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Kempa M, Sławiński G, Zieleniewicz P, Lewicka E, Budrejko S, Daniłowicz-Szymanowicz L. Optimizing sudden cardiac death prevention: a promise of wearable cardioverter-defibrillator. Pol Arch Intern Med 2024; 134:16675. [PMID: 38324344 DOI: 10.20452/pamw.16675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland.
| | - Piotr Zieleniewicz
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
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Hawryszko M, Sławiński G, Zieleniewicz P, Budrejko S, Daniłowicz-Szymanowicz L, Kempa M. When standard cardiac diagnostics fail: the key role of the Apple Watch in confirming the diagnosis of pacemaker ventricular lead damage. Pol Arch Intern Med 2023; 133:16560. [PMID: 37732889 DOI: 10.20452/pamw.16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Maja Hawryszko
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland.
| | - Piotr Zieleniewicz
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | | | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
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Sławiński G, Zieleniewicz P, Młyński M, Budrejko S, Królak T, Daniłowicz-Szymanowicz L, Kempa M. Optimal hospital discharge time after cardiac implantable electronic device implantation: A retrospective study from a tertiary electrotherapy center. Kardiol Pol 2023; 82:206-209. [PMID: 37718580 DOI: 10.33963/v.kp.97210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland.
- Club 30, Polish Cardiac Society, Poland.
| | - Piotr Zieleniewicz
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Mikołaj Młyński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | | | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
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Sławiński G, Zieleniewicz P, Faran A, Dąbrowska-Kugacka A, Kurzyna M, Kempa M, Daniłowicz-Szymanowicz L, Lewicka E. Case report: Transected Hickman catheter and its thrombotic occlusion in a patient with idiopathic pulmonary arterial hypertension-can a catheter replacement be avoided? Front Cardiovasc Med 2023; 10:1230417. [PMID: 37547245 PMCID: PMC10397384 DOI: 10.3389/fcvm.2023.1230417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
A 25-year-old female with idiopathic pulmonary arterial hypertension (PAH), who had a Hickman catheter implanted for continuous intravenous epoprostenol infusion, was admitted to the clinic after inadvertently cutting the catheter with nail scissors during a routine dressing change. Approximately 7 cm of the external segment of the Hickman catheter remained intact, with the distal end knotted by paramedics. A decision was made to repair the damaged Hickman catheter. However, it was discovered that its lumen was completely occluded by thrombosis. Therefore, catheter patency was mechanically restored using a 0.035-inch stiff guidewire in a sterile operating theatre setting, under fluoroscopy guidance. Successful aspiration and catheter flushing were achieved. Continuity of the Hickman catheter was then restored using a repair kit (Bard Access Systems) as per the manufacturer's instructions, with no visible leakage thereafter. Epoprostenol infusion through the Hickman catheter was resumed 24 h later, and the patient was discharged in good general condition two days afterward.
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Affiliation(s)
- Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
- Club 30, Polish Cardiac Society, Warsaw, Poland
| | - Piotr Zieleniewicz
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Faran
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education in EHC Otwock, ERN-Lung Member, Otwock, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Kempa M, Sławiński G, Zieleniewicz P, Dziurkowski Ł, Wabich E, Budrejko S, Zienciuk-Krajka A, Daniłowicz-Szymanowicz L. Implementation of remote monitoring in patients implanted with T-ICD and S-ICD involved in a recall campaign: An excellent tool with insufficient availability. Kardiol Pol 2023; 81:VM/OJS/J/94396. [PMID: 36871303 DOI: 10.33963/kp.a2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland.
| | - Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- Club 30, Polish Cardiac Society, Poland
| | - Piotr Zieleniewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Łukasz Dziurkowski
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Elżbieta Wabich
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Kalarus Z, Średniawa B, Mitręga K, Wierucki Ł, Sokal A, Lip G, Bandosz P, Stokwiszewski J, Boidol J, Zieleniewicz P, Rutkowski M, Kaźmierczak J, Opolski G, Grodzicki T, Zdrojewski T. Prevalence of atrial fibrillation in the 65 or over Polish population. Report of cross-sectional NOMED-AF study. Kardiol Pol 2023; 81:14-21. [PMID: 36043418 DOI: 10.33963/kp.a2022.0202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by an increased risk of thromboembolic complications that can be markedly reduced with anticoagulation. There is a paucity of studies assessing the total prevalence of AF in national populations. AIMS To assess the nationwide prevalence of AF in a population of adults ≥65 old and to determine the impact of duration of electrocardiogram (ECG) monitoring on the number of newly detected AF episodes. METHODS The NOMED-AF study (ClinicalTrials.gov; NCT: 0324347) was a cross-sectional study performed on a nationally representative random sample of 3014 Polish citizens 65 years or older. Final estimates were adjusted to the national population. All participants underwent up to 30 days of continuous ECG monitoring. Total AF prevalence was diagnosed based on the patient's medical records or the presence of AF in ECG monitoring. RESULTS The prevalence of AF in the Polish population ≥65 years was estimated as 19.2% (95% confidence interval [CI], 17.9%-20.6%). This included 4.1% (95% CI, 3.5%-4.8%) newly diagnosed cases and 15.1% (95% CI, 13.9%-16.3%) previously diagnosed cases and consisted of 10.8% (95% CI, 9.8%-11.9%) paroxysmal AF and 8.4% (95% CI, 7.5%-9.4%) persistent/permanent AF. The incidence of all paroxysmal AF events as a function of ECG monitoring duration increased from 1.9% (95% CI, 1.4%-2.6%) at 24 hours to 6.2% (95% CI, 5.3%-7.2%) at 4 weeks. CONCLUSIONS The prevalence of AF in elderly adults is higher than estimated based on medical records only. Four weeks of monitoring compared to 24-hour ECG Holter allow detection of 7-fold more cases of previously undiagnosed paroxysmal AF.
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Affiliation(s)
- Zbigniew Kalarus
- DMS in Zabrze, Medical University of Silesia, Department of Cardiology, Katowice, Poland.,Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, Zabrze, Poland
| | - Beata Średniawa
- DMS in Zabrze, Medical University of Silesia, Department of Cardiology, Katowice, Poland.,Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, Zabrze, Poland
| | - Katarzyna Mitręga
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Łukasz Wierucki
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
| | - Adam Sokal
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.
| | - Gregory Lip
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Piotr Bandosz
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
| | | | - Joanna Boidol
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Piotr Zieleniewicz
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
| | - Marcin Rutkowski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
| | | | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
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Sredniawa B, Mitrega K, Stokwiszewski J, Sokal A, Boidol J, Wierucki L, Zieleniewicz P, Rajca A, Bandosz P, Zdrojewski T, Opolski G, Kazmierczak J, Grodzicki T, Lip G, Kalarus Z. Screening for atrial fibrillation in subjects aged 65 using a long-term continuous ECG telemonitoring vest: the NOninvasive Monitoring for early detection of atrial fibrillation (NOMED-AF) study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) confers a high healthcare burden from stroke, heart failure, dementia and hospitalisation, and one challenge is. Early detection of this arrhythmia in the community, given that it is often asymptomatic.
Aim
To perform population screening for atrial fibrillation and flutter (AF/AFl) using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population aged ≥65 years (age range 65–100 years).
Methods
The NOMED-AF study is a cross-sectional study based on a representative sample of adults aged ≥65 years (n=3014; mean age 77.5±7.9 years; 49.1% female). All study participants were equipped with a mobile long-term continuous ECG telemonitoring vest. National and European estimations were calculated on weighted data.
Results
In 680 subjects AF/AFl (including 279 with SAF; 9.3%) was confirmed. In the NOMED-AF population, the prevalence of AF/AFl was 22.6%, estimated to be 19.2% for Poland [1,251,100 (95% CI: 1,158,300–1,344,000) and 480,100 (95% CI: 426,60–533,700) subjects with AF/AFl and SAF, respectively] and 20.4% for Europe [20,300,000 (95% CI 18.8–21.9 M), including 8,000,000 (95% CI: 6.9–9.3 M) subjects with AF/AFl and SAF, respectively]. The prevalence of AF/AFl was 2.56-fold higher in men than in women and the incidence of silent AF (SAF) was 4.73-fold higher in men than in women. Although the risk of either AF/AFl or SAF increased with age, the odds ratio was significantly higher in women of a particular age group than in men of the corresponding age. Based on our survey, the total number of subjects with AF/AFl in Europe is estimated to be roughly 20.3 million (95% CI 18.8–21.9M), including 8.0 million (95% CI: 6.9–9.3M) subjects with silent AF/AFl (Figure).
Conclusions
Approximately 1 in 5 subjects aged ≥65 years suffers from AF/AFl. The risk for AF/AFl and SAF is higher in men than that in women, but when correlated to a particular age group, the risk increases significantly in women. Continuous ECG telemonitoring allows for more credible AF/AFl and SAF detection.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): The research has received funding from the National Centre for Research and Development under grant agreement (STRATEGMED2/269343/18/NCBR/2016
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Affiliation(s)
- B Sredniawa
- DMS in Zabrze, Medical University of Silesia, Department of Cardiology, Katowice, Poland
| | - K Mitrega
- Silesian Center of Heart Diseases, Department of Cardiology, Zabrze, Poland
| | - J Stokwiszewski
- National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | - A Sokal
- Silesian Center of Heart Diseases, Department of Cardiology, Zabrze, Poland
| | - J Boidol
- Silesian Center of Heart Diseases, Department of Cardiology, Zabrze, Poland
| | - L Wierucki
- Medical University of Gdansk, Department of Preventive Medicine and Education, Gdansk, Poland
| | - P Zieleniewicz
- Medical University of Gdansk, Department of Preventive Medicine and Education, Gdansk, Poland
| | - A Rajca
- Medical University of Gdansk, Department of Preventive Medicine and Education, Gdansk, Poland
| | - P Bandosz
- Medical University of Gdansk, Department of Preventive Medicine and Education, Gdansk, Poland
| | - T Zdrojewski
- Medical University of Gdansk, Department of Preventive Medicine and Education, Gdansk, Poland
| | - G Opolski
- Medical University of Warsaw, First Chair and Department of Cardiology, Warsaw, Poland
| | - J Kazmierczak
- Pomeranian Medical University, Department of Cardiology, Szczecin, Poland
| | - T Grodzicki
- Jagiellonian University Medical College, Department of Internal Medicine and Gerontology, Krakow, Poland
| | - G.Y.H Lip
- University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Z Kalarus
- DMS in Zabrze, Medical University of Silesia, Department of Cardiology, Katowice, Poland
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Zieleniewicz P, Zdrojewski T. Current guidelines and controversies in the diagnosis and therapy of hypertension in the elderly and very elderly — a review of international recommendations. Arterial Hypertension 2020. [DOI: 10.5603/ah.a2020.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wyszomirski A, Pencina MJ, Whelton PK, Wojtyniak B, Gaciong Z, Bandosz P, Zieleniewicz P, Zdrojewski T. P6365Contrasting the impact of the European (ESC/ESH 2018) versus American (ACC/AHA 2017) high blood pressure clinical practice guidelines in Poland. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for the management of arterial hypertension and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the prevention, detection, evaluation, and management of high blood pressure in adults differ in approach to defining stages of hypertension and recommendations for treatment of high blood pressure.
Purpose
To contrast the implications of the ESC/ESH versus ACC/AHA hypertension guidelines among the general population in Poland – a country representing a high CVD risk region in Europe.
Methods
We used data from a representative random sample of 1439 Polish adults aged 40 to 79 from the research program NATPOL 2011. The analysis was weighted in order to reflect the structure of the population in Poland and was stratified by age and gender. We applied the ESC/ESH 10-year SCORE (Systematic COronary Risk Evaluation) and the ACC/AHA ASCVD (atherosclerotic CV disease) risk assessment tools and followed guideline-specific algorithms to detect hypertension and follow recommendations for treatment.
Results
The overall prevalence of hypertension among Polish adults according to the ACC/AHA guideline was 76.9% (95% CI, 74.7–79.0%) versus 51.8% (95% CI, 49.2–54.4%) according to the ESC/ESH guidelines. Application of the ACC/AHA guideline recommendations would result in antihypertensive drug treatment for 63.0% (95% CI, 60.5–65.5%) of Polish adults compared with 46.2% (95% CI, 43.6–48.7%) based on application of the ESC/ESH guidelines (difference 16.8% (95% CI, 14.9–18.8%), table 1).
Table 1 2017 ACC/AHA guideline 2018 ESC/ESH guideline Δ (difference) Hypertension Recommended treatment Hypertension Recommended treatment Hypertension Recommended treatment % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) Age 40–49 (n=391) 63.2 (58.4–68.0) 37.3 (32.6–42.1) 32.0 (27.4–36.6) 21.2 (17.2–25.3) 31.2 (26.6–35.8) 16.1 (12.5–19.8) 50–59 (n=452) 77.7 (73.8–81.5) 61.7 (57.2–66.2) 49.1 (44.5–53.7) 40.0 (35.5–44.6) 28.5 (24.4–32.7) 21.7 (17.9–25.5) 60–69 (n=356) 82.3 (78.3–86.3) 75.3 (70.8–79.8) 62.4 (57.3–67.4) 61.5 (56.5–66.6) 19.9 (15.8–24.1) 13.8 (10.2–17.3) 70–79 (n=231) 90.0 (86.2–93.9) 90.0 (86.2–93.9) 74.5 (68.8–80.1) 76.6 (71.2–82.1) 15.6 (10.9–20.3) 13.4 (9.0–17.8) Gender Male (n=689) 80.4 (77.4–83.4) 67.5 (64.0–71.0) 52.5 (48.8–56.3) 47.2 (43.4–50.9) 27.9 (24.5–31.2) 20.3 (17.3–23.3) Female (n=741) 73.6 (70.4–76.7) 58.8 (55.3–62.4) 51.2 (47.6–54.8) 45.2 (41.6–48.8) 22.4 (19.4–25.4) 13.6 (11.2–16.1)
Conclusions
Application of the ACC/AHA guideline would result in a considerable increase in the prevalence and antihypertensive drug treatment of hypertension in Polish adults compared with application of the ESC/ESH guidelines.
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Affiliation(s)
- A Wyszomirski
- Medical University of Gdansk, Department of Adult Neurology, Gdansk, Poland
| | - M J Pencina
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, United States of America
| | - P K Whelton
- Tulane University, Department of Epidemiology, New Orleans, United States of America
| | - B Wojtyniak
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Z Gaciong
- Medical University of Warsaw, Department of Internal Medicine, Hypertension and Vascular Diseases, Warsaw, Poland
| | - P Bandosz
- Medical University of Gdansk, Department of Hypertension and Diabetology, Gdansk, Poland
| | - P Zieleniewicz
- Medical University of Gdansk, Department of Cardiology and Electrotherapy, Gdansk, Poland
| | - T Zdrojewski
- Medical University of Gdansk, Department of Hypertension and Diabetology, Gdansk, Poland
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Rajca A, Kasprzyk P, Zieleniewicz P, Undrunas A, Wyszomirski A, Nagórka A, Ostrowski M, Rzyman W, Zdrojewski T. Rozpowszechnienie nadciśnienia tętniczego w grupie przewlekle palących — wyniki programu wczesnego wykrywania raka płuc MOLTEST BIS. Arterial Hypertension 2018. [DOI: 10.5603/ah.a2018.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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