The Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline‐directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern.

Introduction The 2019 ESC/EAS guidelines introduced stricter low-density lipoprotein cholesterol (LDL-C) targets, particularly for patients at high and very high cardiovascular (CV) risk. However, data on the implementation of these targets in real-world clinical practice—especially in countries with high/very high CV risk—remain limited. The DISCOVERY study aimed to assess LDL-C management, lipid-lowering therapy (LLT) use, and guideline adherence across multiple countries in Central and Eastern Europe and Central Asia. Methods This prospective, observational, multicenter study enrolled adult patients with hypercholesterolemia (HCL) from 10 countries grouped into three regions. Data was collected at baseline and after 12 weeks of follow-up. LLT patterns, LDL-C levels, target attainment (both investigator-defined and 2019 ESC/EAS-recommended), and physician adherence to guidelines were analyzed. Results A total of 6,447 patients were included; 53.2% were female, and the mean age was 60.5 ± 11.9 years. Most patients (66%) were in secondary prevention. At baseline, 36.8% had been treated with LLT. After the first visit, treatment was changed in 78% of patients, but only 42.4% received high-intensity statins and 9.3% received statin-ezetimibe combinations at follow-up. LDL-C target achievement was poor: only 5.6% of patients met the guideline-recommended LDL-C goals, compared to 45.5% who met physician-defined targets. Among patients with ASCVD, only 3.3% achieved guideline LDL-C targets. The most significant gap was observed between guideline recommendations and physician-set LDL-C goals. No significant difference in LDL-C target attainment was observed between specialists and general practitioners. Discussion The DISCOVERY study reveals suboptimal LDL-C control and low adherence to the 2019 ESC/EAS guidelines in routine practice across countries with high/very high CV risk. These findings highlight the urgent need for strategies to improve physician awareness, promote intensive LLT use, and close the gap between guidelines and clinical practice. A paradigm shift toward proactive LDL-C management is essential to reduce residual CV risk in these populations.

SUMMARY The aim of this study was to examine the effect of the lipid parameter non-high-density lipoprotein cholesterol (non-HDL-C) on the occurrence of major cardiovascular event (MACE) in patients after first-time ST-elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (pPCI) and implantation of drug-eluting stent (DES). Seventy-eight patients (54 male and 24 female, median age 58.62±11.14 years) with the diagnosis of first-time STEMI who were treated with pPCI with DES implantation in the period from January 2018 until January 2020 were included in the study. Patients were followed for two years of the intervention for the occurrence of MACE and its association with baseline non-HDL-C, as well as total cholesterol, LDL-C, HDL-C and triglycerides. During 2-year follow-up, 20 (25.6%) patients had MACE. There was no significant difference in baseline parameters such as age, hypertension, presence of diabetes mellitus, and post-interventional use of statin therapy between patients with and without MACE. The levels of baseline lipid parameters were significantly higher in patients who experienced MACE, as follows: total cholesterol (p=0.009), LDL-C (p=0.028) and non-HDL-C (p=0.007). Pearson χ2-test showed that both non-HDL-C and LDL-C were significant predictors of MACE occurrence during 2-year follow-up, but non-HDL-C had a more significant correlation than LDL-C (p=0.007 vs. p=0.028). Our initial report shows that baseline non-HDL-C was a more significant predictor of the occurrence of MACE after first-time STEMI than LDL-C, which reflects the importance of the residual risk of MACE occurrence while enabling identification and close monitoring of high-risk patients.

Natriuretic peptide (NP) uptake varies in Emergency Departments (EDs) across Europe. The ‘Peptide for Life’ (P4L) initiative, led by Heart Failure Association, aims to enhance NP utilization for early diagnosis of heart failure (HF). We tested the hypothesis that implementing an educational campaign in Western Balkan countries would significantly increase NP adoption rates in the ED.

BACKGROUND The 4S-AF scheme includes: stroke risk, symptoms, severity of burden, and substrate severity domain. AIM Our aim was to assess the adherence to 4S-AF scheme in patients classified according to stroke risk in post-hoc analysis of the BALKAN-AF dataset. METHODS A 14-week prospective enrolment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) was performed in seven Balkan countries from 2014 to 2015. RESULTS Low stroke risk (CHA₂DS₂-VASc score, 0 in males or 1 in females) was present in 162 (6.0%) of the patients. 2,099 (77.4%) of patients had CHA₂DS₂-VASc score ≥3 in females or ≥2 in males (high stroke risk) and 613 (22.6%) had CHA₂DS₂-VASc score <3 in females or <2 in males. 75 (46.3%) of patients with low stroke risk and 1555 (74.1%) of patients with high stroke risk were prescribed oral anticoagulants (OAC). 2677 (98.6%) had data on European Heart Rhythm Association (EHRA) class. Among 2099 patients with high stroke risk, 703 (33.4%) had EHRA class ≥3. 207 (29.4%) of patients with EHRA class ≥3 and high stroke risk were offered rhythm control; 620 (55.2%) of individuals with first-diagnosed or paroxysmal AF with high stroke risk were offered rhythm control. Two or more comorbidities occurred in 1927 (91.8%) of patients with high stroke risk. CONCLUSIONS OAC overuse was observed in patients with low stroke risk, whilst OAC underuse was evident in those with high risk of stroke. The percentage of highly symptomatic patients with high risk of stroke who were offered rhythm control strategy was low.

Background: Left atrial dilatation, according to recent studies is important in the onset of atrial fibrillation, stroke and death. The most reliable echocardiographic parameter of left atrial dilatation is the left atrial volume index (LAVi). Aim: The objective of this study is to evaluate the impact of LAVi on the occurrence of atrial fibrillation after surgical myocardial revascularization (CABG). Methods: A prospective study included 116 patients undergoing surgical myocardial revascularization followed from admission to discharge. The examination was conducted at the Special Hospital “BH Centre for Heart” Tuzla. Preoperative ultrasound examination determined the parameters of left ventricular diastolic function and LAVi in all patients and postoperatively determined the onset of AF, the day of onset, duration in hours, number of episodes. Logistic regression was used to evaluate whether an event occurred or not, and the effect of time on the event of interest was analysed by Cox's parallel hazard regression. Results: 75.9% of patients had diastolic left ventricular dysfunction (LVDD). Preoperative values of LAVi are significantly higher when the LVDD grade is higher. In patients with LVDD and higher LAVi values, the risk of AF occurrence is greater, the longer the duration of AF, and the significantly greater number of AF episodes. As a result of the analysis, the most significant predictors of AF are: LVDD and LAVi. Conclusion: LAVi has the best hazard function in explaining the occurrence of atrial fibrillation after surgical myocardial revascularization.

BACKGROUND The implementation of quality indicators in the atrial fibrillation (AF) care should be considered to improve quality of management and patient outcome. METHODS In the post-hoc analysis of the BALKAN-AF dataset, we assessed concordance with quality indicators for AF management. Available domains for AF management [patient assessment (baseline), anticoagulation, rate control strategy, rhythm control strategy and risk factor management] were identified and assessed at baseline visit. RESULTS Among 132 patients with a CHA2DS2-VASc score of 0 (men) or 1 (women), 75 (56.8%) were prescribed oral anticoagulation (OAC). Of 2539 patients with a CHA2DS2-VASc score ≥ 1 for men and ≥ 2 for women, 1890 (74.4%) were prescribed OAC. Among 1088 patients with permanent AF, 110 (10.1%) individuals were prescribed antiarrhythmic drugs (AADs). Of 1616 patients with structural heart disease, 37 (2.2%) were prescribed class IC AADs. Of 1624 patients with paroxysmal or persistent AF, 59 (3.6%) were offered catheter ablation. Among 2712 AF patients, 2121 (78.2%) had hypertension, 671 (24.7%) were obese, 53 (2.0%) had obstructive sleep apnoea, 110 (4.0%) had alcohol abuse and 340 (12.5%) were smokers. CONCLUSIONS In the BALKAN-AF cohort, the use of OAC for stroke prevention was poorly associated with patients stroke risk. The use of AADs in patients with permanent AF was low. The prescription of class IC AADs to patients with structural heart disease was infrequent. A large proportion of AF patients had their modifiable risk factors identified.