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Due to the complexity of heart failure (HF) and its treatment process, a high level of patient and informal caregiver engagement is required for management results. We aimed to explore the views of HF patients, informal caregivers, and healthcare professionals about personal experiences, perceived needs, and barriers to optimal HF management. A qualitative study using semi-structured interviews with HF patients ( n = 32), their informal caregivers ( n = 21), and healthcare professionals ( n = 5) was conducted in the outpatient HF clinic in Slovenia in 2018. A content analysis method was used to analyze the data. Negative emotional response to disease and its limitations (especially the inability to continue with work) and changes in family roles were the most prevalent topics regarding the impact of HF on livelihood. Among the most common barriers to HF self-care, were the difficulties in changing lifestyle, financial difficulties due to the disease, traditional cuisine/lack of knowledge regarding a healthy diet and lack of self-confidence regarding physical activity. Despite psychological and social difficulties due to HF being highlighted by patients and informal caregivers, only healthcare professionals emphasized the need to address psychosocial aspects of care in HF management. Established differences could inform the implementation of necessary support mechanisms in HF management., Competing Interests: The authors declare no conflict of interest.

Aims: Epidemiological heart failure (HF) data in the era of natriuretic peptides and echocardiography are scarce. The primary aim of this study is to evaluate the HF prevalence in the general population. We will also investigate natriuretic peptide cut-off for diagnosis of HF. Finally, we will be able to identify left ventricular function phenotypes and study relations between cardiac function, clinical presentation, and health-related quality of life., Methods and Results: Screening Of adult urBan pOpulation To diAgnose Heart Failure (SOBOTA-HF) is a cross-sectional prevalence study in a representative sample of Murska Sobota residents aged 55 years or more. Individuals will be invited to attend screening visit with point-of-care N-terminal pro-b-type natriuretic peptide (NT-proBNP) testing. All subjects with NT-proBNP ≥ 125 pg/mL will be invited for a diagnostic visit that will include history and physical examination, electrocardiogram, echocardiography, blood and urine sampling, ankle brachial index, pulmonary function tests, body composition measurement, physical performance tests, and questionnaires. To validate the screening procedure, a control group (NT-proBNP < 125 pg/mL) will undergo the same diagnostic evaluation. An external centre will validate echocardiography results, and the HF diagnosis will be adjudicated within an international HF expert panel. Overall and age-specific HF prevalence will be calculated in individuals ≥ 55 years and extrapolated to the whole population., Conclusions: The SOBOTA-HF study will test the latest HF guideline diagnostic criteria in the general population sample. Next to HF prevalence, it will provide insight into left ventricular function and general patient phenotype; we will also extend current understanding of natriuretic peptides for HF screening., (© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Aims: Heart failure (HF) burden is displaying significant inter-regional differences within Europe and within countries. Due to limited data focusing on regional differences, our aim was to evaluate HF hospitalizations, readmissions, and mortality burden in Slovenian statistical regions., Methods and Results: The Slovenian National Hospitalization Discharge Registry was searched for HF hospitalizations in patients 20 years or over in the period 2004-12. Annual sex and age-standardized HF hospitalizations, mortality, and HF readmissions rates were calculated for Slovenia and for each Slovenian statistical region. Trends were evaluated using ANOVA. Multiple mixed effect logistic regression models, which included statistical region, admission year, sex, age, intensive care unit treatment, and co-morbidities as a fixed effect and hospital identifier as a random effect, were calculated for mortality and readmissions. Overall, 156 859 HF hospitalizations (55 522 where HF was coded as a main diagnosis and 43 606 as first HF hospitalizations) were recorded. Annual standardized rates varied considerably between statistical regions for main (220-511) and first HF hospitalization (392-721), 30 day (12.6-27.1) and 1 year mortality (66-117), and 30 day (31-80.8) and 1 year readmission (99-24) (per 100 000 patient years in 2012). Yearly decline in HF hospitalization rates was seen for national main (3.6; 0.001) and first (8.4; 0.083) HF hospitalizations, while individual regional main and first HF hospitalization trends mostly did not reach statistical significance. No relevant differences in mortality and readmission endpoints for statistical regions were seen when adjusted for patient demographics and specific co-morbidities., Conclusions: Significant regional differences in standardized HF hospitalization, mortality, and readmissions between the regions were seen. There were no differences in mortality and readmissions between statistical regions for individual similar patients., (© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Background: In heart failure (HF), comorbidity burden and prognostic risks increase with age. Studies investigating outcome in elderly patients from large datasets are lacking, particularly in central and eastern European countries. We analyzed the Slovenian data on mortality and readmissions after first HF hospitalization in patients aged 65 years or over., Methods: In this observational epidemiological study, the Slovenian national hospitalization database was searched for HF patients aged ≥65 years with first HF hospitalization between 2008 and 2012. All-cause mortality and readmissions were compared in young-olds (65-74 years), middle-olds (75-84 years), and old-olds (≥85 years) using cumulative probability plots and log rank test. The prognostic value of comorbidities on mortality and readmissions for age groups were assessed using multiple Cox proportional hazards models., Results: Overall, 36,824 patients were included (median age 80 years, 41 % men, 20 % in-hospital mortality). The proportions of young-olds, middle-olds, and old-olds were 26, 48, and 26 %, respectively. Arterial hypertension (60 %), pulmonary disease (44 %), and atrial fibrillation (38 %) were the most prevalent comorbidities, with little variation over age. While age group was associated with higher mortality (P < 0.001), no such associations were seen for readmissions at any time points (P > 0.1 for all). Importance of comorbidities as a predictor for mortality faded with increasing age while only small decrease in hazard ratios for readmissions were seen., Conclusions: Age is an independent predictor of mortality but not readmissions in elderly patients with first HF hospitalization. Comorbidities are important predictors for mortality and readmissions in elderly.

The study of atmospheric air pollution research in complex terrains is challenged by the lack of appropriate methodology supporting the analysis of the spatial relationship between phenomena affected by a multitude of factors. The key is optimal design of a meaningful approach based on small spatial units of observation. The Zasavje region, Slovenia, was chosen as study area with the main objective to investigate in practice the role of such units in a test environment. The process consisted of three steps: modelling of pollution in the atmosphere with dispersion models, transfer of the results to geographical information system software, and then moving on to final determination of the function of small spatial units. A methodology capable of designing useful units for atmospheric air pollution research in highly complex terrains was created, and the results were deemed useful in offering starting points for further research in the field of geospatial health.

The aim of this study was to estimate the population burden of respiratory diseases in the Zasavje region of Slovenia that can be attributed to outdoor air pollution in order to gain relevant grounds for evidence based public health activities. In 2008, 981 schoolchildren (age 6 to 12 years) were observed in a prevalence study. The prevalence of chronic respiratory diseases (CRD) and frequent acute respiratory symptoms (FARS) was related to the level of outdoor air pollution in the local environment (low, moderate and high pollution areas). Logistic regression was used as a method for statistical analysis. The prevalence of CRD was 3.0 % in low pollution areas, 7.5 % in moderate pollution areas, and 9.7 % in high pollution areas (p=0.005). After adjustment for the effects of confounders, 2.91-times higher odds for CRD were registered in high pollution areas in comparison to low pollution areas (p=0.017). The prevalence of FARS was: 7.8 % in low pollution areas, 13.3 % in moderate pollution areas and 15.9 % in high pollution areas (p=0.010). After adjustment for the effects of confounders, 2.02-times higher odds for FARS were registered in high pollution areas in comparison to low pollution areas (p=0.023). The study confirmed a significantly higher prevalence of CRD and FARS in children living in high pollution areas of Zasavje. These results at least partially prompted mutual understanding and cross-sectoral cooperation - prerequisites for solving complex problems involving the impact of air pollution on health.

Background: Limited information is available about Mini Nutritional Assessment (MNA) questionnaire in patients with chronic obstructive pulmonary disease (COPD). We have conceived this analysis to study the associations between MNA questionnaire, body composition, and rehospitalisations in patients with COPD., Methods: This prospective study recruited control subjects and COPD patients for pulmonary function testing, nutritional assessment using MNA questionnaire, body composition measurement, and dyspnoea evaluation. We recorded hospitalisations during 6 months after discharge., Results: Our sample included 22 healthy controls (71 ± 5 years, 59% men) and 108 COPD patients (71 ± 10 years, 75% men, 85% severe or very severe COPD). MNA score was significantly higher in control subjects than in COPD patients (27.0 ± 1.7 vs 21.2 ± 4.9, p < 0.001). MNA score decreased over GOLD stage (p = 0.02) and indicated malnutrition in 14% of patients, and further 55% were at risk of malnutrition. Body mass index but not body composition parameters was higher in control subjects when compared to COPD patients (29.1 ± 3.8 vs 27.0 ± 6.3, p = 0.041). A positive correlation between MNA score, body fat content (p = 0.001), and lean body mass (p < 0.001) was observed. During follow-up, 45 (41%) patients were rehospitalised. Malnourished patients had higher risk of rehospitalisation in univariate analysis (HR 2.62, 95%Cl 1.13-6.07), which was maintained in an adjusted model (HR 2.93, 95%CI 1.05-7.32)., Conclusions: Malnutrition and risk of malnutrition was frequent, associated with lower body fat mass and lean body mass, and independently predicted hospitalisations at six months., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: Self-rated health can be influenced by several characteristics of the social environment. The aim of this study was to evaluate the relationship between self-rated health and self-assessed social class in Slovenian adult population., Methods: The study was based on the Countrywide Integrated Non-communicable Diseases Intervention Health Monitor database. During 2004, 8,741/15,297 (57.1%) participants aged 25-64 years returned posted self-administered questionnaire. Logistic regression was used to determine unadjusted and adjusted estimates of association between poor self-rated health and self-assessed social class., Results: Poor self-rated health was reported by 9.6% of participants with a decrease from lower to upper-middle/upper self-assessed social class (35.9 vs. 3.7%). Logistic regression showed significant association between self-rated health and all self-assessed social classes. In an adjusted model, poor self-rated health remained associated with self-assessed social class (odds ratio for lower vs. upper-middle/upper self-assessed social class 4.23, 95% confidence interval 2.46-7.25; P < 0.001)., Conclusions: Our study confirmed differences in the prevalence of poor self-rated health across self-assessed social classes. Participants from lower self-assessed social class reported poor self-rated health most often and should comprise the focus of multisectoral interventions.

Aims: In patients with chronic heart failure (CHF), there is limited information on self-rated health (SRH). We aimed to examine the distribution of SRH and whether SRH is associated with mortality in patients with stable CHF., Methods and Results: We enrolled 100 patients (71 +/- 11 years, 54% men, left ventricular ejection fraction 47 +/- 11%) in a prospective study with 48 months of follow-up. Self-rated health was assessed using a seven-grade descriptive scale: very good, good, quite good, average, quite poor, poor, and very poor. Median SRH was quite poor and the most frequent SRH (31 patients) was average. During an average follow-up of 1005 +/- 507 days, 58 patients died. More patients in the group that rated their health as quite poor or worse died (70% vs. 43%, P = 0.008). In a Cox proportional hazard model, SRH as a seven-grade descriptive scale [hazard ratios (HR) 1.39, 95% CI 1.10-1.74] or as a median value (HR 2.13, 95% CI 1.23-3.69) predicted mortality. The association remained significant after adjustment for patient characteristics and biomarkers (P < 0.05 for both)., Conclusion: In patients with stable CHF, SRH independently predicts mortality. This suggests that SRH could be used in everyday clinical practice to obtain important prognostic information beyond clinical examination and laboratory work-up.