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2. Risk factors for hospital readmission of elderly patients

Author

Franchi, C, Nobili, A, Mari, D, Tettamanti, M, Djade, Cd, Pasina, L, Salerno, F, Corrao, S, Marengoni, A, Iorio, A, Marcucci, M, Mannucci, Pm, Reposi, Investigators, Pier, Mm, Alessandro, N, Salvatore, C, Spirito, V, Noce, D, Bonazzi, J, Lombardo, R, Sparacio, E, Alborghetti, S, De Vittorio, L, Paolisso, G, Rizzo, Mr, Laieta, Mt, Brignone, C, Roberto, T, Persico, Marcello, Salvatore, T, Sasso, Fc, Utili, R, Durante Mangoni, E, Pinto, D, Fenoglio, L, Bracco, C, Gasbarrone, L, Porcari, P, Famularo, G, Sajeva, Mr, Maniscalco, G, Gunelli, M, Tirotta, D, Realdi, G, Baritussio, A, Frassoni, F, Delsignore, R, Baroni, Mc, Zardo, M, Volpato, S, Fotini, S, Manfredini, R, Longhini, C, Molino, C, Incasa, E, Guarnieri, G, Zanetti, M, Spalluti, A, Rini, G, Mansueto, P, Pepe, I, Licata, G, Calvo, L, Valenti, M, Tuttolomondo, A, Di Sciacca, R, Antonaci, S, Vella, F, Marseglia, A, Centonze, V, Modeo, Me, Palasciano, G, Pugliese, S, Capobianco, C, Murialdo, G, Bovio, M, Laghi Pasini, F, Capecchi, Pl, Bicchi, M, Nuti, R, Valenti, R, Capodarca, C, Auteri, A, Pasqui, Al, Puccetti, L, Olivieri, O, Stanzial, Am, Agnelli, G, Macura, A, Mannarino, E, Lupattelli, G, Rondelli, P, Serra, Mg, Musca, G, Cuccurullo, O, Cappellini, Md, Fabio, G, Motta, I, Cantoni, F, Fargion, S, Bonara, P, Bulgheroni, M, Magrini, F, Massari, F, Tonella, T, Peyvandi, F, Tedeschi, A, Rossio, R, Moreo, G, Ferrari, B, Monzani, V, Savojardo, V, Folli, C, Dionigi Rossi, P, Ziglioli, E, Lilleri, Ms, Selmi, C, Meda, F, Cazzaniga, M, Monti, V, Balduini, Cl, Bertolino, G, Dezzani, L, Cavallo, P, Corazza, Gr, Miceli, E, Secchi, Mb, Wu, Sc, Sofia, L, Anastasio, L, Carbone, M, Bertucci, L, De Feudis, L, Traisci, G, Bergami, E, Rizzioli, E, Cagnoni, C, Bertone, L, Manucra, A, Ronchi, E, Buratti, A, Tognin, T, Bertolini, D, Liberato, Nl, Bernasconi, G, Nardo, B, Venco, A, Guasti, L, Maroni, L, Castiglioni, L, Casella, G, Vanoli, M, Grignani, G, Mancuso, G, Tavella, R, Persico, R, Cicardi, M, Sandrone, G, Magenta, M, Perego, F, Meroni, Mr, Rozzini, R, Falanga, L, Giordano, A, Menardo, G, Bottone, S, Sferrazzo, E, Tassara, R, Melis, D, Rebella, L, Ferri, C, Striuli, R, Scipioni, R, Salmi, R, Gaudenzi, P, Di Todaro, F, Nielsen, I, Giusto, L, Semplicini, A, Gottardo, L, Delitala, G, Carta, S, Atzori, S, Rosei, Ea, Rizzoni, D, Castoldi, L, Altomare, E, Serviddio, G, Salvatore, S, Fera, G, Di Luca ML, Renna, D, Picardi, A, Mazzarelli, C, Vespasiani Gentilucci, U, De Vincentis, A, Hila, D, Bernardi, M, Li Bassi, S, Santi, L, Masala, C, Mammarella, A, Raparelli, V, Rossi Fanelli, F, Delfino, M, Amoroso, A, Serra, P, Fontana, V, Falcone, M, Violi, F, Basili, S, Perri, L, Silveri, Ng, De Marco, G, Giupponi, B, Landolfi, R, Grieco, A, Gallo, A, Perticone, F, Sciacqua, A, Quero, M, Bagnato, C, Bonometti, F, Loria, P, Ballestri, S, Becchi, Ma, Bolondi, L, Rasciti, L, Serio, I, Gualandi, S, Romanelli, G, Carulli, N, Rondinella, S, Giannico, I, Dallegri, F, Ottonello, L, Quercioli, A, Barreca, A, Sacco, A, Bonelli, A, Dentamaro, G, Micale, G, Delitalia, G, Deidda, S, Cuccuru, Lm, Benetti, G, Quagliolo, M, Centenaro, Gr, Macchini, L, Perciccante, A, Coralli, A, Realdi, A, Cricco, L, Morabito, C, Fava, R, Fiorentini, A, Tofi, C., Franchi C, Nobili A, Mari D, Tettamanti M, Djade CD, Pasina L, Salerno F, Corrao S, Marengoni A, Iorio A, Marcucci M, Mannucci PM, REPOSI Investigators [.., Bernardi M, Bolondi L, ], Franchi, C, Nobili, A, Mari, D, Tettamanti, M, Djade, CD, Pasina, L, Salerno, F, Corrao, S, Marengoni, A, Iorio, A, Marcucci, M, Mannucci, PM, Tuttolomondo, A, Mansueto, P, Franchi, Carlotta, Nobili, Alessandro, Mari, Daniela, Tettamanti, Mauro, Djade, Codjo D., Pasina, Luca, Salerno, Francesco, Corrao, Salvatore, Marengoni, Alessandra, Iorio, Alfonso, Marcucci, Maura, Mannucci, Pier Mannuccio, Rizzo, Maria Rosaria, Carlotta, Franchi, Alessandro, Nobili, Daniela, Mari, Mauro, Tettamanti, Codjo D., Djade, Luca, Pasina, Francesco, Salerno, Salvatore, Corrao, Alessandra, Marengoni, Alfonso, Iorio, Maura, Marcucci, Pier Mannuccio, Mannucci, and Zanetti, Michela

Subjects
Male, Settore MED/09 - Medicina Interna, Time Factors, Risk factors, internal medicine, Geriatric patient, hospital admission, Logistic regression, Elderly, Hospital readmission, Internal medicine and geriatric wards, 80 and over, Aged, Aged, 80 and over, Female, Geriatrics, Hospital Departments, Humans, Internal Medicine, Patient Readmission, Risk Factors, Medical diagnosis, Aged, Aged, 80 and over, Female, Geriatrics, Hospital Departments, Humans, Internal Medicine, Male, Patient Readmission, statistics /&/ numerical data, Risk Factors, Time Factors, Univariate analysis, vascular disease, Settore MED/45 - Scienze Infermieristiche Generali, Cliniche E Pediatriche, Ageing, readmission, statistics /&/ numerical data, Hospital Department, liver disease, Human, medicine.medical_specialty, Time Factor, MEDLINE, Hospital readmission, Internal medicine and geriatric wards, Risk factors, Elderly, elderly patients, NO, medicine, Registry Politerapie SIMI (REPOSI), Adverse effect, business.industry, Risk Factor, Univariate, medicine.disease, Comorbidity, elderly, hospital readmission, risk factors, internal medicine and geriatric wards, Internal medicine and geriatric ward, Emergency medicine, business, Geriatric
Abstract

Background: The aim of this study was to identify which factors were associated with a risk of hospital readmission within 3 months after discharge of a sample of elderly patients admitted to internal medicine and geriatric wards. Methods: Of the 1178 patients aged 65 years or more and discharged from one of the 66 wards of the 'Registry Politerapie SIMI (REPOSI)' during 2010, 766 were followed up by phone interview 3 months after discharge and were included in this analysis. Univariate and multivariate logistic regression models were used to evaluate the association of several variables with rehospitalization within 3 months from discharge. Results: Nineteen percent of patients were readmitted at least once within 3 months after discharge. By univariate analysis in-hospital clinical adverse events (AEs), a previous hospital admission, number of diagnoses and drugs, comorbidity and severity index (according to Cumulative Illness Rating Scale-CIRS), vascular and liver diseases with a level of impairment at discharge of 3 or more at CIRS were significantly associated with risk of readmission. Multivariate logistic regression analysis showed that only AEs during hospitalization, previous hospital admission, and vascular and liver diseases were significantly associated with the likelihood of readmission. Conclusions: The results demonstrate the need for increased medical attention towards elderly patients discharged from hospital with characteristics such as AEs during the hospitalization, previous admission, vascular and liver diseases. © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Published
2013
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4. Factors affecting adherence to guidelines for antithrombotic therapy in elderly patients with atrial fibrillation admitted to internal medicine wards

Author

Marcucci, M, Iorio, A, Nobili, A, Tettamanti, M, Pasina, L, Marengoni, A, Salerno, F, Corrao, S, Mannucci, Pm, Tedeschi A, REPOSI Investigators., Rossio, R, Moreo, G, Ferrari, B, Mammarella, A, Raparelli, V, Rondinella, S, Giannico, I, Rasciti, L, Gualandi, S, Monzani, V, Savojardo, V, Fabio, G, Colombo, S, Quercioli, A, Barreca, A, Durante-Mangoni, E, Pinto, D, Incasa, E, Rizzoli, E, Vanoli, M, Casella, G, Musca, G, Cuccurullo, O, Famularo, G, Sajeva, Mr, Picardi, A, Hila, D, Rozzini, R, Giordano, A, Bonelli, A, Dentamaro, G, Gobbo, G, Cazzaniga, M, Gaudenzi, P, Giusto, L, Rizzoni, D, Castoldi, L, Mari, D, Micale, G, Altomare, E, Serviddio, G, Longhini, C, Molino, C, Deidda, S, Cuccuru, Lm, Quagliolo, M, Centenaro, Gr, Pasqui, Al, Puccetti, L, Bertolino, G, Cavallo, P, Bertolini, D, Liberato, Nl, Perciccante, A, Coralli, A, Anastasio, L, Bertucci, L, Macura, A, Matino, D, Morabito, C, Fava, R, Tuttolomondo, A, Di Sciacca, R, Semplicini, A, Magagnotti, G, Fiorentini, A, Tofi, C, Cagnoni, C, Manucra, A, Romanelli, G, Cortellaro, M, Meroni, Mr, Rossi, Dp, Vergani, C., Marcucci, M, Iorio, A, Nobili, A, Tettamanti, M, Pasina, L, Marengoni, A, Salerno, F, Corrao, S, Mannucci, PM, Tedeschi, A, Rossio, R, Moreo, G, Ferrari, B, Mammarella, A, Raparelli, V, Rondinella, S, Giannico, I, Rasciti, L, Gualandi, S, Monzani, V, Savojardo, V, Fabio, G, Colombo, S, Quercioli, A, Barreca, A, Durante-Mangoni, E, Pinto, D, Incasa, E, Rizzoli, E, Vanoli, M, Casella, G, Musca, G, Cuccurullo, O, Famularo, G, Sajeva, MR, Picardi, A, Hila, D, Rozzini, R, Giordano, A, Bonelli, A, Dentamaro, G, Gobbo, G, Cazzaniga, M, Gaudenzi, P, Giusto, L, Rizzoni, D, Castoldi, L, Mari, D, Micale, G, Altomare, E, Serviddio, G, Longhini, C, Molino, C, Deidda, S, Cuccuru, LM, Quagliolo, M, Centenaro, GR, Pasqui, AL, Puccetti, L, Bertolino, G, Cavallo, P, Bertolini, D, Liberato, NL, Perciccante, A, Coralli, A, Anastasio, L, Bertucci, L, Macura, A, Matino, D, Morabito, C, Fava, R, Tuttolomondo, A, Di Sciacca, R, Semplicini, A, Magagnotti, G, Fiorentini, A, Tofi, C, Cagnoni, C, Manucra, A, Romanelli, G, Cortellaro, M, Meroni, MR, Rossi, DP, and Vergani, C

Subjects
Male, medicine.medical_specialty, Settore MED/09 - Medicina Interna, Vitamin K, antithrombotic therapy, NO, Antithrombotic prophylaxis, Atrial fibrillation, Platelet agents, Vitamin K antagonists, Fibrinolytic Agents, Risk Factors, Internal medicine, Antithrombotic, Internal Medicine, medicine, Humans, atrial fibrillation, Registries, Medical prescription, Stroke, Aged, Retrospective Studies, Aged, 80 and over, Antithrombotic prophylaxis, Atrial fibrillation, Platelet agents, Vitamin K antagonists, guidelines, Aspirin, business.industry, antithrombotic prophylaxis, platelet agents, vitamin k antagonists, Retrospective cohort study, medicine.disease, Intracranial Embolism, Italy, Platelet aggregation inhibitor, Female, Guideline Adherence, business, guideline, Platelet Aggregation Inhibitors, Fibrinolytic agent, medicine.drug
Abstract

Introduction Current guidelines for ischemic stroke prevention in atrial fibrillation or flutter (AFF) recommend Vitamin K antagonists (VKAs) for patients at high-intermediate risk and aspirin for those at intermediate-low risk. The cost-effectiveness of these treatments was demonstrated also in elderly patients. However, there are several reports that emphasize the underuse of pharmacological prophylaxis of cardio-embolism in patients with AFF in different health care settings. Aims To evaluate the adherence to current guidelines on cardio-embolic prophylaxis in elderly (> 65 years old) patients admitted with an established diagnosis of AFF to the Italian internal medicine wards participating in REPOSI registry, a project on polypathologies/polytherapies stemming from the collaboration between the Italian Society of Internal Medicine and the Mario Negri Institute of Pharmacological Research; to investigate whether or not hospitalization had an impact on guidelines adherence; to test the role of possible modifiers of VKAs prescription. Methods We retrospectively analyzed registry data collected from January to December 2008 and assessed the prevalence of patients with AFF at admission and the prevalence of risk factors for cardio-embolism. After stratifying the patients according to their CHADS 2 score the percentage of appropriateness of antithrombotic therapy prescription was evaluated both at admission and at discharge. Univariable and multivariable logistic regression models were employed to verify whether or not socio-demographic (age > 80 years, living alone) and clinical features (previous or recent bleeding, cranio-facial trauma, cancer, dementia) modified the frequency and modalities of antithrombotic drugs prescription at admission and discharge. Results Among the 1332 REPOSI patients, 247 were admitted with AFF. At admission, CHADS 2 score was ≥ 2 in 68.4% of patients, at discharge in 75.9%. Among patients with AFF 26.5% at admission and 32.8% at discharge were not on any antithrombotic therapy, and 43.7% at admission and 40.9% at discharge were not taking an appropriate therapy according to the CHADS 2 score. The higher the level of cardio-embolic risk the higher was the percentage of antiplatelet- but not of VKAs-treated patients. At admission or at discharge, both at univariable and at multivariable logistic regression, only an age > 80 years and a diagnosis of cancer, previous or active, had a statistically significant negative effect on VKAs prescription. Moreover, only a positive history of bleeding events (past or present) was independently associated to no VKA prescription at discharge in patients who were on VKA therapy at admission. If heparin was considered as an appropriate therapy for patients with indication for VKAs, the percentage of patients admitted or discharged on appropriate therapy became respectively 43.7% and 53.4%. Conclusion Among elderly patients admitted with a diagnosis of AFF to internal medicine wards, an appropriate antithrombotic prophylaxis was taken by less than 50%, with an underuse of VKAs prescription independently of the level of cardio-embolic risk. Hospitalization did not improve the adherence to guidelines.

Published
2010

5. In-hospital death and adverse clinical events in elderly patients according to disease clustering: the REPOSI study. Marengoni A

Author

Marengoni, A, Bonometti, F, Nobili, A, Tettamanti, M, Salerno, F, Corrao, S, Iorio, A, Marcucci, M, Mannucci, PM, Tedeschi, A, Rossio, R, Moreo, G, Ferrari, B, Mammarella, A, Raparelli, V, Rondinella, S, Giannico, I, Rasciti, L, Gualandi, S, Monzani, V, Savojardo, V, Fabio, G, Colombo, S, Quercioli, A, Barreca, A, Durante Mangoni, E, Pinto, D, Incasa, E, Rizzoli, E, Vanoli, M, Casella, G, Musca, G, Cuccurullo, O, Famularo, G, Sajeva, R, Picardi, A, Hila, D, Rozzini, R, Giordano, A, Bonelli, A, Dentamaro, G, Gobbo, G, Cazzaniga, M, Gaudenzi, P, Giusto, L, Rizzoni, D, Castoldi, L, Mari, D, Micale, G, Altomare, E, Serviddio, G, Longhini, C, Molino, C, Deidda, S, Cuccuru, LM, Quagliolo, M, Centenaro, GR, Pasqui, AL, Puccetti, L, Bertolino, G, Cavallo, P, Bertolini, D, Liberato, NL, Perciccante, A, Coralli, A, Anastasio, L, Bertucci, L, Agnelli, G, Macura, A, Morabito, C, Fava, R, Di Sciacca, R, Macchini, L, Realdi, A, Fiorentini, A, Tofi, C, Cagnoni, C, Manucra, A, Romanelli, G, Cortellaro Meroni, MR, Rossi, DP, Vergani, C., TUTTOLOMONDO, Antonino, Marengoni, A, Bonometti, F, Nobili, A, Tettamanti, M, Salerno, F, Corrao, S, Iorio, A, Marcucci, M, Mannucci, PM, Tedeschi, A, Rossio, R, Moreo, G, Ferrari, B, Mammarella, A, Raparelli, V, Rondinella, S, Giannico, I, Rasciti, L, Gualandi, S, Monzani, V, Savojardo, V, Fabio, G, Colombo, S, Quercioli, A, Barreca, A, Durante Mangoni, E, Pinto, D, Incasa, E, Rizzoli, E, Vanoli, M, Casella, G, Musca, G, Cuccurullo, O, Famularo, G, Sajeva, R, Picardi, A, Hila, D, Rozzini, R, Giordano, A, Bonelli, A, Dentamaro, G, Gobbo, G, Cazzaniga, M, Gaudenzi, P, Giusto, L, Rizzoni, D, Castoldi, L, Mari, D, Micale, G, Altomare, E, Serviddio, G, Longhini, C, Molino, C, Deidda, S, Cuccuru, LM, Quagliolo, M, Centenaro, GR, Pasqui, AL, Puccetti, L, Bertolino, G, Cavallo, P, Bertolini, D, Liberato, NL, Perciccante, A, Coralli, A, Anastasio, L, Bertucci, L, Agnelli, G, Macura, A, Morabito, C, Fava, R, Tuttolomondo, A, Di Sciacca, R, Macchini, L, Realdi, A, Fiorentini, A, Tofi, C, Cagnoni, C, Manucra, A, Romanelli, G, Cortellaro Meroni, MR, Rossi, DP, and Vergani, C

Subjects
Settore MED/09 - Medicina Interna, elderly, in-hospital death
Abstract

OBJECTIVE: The aim of the study was to recognize clusters of diseases among hospitalized elderly and to identify groups of patients at risk of in-hospital death and adverse clinical events according to disease clustering. METHOD: This was a cross-sectional study conducted in 38 internal medicine and geriatric wards in Italy participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The subjects were 1,332 inpatients aged 65 years or older. Clusters of diseases (i.e., two or more co-occurrent diseases) were identified using the odds ratios (OR) for the associations between pairs of conditions, followed by cluster analysis. Logistic regression models were used to evaluate the effect of disease clusters on in-hospital death and adverse clinical events. RESULTS: A total of 86.7% of the patients were discharged, 8.3% were transferred to another hospital unit, and 5.0% died during hospitalization; 36.4% of the patients had at least one adverse clinical event. Patients affected by the clusters, including heart failure (HF) and either chronic renal failure (CRF) or chronic obstructive pulmonary disease, had a significant association with in-hospital death (OR, 4.3;95% confidence interval [CI], 1.6-11.5; OR, 2.9; 95% CI, 1.1-8.3, respectively), as well as patients affected by CRF and anemia (OR, 6.1; 95% CI, 2.3-16.2). The cluster including HF and CRF was also associated with adverse clinical events (OR, 3.5; 95% CI, 1.5-7.8). The effect of both HF and CRF and anemia and CRF on in-hospital death was additive. CONCLUSION: Several groups of older patients at risk of in-hospital death and adverse clinical events were identified according to disease clustering. Knowledge of the relationship among co-occurring diseases may help developing strategies to improve clinical practice and preventative interventions.

Published
2010

6. Comparison of Disease Clusters in Two Elderly Populations Hospitalized in 2008 and 2010

Author

Marengoni, A, Nobili, A, Pirali, C, Tettamanti, M, Pasina, L, Salerno, F, Corrao, S, Iorio, A, Marcucci, M, Franchi, C, Mannucci, Pm, Reposi, Investigators, Pier Mannucci, M, Spirito, V, Noce, D, Bonazzi, J, Lombardo, R, Sparacio, E, Alborghetti, S, De Vittorio, L, Djade, Cd, Paolisso, G, Rizzo, Mr, Laieta, Mt, Roberto, T, Persico, Marcello, Salvatore, T, Sasso, Fc, Utili, R, Durante Mangoni, E, Pinto, D, Fenoglio, L, Brignone, C, Bracco, C, Gasbarrone, L, Porcari, P, Famularo, G, Sajeva, Mr, Maniscalco, G, Gunelli, M, Tirotta, D, Realdi, G, Baritussio, A, Frassoni, F, Delsignore, R, Baroni, Mc, Zardo, M, Volpato, S, Fotini, S, Manfredini, R, Longhini, C, Molino, C, Incasa, E, Guarnieri, G, Zanetti, M, Spalluti, A, Rini, G, Mansueto, P, Pepe, I, Licata, G, Calvo, L, Valenti, M, Tuttolomondo, A, Di Sciacca, R, Antonaci, S, Vella, F, Marseglia, A, Centonze, V, Modeo, Me, Palasciano, G, Pugliese, S, Capobianco, C, Murialdo, G, Bovio, M, Pasini, Fl, Capecchi, Pl, Bicchi, M, Nuti, R, Valenti, R, Capodarca, C, Auteri, A, Pasqui, Al, Puccetti, L, Olivieri, O, Stanzial, Am, Agnelli, G, Macura, A, Mannarino, E, Lupattelli, G, Rondelli, P, Serra, Mg, Musca, G, Cuccurullo, O, Cappellini, Md, Fabio, G, Motta, I, Cantoni, F, Fargion, S, Bonara, P, Bulgheroni, M, Magrini, F, Massari, F, Tonella, T, Peyvandi, F, Tedeschi, A, Rossio, R, Moreo, G, Ferrari, B, Roncari, L, Monzani, V, Savojardo, V, Folli, C, Mari, D, Rossi, Pd, Ziglioli, E, Vergani, C, Lilleri, Ms, Podda, M, Selmi, C, Meda, F, Cazzaniga, M, Monti, V, Balduini, Cl, Bertolino, G, Dezzani, L, Cavallo, P, Corazza, Gr, Miceli, E, Secchi, Mb, Wu, Sc, Balsamo, C, Anastasio, L, Sofia, L, Carbone, M, Bertucci, L, Valentia, V, Traisci, G, De Feudis, L, Bergami, E, Rizzioli, E, Cagnoni, C, Bertone, L, Manucra, A, Ronchi, E, Buratti, A, Tognin, T, Bertolini, D, Liberato, Nl, Bernasconi, G, Nardo, B, Venco, A, Guasti, L, Maroni, L, Castiglioni, L, Vanoli, M, Grignani, G, Casella, G, Mancuso, G, Tavella, R, Persico, R, Cicardi, M, Sandrone, G, Cortellaro, M, Magenta, M, Perego, F, Meroni, Mr, Rozzini, R, Falanga, L, Giordano, A, Menardo, G, Bottone, S, Sferrazzo, E, Tassara, R, Melis, D, Rebella, L, Ferri, C, Striuli, R, Scipioni, R, Salmi, R, Gaudenzi, P, Di Todaro, F, Nielsen, I, Giusto, L, Semplicini, A, Gottardo, L, Delitala, G, Carta, S, Atzori, S, Rosei, Ea, Rizzoni, D, Castoldi, L, Altomare, E, Serviddio, G, Salvatore, S, Fera, G, Di Luca ML, Renna, D, Picardi, A, Mazzarelli, C, Gentilucci, Uv, De Vincentis, A, Hila, D, Bernardi, M, Li Bassi, S, Santi, L, Masala, C, Mammarella, A, Raparelli, V, Rossi Fanelli, F, Delfino, M, Amoroso, A, Serra, P, Fontana, V, Falcone, M, Violi, F, Basili, S, Perri, L, Silveri, Ng, De Marco, G, Giupponi, B, Landolfi, R, Grieco, A, Gallo, A, Perticone, F, Sciacqua, A, Quero, M, Bagnato, C, Loria, P, Ballestri, S, Becchi, Ma, Bellettini, E, Bolondi, L, Rasciti, L, Serio, I, Gualandi, S, Romanelli, G, Bonometti, F, Carulli, N, Rondinella, S, Giannico, I, Dallegri, F, Ottonello, L, Quercioli, A, Barreca, A, Sacco, A, Bonelli, A, Dentamaro, G, Micale, G, Delitalia, G, Deidda, S, Cuccuru, Lm, Benetti, G, Quagliolo, M, Centenaro, Gr, Perciccante, A, Coralli, A, Morabito, C, Fava, R, Macchini, L, Realdi, A, Cricco, L, Fiorentini, A, Tofi, C., Marengoni A, Nobili A, Pirali, C, Tettamanti, M, Pasina, L, Salerno, F, Corrao, S, Iorio, A, Marcucci, M, Franchi, C, Mannucci, Pm, Investigators, Reposi, Zanetti, Michela, Marengoni, A., Nobili, A., Pirali, C., Tettamanti, M., Pasina, L., Salerno, F., Corrao, S., Iorio, A., Marcucci, M., Franchi, C., Mannucci, P. M, Rizzo, Mr, Marengoni A, Nobili A, Pirali C, Tettamanti M, Pasina L, Salerno F, Corrao S, Iorio A, Marcucci M, Franchi C, Mannucci PM, REPOSI Investigators [.., Bernardi M, Bolondi L, ], Mannucci, P., and Mansueto, P.

Subjects
Registrie, Male, Aging, Cirrhosis, Settore MED/09 - Medicina Interna, Time Factors, hispitalization, Gerontology, aging populations, atterns of multimorbidity, diseases in the elderly population, Health care, 80 and over, Prevalence, Chronic diseases, Cluster analysis, Hospitalized elderly, Registries, aging population, Aged, 80 and over, education.field_of_study, Settore MED/45 - Scienze Infermieristiche Generali, Cliniche E Pediatriche, Hospitalization, Italy, elderly, disease clusters, Female, hospitalized, Human, medicine.medical_specialty, Time Factor, Anemia, MULTIMORBIDITY, Population, MEDLINE, Malignancy, Diabetes mellitus, Internal medicine, medicine, Multimorbidity, Humans, education, Aged, Chronic Disease, Cluster Analysis, Geriatrics and Gerontology, Cluster Analysi, business.industry, medicine.disease, Physical therapy, disease cluster, business
Abstract

Background: As chronicity represents one of the major challenges in the healthcare of aging populations, the understanding of how chronic diseases distribute and co-occur in this part of the population is needed. Objectives: The aims of this study were to evaluate and compare patterns of diseases identified with cluster analysis in two samples of hospitalized elderly. Methods: Data were obtained from the multicenter ‘Registry Politerapie SIMI (REPOSI)' that included people aged 65 or older hospitalized in internal medicine and geriatric wards in Italy during 2008 and 2010. The study sample from the first wave included 1,411 subjects enrolled in 38 hospitals wards, whereas the second wave included 1,380 subjects in 66 wards located in different regions of Italy. To analyze patterns of multimorbidity, a cluster analysis was performed including the same diseases (19 chronic conditions with a prevalence >5%) collected at hospital discharge during the two waves of the registry. Results: Eight clusters of diseases were identified in the first wave of the REPOSI registry and six in the second wave. Several diseases were included in similar clusters in the two waves, such as malignancy and liver cirrhosis; anemia, gastric and intestinal diseases; diabetes and coronary heart disease; chronic obstructive pulmonary disease and prostate hypertrophy. Conclusion: These findings strengthened the idea of an association other than by chance of diseases in the elderly population.

Published
2013

7. In-hospital death according to dementia diagnosis in acutely ill elderly patients: the REPOSI study

Author

Marengoni, A, Corrao, S, Nobili, A, Tettamanti, M, Pasina, L, Salerno, F, Iorio, A, Marcucci, M, Bonometti, F, Mannucci, Pm, SIMI Investigators Tedeschi, A, Rossio, R, Moreo, G, Ferrari, B, Mammarella, A, Raparelli, V, Rondinella, S, Giannico, I, Rasciti, L, Gualandi, S, Monzani, V, Savojardo, V, Fabio, G, Colombo, S, Quercioli, A, Barreca, A, Durante-Mangoni, E, Pinto, D, Incasa, E, Rizzioli, E, Vanoli, M, Casella, G, Musca, G, Cuccurullo, O, Famularo, G, Sajeva, Mr, Picardi, A, Hila, D, Rozzini, R, Giordano, A, Bonelli, A, Dentamaro, G, Gobbo, G, Cazzaniga, M, Gaudenzi, P, Giusto, L, Rizzoni, D, Castoldi, L, Mari, D, Micale, G, Altomare, E, Serviddio, G, Longhini, C, Molino, C, Deidda, S, Cuccuru, Lm, Quagliolo, M, Centenaro, Gr, Pasqui, Al, Puccetti, L, Bertolino, G, Cavallo, P, Bertolini, D, Liberato, Nl, Perciaccante, A, Coralli, A, Anastasio, L, Bertucci, L, Agnelli, G, Macura, A, Morabito, C, Fava, R, Tuttolomondo, A, Di Sciacca, R, Macchini, L, Realdi, A, Fiorentini, A, Tofi, C, Cagnoni, C, Manucra, A, Romanelli, G, Cortellaro, M, Meroni, Mr, Rossi, Dp, Vergani, C, Ogliari, G, Marengoni, A, Corrao, S, Nobili, A, Tettamanti, M, Pasina, L, Salerno, F, Iorio, A, Marcucci, M, Bonometti, F, Mannucci, PM, and SIMI Investigators

Subjects
Male, medicine.medical_specialty, Pediatrics, Settore MED/09 - Medicina Interna, MEDLINE, Charlson index, Logistic regression, NO, older patient, Sex Factors, Acute illnesses, Dementia, Hospitalization, Mortality, Older patients, mental disorders, medicine, Dementia, Humans, Dementia diagnosis, Hospital Mortality, Intensive care medicine, Aged, In hospital death, Aged, 80 and over, business.industry, acute illnesses, Confounding, Age Factors, risk of death, medicine.disease, Settore MED/45 - Scienze Infermieristiche Generali, Cliniche E Pediatriche, mortality, older patients, acute illnesse, Psychiatry and Mental health, Pneumonia, hospital admission, Logistic Models, Acute Disease, Female, Geriatrics and Gerontology, business, dementia, hospitalization
Abstract

The aim of the study was to explore the association of dementia with in-hospital OBJECTIVE:The aim of the study was to explore the association of dementia with in-hospital death in acutely ill medical patients. METHODS: Thirty-four internal medicine and 4 geriatric wards in Italy participated in the Registro Politerapie SIMI-REPOSI-study during 2008. One thousand three hundred and thirty two in-patients aged 65 years or older were enrolled. Logistic regression models were used to evaluate the association of dementia with in-hospital death. Socio-demographic characteristics, morbidity (single diseases and the Charlson Index), number of drugs, and adverse clinical events during hospitalization were considered as potential confounders. RESULTS: One hundred and seventeen participants were diagnosed as being affected by dementia. Patients with dementia were more likely to be women, older, to have cerebrovascular diseases, pneumonia, and a higher number of adverse clinical events during hospitalization. The percentage of patients affected by dementia who died during hospitalization was higher than that of patients without dementia (9.4 versus 4.9%). After multiadjustment, the diagnosis of dementia was associated with in-hospital death (OR = 2.1; 95% CI = 1.0-4.5). Having dementia and at least one adverse clinical event during hospitalization showed an additive effect on in-hospital mortality (OR = 20.7; 95% CI = 6.9-61.9). CONCLUSIONS: Acutely ill elderly patients affected by dementia are more likely to die shortly after hospital admission. Having dementia and adverse clinical events during hospital stay increases the risk of death.

Published
2010

8. In-hospital death and adverse clinical events in elderly patients according to disease clustering: The REPOSI study

Author

Marengoni, A, Bonometti, F, Nobili, A, Tettamanti, M, Salerno, F, Corrao, S, Iorio, A, Marcucci, M, Mannucci, Pm, Tedeschi A, Italian Society of Internal Medicine (SIMI) Investigators., Rossio, R, Moreo, G, Ferrari, B, Mammarella, A, Raparelli, V, Rondinella, S, Giannico, I, Rasciti, L, Gualandi, S, Monzani, V, Savojardo, V, Fabio, G, Colombo, S, Quercioli, A, Barreca, A, Durante-Mangoni, E, Pinto, D, Incasa, E, Rizzoli, E, Vanoli, M, Casella, G, Musca, G, Cuccurullo, O, Famularo, G, Sajeva, Mr, Picardi, A, Hila, D, Rozzini, R, Giordano, A, Bonelli, A, Dentamaro, G, Gobbo, G, Cazzaniga, M, Gaudenzi, P, Giusto, L, Rizzoni, D, Castoldi, L, Mari, D, Micale, G, Altomare, E, Serviddio, G, Longhini, C, Molino, C, Deidda, S, Cuccuru, Lm, Quagliolo, M, Centenaro, Gr, Pasqui, Al, Puccetti, L, Bertolino, G, Cavallo, P, Bertolini, D, Liberato, Nl, Perciccante, A, Coralli, A, Anastasio, L, Bertucci, L, Agnelli, G, Macura, A, Morabito, C, Fava, R, Tuttolomondo, A, Di Sciacca, R, Macchini, L, Realdi, A, Fiorentini, A, Tofi, C, Cagnoni, C, Manucra, A, Romanelli, G, Cortellaro, M, Meroni, Mr, Rossi, Dp, Vergani, C., Marengoni, A, Bonometti, F, Nobili, A, Tettamanti, M, Salerno, F, Corrao, S, Iorio, A, Marcucci, M, Mannucci, PM, and Italian Society of Internal Medicine (SIMI) Investigators

Subjects
Male, Aging, Disease clusters, Pediatrics, medicine.medical_specialty, Settore MED/09 - Medicina Interna, Hospital unit, Disease, Hospital mortality, disease clustering, Logistic regression, NO, 80 and over, Medicine, Cluster Analysis, Humans, Hospital Mortality, Aged, Aged, 80 and over, In hospital death, Medical Errors, business.industry, Clinical events, Female, Italy, REPOSI, In-hospital death, elderly patients, Odds ratio, Settore MED/45 - Scienze Infermieristiche Generali, Cliniche E Pediatriche, elderly patient, Geriatrics and Gerontology, business, patients at risk of in-hospital death, adverse clinical events according to disease clustering
Abstract

OBJECTIVE: The aim of the study was to recognize clusters of diseases among hospitalized elderly and to identify groups of patients at risk of in-hospital death and adverse clinical events according to disease clustering. METHOD: This was a cross-sectional study conducted in 38 internal medicine and geriatric wards in Italy participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The subjects were 1,332 inpatients aged 65 years or older. Clusters of diseases (i.e., two or more co-occurrent diseases) were identified using the odds ratios (OR) for the associations between pairs of conditions, followed by cluster analysis. Logistic regression models were used to evaluate the effect of disease clusters on in-hospital death and adverse clinical events. RESULTS: A total of 86.7% of the patients were discharged, 8.3% were transferred to another hospital unit, and 5.0% died during hospitalization; 36.4% of the patients had at least one adverse clinical event. Patients affected by the clusters, including heart failure (HF) and either chronic renal failure (CRF) or chronic obstructive pulmonary disease, had a significant association with in-hospital death (OR, 4.3;95% confidence interval [CI], 1.6-11.5; OR, 2.9; 95% CI, 1.1-8.3, respectively), as well as patients affected by CRF and anemia (OR, 6.1; 95% CI, 2.3-16.2). The cluster including HF and CRF was also associated with adverse clinical events (OR, 3.5; 95% CI, 1.5-7.8). The effect of both HF and CRF and anemia and CRF on in-hospital death was additive. CONCLUSION: Several groups of older patients at risk of in-hospital death and adverse clinical events were identified according to disease clustering. Knowledge of the relationship among co-occurring diseases may help developing strategies to improve clinical practice and preventative interventions.

Published
2010

10. Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results.

Author

Nasso G, Vignaroli W, Amodeo V, Bartolomucci F, Larosa C, Contegiacomo G, Demola MA, Girasoli C, Valenzano A, Fiore F, Bonifazi R, Triggiani V, Vitobello V, Errico G, Lamanna A, Hila D, Loizzo T, Franchino R, Sechi S, Valenti G, Diaferia G, Brigiani MS, Arima S, Angelelli M, Curcio A, Greco F, Greco E, Speziale G, and Santarpino G

Abstract

Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study. Until December 2019, 100 patients optimized therapy with statin ± ezetimibe (SG). Since January 2020, 80 matched patients added treatment with Evolocumab every 2 weeks (EG). All 180 patients were followed-up at 3 and 12 months, comparing outcomes. Results: The two groups are homogenous. At 3 months and 1 year, a significant decrease in the parameter mean levels of LDL cholesterol and total cholesterol is detected in the Evolocumab group compared to the standard group. No mortality was detected in either group. No complications or drug discontinuation were recorded. In the SG group, five patients (5%) suffered a myocardial infarction during the 1-year follow-up. In the EG group, two patients (2.5%) underwent PTCA due to myocardial infarction. There is no significant difference in overall survival according to the new treatment ( p -value = 0.9), and the hazard ratio is equal to 0.94 (95% C.I.: [0.16-5.43]; p -value = 0.9397). Conclusions: The use of Evolocumab, which was started immediately after coronary artery bypass graft surgery, significantly reduced LDL cholesterol and total cholesterol levels compared to statin treatment alone and is completely safe. However, at one year of follow-up, this result did not have impact on the reduction in major clinical events.

Published
2024
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11. Safety and Efficacy of PCSK9 Inhibitors in Patients with Acute Coronary Syndrome Who Underwent Coronary Artery Bypass Grafts: A Comparative Retrospective Analysis.

Author

Nasso G, Larosa C, Bartolomucci F, Brigiani MS, Contegiacomo G, Demola MA, Vignaroli W, Tripoli A, Girasoli C, Lisco R, Trivigno M, Tunzi RM, Loizzo T, Hila D, Franchino R, Amodeo V, Ventra S, Diaferia G, Schinco G, Agrò FE, Zingaro M, Rosa I, Lorusso R, Del Prete A, Santarpino G, and Speziale G

Abstract

Background . The in-hospital reduction in low-density lipoprotein cholesterol (LDL-C) levels following acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in those patients undergoing coronary artery bypass graft (CABG) has never been demonstrated. Methods . From January 2022 to July 2023, we retrospectively analyzed 74 ACS patients characterized by higher LDL-C levels than guideline targets and who underwent coronary bypass surgery. In the first period (January 2022-January 2023), the patients increased their statin dosage and/or added Ezetimibe (Group STEZE, 43 patients). At a later time (February 2023-July 2023), the patients received not only statins and Ezetimibe but also Evolocumab 140 mg every 2 weeks starting as early as possible (Group STEVO, 31 patients). After one and three months post-discharge, the patients underwent clinical and laboratory controls with an evaluation of the efficacy lipid measurements and every adverse event. Results . The two groups did not differ in terms of preoperative risk factors and Euroscore II (STEVO: 2.14 ± 0.75 vs. STEZE: 2.05 ± 0.6, p = 0.29). Also, there was no difference between the groups in terms of ACS (ST-, Instable angina, or NSTE) and time of symptoms onset regarding total cholesterol, LDL-C, and HDL-C trends from the preprocedural period to 3-month follow-up, but there was a more significant reduction in LDL-C and total cholesterol in the STEVO group ( p = 0.01 and p = 0.04, respectively) and no difference in HDL-C rise ( p = 0.12). No deaths were reported. In three STEZE group patients, angina recurrence posed the need for percutaneous re-revascularization. No STEVO patients developed significant adverse events. The statistical difference in these serious events, 7% in STEZE vs. 0% in STEVO, was not significant ( p = 0.26). Conclusions . Evolocumab initiated "as soon as possible" in ACS patients submitted to CABG with high-intensity statin therapy and Ezetimibe was well tolerated and resulted in a substantial and significant reduction in LDL-C levels at discharge, 1 month, and 3 months. This result is associated with a reduction but without a statistical difference between groups.

Published
2024
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12. Repair of congenitally dysplastic aortic valve by bicuspidization: midterm results.

Author

Luciani GB, De Rita F, Lucchese G, Hila D, Rungatscher A, Faggian G, and Mazzucco A

Subjects
Adult, Aortic Valve Insufficiency congenital, Aortic Valve Insufficiency diagnosis, Echocardiography, Transesophageal, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Treatment Outcome, Aortic Valve abnormalities, Aortic Valve surgery, Aortic Valve Insufficiency surgery, Cardiac Surgical Procedures methods, Plastic Surgery Procedures methods
Abstract

Background: Repair of congenital aortic valve (CAV) lesions may be achieved by creation of either tricuspid or bicuspid valve morphology. To define feasibility and outcome of CAV repair by bicuspidization a 10-year experience was reviewed., Methods: Between January 2002 and December 2011, 147 consecutive patients underwent operation for CAV insufficiency; 58 had valve or root repair (group 1) and 89 had valve or root replacement (group 2). Patients having repair were younger (42.9 vs 51.3 years, p=0.001), with lesser prevalence of severe insufficiency (72% vs 90%, p=0.002). In patients having repair, morphology of CAV was bicuspid in 51, monocuspid in 4, and quadricuspid in 3, whereas in the replacement group it was bicuspid in 87 and quadricuspid in 2 (p=0.04). Surgery consisted of an isolated aortic valve procedure in 20 versus 45 patients, associated with aortic root or ascending aortic repair in 38 versus 44 patients, in group 1 versus 2 (p=0.04)., Results: There were no hospital and 3 late deaths during a mean follow-up of 3.8±2.5 years (range 0.2 to 10.0). Eight-year survival (89%±10% vs 97%±2% [p=0.7]), freedom from valve-related events (84%±10% vs 89%±4% [p=0.8]), and freedom from aortic valve reoperation (95%±3% vs 93%±3% [p=0.6]) were comparable. Risk factors for reoperation at univariate analysis were isolated valve surgery (p=0.001), Ross operation (p=0.001), and endocarditis (p=0.002). Follow-up echocardiography of repair patients showed mild or less aortic insufficiency in 51 (88%) and mild or less stenosis in 57 (98%)., Conclusions: Valve repair by preservation or creation of bicuspid morphology is feasible in almost half of all comers with CAV insufficiency, with satisfactory and stable midterm functional outcome. Rates of valve-related adverse events and reoperation are similar to those of patients having replacement., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Published
2012
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