174 (18%) had positive LN (table 1). Maximal tumour diameter >2cm, positive LVSI, grade ≥ 2, uncommon histological type (neuroendocrine, sarcoma, etc.) and macrometstasis (MAC) or MIC in LN were factors associated with significantly decreased five-years disease free survival (DFS) (table 2). MAC, MIC or ITC was the largest LN metastasis in 84 (9%), 59 (6%) and 31 (3%) cases respectively. Adjuvant (chemo)radiation was administred in 89%, 85% and 58% of patients with MAC, MIC and ITC. DFS reached 75%, 73% and 83% in patients with MAC, MIC and ITC compared with 90% in the N0 patients. Patients with MAC and MIC had significantly decreased DFS than those with N0 disease (HR=2.36 and 2.55). Conclusion* Early-stage cervical cancer patients with MIC in pelvic LN have significantly decreased DFS. Their management should follow the same principles as in patients with MAC.

Coronary heart disease, sometimes also referred to as ischemic heart disease, remains the leading condition causing most deaths and disability-adjusted life years worldwide. Acute coronary syndrome (ACS) represents a subset that is defined by sudden reduction of blood supply in the coronary arteries. ACS consists of unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). The current short communication aims to provide current ACS prevalence and incidence data analysis to inform development of clinical practice guidelines in the Czech Republic. The Institute of Health Information and Statistics of the Czech Republic has provided the data that are collected by the National Health Information System with the National Register of Reimbursed Health Services as a primary source providing data for the period from 2015 to 2017. There has been a slight decrease in the number of hospitalized patients for ACS in the Czech Republic from 2015 to 2017. Sex difference remains large, with majority (two thirds) of those hospitalized for unstable angina, NSTEMI, or STEMI being men. Hospitalization with STEMI is reported in younger age with no sex difference compared with NSTEMI and unstable angina.

ObjectivesCOVID-19 might either be entirely asymptomatic or manifest itself with a large variability of disease severity. It is beneficial to identify early patients with a high risk of severe course. The aim of the analysis was to develop a prognostic model for the prediction of the severe course of acute respiratory infection.DesignA population-based study.SettingCzech Republic.ParticipantsThe first 7455 consecutive patients with COVID-19 who were identified by reverse transcription-PCR testing from 1 March 2020 to 17 May 2020.Primary outcomeSevere course of COVID-19.ResultOf a total 6.2% of patients developed a severe course of COVID-19. Age, male sex, chronic kidney disease, chronic obstructive pulmonary disease, recent history of cancer, chronic heart failure, acid-related disorders treated with proton-pump inhibitors and diabetes mellitus were found to be independent negative prognostic factors (Area under the ROC Curve (AUC) was 0.893). The results were visualised by risk heat maps, and we called this diagram a ‘covidogram’. Acid-related disorders treated with proton-pump inhibitors might represent a negative prognostic factor.ConclusionWe developed a very simple prediction model called ‘covidogram’, which is based on elementary independent variables (age, male sex and the presence of several chronic diseases) and represents a tool that makes it possible to identify—with a high reliability—patients who are at risk of a severe course of COVID-19. Obtained results open clinically relevant question about the role of acid-related disorders treated by proton-pump inhibitors as predictor for severe course of COVID-19.

BACKGROUND: Up to 26% of patients with early-stage cervical cancer experience relapse after primary surgery. However, little is known about which factors influence prognosis following disease recurrence. Therefore, our aims were to determine post-recurrence disease-specific survival (PR-DSS) and to identify respective prognostic factors for PR-DSS.METHODS: Data from 528 patients with early-stage cervical cancer who relapsed after primary surgery performed between 2007 and 2016 were obtained from the SCANN study (Surveillance in Cervical CANcer). Factors related to the primary disease and recurrence were combined in a multivariable Cox proportional hazards model to predict PR-DSS.RESULTS: The 5-year PR-DSS was 39.1% (95% confidence interval [CI] 22.7%-44.5%), median disease-free interval between primary surgery and recurrence (DFI1) was 1.5 years, and median survival after recurrence was 2.5 years. Six significant variables were identified in the multivariable analysis and were used to construct the prognostic model. Two were related to primary treatment (largest tumour size and lymphovascular space invasion) and four to recurrence (DFI1, age at recurrence, presence of symptoms, and recurrence type). The C-statistic after 10-fold cross-validation of prognostic model reached 0.701 (95% CI 0.675-0.727). Three risk-groups with significantly differing prognoses were identified, with 5-year PR-DSS rates of 81.8%, 44.6%, and 12.7%.CONCLUSIONS: We developed the robust model of PR-DSS to stratify patients with relapsed cervical cancer according to risk profiles using six routinely recorded prognostic markers. The model can be utilised in clinical practice to aid decision-making on the strategy of recurrence management, and to better inform the patients.

Background Neutrophil gelatinase-associated lipocalin (NGAL) is marker of renal function and is strongly associated with presence of comorbidities. AHEAD comorbidity score is commonly used to predict survival in acute heart failure patients and could predict events even in chronic heart failure. Methods 547 stable patients with chronic heart failure patients with left ventricular ejection fraction Results Median age was 66 years, 80.3% were men. The etiology of heart failure was in 54% ischemic heart disease, in 40% dilatated cardiomyopathy, in 0.5% hypertrophic cardiomyopathy. 60% of patients were in NYHA class II. In the first two years of follow-up, 74 events (13.5%) occurred, including all-cause death, left ventricle assist device implantation or orthotopic heart transplantation. The AHEAD comorbidity score (Atrial fibrillation, low Haemoglobin level 70 years; Abnormal renal parameters with creatinine >130 μmol/L, Diabetes mellitus; 1 point for each comorbidity present) was set in this registry. Patients with AHEAD 0–1 survived without event in 89.2%, AHEAD 2–3 in 82.4% and AHEAD 4–5 only in 63.5% (p Also levels of NGAL are higher when comorbidities from AHEAD score are present: Atrial fibrillation (62 vs. 50 ng/mL; p NGAL levels are singificantly higher in patients with higher AHEAD score. Mean level of NGAL in AHEAD 0–1 (N=320) is 51 ng/mL, in AHEAD 2–3 (N=190) is 78 ng/mL and in AHEAD 4–5 (N=37) is 142 ng/mL (Kruskal-Wallis test p Conclusion In stable chronic heart failure registry FAR NHL, comorbidity score AHEAD can predict events. Serum NGAL level is significantly higher when AHEAD score comorbidities are present: Atrial fibrillation, low Haemoglobin, Eldery, Abnormal renal function and Diabetes mellitus. Funding Acknowledgement Type of funding source: None

Introduction: The mortality burden of COPD continues to be high among Western countries.There is a need to publish valid data related to Eastern Europe. Methods: Population based study in the whole population of the Czech Republic(CZ)using data analyzed by Institute of Health Information and Statistics from 2010 to 2018.The main data source of the analysis is new National Registry of Reimbursed Health Services(NRRHS)containing data of health insurance companies on diagnosed,procedures and administered treatment. Results: Fifty thousand COPD cases(0.5%population)are newly diagnosed each year. 235.574(2.2%pop.)of COPD patients were regularly managed by respiratory physicians. Totally 710.749 individuals (6.7%pop.)had any time history of COPD diagnosis.Life expectancy in COPD population increased significantly from 2012 to 2018 and is comparable to overall life expectancy in the CZ (10.6 million)population.However total number of deaths attributable to COPD increased (23.1/100.000 in 2012;31.6/100.000 in 2018). We have calculated national lost years during two intervals:15,657 lost years(2012-2014),and 10,294 lost years(2015-2017). Therefore 5.362 previously „lost years: of life were prevented.Within the overall CZ population of all living individuals,a significant increase in life expectancy of COPD cohort was noted. Conclusion: Although COPD mortality rate have declined from 2012 to 2018 in the CZ,the total number of deaths due to COPD has increased.

Background Percutaneous left atrial appendage closure (LAAC) is noninferior to vitamin K antagonists (VKAs) for preventing atrial fibrillation (AF)–related stroke. However, direct oral anticoagulants (DOACs) have an improved safety profile over VKAs, and their effect on cardiovascular and neurological outcomes relative to LAAC is unknown. Objectives This study sought to compare DOACs with LAAC in high-risk patients with AF. Methods Left Atrial Appendage Closure vs. Novel Anticoagulation Agents in Atrial Fibrillation (PRAGUE-17) was a multicenter, randomized, noninferiority trial comparing LAAC with DOACs. Patients were eligible to be enrolled if they had nonvalvular AF; were indicated for oral anticoagulation (OAC); and had a history of bleeding requiring intervention or hospitalization, a history of a cardioembolic event while taking an OAC, and/or a CHA2DS2-VASc of ≥3 and HAS-BLED of >2. Patients were randomized to receive LAAC or DOAC. The primary composite outcome was stroke, transient ischemic attack, systemic embolism, cardiovascular death, major or nonmajor clinically relevant bleeding, or procedure-/device-related complications. The primary analysis was by modified intention to treat. Results A high-risk patient cohort (CHA2DS2-VASc: 4.7 ± 1.5) was randomized to receive LAAC (n = 201) or DOAC (n = 201). LAAC was successful in 181 of 201 (90.0%) patients. In the DOAC group, apixaban was most frequently used (192 of 201; 95.5%). At a median 19.9 months of follow-up, the annual rates of the primary outcome were 10.99% with LAAC and 13.42% with DOAC (subdistribution hazard ratio [sHR]: 0.84; 95% confidence interval [CI]: 0.53 to 1.31; p = 0.44; p = 0.004 for noninferiority). There were no differences between groups for the components of the composite endpoint: all-stroke/TIA (sHR: 1.00; 95% CI: 0.40 to 2.51), clinically significant bleeding (sHR: 0.81; 95% CI: 0.44 to 1.52), and cardiovascular death (sHR: 0.75; 95% CI: 0.34 to 1.62). Major LAAC-related complications occurred in 9 (4.5%) patients. Conclusions Among patients at high risk for stroke and increased risk of bleeding, LAAC was noninferior to DOAC in preventing major AF-related cardiovascular, neurological, and bleeding events. (Left Atrial Appendage Closure vs. Novel Anticoagulation Agents in Atrial Fibrillation [PRAGUE-17]; NCT02426944 )

Cil: Cilem teto studie bylo porovnat nastaveni mezikomoroveho zpožděni pomoci trojrozměrne echokardiografie (3DE) s využitim systolic dyssynchrony indexu (SDI) oproti nastaveni dle siře komplexu QRS u nemocných s nově implantovaným biventrikularnim kardiostimulatorem (srdecni resynchronizacni lecbou, SRL). Sledovali jsme vliv na redukci objemů leve komory (LK) a pocet echokardiografických responderů v odstupu sesti měsiců od implantace.Metodika: Do teto randomizovane otevřene studie bylo zařazeno 63 nemocných s nedavno implantovanou SRL. Nemocni byli rozděleni do dvou skupin dle způsobu nastaveni mezikomoroveho zpožděni: v prvni skupině dle siře komplexu QRS (n = 31) s cilem dosahnout nejužsiho komplexu QRS, ve 2. skupině pomoci SDI (n = 32) s cilem dosahnout jeho nejnižsi hodnoty. Nemocni před implantaci SRL a po sesti měsicich od implantace podstoupili 3DE vysetřeni ke zhodnoceni objemů leve komory (LK), ejekcni frakce LK (EFLK) a SDI. Hodnotili jsme tež klinickou odpověď a měřili koncentraci N-terminalniho fragmentu natriuretickeho propeptidu typu B (NT-proBNP).Výsledky: Po sesti měsicich nebyl zaznamenan signifikantni rozdil v redukci end-systolickeho objemu LK (-33 ± 55 ml vs. -48 ± 43 ml, p = 0,367), ve zlepseni EFLK (+7,3 ± 10,9 % vs. +10,2 ± 9,4 %, p = 0,210), v klinicke odpovědi a v poklesu koncentrace NT-proBNP mezi oběma skupinami. Pocet echokardiografických responderů byl v obou skupinach podobný (14 vs. 18, p = 0,612).Zavěr: Individualni optimalizace mezikomoroveho zpožděni pomoci SDI nepřinesla v odstupu sesti měsiců oproti nastaveni dle siře komplexu QRS signifikantni zlepseni echokardiografických a klinických parametrů.

Uvod: Aortokoronarni bypass na bijicim srdci (OPCAB) je zavedena technika revaskularizace myokardu, ktera se použiva po celem světě. Nicmeně pocet pacientů, kteři podstupuji tento druh operace, se lisi podle pracovistě. Chtěli jsme zjistit, zda nejnovějsi publikace týkajici se koronarni revaskularizace bez mimotělniho oběhu (MO) změnily vnimani OPCAB v ocich ceských kardiochirurgů.Metody: Udaje z Narodniho kardiochirurgickeho registru CR byly využity k vyhodnoceni trendů v poctu revaskularizaci bez MO u pacientů s ischemickou chorobou srdecni a k analýze faktorů, ktere jsou pro chirurgy urcujici při volbě strategie OPCAB. Zkoumane obdobi bylo mezi lety 2010-2015.Výsledky: Aortokoronarni bypass bez MO se provadi na vsech 12 kardiochirurgických pracovistich v CR. Celkově jsme zaznamenali mirný pokles izolovaných revaskularizaci mezi rokem 2010 a 2015 (z 3 884 na 3 569), přicemž procento připadů OPCAB take klesalo (z 26,7 % na 24,9 %). Během studie se průměrný věk pacientů, operovaných na bijicim srdci zvýsil (66,2 vs. 68,1 roku) a zahrnoval pacienty se stale větsim poctem komorbidit. Průměrna celkova doba operace OPCAB klesla (3,3 vs. 3,1 hodiny) a ve srovnani se standardni revaskularizaci trva OPCAB podstatně meně casu (3,1 vs. 3,3 hodiny, p < 0001). Pocet perifernich anastomoz provaděných bez MO byl signifikantně nižsi než u operaci na MO a obecně se snižil (2,1 vs. 3,0, p < 0,001 v roce 2010 a 1,9 vs. 2,9, p < 0,001 v roce 2015).Zavěry: Pocet revaskularizaci bez MO měl v CR mezi lety 2010 a 2015 klesajici tendenci. Nicmeně neni jasne, zda k tomu doslo vlivem nedavno publikovaných, siroce uznavaných prospektivnich randomizovaných studii. Přestože tyto prace neprokazaly nadřazenost OPCAB u vysoce rizikových pacientů, cesti kardiochirurgove upřednostňuji off-pump strategii pravě u těchto nemocných, zejmena s anamnezou renalni insuficience. Zda se, že komunita ceských kardiochirurgů je v tomto připadě znacně konzervativni a ma tendenci k neuplne revaskularizaci.

Background: The number of patients with heart failure is steadily increasing, as are the costs of their treatment. Nearly 70% of the costs associated with the treatment of heart failure are direct medical costs, and 70-80% of these are spent on hospitalizations. The aim of our study is to describe the all-cause hospitalization costs of patients with chronic heart failure (chronic HF) from the perspective of the healthcare system in the Czech Republic. Methods: In total, 1274 consecutively collected patients discharged in a stable condition from hospitalization for acute heart failure (= index hospitalization) from 2006 to 2012 were followed-up for 2 years. Their all-cause mortality and all-cause hospitalizations were retrospectively evaluated. The in-patient costs were calculated based on the relative weights of DRG codes for particular hospitalization events and on the basic DRG tariff for 2013 (CZK 28,898). Results: At the end of the 2-year follow-up, a total of 1511 hospitalizations were recorded. A total of 31.8% of patients survived without any hospitalization, 32.1% of patients survived with at least one hospitalization, and 36.1% of patients died. Re-hospitalizations for acute heart failure accounted for 31.2% of all cases. The average cost for one chronic HF patient hospitalized for any reason was CZK 85,414; the cost for acute heart failure re-hospitalization was CZK 31,320 during the 2-year follow-up period. The cost of all-cause hospitalizations within the first year after the index hospitalization was higher compared to the cost during the second year (CZK 58,528/year vs. CZK 23,082/year). As the estimated number of chronic HF patients is 230,000 (data from the Institute of Health Information and Statistics of the Czech Republic), we can calculate the total cost of all-cause hospitalizations of chronic HF patients to be approximately CZK 7.98 billion per year in the Czech Republic. Conclusion: The data from clinical practice confirm that patients with chronic HF discharged from acute heart failure hospitalization are at high risk of death and/or subsequent hospitalization. The average annual costs for all-cause hospitalizations of CHS patients within the first and second years are CZK 58,528 and CZK 23,082 per patient, respectively. The costs attributed to all-cause hospitalization care of chronic HF patients can be estimated as approximately 7.7% of all annual inpatient expenses of health insurance companies and 2.7% of total healthcare expenditures in the Czech Republic. (C) 2018 The Czech Society of Cardiology. Published by Elsevier Sp. z o.o. All rights reserved.

Kontext: Diuretika jsou doporucena ke kontrole symptomů kongesce a retence tekutin u pacientů se srdecnim selhanim, ale jejich vliv doposud nebyl zkouman v randomizovaných klinických studiich. Existuji konfliktni data o možnem pozitivnim a negativnim ucinku v zavislosti na davce klickoveho diuretika. Cilem nasi analýzy je vyhodnotit, zda by relativně male zvýseni davky furosemidu mohlo snižit výskyt rehospitalizaci pro akutni dekompenzaci a/nebo celkovou mortalitu.Metody a výsledky: Celkem jsme vyhodnotili 1 119 pacientů přijatých pro akutni dekompenzaci srdecniho selhani, kteři byli propustěni do domaciho osetřovani ve stabilizovanem stavu. Vsichni přeživsi pacienti byli sledovani po dobu nejmeně dvou let. Primarnim cilovým ukazatelem byla kombinace opakovane hospitalizace pro akutni srdecni selhani a celkove mortality. Primarni analýza prokazala významne rozdily v charakteristikach a prognoze mezi pacienty, kteři nemuseli uživat žadna klickova diuretika, a těmi, jimž bylo nutno podavat furosemid v davce > 125 mg. Srovnali jsme proto skupinu pacientů uživajicich furosemid v nizkých davkach (10-40 mg) se skupinou uživajicich pouze vysoke davky furosemidu (41-125 mg). Vyssi davka diuretika korelovala se zavažnosti onemocněni (nižsi systolický krevni tlak, NYHA III, nižsi ejekcni frakce leve komory, vyssi hodnoty kreatininu). Dlouhodobě byly mortalita a pocty opakovaných hospitalizaci nižsi ve skupině s nižsimi davkami diuretik (p = 0,037, resp. p = 0,036), avsak po adjustaci parovanim podle propensity skore (propensity score matching) byla incidence primarniho ciloveho ukazatele v obou skupinach srovnatelna.Zavěr: Davka klickoveho diuretika doporucena pacientům s akutnim srdecnim selhanim při jejich propustěni z nemocnice koreluje se zavažnosti srdecniho selhani. Vyssi davka furosemidu (41-125 mg) ve srovnani s nižsi davkou (10-40 mg) ma po adjustaci obou skupin pacientů pomoci propensity skore neutralni vliv na výskyt kombinovaneho ciloveho ukazatele mortality a/nebo rehospitalizaci pro akutni dekompenzaci srdecniho selhani. V žadnem připadě tato relativně vyssi davka neměla pozitivni ucinky na sniženi rizika rehospitalizaci/mortality.

Introduction Crohns disease (CD) belongs to chronic diseases that highly affect the patient´s quality of life (QoL). The effect of the disease and impairment of QoL in CD patients is already known. The aim was to assess how surgical treatment influences the patients QoL and determine factors that can affect postoperative QoL. Methods and patients We compared the QoL before and after surgery in patients who had undergone a bowel resection at our department due to CD between 2010-2016. The patients filled in a standardized QLQ-CR29 questionnaire to assess QoL in the preoperative period and the postoperative period after a 2-month interval. The control groups were CD patients who had not undergone surgical treatment (bowel resection) and a healthy cohort. In the QoL evaluation, 132 patients with CD who had undergone surgery (bowel resection), 83 patients with CD without an operation and 104 healthy subjects were enrolled. Results 104 of the operated patients experienced a postoperative improvement of the overall QoL (78.8 %), 2 patients did not register any changes in QoL (1.5 %) and 26 patients (19.7 %) experienced a worsening of their postoperative QoL. The results were statistically significant (p Conclusion We detected a significant improvement of the overall QoL after surgical resection in CD patients (measured 2 months after surgery). Gender was identified as the only statistically relevant factor with influence on postoperative QoL.Key words: bowel resection - Crohn´s disease - Czech cohort - inflammatory bowel disease - quality of life - surgical treatment.

Background The identification of high-risk heart failure (HF) patients makes it possible to intensify their treatment. Our aim was to determine the prognostic value of a newly developed, high-sensitivity troponin I assay (Atellica®, Siemens Healthcare Diagnostics) for patients with HF with reduced ejection fraction (HFrEF; LVEF < 40%) and HF with mid-range EF (HFmrEF) (LVEF 40%–49%). Methods and results A total of 520 patients with HFrEF and HFmrEF were enrolled in this study. Two-year all-cause mortality, heart transplantation, and/or left ventricular assist device implantation were defined as the primary endpoints (EP). A logistic regression analysis was used for the identification of predictors and development of multivariable models. The EP occurred in 14% of the patients, and these patients had higher NT-proBNP (1,950 vs. 518 ng/l; p < 0.001) and hs-cTnI (34 vs. 17 ng/l, p < 0.001) levels. C-statistics demonstrated that the optimal cut-off value for the hs-cTnI level was 17 ng/l (AUC 0.658, p < 0.001). Described by the AUC, the discriminatory power of the multivariable model (NYHA > II, NT-proBNP, hs-cTnI and urea) was 0.823 (p < 0.001). Including heart failure hospitalization as the component of the combined secondary endpoint leads to a diminished predictive power of increased hs-cTnI. Conclusion hs-cTnI levels ≥ 17 ng/l represent an independent increased risk of an adverse prognosis for patients with HFrEF and HFmrEF. Determining a patient’s hs-cTnI level adds prognostic value to NT-proBNP and clinical parameters.

Uvod: Chirurgicka ablace je zavedenou metodou lecby fibrilace sini (FS) u pacientů s indikaci k jinemu kardiochirurgickemu výkonu. V jednotlivých centrech se vsak využivaji různe postupy a strategie ablace a souhrnna narodni data o chirurgicke lecbě FS nebyla v posledni době publikovana. Cilem prace bylo přinest souhrnne udaje o aktualnich trendech konkomitantni lecby i samostatných výkonů pro FS v Ceske republice.Metodika: Zdrojem dat byly udaje z Narodniho kardiochirurgickeho registru a ze specialniho dotazniku, vytvořeneho přimo pro ucely teto analýzy. Analyzovany byly trendy cetnosti provaděni konkomitantni ablace u kardiochirurgických pacientů s FS, provaděni ablace u různých typů výkonů a analýza faktorů, ktere vedou chirurgy k neprovedeni konkomitantni ablace při kardiochirurgickem výkonu. Shromažděna a analyzovana byla take data o samostatných výkonech pro izolovanou formu FS. Sledovaným obdobim byly roky 2010-2015.Výsledky: V celem souboru pacientů byla konkomitantni ablace FS provedena u 54 % pacientů s anamnezou fibrilace sini. Toto procento lehce klesalo během sledovaneho obdobi z 59 % v roce 2010 na 51 % v roce 2015. Konkomitantni ablace byla provaděna nejcastěji u pacientů podstupujicich operaci mitralni chlopně (71 %) a nejmeně casto u samostatne chirurgicke revaskularizace myokardu (40 %). V mnohorozměrne analýze byly jako nejsilnějsi nezavisle prediktory neprovedeni konkomitantni chirurgicke ablace FS identifikovany věk, anamneza infarktu myokardu, reoperace, renalni selhani, těžka systolicka dysfunkce leve komory (s ejekcni frakci ≤ 30 %) a předoperacni hemodynamicka nestabilita. Samostatne chirurgicke výkony pro izolovanou FS byly během sledovaneho obdobi provaděny v 9 (75 %) centrech v CR, celkem bylo provedeno 132 takovýchto výkonů; ve větsině center byly tyto výkony opustěny, přicemž některa centra přesla na strategii hybridnich ablaci FS. Hybridni ablace byly v roce 2016 provaděny již v pěti centrech, celkový pocet procedur byl 144 do konce roku 2015.Zavěr: Prevalence konkomitantnich chirurgických zakroků pro FS v CR lehce klesa a u teměř poloviny kardiochirurgických pacientů byla FS během výkonu ponechana bez chirurgicke lecby. Samostatne chirurgicke výkony pro izolovanou FS byly v CR teměř opustěny, přicemž je pozorovano postupne rozsiřovani hybridni lecby.

PURPOSE: The purpose of this study was to analyze pressure injury (PI) occurrence upon admission and at any time during the hospital course inpatients care facilities in the Czech Republic. Secondary aims were to evaluate demographic and clinical data of patients with PI and the impact of a PI on length of stay (LOS) in the hospital. DESIGN: Retrospective, cross-sectional analysis. SETTING AND SUBJECTS: The sample comprised data of hospitalized patients entered into the National Register of Hospitalized Patients (NRHOSP) database of the Czech Republic between 2007 and 2014 with a diagnosis L89 (pressure ulcer of unspecified site based on the International Classification of Diseases, Tenth Revision, ICD-10). Electronic records of 17,762,854 hospitalizations were reviewed. METHOD: Data from the NRHOSP from all acute and non-acute care hospitals in the Czech Republic were analyzed. Specifically, we analyzed patients admitted to acute and non-acute care facilities with a primary or secondary diagnosis of PI. RESULTS: The NRHOSP database included 17,762,854 cases, of which 46,224 cases (33,342 cases in acute care hospitals; 12,882 in non-acute care hospitals) had the L89 diagnosis (0.3%). The mean age of patients admitted with a PI was 73.8 +/- 15.3 years (mean +/- SD), and their average LOS was 33.2 +/- 76.9 days. The mean LOS of patients hospitalized with L89 code as a primary diagnosis (n = 6877) was significantly longer compared to those patients for whom L89 code was a secondary diagnosis (25.8 vs 20.2 days, P

Background Hyperuricaemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricaemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients. Methods and results The prospective acute heart failure registry (AHEAD) was used to select 3,160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricaemia was defined as UA ≥500μmol/l and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricaemia, with treated hyperuricaemia and with untreated hyperuricaemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricaemia, unlike those with hyperuricaemia, had a higher left ventricular ejection fraction, a better renal function and higher haemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with ACEIs/ARBs and/or beta-blockers. In a primary analysis, the patients without hyperuricaemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricaemia had a similar five-year survival rate as those with untreated hyperuricaemia (42.0% vs 39.7%, p=0.362) whereas those with treated hyperuricaemia had a poorer prognosis (32.4% survival rate; p=0.006 vs non-hyperuricaemia group and p=0.073 vs untreated group). Conclusion Hyperuricaemia was associated with an unfavourable cardiovascular risk profile in HF patients. Treatment of hyperuricaemia with low doses of allopurinol did not improve the longterm prognosis of HF patients. Acknowledgement/Funding Ministry of Health CZ 65269705 and MUNI/A/1250/2017

Background Spironolactone is recommended as a fourth line antihypertensive drug by current hypertension guidelines. This drug had relatively few adverse effects in short term clinical trials, but data about their occurrence during long-term treatment of resistant hypertension are scarce. Purpose To evaluate the occurrence and type of adverse effects of spironolactone during long-term treatment and their possible clinical and laboratory predictors. Methods We prospectively followed 274 patients with resistant arterial hypertension who started treatment with spironolactone between September 2007 and December 2016. The duration of spironolactone use, its dose, the incidence of adverse events, blood pressure, and laboratory findings were recorded at baseline and during the last clinical examination. Results Patients were followed for an average of 35 (± 29) months, the mean dose of spironolactone was 27.5 mg/day. Adverse effects occurred in 72 patients (26.3%) and in 61 (84.7%) lead to discontinuation of spironolactone. The most common adverse reactions were gynaecomastia (30.6%), hyperkalaemia (30.6%) and symptomatic hypotension (26.4%). The mean duration of spironolactone treatment before their occurrence was 25 (± 27) months. According to the Kaplan-Meier curve, the median for the incidence of adverse events would be 97 months (91.5–102.5 months), i.e. 50% of patients could be treated with no adverse events for more than 8 years. Adverse events were more common in the elderly (hazard ratio – HR 1.38, P=0.007), patients with higher baseline serum creatinine (HR 1.12, P=0.035) and patients taking angiotensin receptor blockers (HR 1.65, P=0.040). Kaplan-Meier estimate – adverse events Conclusion During long-term treatment of resistant hypertension with spironolactone, more than a quarter of patients experience adverse reactions that usually require discontinuation of spironolactone. Acknowledgement/Funding Supported by the grants of Palacký University in Olomouc Nr. IGA_LF_2016_038 and IGA_LF_2017_029.

Background Beta-blockers (BB) decrease morbidity and mortality in heart failure patients and are part of the first line treatment together with inhibitors of angiotensin converting enzyme. New metaanalysis from year 2014 of main BB studies in chronic heart failure showed no benefit of BB in patients with atrial fibrillation (AF). Methods 1088 at least one month stable chronic heart failure patients with ejection fraction Results 80% patients were male with median age 66 years. Aetiology of heart failure was in 49.4% ischemic heart disease, in 42.3% dilated cardiomyopathy, in 0.5% hypertrophy cardiomyopathy. From those receiving beta-blockers 20% received low dose similar to the starting dose, 57% medium dose and 17% high dose which was set as the target BB dose. Nearly 93.8% of patients received BB. But only 17.0% received the high dose of BB. 6.2% of patients were not treated by BB at all. One third of patients (34.5%) had atrial fibrillation in medical history or newly recorded on electrocardiogram. Patients with AF were much older (median 63 vs. 70 years, respectively; p The primary endpoint was set as all cause death, mechanical circulatory support implantation, orthotopic heart transplantation or hospitalization for acute heart failure. Patients with AF survived without primary endpoint in 70.6%, patients without AF in 78.8% (p=0.005) even after age standardization. There was significantly different survival according to dose of beta-blocker, the higher was dose of BB, the higher was survival. Patients with no beta-blocker survived without primary endpoint in 63.9%, with low dose survived in 72.6%, medium dose in 77.0% and with high dose in 80.9%. We devided FAR NHL patients into two groups according to atrial fibrillation. Patients without AF had the better survival without primary endpoint. The higher dose of beta-blockers they got, the better survival they had (69.5%, 76.7%, 78.9%, 85.1%; p=0.007). Also patients with AF had better survival without primary endpoint, the higher dose of beta-blocker they got, the higher was their survival without endpoitnt (56.0%, 63.6%, 73.0%, 75.8%; p=0.007). Conclusion In FAR NHL registry of stable chronic heart failure patietnts was one third of patients with atrial fibrillation. Nearly 94% of patients received beta-blocker. But only 17% received the target dose. Pacients even with or without atrial fibrillation had the significantly better survival without primary endpoint the higher was the dose of beta-blocker.

The prevalence of diabetes is on the rise worldwide especially in developed countries. The aim of glucose management in all types of diabetes is to minimize chronic and acute complications associated with diabetes. All patients with type 1 diabetes mellitus (T1DM) require insulin. Main areas of technology advances in diabetes are continuous subcutaneous insulin infusion (CSII) and also continuous glucose monitoring systems for the management of patients with both types of diabetes. It is very important to analyse the epidemiological situation within each country before and during the clinical practice guidelines (CPGs) development and implementation. The analyses will allow us to monitor the effect of the CPG after its implementation. The aim of this short communication is to analyse the epidemiology of prevalence and incidence of diabetes mellitus and use of CSII to inform development of CPGs in the Czech Republic. The analysis is developed based on the data managed by Institute of Health Information and Statistics of the Czech Republic. We used the National Register of Reimbursed Health Services 2015–2017 as primary source, and the annual report type A (Ministry of Health) 1-01: for Diabetology (A MH 004) 2007–2017 was used as validation source. The presented data are related to the year 2016 because we were able to validate them based on the data from 2015 to 2017 for this cohort of patients. The number of patients with T1DM is increasing in the Czech Republic with no significant sex difference. Life expectancy is about 11 years lower in the T1DM population. The majority of the patients are in older age; however, these are not treated with CSII compared with the younger population. From 61 533 patients with T1DM, 81% were reported with acute and chronic complications in 2016. Only 5011 of these patients were reported as using CSII.

Background Hyperuricemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients. Methods The prospective acute heart failure registry (AHEAD) was used to select 3160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricemia was defined as UA >= 500 mu moL/L and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricemia, with treated hyperuricemia, and with untreated hyperuricemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricemia, unlike those with hyperuricemia, had a higher left ventricular ejection fraction, a better renal function, and higher hemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and/or beta-blockers. Results In a primary analysis, the patients without hyperuricemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricemia had a similar 5-year survival rate as those with untreated hyperuricemia (42.0% vs 39.7%, P = 0.362) whereas those with treated hyperuricemia had a poorer prognosis (32.4% survival rate, P = 0.006 vs non-hyperuricemia group and P = 0.073 vs untreated group). Conclusion Hyperuricemia was associated with an unfavorable cardiovascular risk profile in HF patients. Treatment with low doses of allopurinol did not improve the prognosis of HF patients.

BACKGROUND:According to guidelines, the prognosis of patients with chronic heart failure can be predicted by determining the levels of natriuretic peptides, the NYHA classification and comorbidities. The aim our work was to develop a prognostic score in chronic heart failure patients that would take account of patients' comorbidities, NYHA and NT-proBNP levels. METHODS AND RESULTS:A total of 1,088 patients with chronic heart failure with reduced ejection fraction (HFrEF) (LVEF1000 ng/L respectively. Discrimination abilities of NYHA and NT-proBNP were AUC 0.670 (p40 mg daily) (AUC 0.773; p