We aimed to evaluate the prognostic impact of renal insufficiency and fluctuation of glomerular filtration observed during hospitalization for heart failure (HF).
We followed 3,639 patients ...hospitalized for acute HF and assessed the mortality risk associated with moderate or severe renal insufficiency, either permanent or transient.
After adjustment, severe renal failure defined as estimated glomerular filtration (eGFR) <30 mL/min indicates ≈60% increase in 5-year mortality risk. Similar risk also had patients with only transient decline of eGFR to this range. In contrast, we did not observe any apparent mortality risk attributable to mild/moderate renal insufficiency (eGFR 30-59.9 mL/min), regardless of whether it was transient or permanent.
Even transient severe renal failure during hospitalization indicates poor long-term prognosis of patients with manifested HF. In contrast, only moderate renal insufficiency observed during hospitalization has no additive long-term mortality impact.
•In 2018 EPS was widely used in 19 EU countries.•A pilot project exists in one other EU country, whilst projects for EPS are under way in 3 other EU states.•EPS in EU countries use analogous ...technical solutions apart from those employed in the UK.•EPS in EU countries differ significantly in authentication procedures and advanced functions.•Cross-border interoperability is still low and its development might be affected by differences in the pre-existing EPS.
The electronic prescribing system (EPS) is now widely used in the USA and largely also in EU member countries. Nevertheless, comparisons of different EPS are very scarce. Whilst the EU strives for cross-border interoperability in healthcare, the aim of this study is to provide a contemporary account of the state of national EPS in such countries.
For the sake of consistency the state of each of the EPS as of the end of 2018 was researched using an e-mail questionnaire. Respondents were chosen from among authors who have previously published studies on electronic prescriptions.
Data on EPS was gathered from 23 out of the 28 EU member states. In 2018 EPS was in daily use in 19 EU states, and one further country had a pilot project, whereas the remaining 3 were only at the planning stage. Most of the EPS do not differ significantly in basic design, however authentication procedures vary substantially.
There is a significant increase in EPS usage in EU countries as compared with previous studies. Cross-border interoperability in the EU is still limited, and further advancement might be hampered by differences in authentication procedures.
Although it was not possible to acquire data from all the EU countries, this study shows the present state of electronic prescription in most of them and demonstrates continuous development in this area.
Compared with Western Europe, the decline in cardiovascular (CV) mortality has been delayed in former communist countries in Europe, including the Czech Republic. We have assessed longitudinal trends ...in major CV risk factors in the Czech Republic from 1985 to 2016/17, covering the transition from the totalitarian regime to democracy.
There were 7 independent cross-sectional surveys for major CV risk factors conducted in the Czech Republic in the same 6 country districts within the WHO MONICA Project (1985, 1988, 1992) and the Czech post-MONICA study (1997/98, 2000/01, 2007/08 and 2016/2017), including a total of 7,606 males and 8,050 females. The population samples were randomly selected (1%, aged 25-64 years).
Over the period of 31/32 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 23.9%; p < 0.001) and no change in females. BMI increased only in males. Systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension, the proportion of individuals treated by antihypertensive drugs and consequently hypertension control improved in both genders. A substantial decrease in total cholesterol was seen in both sexes (males: from 6.21 ± 1.29 to 5.30 ± 1.05 mmol/L; p < 0.001; females: from 6.18 ± 1.26 to 5.31 ± 1.00 mmol/L; p < 0.001).
The significant improvement in most CV risk factors between 1985 and 2016/17 substantially contributed to the remarkable decrease in CV mortality in the Czech Republic.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The primary medication non-adherence occurs when a patient does not collect his or her newly prescribed medication. Various studies give estimates that this occurs between 0.2 percent and 74 percent. ...Recently, this topic has been researched by analyzing data in national electronic prescription systems. The database of the Czech electronic prescription system was used to obtain the number of all prescriptions issued and collected in 2021 for fifty particular substances (associated with six medication groups). Additionally, a similar query was performed with an additional criterion that the same substance had not been prescribed within the last 365 days. The data were obtained separately in five age categories. The total number of prescriptions analyzed in this study was over 21 million, which represents almost 30 percent of all prescriptions issued in the Czech Republic in 2021. The primary medication non-adherence in the selected substances was 4.56 percent, which negatively correlates (rxy = 0.707) with the age of a patient. There is a higher primary non-adherence in the Psychoanaleptics and Lipid modifying medication groups than in the whole studied sample (
< 0.05). Lipid-modifying medication group and several other particular substances showed a larger difference between primary non-adherence and overall non-adherence, indicating issues in the initiation of these drugs. The results of our study are following earlier studies with similar methodologies from other countries. However, the difference between primary non-adherence and overall non-adherence had not been observed in other studies before. The electronic prescription system proved to be a valuable tool for conducting this type of research.
Studies on the incidence, acute and subsequent mortality from myocardial infarction are limited mostly to selected clinical cohorts and populations and cover relatively short periods. Our aim was to ...describe and analyse long-term trends on a national scale.
Acute myocardial infarction (AMI) was defined by the International Classification of Diseases (ICD)10; codes I21 and I22. Our natiowide 1994-2016 data on AMI mortality were obtained from the official mortality statistics (Czech Bureau of Statistics), data on morbidity (hospitalizations) from the National Register of Hospitalizations (Institute for Health Information and Statistics). For further analyses, data from the Czech EUROASPIRE I-V and Czech IMPACT studies were used.
Over the 1994-2016 period the total number of AMI cases per year decreased from 34,084 to 19,015, that of patients hospitalized for AMI from 22,373 to 15,419, the total number of deaths due to AMI from 14,834 to 4,673, in those treated because of AMI from 3,794 to 1,137, and hospital fatality in patients treated for AMI decreased from 17% to 7.5%. Over the years 1997-2016, the one-year all-cause mortality rate after AMI declined from 25.1 to 17.9%, cardiovascular (CV) mortality from 22.3 to 14.2%, five-year all-cause mortality from 41.7 to 34%, and CV mortality from 34.1 to 23.6%.
The Czech Republic has witnessed a pronounced decrease in AMI incidence and fatality and, consequently, long-term mortality. The decreasing incidence and improving course of AMI are due to progress in primary prevention, in acute coronary care and interventional cardiology, and in secondary coronary heart disease (CHD) prevention.
It is very difficult to find a consensus that will be accepted by most players when creating health care legislation. The Czech electronic prescription system was launched in 2011 and new functions ...were introduced in 2018. To ensure that these functions will not conflict with any other existing law, a process modeling tool based on the patent "Method and system for automated requirements modeling" was used successfully in the Czech Republic for the first time.
The aim of this project was to develop another successful application of process modeling to add COVID-19 vaccination records to the existing electronic prescription system.
The method employed was based on the mathematical theory of hierarchical state diagrams and process models. In the first step, sketches that record the results of informal discussions, interviews, meetings, and workshops were prepared. Subsequently, the architecture containing the main participants and their high-level interactions was drafted. Finally, detailed process diagrams were drawn. Each semiresult was discussed with all involved team members and stakeholders to incorporate all comments. By repeating this procedure, individual topics were gradually resolved and the areas of discussion were narrowed down until reaching complete agreement.
This method proved to be faster, clearer, and significantly simpler than other methods. Owing to the use of graphic tools and symbols, the risk of errors, inaccuracies, and misunderstandings was significantly reduced. The outcome was used as an annex to the bill in the legislative process. One of the main benefits of this approach is gaining a higher level of understanding for all parties involved (ie, legislators, the medical community, patient organizations, and information technology professionals). The process architecture model in a form of a graphic scheme has proven to be a valuable communication platform and facilitated negotiation between stakeholders. Moreover, this model helped to avoid several inconsistencies that appeared during workshops and discussions. Our method worked successfully even when participants were from different knowledge areas.
The vaccination record process model was drafted in 3 weeks and it took a total of 2 months to pass the bill. In comparison, the initial introduction of the electronic prescription system using conventional legislative methods took over 1 year, involving immediate creation of a text with legislative intent, followed by paragraph-by-section wording of the legislation that was commented on directly. These steps are repeated over and over, as any change in any part of the text has to be checked and rechecked within the entire document. Compared with conventional methods, we have shown that using our method for the process of modification of legislation related to such a complex issue as the integration of COVID-19 vaccination into an electronic prescription model significantly simplifies the preparation of a legislative standard.
We analyzed the mortality risk and its predictors in patients hospitalized for heart failure (HF).
Patients discharged from hospitalization for acute decompensation of HF in 2010- 2020 and younger ...than 86 years were followed (n=4097). We assessed the incidence and trends of all-cause death, its main predictors, and the pharmacotherapy recommended at discharge from the hospital.
The 30 days all-cause mortality was in discharged patients 3.2%, while 1-year 20.4% and 5-years 55.4%. We observed a modest trend to decreased 1-year mortality risk over time. Any increase of year of hospitalization by one was associated with about 5% lower risk in the fully adjusted model. Regarding predictors of 1-year mortality risk, a positive association was found for age over 65, history of malignancy, and peak brain natriuretic peptide during hospitalization ≥10times higher than normal concentration. In contrast, as protective factors, we identified LDL ≥1.8 mmol/L, treatment with beta-blockers, renin-angiotensin axis blockers, statins, and implanted cardioverter in the same regression model. The ejection fraction category and primary etiology of HF (coronary artery disease vs. others) did not significantly affect the mortality risk in a fully adjusted model.
Despite advances in cardiovascular disease management over the last two decades, the prognosis of patients hospitalized for heart failure remained highly unfavorable.
•Outpatient electronic prescription system is used in the Czech Republic.•The usage has been low between 2013–2016.•High usage from 2018 is caused by making the system compulsory.•Still about twenty ...per cent of Czech physicians does not use the system at all.•Still, new functions of the system are awaited.
Outpatient Electronic Prescription Systems (OEPSs) are widely used in some European states, such as Denmark, Sweden and the Netherlands. The Czech OEPS (known as eRecept) was introduced in 2011, but with limited functions and voluntary usage it was not much accepted until 2018, when its usage was made compulsory not only for pharmacies, but for physicians as well.
Using data from the Czech State Institute for Drug Control (Státní ústav pro kontrolu léčiv or SÚKL in Czech) and from other sources, the system was described and data about its performance since 2013 have been obtained.
The usage of the system was very low between 2013 and 2016, whilst moderate growth was seen in 2017. By 2018, the system has been widely adopted, although some twenty per cent of Czech physicians still do not use the system at all.
A sudden rise in usage can be explained as the result of making the system compulsory starting in January 2018. Still, new features of the system are eagerly awaited and should be introduced to expand its benefits.
The Czech Republic has joined the EU countries widely using the OEPS.
Abstract Objective The aim of this study was to investigate gender related differences in the management and risk factor control of patients with coronary heart disease (CHD), taking into account ...their age and educational level. Methods Analyses are based on the EUROASPIRE IV (EUROpean Action on Secondary and Primary Prevention through Intervention to Reduce Events) survey. Males and females between 18 and 80 years of age, hospitalized for a first or recurrent coronary event were included in the study. Results Data were available for 7998 patients of which 75.6% were males. Overall, females had a worse risk factor profile compared to males and were more likely to have 3 or more risk factors (30.4% vs. 35.4%; p < 0.001) across all age groups. A significant gender by education interaction (p < 0.05) and gender by age interaction effect (p < 0.05) was found. Furthermore, males were more likely to have a LDL-cholesterol on target (OR = 1.501.28–1.76), a HbA1c on target (OR = 1.331.07–1.64), to be non-obese (OR = 1.451.30–1.62) and perform adequate physical activity (OR = 1.711.46–2.00). In contrast males were less likely to be non-smokers (OR = 0.710.60–0.83). Furthermore, males were less likely to have made a dietary change (OR = 0.790.63–0.99) or a smoking cessation attempt (OR = 0.700.50–0.96) and more likely to have received smoking cessation advice if they were smokers (OR = 1.521.10–2.09). Conclusion Whereas gender differences in CHD treatment are limited, substantial differences were found regarding target achievement. The largest gender difference was seen in less educated and elderly patients. The gender gap declined with decreasing age and higher education.
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