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.

To date, the prevalence of CHD worldwide is ∼9 per 1000 newborns, with substantial geographic variation. The latest knowledge in the world for the last 50 years about their origin, diagnosis and therapy has contributed to their care. Since adult patients with CHD now present increasing numbers at advanced ages, including the elderly, the term grown-up CHD no longer appears appropriate and was therefore replaced with adult CHD (ACHD) according to the ESC guidelines published in 2020 year. Due to medical, surgical, and technological evolutions over the past decades, >90% of individuals who are born with CHD now survive into adulthood. ACHD represent a challenge for clinicians. Despite optimal medical and surgical treatment, many will experience a progressive decline in cardiopulmonary function leading to advanced heart failure. Severe ventricular dysfunction and/or pulmonary hypertension may not be amenable to corrective repair. Their early recognition and follow-up in adolescence will contribute to better care for these patients. Importantly, the care for ACHD patients is a lifelong process and requires advance care planning strategies.

Symptom‐focused management is one of the cornerstones of optimal atrial fibrillation (AF) therapy.

Abstract Objective We investigated the impact of multimorbidity and polypharmacy on the management of atrial fibrillation (AF) patients in clinical practice and assessed factors associated with polypharmacy and oral anticoagulation (OAC) use in AF patients with multimorbidity and polypharmacy. Methods A 14-week prospective study of consecutive non-valvular AF patients was performed in seven Balkan countries. Results Of 2712 consecutive patients, 2263 patients (83.4%) had multimorbidity (AF + ≥2 concomitant diseases) and 1505 patients (55.5%) had polypharmacy. 1416 (52.2%) patients had both multimorbidity and polypharmacy. Overall, 1164 (82.2%) patients received OAC, 200 (14.1%) patients received antiplatelet drugs alone and 52 (3.7%) patients had no antithrombotic therapy (AT). Non-emergency centre and paroxysmal AF were significantly associated with OAC non-use in patients with multimorbidity, whilst age ≥80 years and non-emergency centre were identified to be independent predictors of OAC non-use in patients with polypharmacy. Conclusions Multimorbidity and polypharmacy were common among AF patients in our study. AT was suboptimal and approximately 18% of multimorbid patients with polypharmacy were not anticoagulated. Pattern of AF and non-emergency centre were associated with OAC non-use in AF patients with multimorbidity, whilst non-emergency centre and age ≥80 years were associated with OAC non-use in AF patients with polypharmacy. Key Message Multimorbidity and polypharmacy are common among patients with AF. Antithrombotic therapy was suboptimal in AF patients with multimorbidity and polypharmacy. Approximately, 18% of multimorbid patients with polypharmacy were not anticoagulated.

Atrial fibrillation (AF) often co‐exists with renal function (RF) impairment. We investigated the characteristics and management of AF patients across creatinine clearance strata and potential changes in the use of nonvitamin K oral anticoagulants (NOAC) according to different equations for estimation of RF.

ABSTRACT Objectives: To examine a relationship between protein C (PC) and antithrombin III (AT III) activities with ejection fraction of left ventricle (EFLV), in the early phase of acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), and to investigate whether PC and AT III are associated with major adverse cardiovascular events (MACE) within 6 months following from pPCI. Patients and methods: The research had a prospective character and included 357 patients who had, following the diagnosis of the STEMI, undergone pPCI at the Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia, from January 2010 until April 2019. Results: The EFLV positively correlated with PC values (rho = 0.229). There was a statistically significant increase in the PC values between patients with MACE compared with those without MACE at 6 months’ follow-up evaluation (p < 0.0001). Also, significant difference in PC values between patients who died in hospital and those who were alive at 6 months’ follow-up (p < 0.01) was observed. PC values were different across different EFLV groups (p < 0.001), increasing from the 1st to the 4th EFLV quartiles: the median and the interquartile values for the 1st, 2nd, 3rd and 4th quartiles were 1.0400IU/l ± 0.15, 1.1400IU/l ± 0.15, 1.1350IU/l ± 0.16 and 1.2200IU/l ± 0.14, respectively. Conclusion: Increased PC activity in the early phase of STEMI is associated with higher EFLV 5 days after the pPCI as well as with MACE at 6 months after the pPCI.

Atrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region.

INTRODUCTION The Atrial fibrillation Better Care (ABC) pathway provides a useful way of simplifying decision-making considerations in a holistic approach to atrial fibrillation management. OBJECTIVES To evaluate adherence to ABC pathway and to determine major gaps in adherence to ABC pathway in patients in BALKAN-AF survey. PATIENTS AND METHODS In this ancillary analysis, patients in BALKAN-AF survey were divided into groups: "A (Avoid stroke)+B (Better symptom control)+C (Cardiovascular and comorbidity risk management)"-adherent and non-adherent "A+B+C" management.  Results: Of 2,712 enrolled patients, 1,013 (43.8%) patients with mean (SD) age of 68.8 (10.2) years and mean CHA2DS2-VASc score of 3.4 (1.8) had "A+B+C"-adherent management and 1,299 (56.2%) had non-adherent-"A+B+C" management. Independent predictors of increased "A+B+C"-adherent management were: capital city [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.03-1.46, p = 0.02], treatment by cardiologist (OR 1.34, 95% CI 1.08-1.66, p = 0.01), hypertension (OR 2.20, 95% CI 1.74-2.77, p <0.001), diabetes mellitus (OR 1.28, 95% CI 1.05-1.57, p = 0.01) and multimorbidity (the presence of two or more long-term conditions) (OR 1.85, 95% CI 1.43-2.38, p <0.001). Independent predictors of decreased "A+B+C"-adherent management were: age ≥80 years (OR 0.61, 95% CI 0.48-0.76, p < 0.001) and history of bleeding (OR 0.50, 95% CI 0.33-0.75, p = 0.001). CONCLUSIONS Physicians' adherence to integrated AF management based on the ABC pathway was suboptimal in our study. Addressing the identified clinical  and system-related factors associated with non-adherent-"A+B+C" management using targeted approaches is needed to optimize treatment of AF patients in the Balkan region.

Introduction: The study evaluated of microalbuminuria as a predictor of heart failure in patients with diabetes mellitus type 2. Materials and methods: The prospective study conducted in a period of time from 01-Feb-2007 to 01-Feb-2010.The study included 100 patients with type 2 diabetes, who had diabetes longer than 5 years. All subjects (average age 66 ± 10 years, 33% male, 67% female) were tested for the presence of microalbuminuria, and 50 patients had microalbuminuria. The second group comprised 50 patients without of microalbuminuria with diabetes mellitus type 2. Results: In the patients with microalbuminuria and diabetes mellitus were found 22% of heart failure and 6% in the second group. Average time to the occurance of heart failure in the first group was 32,5 months, in the second group was 35,3 months. Conclusions: The results show that microalbuminuria is an independent risk factor for heart failure in patients with diabetes mellitus type 2 and microalbuminuria. Patients without microalbuminuria had 3,7 less likely to development heart failure compared to patients with microalbuminuria and diabetes mellitus.