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1. Prognostic significance of serum uric acid in outpatients with chronic heart failure is complex and related to body mass index: Data from the IN-CHF Registry

Author

Baldasseroni, S, Urso, R, Maggioni, Ap, Orso, F, Fabbri, G, Marchionni, N, Tavazzi, L, the IN CHF Investigators: Mezzani, A, Bielli, M, Milanese, G, Ugliengo, G, Pozzi, R, Rabajoli, F, Bosimini, E, Begliuomini, G, Ferrari, A, Barzizza, F, Valsecchi, F, Dadda, F, Faggiano, P, Castiglioni, G, Gibelli, G, Turelli, Al, Belluschi, R, Bianchi, C, Emanuelli, C, Gramenzi, S, Foti, S, Agnelli, D, Mascioli, G, Cazzani, E, Zanelli, E, Domenighini, D, Castelli, C, Moroni, E, Gara, E, Guzzetti, S, Muzzupappa, S, Turiel, M, Cappiello, E, Sandrone, G, Recalcati, F, Valenti, D, Achilli, F, Vincenzi, A, Rusconi, F, Palvarini, M, Ghio, S, Fontana, A, Giusti, A, Scelsi, L, Sebastiani, R, Ceresa, M, Nassiacos, D, Meloni, S, Nicoli, T, Bandini, P, Pedretti, R, Paolucci, M, Amati, L, Ravetta, M, Morandi, F, Provasoli, S, Bertolini, A, Imperiale, D, Agen, W, Planca, E, Quorso, P, Ferro, A, Pedrolli, C, Russo, P, Tarantini, L, Candelpergher, G, Cannarozzo, Pp, De Cian, F, Agnoli, A, Stefanini, Mg, Cacciavillani, L, Boffa, Gm, Mario, L, Renosto, G, Stritoni, P, Varotto, L, Penzo, M, Perini, G, Giuliano, G, Barducci, E, Piazza, R, Albanese, Mc, Fresco, C, Picco, F, Venturini, P, Camerini, A, Griffo, R, Derchi, G, Delfino, L, Pizzorno, L, Mazzantini, S, Torre, F, Orlandi, S, Bertoli, D, Gentile, A, Naccarella, F, Gatti, M, Coluccini, M, Morgagni, G, Alfano, G, Reggianini, L, Sansoni, S, Serra, W, Passerini, F, Del Corso, P, Rusconi, L, Marzaloni, M, Mezzetti, M, Gambarati, Gp, Mariani, Pr, Volterrani, C, Venturi, F, Zambald, G, Casolo, G, Moschi, G, Geri Brandinelli, A, Miracapillo, G, Boni, A, Italiani, G, Vergoni, W, Paci, Am, Lattanzi, F, Reisenhofer, B, Severini, D, Taddei, T, Dalle Luche, A, Comella, A, Gasperini, U, Cocchieri, M, Alunni, G, Bosi, E, Panciarola, R, Maragoni, G, Bardelli, G, Testarmata, P, Pasetti, L, Budini, A, Gabrilelli, D, Coderoni, B, Midi, P, Romaniello, C, Del Sindaco, D, Leggio, F, Terranova, A, Pulignano, G, Pozzar, F, Ansalone, G, Magris, B, Giannantoni, P, Cacciatore, G, Bottero, G, Scaffidi, G, Valtorta, C, Salustri, A, Amadeo, F, Barbato, G, Aspromonte, N, Baldo, V, Baldo, E, Frattaroli, C, Mariani, A, Di Marco, G, Levantesi, G, Potena, Ap, Colonna, N, Montano, A, Sensale, P, Maiolica, O, Somelli, A, Napolitano, F, Provvisiero, P, Bottiglieri, P, Ciriello, N, Angelini, E, Andriulo, C, De Santis, F, Cocco, F, Zecca, A, Pennetta, A, Mariello, F, Magliari, F, De Giorgi, A, Callerame, M, Santoro, V, Pede, S, Renna, A, De Donno, O, De Lorenzi, E, Polimeni, G, Russo, Va, Mangia, R, Truncellito, L, Cariello, Fp, Affinita, M, Perticone, F, Cloro, C, Borelli, D, Matta, M, Lopresti, D, Misuraca, G, Caporale, R, Chiappetta, P, Tripodi, E, Tassone, F, Salituri, S, Errigo, C, Meringolo, G, Donnangelo, L, Canonico, G, Coco, R, Franco, M, Coglitore, A, Donato, A, Di Tano, G, Cento, Domenico, DE GREGORIO, Cesare, Mongiovı, M, Schillaci, Am, Mirto, Ij, Clemenza, F, Ingrillı, F, Cavallaro, A, Aloisi, B, Ledda, G, Rizzo, C, Porcu, M, Salis, S, Pistis, L, Pili, G, Piras, S, Maoddi, I, and Uras, F.

Subjects
Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Hyperuricemia, Models, Biological, Severity of Illness Index, Body Mass Index, chemistry.chemical_compound, Thinness, Internal medicine, Severity of illness, Ambulatory Care, Humans, Medicine, Registries, Mortality, Survival analysis, Aged, Retrospective Studies, Aged, 80 and over, Heart Failure, Nutrition and Dietetics, business.industry, Hazard ratio, Middle Aged, Prognosis, medicine.disease, Survival Analysis, Confidence interval, Uric Acid, Surgery, Italy, chemistry, Heart failure, Cardiology, Uric acid, Female, Cardiology and Cardiovascular Medicine, business, Body mass index
Abstract

In the field of cardiovascular diseases, elevated levels of serum uric acid (UA) reflect a marked activation of the xanthine oxidase pathway with increase in free radicals production; it is often associated with an inflammatory state, oxygen consumption and endothelial dysfunction. All these associations have been also confirmed in heart failure (HF) but the pathophysiological role of UA in this setting is not well understood. The aim of this study was to evaluate the prognostic role of UA in outpatients enrolled in the Italian Registry of Congestive Heart Failure (IN-CHF).All patients met the European Society of Cardiology (ESC) criteria for diagnosis of HF. We considered patients with complete clinical data and UA level available at the baseline and at 1-year follow-up. The study population was composed of 877 patients aged 63 ± 12 years. One-year mortality was 10.8% and dead patients had a higher level of UA than survivors (7.1 mg dl⁻¹ vs 6.6 mg dl⁻¹, p0.0207). In multivariable full model of analysis, UA did not result in an independent predictor of death in overall population, but only in patients with low body mass index (BMI) (≤22 kg m⁻²) (hazard ratio (HR): 2.38, 95% confidence interval (CI) 1.36-4.18). In this subgroup, a statistically significant gradual relationship between UA and survival was detected starting from values higher than 8 mg dl⁻¹.Elevated level of UA is not an independent predictor of mortality in chronic HF, but it markedly worsens outcome if associated with low level of BMI. This association is likely an indicator of chronic inflammatory and catabolic state.

Published
2012

2. Prevalence and treatment of cancer pain in Italian oncological wards centres: a cross-sectional survey

Author

MERCADANTE, S, ROILA, F, BERRETTO, O, LABIANCA, R, CASILINI, S, BOTTERO, G, TROVA, V, CASCINU, S, DI VITO, F, LORUSSO, V, TROCCOLI, G, ENDRIZZI, L, DANIELE, B, MARTONI, A, MARINI, G, VITELLO, S, ROMITO, S, SBALZARINI, G, SERRAVEZZA, G, MANENTE, P, MOLICA, S, PALAZZO, S, PRANTERA, T, MERLANO, M, DI GIROLAMO, G, AMADORI, D, SOBRERO, A, ALGERI, R, BRETTI, S, GRECO, E, D'APRILE, M, FORCIGNANO, C, BONETTI, A, AITINI, E, PIAZZA, E, PIVA, L, TABBIADON, D, CARTENI', G, CATALANO, G, ALABISO, O, LANDRISCINA, G, DOGLIOTTI, L, FILIPPELLI, G, BERTE', R, RICCI, S, MANZIONE, L, IACONO, C, MARANGOLO, M., GEBBIA, Nicolo', PALMERI, Sergio, MERCADANTE, S, ROILA, F, BERRETTO, O, LABIANCA, R, CASILINI, S, BOTTERO, G, TROVA, V, CASCINU, S, DI VITO, F, LORUSSO, V, TROCCOLI, G, ENDRIZZI, L, DANIELE, B, MARTONI, A, MARINI, G, VITELLO, S, ROMITO, S, SBALZARINI, G, SERRAVEZZA, G, MANENTE, P, MOLICA, S, PALAZZO, S, PRANTERA, T, MERLANO, M, DI GIROLAMO, G, AMADORI, D, SOBRERO, A, ALGERI, R, BRETTI, S, GRECO, E, D'APRILE, M, FORCIGNANO, C, BONETTI, A, AITINI, E, PIAZZA, E, PIVA, L, TABBIADON, D, CARTENI', G, CATALANO, G, ALABISO, O, LANDRISCINA, G, DOGLIOTTI, L, GEBBIA, N, PALMERI, S, FILIPPELLI, G, BERTE', R, RICCI, S, MANZIONE, L, IACONO, C, and MARANGOLO, M

Subjects
Adult, Male, medicine.medical_specialty, Settore MED/06 - Oncologia Medica, Cross-sectional study, Pain medicine, MEDLINE, Pain, Severity of Illness Index, Neoplasms, Oncology Service, Hospital, Epidemiology, Severity of illness, medicine, Prevalence, Humans, Aged, Aged, 80 and over, Primary Health Care, business.industry, Cancer pain,Epidemiology,Opioids, Nursing research, Physicians, Family, Middle Aged, Large sample, Analgesics, Opioid, Cross-Sectional Studies, Oncology, Italy, Family medicine, Health Care Surveys, Physical therapy, Female, Cancer pain, business
Abstract

The aim of this national cross-sectional survey was to draw information on pain prevalence and intensity from a large sample of patients who were admitted to oncologic centres for different reasons and to evaluate the pain treatment and possible influencing factors.A total of 2,655 patients completed the study. Nine hundred and one patients (34%) reported pain.Higher pain levels were observed in inpatients, in the presence of bone metastases, and with low levels of Eastern Cooperative Oncology Group status. The number of patients receiving strong opioids increased with the highest levels of pain. However, a significant part of patients with moderate-severe pain were not receiving appropriate medication, patients being predominantly administered non-opioid drugs. General practitioners' attitudes did not negatively influence the opioid prescription.The results of this survey indicate a need for continuing educational and informative program in pain management for oncologists and more generally for any physician dealing with cancer patients.

Published
2008

3. Age-dependent prognostic significance of atrial fibrillation in outpatients with chronic heart failure: data from the Italian Network on Congestive Heart Failure Registry

Author

Baldasseroni, S, Orso, F, Fabbri, G, De Bernardi, A, Cirrincione, V, Gonzini, L, Fumagalli, S, Marchionni, N, Midi, P, Maggioni, Ap, Mezzani, A, Bielli, M, Milanese, U, Ugliengo, G, Pozzi, R, Rabajoli, F, Bosimini, E, Begliuomini, G, Ferrari, A, Barzizza, F, Valsecchi, Mg, Dadda, F, Faggiano, P, Castiglioni, G, Gibelli, G, Turelli, Al, Belluschi, R, Bianchi, C, Emanuelli, C, Gramenzi, S, Foti, G, Agnelli, D, Mascioli, G, Cazzani, E, Zanelli, E, Domenighini, D, Castelli, C, Moroni, E, Gara, E, Guzzetti, S, Muzzupappa, S, Turiel, M, Cappiello, E, Sandrone, G, Recalcati, F, Valenti, D, Achilli, F, Vincenzi, A, Rusconi, F, Palvarini, M, Ghio, S, Fontana, A, Giusti, A, Scelsi, L, Sebastiani, R, Ceresa, M, Nassiacos, D, Meloni, S, Nicoli, T, Bandini, P, Pedretti, R, Paolucci, M, Amati, L, Ravetta, M, Morandi, F, Provasoli, S, Bertolini, A, Imperiale, D, Agen, W, Planca, E, Quorso, P, Ferro, A, Pedrolli, C, Russo, P, Tarantini, L, Candelpergher, G, Cannarozzo, Pp, De Cian, F, Agnoli, A, Stefanini, Mg, Cacciavillani, L, Boffa, Gm, Mario, L, Renosto, G, Stritoni, P, Varotto, L, Penzo, M, Perini, G, Giuliano, G, Barducci, E, Piazza, R, Albanese, Mc, Fresco, C, Picco, F, Venturini, P, Camerini, A, Griffo, R, Derchi, G, Delfino, L, Pizzorno, L, Mazzantini, S, Torre, F, Orlandi, S, Bertoli, D, Gentile, A, Naccarella, F, Gatti, M, Coluccini, M, Morgagni, G, Alfano, G, Reggianini, L, Sansoni, S, Serra, W, Passerini, F, Del Corso, P, Rusconi, L, Marzaloni, M, Mezzetti, M, Gambarati, Gp, Mariani, Pr, Volterrani, C, Venturi, F, Zambaldi, G, Casolo, G, Moschi, G, Geri Brandinelli, A, Miracapillo, G, Boni, A, Italiani, G, Vergoni, W, Paci, Am, Lattanzi, F, Reisenhofer, B, Severini, D, Taddei, T, Dalle Luche, A, Comella, A, Gasperini, U, Cocchieri, M, Alunni, G, Bosi, E, Panciarola, R, Maragoni, G, Bardelli, G, Testarmata, P, Pasetti, L, Budini, A, Gabrilelli, D, Coderoni, B, Romaniello, C, Del Sindaco, D, Leggio, F, Terranova, A, Pulignano, G, Pozzar, F, Ansalone, G, Magris, B, Giannantoni, P, Cacciatore, G, Bottero, G, Scaffidi, G, Valtorta, C, Salustri, A, Amaddeo, F, Barbato, G, Aspromonte, N, Baldo, V, Baldo, E, Frattaroli, C, Mariani, A, Di Marco, G, Levantesi, G, Potena, Ap, Colonna, N, Montano, A, Sensale, P, Maiolica, P, Somelli, A, Napolitano, F, Provvisiero, P, Bottiglieri, P, Ciriello, N, Angelini, E, Andriulo, C, De Santis, F, Cocco, F, Zecca, A, Pennetta, A, Mariello, F, Magliari, F, De Giorgi, A, Callerame, M, Santoro, V, Pede, S, Renna, A, De Donno, O, De Lorenzi, E, Polimeni, G, Russo, Va, Mangia, R, Truncellito, L, Cariello, Fp, Affinita, M, Perticone, F, Cloro, C, Borelli, D, Matta, M, Lopresti, D, Misuraca, G, Caporale, R, Chiappetta, P, Tripodi, E, Tassone, F, Salituri, S, Errigo, C, Meringolo, G, Donnangelo, L, Canonico, G, Coco, R, Franco, M, Coglitore, A, Donato, A, Di Tano, G, Cento, D, DE GREGORIO, Cesare, Mongiovì, M, Schillaci, Am, Mirto, U, Clemenza, F, Ingrillì, F, Cavallaro, A, Aloisi, B, Ledda, G, Rizzo, C, Porcu, M, Salis, S, Pistis, L, Pili, G, Piras, S, Maoddi, I, and Uras, F.

Subjects
Male, medicine.medical_specialty, Adrenergic beta-Antagonists, Age dependent, Angiotensin-Converting Enzyme Inhibitors, VENTRICULAR SYSTOLIC DYSFUNCTION, POPULATION-BASED COHORT, Age Distribution, Older patients, Internal medicine, Atrial Fibrillation, Outpatients, medicine, Humans, Pharmacology (medical), Registries, Aged, Heart Failure, business.industry, Network on, Anticoagulants, Atrial fibrillation, Middle Aged, medicine.disease, Prognosis, Death, Sudden, Cardiac, Italy, Heart failure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents
Abstract

Objectives: The role of atrial fibrillation (AF) in older patients with heart failure (HF) is controversial because many variables seem to influence their outcome. We investigated the predictivity of AF in 3 age groups of outpatients with HF. Methods: We analyzed 8,178 outpatients enrolled in the Italian Network on Congestive Heart Failure Registry with HF diagnosed according to the European Society of Cardiology criteria. A trained cardiologist established the diagnosis of AF and HF at the entry visit at each center. We stratified the population into 3 age groups, as follows: group A, ≤65 years; group B, 66–75 years, and group C, >75 years. Results: Group A was composed of 4,261 patients, 683 with AF (16.0%); in group B there were 2,651 patients, 638 with AF (24.1%), and group C was composed of 1,266 patients, 412 with AF (32.5%). The 1-year mortality rate was higher in AF patients in all groups. In a multivariate model, AF remained an independent risk factor for death in groups A and B, but not in group C [group A: hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.10–1.81; group B: HR 1.29, 95% CI 1.00–1.67; group C: HR 1.05, 95% CI 0.78–1.43]. Conclusion: The prevalence of AF increased with age and was associated with a higher mortality rate. However, AF independently predicted all-cause mortality only in patients aged ≤75 years.

Published
2010

4. Use of digitalis in the treatment of heart failure: data from the Italian Network on Congestive Heart Failure (IN-CHF)

Author

Camerini, A, Griffo, R, Aspromonte, N, Ingrilli', F, Lucci, D, Naccarella, F, Maggioni, Ap, IN-CHF INVESTIGATORS- Piemonte Borgomanero (M. Zanetta, A. M. Paino), Casale Monferrato (M. Ivaldi, A. Giusti), Uslenghi, Cuneo (E., Milanese, U., Deorsola), A., Greco Lucchina, Orbassano (P., Pozzi, R., Rabajoli), F., Veruno (P. Giannuzzi, E. Bosimini), Valle d’Aosta Aosta (M. De Marchi, G. Begliuomini), Richichi, Lombardia Belgioioso (I., Ferrari, A., Barzizza), F., Bergamo Riabilitazione Cardiologica (A. Gavazzi, F. Dadda), Bergamo U. O. Cardiologia Cardiovascolare (A. Gavazzi, A. Fontana), Brescia (C. Rusconi, P. Faggiano), Cogo, Cassano D’Adda (R., Castiglioni, G., Gibelli), G., Chiari (F. Bortolini, A. L. Turelli), Como (G. Ferrari, R. Jemoli), Pirelli, Cremona (S., Bianchi, C., Emanuelli), C., De Martini), Desio (M., Erba (G. Maggi, D. Agnelli), Ferrara), Esine (E., Rovelli, Garbagnate Milanese (G., Lureti, G., Cazzani), E., Giordano, Gussago (A., Zanelli, E., Domenighini), D., Legnano (S. De Servi, C. Castelli), Mariano Comense (G. Bellati, E. Moroni), Milano Fondazione Don Carlo Gnocchi IRCCS (M. Ferratini, E. Gara), Malliani, Milano Sacco (A., Muzzupappa, S., Turiel, M., Guzzetti, S., Cappiello), E., Milano Niguarda (S. Klugmann, F. Recalcati), Milano Pio Albergo Trivulzio (S. Corallo, D. Valenti), Cobelli), Montescano (F., Monza (A. Grieco, A. Vincenzi), Schweiger, Passirana-Rho (C., Rusconi, F., Palvarini), M., Ferrari, Pavia IIAARR S. Margherita (E., Carbone), M., Tavazzi, Pavia IRCCS Policlinico San Matteo (L., Campana, C., Serio), A., Croce, Saronno (A., Nassiacos, D., Meloni), S., Seriate (P. Giani, T. Nicoli), Sondalo (G. Occhi, P. Bandini), Sondrio (S. Giustiniani, M. Moizi), Tradate Fondazione S. Maugeri (R. Pedretti, M. Paolucci), Onofri, Tradate Ospedale di Circolo Galmarini (M., Amati, L., Ravetta), M., Venco, Varese Medicina Interna Azienda Ospedaliera e Universitaria (A., Bertolini, A., Saggiorato), P., Salerno Uriarte, Varese U. O. Cardiologia Azienda Ospedaliera e Universitaria (J., Morandi, F., Provasoli), S., Vizzolo Predabissi (M. Lombardo, P. Quorso), P. A. Trento Rovereto Cardiologia Ospedale Civile (G. Vergara, A. Ferro), Rovereto Medicina Ospedale Civile (M. Mattarei, C. Pedrolli), Catania, Veneto Belluno (G., Tarantini, L., Russo), P., Castelfranco Veneto (L. Celegon, G. Candelpergher), Conegliano Veneto (P. Delise, C. Marcon), Guarnerio, Feltre (M., De Cian, F., Agnoli), A., Montebelluna (G. Neri, M. G. Stefanini), Iliceto, Padova (S., Boffa, G. M., Tiso), E., Pieve di Cadore (J. Dalle Mule, A. Stefania), San Bonifacio (R. Rossi, E. Carbonieri), Treviso (P. Stritoni, G. Renosto), Fontanelli, Vicenza (A., Ottani, F., Varotto), L., Perini), Villafranca (G., Friuli Venezia Giulia Gorizia (D. Igidbashian, G. Giuliano), Monfalcone (T. Morgera, E. Barducci), San Vito al Tagliamento (M. Carone, G. Pascottini), Fioretti, Udine A. O. S. Maria della Misericordia (P., Albanese, M. C., Fresco), C., Udine Casa di Cura Città di Udine (P. Venturini, F. Picco), Liguria Arenzano (R. Griffo, A. Camerini), Chierchia, Genova Ospedali Civili (S., Mazzantini, S., Torre), F., Spirito, Genova Ospedali Galliera (P., Derchi, G., Delfino), L., Genova-Sestri Ponente (S. Domenicucci, L. Pizzorno), Località S. Caterina-Sarzana (G. Filorizzo, D. Bertoli), Rapallo (G. Gigli, S. Orlandi), Gentile), Sestri Levante (A., Emilia Romagna Bentivoglio (G. Di Pasquale, R. Vandelli), Bologna Cardiologia Tiarini-Corticella (F. Naccarella, M. Gatti), Forlì (F. Rusticali, G. Morgagni), Modena Medicina d’Urgenza Ospedale Civile S. Agostino (S. Zucchelli, M. Pradelli), Modena U. O. Cardiologia Ospedale Civile S. Agostino (G. R. Zennaro, G. Alfano), Modena, Modena Ospedale Policlinico (M. G., Reggianini, L., Coppi), F., Parma (D. Ardissino, W. Serra), Piacenza (A. Capucci, F. Passerini), Riccione (L. Rusconi, P. Del Corso), Piovaccari, Rimini (G., Bologna, F., Caccamo), L., Gambarati), Scandiano (G., Bernardi, Toscana Castelnuovo Garfagnana (D., Mariani, P. R., Volterrani), C., Cosmi), Cortona (F., Empoli (V. Mazzoni, F. Venturi), Firenze Divisione di Cardiologia A. O. Careggi (D. Antoniucci, G. Moschi), Zuppiroli, Firenze U. O. Cardiologia 3 A. O. Careggi (A., Pieri, F., Beligni), C., Firenze U. O. Cardiologia 2 A. O. Careggi (M. Ciaccheri, G. Castelli), Santoro, Firenze Nuovo Ospedale San Giovanni di Dio (G. M., Minneci, C., Sulla), A., Firenze P. O. di Camerata (F. Marchi, G. Zambaldi), Fucecchio (A. Zipoli, A. Geri Brandinelli), Grosseto (S. Severi, G. Miracapillo), Pesola, Lido di Camaiore (A., Comella, A., Magnacca), M., Lucca (E. Nannini, A. Boni), Mantini, Montevarchi (G., Bongini, M., Palmerini), L., Vergoni, Pescia (W., Italiani, G., Di Marco), S., Pisa A. O. Pisana (M. De Tommasi, A. M. Paci), Pontedera (G. Tartarini, B. Reisenhofer), Umbria Città di Castello (M. Cocchieri, D. Severini), Foligno (L. Meniconi, U. Gasperini), Ambrosio, Perugia (G., Alunni, G., Murrone), A., Spoleto (G. Maragoni, G. Bardelli), Mocchegiani, Marche Ancona Centro Cardiologia Ambulatoriale G. M. Lancisi (R., Pasetti, L., Budini), A., Ancona Divisione di Cardiologia G. M. Lancisi (G. Perna, D. Gabrielli), Russo, Ancona Geriatrico Sestilli-INRCA IRCCS (P., Testarmata, P., Antonicelli), R., Camerino (R. Amici, B. Coderoni), Lazio Albano Laziale (G. Ruggeri, P. Midi), Frascati (G. Giorgi, F. Comito), Frosinone (G. Faticanti, F. Qualandri), Grottaferrata (D. Galileo Faroni, C. Romaniello), Roma INRCA (F. Leggio, D. del Sindaco), Majid Tamiz, Roma C. Forlanini (A., Avallone, A., Suglia), F., Roma Cristo Re (V. Baldo, E. Baldo), Roma I U. O. Cardiologia San Camillo (E. Giovannini, G. Pulignano), Roma II Divisione di Cardiologia con UTIC San Camillo (S. F. Vajola, E. Picchio), Tanzi, Roma Serv. Centr. Cardiologia-PS Cardiologico San Camillo (P., Pozzar, F., Terranova), A., Santini, Roma San Filippo Neri (M., Ansalone, G., Magris), B., Boccanelli, Roma San Giovanni (A., Cacciatore, G., Bottero), G., Palamara, Roma Sandro Pertini (A., Valtorta, C., Salustri), A., Roma S. Andrea (M. Volpe, L. De Biase), Gaspardone, Roma S. Eugenio (A., Amaddeo, F., Barbato), G., Ceci, Roma Santo Spirito (V., Aspromonte, N., Chiera), A., Scabbia, Viterbo (E. V., Pontillo, D., Castellani), R., Abruzzo Popoli (C. Frattaroli, A. Mariani), De Simone, Vasto (G., Levantesi, G., Di Marco), G., Molise Larino Medicina Generale-U. O. Geriatria (F. Porfilio, A. Pasquale Potena), Staniscia, Termoli (D., Colonna, N., Montano), A., Mininni, Campania Napoli Divisione di Cardiologia A. O. V. Monaldi (N., Miceli, D., Scherillo), M., Napoli I Divisione Med-Centro Diagnosi e Cura SCC A. O. V. Monaldi (P. Sensale, O. Maiolica), Napoli Medicina Incurabili (M. Visconti, A. Costa), Napoli Cardiologia San Gennaro (P. Capogrosso, A. Somelli), Vergara, Nola U. O. Cardiologia e UTIC P. O. Maria della Pietà (G., Napolitano, F., Provvisiero), P., Oliveto Citra (G. D’Angelo, P. Bottiglieri), Puglia Bari (G. Antonelli, N. Ciriello), Ignone, Brindisi (G., Angelini, E., Andriulo), C., Casarano (G. Pettinati, F. De Santis), Francavilla Fontana (V. Cito, F. Cocco), Galatina (F. Daniele, A. Zecca), Gallipoli (F. Cavalieri, C. Picani), Lecce Vito Fazzi (F. Magliari, A. De Giorgi), Santoro), Mesagne (V., San Pietro Vernotico (S. Pede, A. Renna), Scorrano (E. De Lorenzi, O. De Donno), Baldi, Taranto S. S. Annunziata (N., Polimeni, G., Russo), V. A., Tricase (A. Galati, R. Mangia), Basilicata Policoro (B. D’Alessandro, L. Truncellito), Calabria Belvedere Marittimo (F. P. Cariello, F. Rosselli), Catanzaro U. O. Cardiologia Policlinico (G. Borrello, M. Affinita), Catanzaro U. O. Malattie Cardiovascolari Policlinico (F. Perticone, C. Cloro), Sollazzo, Cetraro (G., Matta, M., Lopresti), Venneri, Cosenza Cardiologia Annunziata (N., Misuraca, G., Caporale), R., Cosenza Medicina Annunziata (A. Noto, P. Chiappetta), Tassone), Reggio Calabria E. Morelli (F., Salituri), Rossano (S., Iannopollo, Siderno (M., Errigo, C., Marando), G., Trebisacce (L. Donnangelo, G. Meringolo), Canonico), Sicilia Avola (G., Carini, Catania Cannizzaro (V., Coco, R., Franco), M., Catania Cardiochirurgia Ferrarotto (M. Abbate, G. Leonardi), Messina Papardo (R. Grassi, G. Di Tano), Consolo), Messina Piemonte (G., Coglitore, Messina (S., Cento, D., De Gregorio), C., Palermo Casa del Sole Lanza di Trabia (V. Sperandeo, M. Mongiovì), Palermo Buccheri La Ferla FBF (A. Castello, A. M. Schillaci), Palermo Civico e Benfratelli (E. D’Antonio, U. Mirto), Di Pasquale), Palermo G. F. Ingrassia (P., Palermo V. Cervello (A. Canonico, M. Floresta), Battaglia, Palermo P. O. Villa Sofia (A., Ingrillì, F., Cirrincione), V., Piazza Armerina M. Chiello (B. Aloisi, A. Cavallaro), Braschi, Trapani (G. B., Ledda, G., Rizzo), C., Sanna, Sardegna Cagliari San Michele Brotzu (A., Porcu, M., Salis), S., Lai, Cagliari SS. Trinità (C., Pili, G., Piras), S., Iglesias (E. Spiga, G. Pes), Nuoro (G. Mureddu, I. Maoddi), and Sassari SS. Annunziata (P. Terrosu, F. Uras).

Subjects
Adult, Heart Failure, Male, Dose-Response Relationship, Drug, Digitalis Glycosides, Middle Aged, Prognosis, Risk Assessment, Severity of Illness Index, Survival Analysis, Drug Administration Schedule, Drug Utilization, Treatment Outcome, Italy, Atrial Fibrillation, Heart Function Tests, Multivariate Analysis, Ambulatory Care, Confidence Intervals, Odds Ratio, Humans, Female, Registries, Aged, Retrospective Studies
Abstract

Since the large multicenter DIG trial has shown no effects of digitalis on the all-cause mortality of patients with chronic heart failure (HF), the broad prescription of this drug in patients with HF appears to be at the very least, questionable. The aims of this study were: to analyze prescription patterns of digitalis, from 1995 to 2000, in a large group of outpatients with HF; to analyze the independent predictors of digitalis prescription and to evaluate the impact of the results of the DIG trial on the prescription rate of this drug.From 1995 to 2000, 11 070 HF outpatients (mean age 64 +/- 12 years, ejection fraction 35 +/- 12%) were enrolled in a large Italian database.Out of 11 070 patients, 7198 (65%) were treated with digitalis. At multivariate analysis, the following variables were independently associated with digitalis prescription; atrial fibrillation (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.9-3.8), ejection fraction30% (OR 1.7, 95% CI 1.5-1.9), NYHA class III-IV vs II-III (OR 1.3, 95% CI 1.2-1.5), admission for HF during the previous year (OR 1.4, 95% CI 1.2-1.5). After the publication of the DIG trial, there was a significant reduction in the rate of digitalis prescription: the percentage of patients taking digitalis fell from 68% in 1996-1997 to 61% in 1998-1999 (p0.001).Over 60% of Italian outpatients with HF were treated with digitalis; as expected, patients with a low ejection fraction, atrial fibrillation and in a more advanced stage of HF are more likely to receive this drug. Finally, after the publication of the DIG trial, the rate of digitalis prescription significantly decreased.

Published
2004

5. A low pulse pressure is an independent predictor of mortality in heart failure: Data from a large nationwide cardiology database (IN-CHF registry)

Author

Schillaci, Giuseppe, Di Luzio, Silvia, Coluccini, Mario, Gonzini, Lucio, Porcu, Maurizio, Pozzar, Francesco, Maggioni, Aldo P, Investigators, Mezzani, A, Bielli, M, Milanese, U, Ugliengo, G, Pozzi, R, Rabajoli, F, Bosimini, E, Begliuomini, G, Ferrari, A, Barzizza, F, Valsecchi, Mg, Dadda, F, Faggiano, P, Castiglioni, G, Gibelli, G, Turelli, Al, Belluschi, R, Bianchi, C, Emanuelli, C, Gramenzi, S, Foti, G, Agnelli, D, Mascioli, G, Cazzani, E, Zanelli, E, Domenighini, D, Castelli, C, Moroni, E, Gara, S, Guzzetti, S, Muzzupappa, S, Turiel, M, Cappiello, E, Sandrone, G, Recalcati, F, Valenti, D, Achilli, F, Vincenzi, A, Rusconi, F, Palvarini, M, Ghio, S, Fontana, A, Giusti, A, Scelsi, L, Sebastiani, R, Ceresa, M, Nassiacos, D, Meloni, S, Nicoli, T, Bandini, P, Pedretti, R, Paolucci, M, Amati, L, Ravetta, M, Morandi, F, Provasoli, S, Bertolini, A, Imperiale, D, Agen, W, Planca, E, Quorso, P, Ferro, A, Pedrolli, C, Russo, P, Tarantini, L, Candelpergher, G, Cannarozzo, Pp, De Cian, F, Agnoli, A, Stefanini, Mg, Cacciavillani, L, Boffa, Gm, Mario, L, Renosto, G, Stritoni, P, Varotto, L, Penzo, M, Perini, G, Giuliano, G, Barducci, E, Piazza, R, Albanese, Mc, Fresco, C, Picco, F, Venturini, P, Camerini, A, Griffo, R, Derchi, G, Delfino, L, Pizzorno, L, Mazzantini, S, Torre, F, Orlandi, S, Bertoli, D, Gentile, A, Naccarella, F, Gatti, M, Coluccini, M, Morgagni, G, Alfano, G, Reggianini, L, Sansoni, S, Serra, W, Passerini, F, Del Corso, P, Rusconi, L, Marzaloni, M, Mezzetti, M, Gambarati, Gp, Mariani, Pr, Volterrani, C, Venturi, F, Zambaldi, G, Casolo, G, Moschi, G, Geri Brandinelli, G, Miracapillo, G, Boni, A, Italiani, G, Vergoni, W, Paci, Ap, Lattanzi, F, Reisenhofer, B, Severini, D, Taddei, T, Dalle Luche, A, Comella, A, Gasperini, U, Cocchieri, M, Alunni, G, Bosi, E, Panciarola, R, Maragoni, G, Bardelli, G, Testarmata, P, Pasetti, L, Budini, A, Gabrielli, D, Coderoni, B, Midi, P, Romaniello, C, Del Sindaco, D, Leggio, F, Terranova, A, Pulignano, G, Pozzar, P, Ansalone, G, Magris, B, Giannantoni, P, Cacciatore, G, Bottero, G, Scaffidi, G, Valtorta, C, Salustri, A, Amaddeo, F, Barbato, G, Aspromonte, N, Baldo, V, Baldo, E, Frattaroli, C, Mariani, A, Di Marco, G, Levantesi, G, Potena, Ap, Colonna, N, Montano, A, Sensale, P, Maiolica, O, Somelli, A, Napolitano, F, Provvisiero, P, Bottiglieri, P, Ciriello, N, Angelini, E, Andriulo, C, De Santis, F, Cocco, F, Pennetta, A, Mariello, F, Magliari, F, De Giorgi, A, Callerame, M, Santoro, V, Pede, S, Renna, A, De Donno, O, De Lorenzi, E, Polimeni, V, Russo, Va, Mangia, R, Truncellito, L, Cariello, Fp, Affinita, M, Perticone, F, Cloro, C, Borelli, D, Matta, M, Lopresti, D, Misuraca, A, Caporale, R, Chiappetta, P, Tripodi, E, Tassone, F, Salituri, S, Errigo, C, Meringolo, G, Donnangelo, L, Canonico, G, Coco, R, Franco, M, Coglitore, A, Donato, A, Di Tano, G, Cento, D, DE GREGORIO, Cesare, Mongiovì, M, Schillaci, Am, Mirto, U, Clemenza, F, Ingrillì, F, Cavallaro, A, Aloisi, B, Ledda, G, Rizzo, C, Porcu, M, Salis, S, Pistis, L, Pili, G, Piras, S, Maoddi, I, and Uras, F.

Subjects
Adult, Male, medicine.medical_specialty, Blood Pressure, Independent predictor, Low pulse pressure, Predictive Value of Tests, Internal medicine, Humans, Medicine, Aged, Female, Follow-Up Studies, Heart Failure, Italy, Middle Aged, Pulse, Registries, Stroke Volume, business.industry, medicine.disease, Heart failure, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

A high pulse pressure (PP) predicts cardiovascular mortality in hypertension and in the elderly. We analyzed the data from the Italian Network of Congestive Heart Failure Registry to test the prognostic role of PP in patients with heart failure.A total of 8660 patients with heart failure (mean age 64 +/- 12 years, 73% male) were divided into four groups according to their PP (40, 40-49, 50-59, andor = 60 mmHg), and followed prospectively.After 1 year, 995 patients (11.5%) died. Both the mean arterial pressure and systolic blood pressure were found to be inversely associated with mortality at univariate and multivariate analyses. An inverse univariate relation was observed between PP and all-cause mortality. An excess mortality risk in the lowest PP group (odds ratio 1.40, 95% confidence interval 1.09-1.79 vs the highest PP group) was confirmed in a multivariate analysis which took into account the effect of several other variables, including mean arterial pressure. Similar findings were obtained for cardiovascular mortality. When we replaced systolic blood pressure with mean arterial pressure in the model, PP did not retain its independent prognostic role, possibly because of the high co-linearity between these two variables (r = 0.87).For any given level of mean arterial pressure, a low PP is an independent predictor of all-cause and cardiovascular death in patients with heart failure. The association may be partly related to the strong influence of low systolic blood pressure on mortality. Different pathophysiological mechanisms may underlie the opposite prognostic significance of PP in hypertension and heart failure.

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