The aim of the study was to estimate the direct and indirect effects of the COVID-19 pandemic on excess all-cause mortality in the Czech Republic by sex, age group and cause of death. National mortality data for the period 2015–2022 were used. For each of the COVID-19 pandemic years (2020–2022), national mortality rates were compared with 2015–2019, and mortality excess was estimated for all causes and selected causes of death separately by sex and age group. In the COVID-19 pandemic years 2020, 2021 and 2022, the overall excess in all-cause mortality was 15

OBJECTIVE:To describe the current epidemiology of overweight and obesity among pregnant women in Czechia in the context of demographic trends and basic perinatal outcomes. MATERIALS AND METHODOLOGY:The analysis was based on data from the National Reproductive Health Registry (NRRZ) from April 1 to September 30, 2025, focusing on 1st trimester BMI. Since April 1, 2025, the new Registry Report systematically records women's height and weight at the beginning and the end of pregnancy. First-trimester BMI and its associations with selected demographic characteristics (particularly age, education, and parity) and selected clinical indicators of pregnancy and delivery outcomes were evaluated. For comparison, data from the European Union Statistics on Income and Living Conditions (EU-SILC) and European Health Interview Survey (EHIS) were also used. A total of 23,573 women with complete 1st trimester BMI data were included in the analysis. RESULTS AND CONCLUSION:Among the 23,573 pregnant women with available BMI data, 53.4% were normal weight, 24.3% were overweight, and 17.7% were obese. Overweight and obesity were more frequent among older women, had lower educational attainment, and higher parity. Higher BMI was associated with an increased risk of preterm birth, foetal macrosomia, caesarean section, gestational hypertension, preeclampsia, and gestational diabetes. Overweight and obesity affect more than 40% of pregnant women in Czechia representing a significant risk factor for adverse perinatal outcomes. Systematic data collection allows, for the first time, a detailed national analysis and provides a basis for preventive interventions.

Objectives The evidence on coronavirus disease 2019 (COVID-19) vaccine uptake in Central and Eastern Europe remains sparse. We examined predictors of COVID-19 vaccination status in Czechia, using linkage of multiple routine nationwide datasets on objective measures of both vaccination and its predictors.Methods We used linked administrative data on 6 398 768 individuals aged 26 and older alive on 31 December 2023. Individual-level data were linked across national registries from the Infectious Diseases Information System, National Health Information System, the National Registry of Reimbursed Health Services, and the Ministry of Labour and Social Affairs.Results The prevalence of unvaccinated status was 22.4%; after multivariable adjustment it was associated with all examined characteristics (age, sex, comorbidity index, registration with a general practitioner (GP), socioeconomic status, unemployment, and district of residence). The prevalence of unvaccinated status among individuals defined by the lowest quintile of income receiving social benefits was 42.1%, and the multivariable adjusted odds ratio (OR) was 3.91 (95% CI 3.87-3.96) compared to the highest quintile; the adjusted OR among unemployed vs. employed subjects was 1.52 (95% CI 1.51-1.53). Higher morbidity index and being registered with a GP were associated with lower odds of unvaccinated status.Conclusions These results suggest substantial socioeconomic inequalities in objectively recorded vaccination status.

AIMS:Glucagon-like peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular risk in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease and are recommended in guidelines. We evaluated the real-world effectiveness of GLP-1RA therapy on cardiovascular outcomes in patients with T2D after myocardial infarction (MI) or ischemic stroke and examined trends and disparities. METHODS:Using nationwide Czech registry data (2015-2024), we identified patients with incident nonfatal MI or ischemic stroke and confirmed T2D. GLP-1RA users-initiating therapy within 12 months post-event-were propensity score-matched to non-users. The primary outcome was major adverse cardiovascular events (MACE: nonfatal MI, nonfatal stroke, cardiovascular death); secondary outcomes included individual components and all-cause mortality. RESULTS:GLP-1RA therapy was initiated in only ∼2% of MI and stroke survivors with T2D. Among 126,845 MI survivors, 28,206 had T2D; the matched cohort comprised 2,271 patients (401 GLP-1RA; median follow-up 35 months). GLP-1RA use was associated with lower risk of MACE (HR:0.7; 95%CI:0.52-0.93), all-cause (HR:0.61;95%CI:0.47-0.80) and cardiovascular death (HR:0.54, 95%CI:0.36-0.80). Among 177,115 stroke survivors, 73,750 had T2D; the matched cohort comprised 2,235 patients (385 GLP-1RA; median follow-up 27 months). GLP-1RA use was associated with lower risk of MACE (HR:0.71; 95%CI:0.54-0.94), all-cause (HR:0.59;95%CI:0.46-0.76) and cardiovascular death (HR:0.55; 95%CI:0.37-0.81). CONCLUSIONS:GLP-1RA therapy after MI or stroke in T2D was associated with substantially lower risks of MACE, cardiovascular and all-cause death in real-world practice. Utilization remained low, particularly among women and older adults, underscoring the need for broader and more equitable implementation in secondary prevention.

Background/Objectives: Coronary microvascular dysfunction (CMD) is considered a key mechanism of Takotsubo syndrome (TTS), but its phenotype-specific territorial distribution remains unclear. This study investigated CMD within the left anterior descending artery (LAD) and left circumflex/obtuse marginal/ramus intermedius (LCx/OM/RI) territories in apical (AP) and midventricular (MV) TTS. Methods: In this prospective single-centre study, 31 patients with acute TTS were enrolled (median age, 71 years; 93.5% women; 20 AP and 11 MV). During the acute phase, coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and fractional flow reserve (FFR) were assessed invasively in both territories. CMD was defined as CFR ≤ 2 and/or IMR > 25; the neutral descriptive subtypes Pattern A (CFR ≤ 2 with IMR ≤ 25) and Pattern B (CFR ≤ 2 with IMR > 25) were distinguished. Results: FFR was ≥0.80 in all patients, excluding haemodynamically significant epicardial disease; at least one abnormal microvascular parameter was present in 26/31 patients (83.9%). LAD-CFR was significantly lower in AP than in MV TTS (1.6 vs. 2.6; p = 0.003), whereas LCx/OM/RI-CFR did not differ (1.6 vs. 1.5; p = 0.679). Bifocal CFR reduction predominated in AP TTS (55.0% vs. 9.1%; p = 0.020), whereas isolated LCx/OM/RI involvement occurred only in MV TTS (45.5% vs. 0.0%; p = 0.003). Pattern B in the LAD territory was more common in AP TTS (50.0% vs. 9.1%; p = 0.047). Conclusions: In this cohort, TTS showed a phenotype-specific territorial distribution of CMD: the apical phenotype predominantly involved Pattern B in the LAD territory, whereas the midventricular phenotype showed isolated LCx/OM/RI involvement within the interrogated left coronary circulation. These hypothesis-generating findings suggest phenotype-associated differences that require confirmation in larger, adequately powered cohorts.

BACKGROUND:Approximately 20% of pregnant women have elevated lipid levels. While nonpharmacological therapy suffices for most patients, some require pharmacotherapy. OBJECTIVE:This study analyzed the outcomes of pregnancy in women treated with lipid-lowering drugs. METHODS:Nationwide data on all births and abortions in the Czech Republic (2011-2023) were obtained from the National Registry of Reproductive Health and the National Registry of Reimbursable Health Services. Women with preexisting lipid disorders who were prescribed any lipid-lowering drug from select Anatomical Therapeutic Chemical groups (C10A, C10B) within 1 year before pregnancy, and women with treatment initiation during pregnancy, were included in the analysis. Univariate logistic regression was performed to calculate the odds ratios (ORs) for adverse outcomes. RESULTS:Among 1,342,432 deliveries, 1100 women were treated with lipid-lowering drugs during pregnancy. Statin treatment had increased odds of cesarean section (OR 1.68-1.96), preterm delivery (OR 1.42-2.58), and low birth weight (OR 1.23-2.16). Atorvastatin and rosuvastatin were comparably safe, but simvastatin had higher odds of complications. Treatment with cholestyramine was associated with higher odds of cesarean section (OR 2.45), preterm delivery (OR 4.78), and low birth weight (OR 3.16) compared to fenofibrate or statins. No detrimental effect on neonatal hypoxia was observed. The fixed combination of atorvastatin and amlodipine was limited in use but associated with a higher risk of adverse outcomes. CONCLUSION:Atorvastatin and rosuvastatin had a relatively low risk of adverse maternal and fetal outcomes, comparable to fibrates. Cholestyramine and the fixed combination of statin and amlodipine were associated with increased risk.

INTRODUCTION:The prospective SENTIX study (NCT02494063) demonstrated non-inferiority in PFS of sentinel lymph node biopsy (SLNB) without pelvic lymphadenectomy (PLND) compared with the reference rate. We report the final analysis of quality of life (QoL), lower limb lymphoedema (LLL), and postoperative complications. METHODS:Patients with early-stage cervical cancer (tumours ≤4 cm) underwent SLNB. Patients with bilateral SLN detection and negative frozen sections (SLN group; n = 594) did not undergo further lymphadenectomy. Patients with unilateral or unsuccessful SLN detection underwent unilateral or bilateral PLND (PLND group; n = 134), enabling comparison of morbidity, lymphoedema and quality-of-life outcomes. EORTC QLQ-C30 was completed at baseline, 6, 12, and 24 months. LLL was assessed subjectively as patient-reported lymphoedema (S-LLL) and objectively (O-LLL) using circumferential measurements of both limbs. RESULTS:Global Health Status and functional scales were preserved in the SLN group, whereas the PLND group showed small declines in several functional domains that did not reach the threshold for clinical relevance. Fatigue and pain were transient after surgery, resolving by 6-12 months. Severe O-LLL was rare (≤2% of patients in both groups). S-LLL occurred less frequently in the SLN group (7% vs. 16%), and cases of LLL were more often graded as mild after SLNB. Symptomatic lymphoceles were rare, with no difference between groups. Early postoperative complications occurred in 12.5% vs. 21.5% of patients in the SLN and PLND groups (P = 0.01), with most being grade I-II. CONCLUSION:SLNB was associated with preserved QoL, less frequent and milder lymphoedema, and fewer early postoperative complications than PLND.

OBJECTIVE:To assess sentinel lymph node (SLN) bilateral detection rate, anatomical distribution, and tracer performance in early-stage cervical cancer patients undergoing primary surgery, based on data from the prospective multicenter SENTIX trial. METHODS:Patients with FIGO 2018 stage IA1 (LVSI+) to IB2 cervical cancer and no suspicious lymph nodes on preoperative imaging were enrolled in the SENTIX trial. SLN biopsy was performed using blue dye (BD), radiocolloid (RC), indocyanine green (ICG), or their combinations. Only patients with successful bilateral SLN detection and negative intraoperative frozen section proceeded to radical hysterectomy or fertility-sparing surgery. SLN locations and metastatic status were documented by anatomical region and centrally reviewed for consistency. RESULTS:Among 724 patients who underwent SLN biopsy, the overall bilateral detection rate was 92.3 %, with the highest rate (100 %) achieved using ICG and RC combination. If mapping-failure cases were considered, the bilateral detection rate would be 84.6 %. Most SLNs (91.6 %) were located at pelvic level I, predominantly in the external iliac and interiliac regions. SLNs above the interiliac bifurcation were infrequent (2.7 %), and isolated positive SLNs in pelvic level II were rare (1.3 %). No SLNs were identified in paraaortic regions. Bilateral detection was unaffected by BMI, histology, or prior conization. Although detection was slightly lower in tumors >2 cm, bilateral rates exceeded 90 %. CONCLUSIONS:SLN mapping demonstrated high bilateral detection across tracers and patient subgroups. Nearly all SLNs were confined to pelvic level I, underscoring anatomical predictability. These results demonstrate reproducible SLN mapping in tumors ≤4 cm and may help inform individualized surgical planning.

Background and Aims Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndrome (ACS). Methods Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n = 4787) and in validation cohorts from the UK (n = 1141), Czechia (n = 927), and Germany (n = 220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated. Results On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI [per log2 increase: adjusted odds ratio 1.53, 95% confidence interval (CI) 1.13-2.09, P = .007] and 30-day mortality (adjusted hazard ratio 2.73, 95% CI 1.85-4.02, P < .001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of .72 (95% CI .68-.76) for in-hospital AKI and .91 (95% CI .87-.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC .73, 95% CI .70-.77; Czechia: AUC .75, 95% CI .68-.81; Germany: AUC .71, 95% CI .55-.87) and 30-day mortality (UK: AUC .87, 95% CI .83-.91; Czechia: AUC .91, 95% CI .87-.94; Germany: AUC .96, 95% CI .92-1.00), outperforming the contrast-associated AKI score and the Global Registry of Acute Coronary Events 2.0 score, respectively. Conclusions Circulating PENK offers incremental value for predicting in-hospital AKI and mortality in ACS. The simple six-item KID-ACS risk score integrates PENK and provides a novel tool for simultaneous assessment of renal and mortality risk in patients with ACS.

Integrating data and information systems into national health strategies is crucial in addressing the growing health care demands. This increase is driven by an aging population and the rising prevalence of chronic diseases. Such systems enable the collection, analysis, and publication of health data and provide critical insights based on data-driven decision-making that support policy decisions, health interventions, and service delivery. Moreover, the systems enhance the capacity for public health surveillance and enable health authorities to monitor health trends, predict disease outbreaks, and effectively manage health crises such as the recent COVID-19 pandemic. This paper highlights the key aspects and characteristics that, according to international references, a well-functioning health information system and data-driven decision-making at the national level should have. We present the outputs in the form of the National Health Data-Sharing Strategy for the Czech Republic, along with successfully implemented case studies across selected domains of its health care system. The Czech National Health Information System has been established as the backbone for centralizing health data. It is a nationwide public administration tool that collects and processes data from the essential registries of public administration bodies, ministries, health services providers, or other persons submitting data to this system. It is the foundation for shaping a health care system that is responsive to patient needs, ensures efficient resource use, and promotes a patient-centered approach. Two examples are given of the tracking of fictitious patient pathways through the health care system. The take-home message of the study is a policy-oriented endorsement of comprehensive, secure, and interoperable health information systems as the basic infrastructure for modern, patient-centered, and data-driven health care. The paper strongly advocates the National Health Information System of the Czech Republic as the primary health database for designing, implementing, and governing such a system in alignment with European and global standards.

OBJECTIVES:Heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) frequently coexists with atrial fibrillation (AF), leading to worse prognosis and greater therapeutic complexity. Although beta-blockers (BBs) are a cornerstone of HF treatment, their benefit in patients with AF remains unclear. METHODS:We analyzed 1088 patients with stable chronic HF and left ventricular ejection fraction < 50% enrolled in the multicentre FAR NHL registry. Patients were stratified by the presence of AF and achieved BB dose: low ( < 25%), medium (25-49%), or high (≥50% of target). The primary endpoint was a composite of all-cause mortality, hospitalization for acute HF, left ventricular assist device (LVAD) implantation, or heart transplantation. RESULTS:AF was present in 379 patients (34.5%). BBs were prescribed to 94% of patients, but only 17% achieved high-dose therapy. The event rate was higher in AF patients (28.0%) than in those without AF (20.5%, p = 0.005). High BB dose was independently associated with a lower risk of the primary endpoint (HR 0.62, 95% CI 0.48-0.80; p < 0.001), consistently across both rhythm group. CONCLUSION:Higher BB doses were associated with improved outcomes in patients with chronic HF, regardless of AF status. These real-world data support up-titration of BBs as a key component in optimized guideline-directed therapy, even in patients with coexisting AF.

Patients with acute myocardial infarction (AMI) who have concomitant peripheral artery disease (PAD) represent a subgroup at high risk of subsequent ischaemic events. This post hoc analysis of PRAGUE-18, a multicenter, randomised trial comparing prasugrel versus ticagrelor in primary PCI, analysed the effect of symptomatic PAD and intensity of antithrombotic therapy on the prognosis of AMI patients treated with primary percutaneous coronary intervention (PCI). During 12-month follow-up, de-escalation from intensive antiplatelet therapy to clopidogrel was allowed with the permission of the treating physician for economic reasons. Symptomatic PAD was present in 2.9% of the study population (n = 1230). The presence of PAD did not significantly affect short-term outcome. At one year, the risk of death was higher in patients with concomitant PAD, 49 (4.1%) vs. 6(16.7%), HR 4.211 (1.803–9.830); p = 0,001. All-cause mortality significantly increased only in subgroup of patients who de-escalated to clopidogrel [6.37 (2.16–18.84), p = 0.001] as opposed to those who did not [3.02 (0.72–12.61), p = 0.13]. These findings suggest that long-term intensive antithrombotic therapy may be particularly important for post-AMI patients with concomitant symptomatic PAD and warrant further investigation.

OBJECTIVE:This study aims to present the methodological framework and analytical approaches for utilizing national individual-level data on diabetes mellitus in pregnancy, a condition that poses a significant risk to the health of both mother and child. MATERIALS AND METHODOLOGY:The National Health Information System serves as the central repository for data on the Czech healthcare system. Through the integration of various recorded datasets, it enables detailed analysis of the incidence of diabetes mellitus in connection with pregnancy, provided that an appropriate analytical algorithm is applied. The input dataset for the analysis consisted of births recorded between 2012 and 2023 in the National Register of Reproductive Health, specifically the Mothers module. In total, 1,240,227 births were included in the analysis. For each case, the presence of the disease was verified using records from the National Register of Reimbursed Health Services. RESULTS AND CONCLUSION:Based on the defined criteria, including specific medications, reported medical procedures, medical devices, and disease diagnoses, the prevalence of diabetes mellitus among parturient women was determined to be 15.4%. Thanks to the interconnected structure of the National Health Information System and newly established definition of a pregnant woman with diabetes, it will be possible to continue analyzing the prevalence and health impacts of this condition at the national level.

Background: Coronary artery disease (CAD) is the leading cause of death worldwide, which has driven significant advances in the field of interventional cardiology. The combination of intravascular ultrasound (IVUS) and near-infrared light spectroscopy (NIRS) offers a detailed view of coronary artery morphology and plaque composition. This advanced imaging capability facilitates a more accurate assessment of CAD and enhances therapeutic strategies. Objective: NIRS can detect and quantify lipid content in atherosclerotic plaque using the Lipid Core Burden Index (LCBI) and the Maximal Lipid Core Burden Index in a 4 mm segment (maxLCBI4mm). In this study, we examined the relationship between these indices and atherosclerotic plaque progression in the crucial area of the left main coronary artery (LM) during a follow-up period of 9 to 12 months after percutaneous coronary interventions (PCI). Methods: A prospective, single-centre study was conducted involving 27 patients with significant left main stenosis who underwent IVUS-NIRS guided PCI. Serial assessments of the LCBI, maxLCBI4mm, and IVUS-derived plaque volume (PV) were performed at baseline, immediately post-PCI, and during follow-up at 9 to 12 months in 18 patients. Results: The mean age of the study population was 72.7 years, with a predominance of male patients (88%). The average LCBI of the LM coronary artery before PCI was 128.9 +/- 122.0, while maxLCBI4mm was 263.7 +/- 172.0. The IVUS-measured PV post-PCI was 418.7 +/- 203.3 mm3, increasing to 454.5 +/- 209.4 mm3 at follow-up (p = 0.105). Analysis revealed no significant correlation between the difference in PV and baseline LCBI or maxLCBI4mm, with p-values of 0.626 and 0.786, respectively. Conclusion: This study found no significant association between initial LCBI and maxLCBI4mm segment values and subsequent changes in PV in the left main coronary artery. However, correlation graphs indicate a trend toward decreased PV in patients with high initial LCBI and maxLCBI4mm.