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Objective: assessing the equity in the access to the percutaneous transluminal coronary angioplasty (PTCA) and in its time trend among patients with ST-elevation acute myocardial infarction., Design: observational study based on regional administrative data: Hospital Discharge Registry, Health Registry, and 2001 Census data. Two indexes were used as deprivation measure: deprivation status at small area level (as proxy of the individual deprivation) and deprivation status at Local Health Agency level. The residence in a mountain municipality was used as extra measure of contextual deprivation., Setting and Participants: patients with first emergency hospital admission for acute myocardial infarction (AMI) with ST-elevation, resident in Tuscany Region (Central Italy) and hospitalized during the period 2001-2008., Main Outcome Measures: relative risk (RR) of the PTCA utilization., Results: multivariate analysis by multilevel multiple logistic regression showed a significant lower PTCA utilization in females (RR: 0.91, p <0.0001), in patients with high deprivation status at Local Health Agency level (RR: 0.71, p <0.0001), in residents in a mountain municipality (RR: 0.90, p <0.0001), and in patients with comorbidity (RR: 0.98, p =0.006; RR: 0.87, p <0.0001; RR: 0.69, p <0.0001 for Charlson comorbidity index equal to 1, 2, ≥3, respectively). The PTCA utilization over time has grown significantly (p <0.0001), from 26.6% in 2001 to 57.4% in 2008. This increase was more pronounced in patients with high deprivation status at Local Health Agency level (RR: 4.01, p <0.0001 for year 2008 vs. 2001), with consequent reduction of the initial differential with respect to patients with low deprivation status at Local Health Agency level (RR: 0.40, p <0.0001 in 2001 and RR: 0.93, p =0.114 in 2008). However, the differential associated with gender and residence in a mountain municipality persisted over time., Discussion: In Tuscany during the period 2001-2008 a significant reduction of the differential in the PTCA utilization associated with the deprivation status at Local Health Agency level was observed. This finding could be explained by the diffusion and organization of suitable invasive cardiology units in the region, the organizational models of care, the different propensity to the PTCA utilization by the referral hospitals.

Background: Utilization of Emergency Medical Services (EMS) declined during COVID-19 pandemic, but most of the studies analyzed components of the EMS system individually. The study aimed to evaluate the indirect impact of COVID-19 pandemic on the utilization of all the components of the EMS system of Tuscany Region (Italy) during the first pandemic wave. Methods: Administrative data from the health care system of Tuscany were used. Changes in utilization for out-of-hospital emergency calls and emergency vehicle dispatched, emergency department (ED) visits, and patients being admitted from the ED to an inpatient hospital bed (hospitalizations from ED) during the first pandemic wave were analyzed in relation with corresponding periods of the previous two years. Percentage changes and 95%CI were calculated with Poisson models. Standardized Ratios were calculated to evaluate changes in in-hospital mortality and hospitalizations requiring ICU. Results: Significant declines were observed in the utilization of all the EMS considered starting from the week in which the first case of COVID-19 was diagnosed in Italy till the end of the first pandemic wave. During the epidemic peak, the maximum decreases were observed: -33% for the emergency calls, -45% for the dispatch of emergency vehicles, -71% for ED admissions. Furthermore, a decline of 37% for hospitalizations from ED was recorded. Significant decreases in ED admissions for life threatening medical conditions were observed: acute cerebrovascular disease (-36%, 95% CI: -43, -29), acute myocardial infarction (-42%, 95% CI: -52, -31) and renal failure (-42%, 95% CI: -52, -31). No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the epidemic peak. Conclusion: All the components of the EMS showed large declines in their utilization during COVID-19 pandemic; furthermore, major reductions were observed for admissions for time-dependent and life-threatening conditions. Efforts should be made to ensure access to safe and high-quality emergency care during pandemic. [ABSTRACT FROM AUTHOR]

Cardiovascular complications in patients undergoing non-cardiac surgery are associated with longer hospital stays and higher in-hospital mortality. The aim of this study was to assess the incidence of in-hospital myocardial infarction and/or myocardial injury in patients undergoing hip fracture surgery and their association with mortality. Moreover, we evaluated the prognostic value of troponin increase stratified on the basis of peak troponin value. The electronic records of 1970 consecutive hip fracture patients were reviewed. Patients <70 years, those with myocardial infarction <30 days, and those with sepsis or active cancer were excluded from the study. Troponin and ECG were obtained at admission and then at 12, 24, and 48 h after surgery. Echocardiography was made before and within 48 h after surgery. Myocardial injury was defined by peak troponin I levels > 99th percentile. A total of 1854 patients were included. An elevated troponin concentration was observed in 754 (40.7%) patients in the study population. Evidence of myocardial ischemia, fulfilling diagnosis of myocardial infarction, was found in 433 (57%). ECG and echo abnormalities were more frequent in patients with higher troponin values; however, mortality did not differ between patients with and without evidence of ischemia. Peak troponin was between 0.1 and 1 µg/L in 593 (30.3%). A total of 191 (10%) had peak troponin I ≥ 1 µg/L, and 98 died in hospital (5%). Mortality was significantly higher in both groups with troponin increase (HR = 1.37, 95% CI 1.1–1.7, p < 0.001 for peak troponin I between 0.1 and 1 µg/L; HR = 2.28, 95% CI 1.72–3.02, p < 0.0001 for peak troponin ≥1 µg/L) in comparison to patients without myocardial injury. Male gender, history of coronary heart disease, heart failure, and chronic kidney disease were also associated with in-hospital mortality. Myocardial injury/infarction is associated with increased mortality after hip fracture surgery. Elevated troponin values, but not ischemic changes, are related to early worse outcome. [ABSTRACT FROM AUTHOR]