Background and Aims There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in heart failure (HF) populations from different country income levels. Methods A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0–4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. Results At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12–2.26) and 2.92 (1.99–4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93–1.87) and 1.97 (1.33–2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. Conclusions Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels.

Background Premature coronary artery disease is one of the most pressing global issues in modern cardiology. The aim of the study was to investigate the role of family history of premature cardiovascular disease (CVD) in patients aged < 50 years with myocardial infarction (MI) compared to that in patients aged ≥50 years with MI and to that in young people without MI (no-MI < 50). Methods The studied group (MI < 50) consisted of 240 patients aged 26–49 years with MI. The control groups consisted of 240 patients (MI ≥ 50) with MI aged 50–92 years and 240 healthy people aged 30–49 years without a history of MI (no-MI < 50). Results There were statistically significant differences between the MI < 50 and MI ≥ 50 and no-MI < 50 groups regarding the family history of premature MI/ischaemic stroke and the percentage of patients with ≥2 relatives affected (10.8, 2.9, and 3.7%, respectively; p < 0.0001). There was a statistically significant difference in the patient age at the first MI occurrence among patients without a family history of premature CVD, those with 1 affected relative, and those with ≥2 affected first-degree relatives (56.6, 48.6 and 41.8 years, respectively) as well as those with affected first- and second-degree relatives (56.5, 50.7 and 47.0 years, respectively). Conclusions A younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature MI/ischaemic stroke. Thus, the family history of premature atherosclerosis involving not only first- but also second-degree relatives seems to be a valuable factor in CVD risk evaluation in young people. Graphical Abstract

A b s t r a c tBackground: Transcatheter closure of patent foramen ovale (PFO) and atrial septal defect (ASD) are procedures commonly performed in recent years.Aim: To assess long-term results of percutaneous closure of ASD and PFO in adult patients. Material and methods: The study group comprised 64 patients (45 women, mean age 50.5 ±12.7 years), who in 2004-2010 underwent percutaneous closure of ASD or PFO. The occurrence of clinical end-points in the follow-up and possible changes in quality of life and echocardiographic parameters were taken into consideration.Results: In a mean follow-up period of 310 ±305 days there were no deaths or recurrent neurological or peripheral embolic events. In patients with PFO there was no minimal residual shunt immediately after the procedure in transthoracic and transoesophageal echocardiography, while in patients with ASD early closure of the shunt (up to 24 h) was achieved in 64% of patients, and after 8 months of observation in 84%. The majority of patients were free of complications after the procedure, but one patient underwent urgent surgery after dislocation of the device within 3 h of the procedure and two patients were diagnosed with new-onset atrial fibrillation (AF) about one month after the procedure. Telephone survey revealed that most patients (81% of patients with ASD and 29% of patients with PFO) noted a marked improvement in health status, relief of symptoms of heart failure, syncope and other symptoms experienced prior to the procedure.Conclusions: Transcatheter closure of ASD and PFO is a safe and effective procedure. Moreover, a significant improvement of quality of life can be observed.Key words: transcatheter closure, atrial septal defect, patent foramen ovale, septal occluder, quality of life S t r e s z c z e n i e Wstęp: W ostatnich latach coraz szerzej stosowane są przezskórne techniki leczenia przetrwałego otworu owalnego (ang. patent foramen ovale, PFO) oraz ubytków w przegrodzie międzyprzedsionkowej (ang. atrial septal defect, ASD).Cel: Ocena odległych wyników przezskórnego zamknięcia ASD i PFO u dorosłych pacjentów. Materiał i metody: Badaniem objęto 64 chorych (45 kobiet, średni wiek 50,5 ±12,7 roku), u których w latach 2004-2010 wykonano zabieg przezskórnego zamknięcia ASD lub PFO. Oceniano występowanie klinicznych punktów docelowych w obserwacji odległej, zmiany parametrów echokardiograficznych w kontrolnych badaniach przezklatkowych i przezprzełykowych oraz jakość życia pacjentów.Wyniki: Średni czas obserwacji pacjentów po zabiegu wynosił 331 ±345 i 267 ±202 dni, odpowiednio u osób z ASD i PFO. W przypadku PFO nie obserwowano cech przecieku bezpośrednio po zabiegu w kontrolnym badaniu echokardiograficznym przezklatkowym i przezprzełykowym, natomiast u pacjentów z ASD wczesne całkowite zamknięcie przecieku (do 24 godz.) uzyskano u 64%, a w obserwacji 8-miesięcznej u 84% chorych. W obserwacji odległej u żadnego z pacjentów nie stwierdzono zgonu lub ponownego incydentu udarowego po zabiegu. U większości chorych nie zaobserwowano powikłań po zab...

Abstract Background: Premature coronary artery disease is one of the most pressing global issues in modern cardiology. The aim of the study was to investigate the role of family history of premature cardiovascular disease (CVD) in patients aged <50 years with myocardial infarction (MI) compared to that in patients aged ≥50 years with MI and to that in young people without MI (no-MI<50).Methods: The studied group (MI<50) consisted of 240 patients aged 26-49 years with MI. The control groups consisted of 240 patients (MI≥50) with MI aged 50-92 years and 240 healthy people aged 30-49 years without a history of MI (no-MI<50).Results: There were statistically significant differences between the MI<50 and MI≥50 and no-MI<50 groups regarding the family history of premature MI/ischaemic stroke and the percentage of patients with ≥2 relatives affected (10.8%, 2.9%, and 3.7%, respectively; p<0.0001). There was a statistically significant difference in the patient age at the first MI occurrence among patients without a family history of premature CVD, those with 1 affected relative, and those with ≥2 affected first-degree relatives (56.6, 48.6 and 41.8 years, respectively) as well as those with affected first- and second-degree relatives (56.5, 50.7 and 47.0 years, respectively). Conclusions: A younger age of patients with myocardial infarction is inversely associated with a higher number of relatives with a history of premature MI/ischaemic stroke. Thus, the family history of premature atherosclerosis involving not only first- but also second-degree relatives seems to be a valuable factor in CVD risk evaluation in young people.

Background. Premature coronary artery disease is one of the most pressing global issues in modern cardiology. The aim of the study was to investigate the role of family history of premature cardiovascular disease (CVD) in patients aged <50 years with myocardial infarction (MI) compared to that in patients aged ≥50 years with MI and to that in young people without MI (no-MI<50). Methods. The studied group (MI<50) consisted of 240 patients aged 26-49 years with MI. The control groups consisted of 240 patients (MI≥50) with MI aged 50-92 years and 240 healthy people aged 30-49 years without a history of MI (no-MI<50). Results. There were statistically significant differences between the MI<50 and MI≥50 and no-MI<50 groups regarding the family history of premature MI/ischaemic stroke and the percentage of patients with ≥2 relatives affected (10.8%, 2.9%, and 3.7%, respectively; p<0.0001). There was a statistically significant difference in the patient age at the first MI occurrence among patients without a family history of premature CVD, those with 1 affected relative, and those with ≥2 affected first-degree relatives (56.6, 48.6 and 41.8 years, respectively) as well as those with affected first- and second-degree relatives (56.5, 50.7 and 47.0 years, respectively). Conclusions. A younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature MI/ischaemic stroke. Thus, the family history of premature atherosclerosis involving not only first- but also second-degree relatives seems to be a valuable factor in CVD risk evaluation in young people.