Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to ...those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women were suffering from rheumatic diseases. A total of 20 deaths were reported case fatality rate 31%, 95% confidence interval (CI): 19-42 compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.
•State of art of management and treatment of hypertension emergency/urgency in Italy.•Good knowledge of definition and treatment.•Fair quality of blood pressure measurement technique.•Lack of ...protocol or fast track for this problem.•Differences in terms of treatment and diagnosis across macro-areas.
Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension. 665 questionnaires were collected from EDs, Emergency and Urgency Medicine, Cardiology or Coronary Units, Internal Medicines, Intensive care, Stroke units. Symptoms considered suspicious of acute organ damage were: chest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%) and epistaxis (34.4%). Exams more frequent prescribed were: electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). The use of intravenous or oral medications to treat HEs was 94.7% and 3.5%, while for HUs 24.4% and 70.8% respectively. Of note, a surprisingly high percentage of physicians (22 % overall, 24.5% in North Italy) used to prescribe sublingual nifedipine. After discharge, home blood pressure monitoring and general practitioner re-evaluation were more frequently suggested, while ambulatory blood pressure monitoring and hypertension specialist examination were less prescribed. The differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration. This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy.
OBJECTIVE:Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Italian Emergency Department (ED), however the diagnostic and therapeutic approach may differ ...across the Italian country. The aim of the study GEAR (Gestione delle Emergenze e urgenze in ARea critica) was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of on-line survey.
DESIGN AND METHOD:The young investigator research group of the Italian Society of Hypertension developed a 23-items questionnaire spread by e-mail invitation to the members of Italian Scientific societies involved in the field of Emergency Medicine and Hypertension.
RESULTS:665 questionnaires were collected59.7% from EDs, 22% from Emergency and Urgency Medicine wards, 8.7% from Cardiology or Coronary Units, 5.7% from Internal Medicines and 3.9% from Intensive care or Stroke units. The definition of HE and HU was correctly identified by 81.2% and 89.3% of the responders respectively. The symptoms considered suspicious of acute organ damage werechest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%), epistaxis (34.4%). Appropriate cuffs, for different arm sizes, were not widely available in all units94% had standard cuffs, 57% small and 75.6 % large cuffs, extra-large only 38.5%. The exams more frequent prescribed to evaluate target organ damage were electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). HEs were treated by 94.7% of the physicians by intravenous medications and by 3.5% by oral drugs, while HUs were treated by intravenous drugs in 24.4% of the cases and by oral drugs in 70.8%. When patients were discharged from ED, 87.5 % of the responders recommended home blood pressure monitoring, 87.5% general practitioner re-evaluation, while ambulatory blood pressure monitoring and hypertension specialist examination were less frequently recommended.
CONCLUSIONS:This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy. Strong unmet needs clearly emerged, especially for educational initiatives, standardized treatment protocols and interrelationship with the chronic care system.
OBJECTIVE:Limited information is available on the association between serum uric acid (SUA) and metabolic syndrome, diabetes mellitus, renal failure, blood pressure (BP) control and cardiovascular ...(CV) risk profile in treated hypertensives of eastern European countries.
DESIGN AND METHOD:The BP-CARE study examined BP control and CV risk profile in about 8000 treated hypertensive patients followed by non-specialist or specialist physicians in Albania, Belarus, Bosnia, Czech Republic, Latvia, Romania, Serbia, Slovakia and Ukraine. In 3220 of them measurements included, along with clinic BP, 24-hour BP, metabolic and renal function variables, SUA values.
RESULTS:51% were males, while mean age (±SD) was 60.0 ± 10.9 yrs, clinic BP 147.3 ± 18/87.8 ± 10 mmHg, 24 hour BP 137.3 ± 19/81.3 ± 10 mmHg and SUA values 5.68 ± 1.9 mg/dl, with a normal distribution in the population. SUA was significantly higher in males than females (5.99 ± 1.9 vs 5.34 ± 1.9 mg/dl, P < 0.0001) and progressively and significantly greater from the low to the medium, high and very high risk patients (4.87 ± 1.38 vs 5.85 ± 2.00, P < 0.0001, ESH CV risk categories). Significant differences were also found between diabetic and non-diabetic patients (5.92 ± 2.2 vs 5.58 ± 1.8, P < 0.0001), patients with and without metabolic syndrome (5.92 ± 2.1 vs 5.43 ± 1.7, P < 0.0001) and from stage 1 to stage 5 renal insufficiency (from 5.87 ± 2.0 to 10.48 ± 3.4, P < 0.0001). No significant difference in SUA was found between patients treated and non-treated with diuretic or angiotensin II blockers or in those under antihypertensive drug combination vs monotherapy. No difference in SUA was also found when analyzing the data in relation to clinic or 24-hour BP control.
CONCLUSIONS:These data provide evidence that similarly to what described in western Europe, in central and eastern European countries SUA values are closely related to metabolic alterations, including diabetes mellitus, to renal insufficiency and CV risk profile. At variance from other studies, however, no relationship was found with BP control.
OBJECTIVE:Endothelial Dysfunction (ED) of peripheral arteries in Chronic Heart Failure (CHF) subjects has been demonstrated. We assessed endothelial function in subjects undergoing unconventional ...treatments for CHF, namely Heart Transplantation (HTX), continuous-flow Left Ventricular Assist Device implantation (LVAD), and repeated levosimendan infusions (r-LEVO).
DESIGN AND METHOD:Twenty HTX recipients (median time from HTX 21 months), 20 patients supported with LVAD (median time from implant 39 months), and 20 patients receiving monthly Levosimendan infusions (median time on treatment 28 months) were enrolled and compared to a group of 20 healthy subjects. ED was evaluated with ultrasound assessment of the diameter before and after ischemic stress at the brachial artery level. The difference between the two diameters normalized for the baseline value (Flow Mediated Dilation - FMD) has been used for the analysis. All the patients were stable at the time of FMD assessment, with those on r-LEVO being evaluated prior to infusion.
RESULTS:FMD was significantly lower in HTX and LVAD groups with respect to controls (9.8 ± 7.4, 9.3 ± 5.7, and 15.6 ± 6.4% respectively, p = 0.01), but not in r-LEVO group (12.5 ± 6.9%).When patients were analyzed according to time from the operation or on treatment, (< versus > of the median value), no differences were seen in HTX and r-LEVO group, while in LVAD group FMD was borderline significantly higher in patients with longer follow-up (8.4 ± 6.4% versus 10.2 ± 5.2%, p = 0.05).
CONCLUSIONS:Based on this preliminary data we can inference the following1- FMD is abnormal in HTX recipients, despite their good functional status, probably due to factors unrelated to CHF (e.g. hypertension, renal insufficiency, denervation, and drug effects); 2- LVAD patients also show ED, with possible better adaptation in very long-term survivors; 3- Near-normal FMD values in CHF patients who remain stable with r-LEVO suggest that pulsed treatment may obtain favorable effects at peripheral level, persisting after clearance of the drug and its metabolites.
OBJECTIVE:Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in augmenting mortality in oncological patients by affecting pericardium, myocardium, ...valvs and coronaries. Currently, regarding the risk of coronary heart disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5–10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patient without cardiovascular risk factors who sustained radiotherapy, using a cohort of high cardiovascular risk patients as control group.
DESIGN AND METHOD:A population of 115 patients who sustained chest irradiation, presenting without classic cardiovascular risk factors was evaluated with exercise stress electrocardiography. 135 patients with high profile of cardiovascular risk candidate to stress testing for primary prevention or for atypical symptoms served as control group.
RESULTS:The cohort of irradiated patients without classical cardiovascular risk factors was younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p < 0.001) and presents a lower percentage of males when compared with the control group. In this latter group 25.9% of subjects has diabetes, 62.9% dislipidemia, 67.4% hypertension and 19.2% actively smoke. Despite this important differences regarding classic cardiovascular risk factor no significant differences were founded in the number of positive exercise stress electrocardiography (10.4 vs 5.9%, p = ns).
CONCLUSIONS:Chest irradiation represent a strong cardiovascular risk factor, equalizing the rate of positive exercise stress electrocardiograms among two cohort of patients significantly different for the rate of classic cardiovascular risk factors.
OBJECTIVE:Reumatoid Arthritis (RA) patients display an increased cardiovascular (CV) risk. It is still debated, however, which CV risk chart is more adequate to define the CV risk profile of ...individual RA patient. Our study was aimed at assessing the ESH/ESC score in determining the CV risk and to compare the results with those obtained via the Framingham Risk Score (FRS) and the SCORE, both as classic and as modified according to EULAR recommendations.
DESIGN AND METHOD:Anamnestic data, clinic blood pressure (BP) and laboratory data were collected in 55 consecutive RA patients. Rheumatological score of disease activity (DAS28 Erythrocyte sedimentation rate - ESR, CDAI and SDAI) and CV risk model (FRS, SCORE, ESH/ESC) were calculated with a correcting factor of 1.5 when patients displayed at least 2 out of 3 of the following conditionsa long standing diseases (>10 years), with extra-articular disease or seropositivity for Reumatoid Factor (RF) or Anti–citrullinated protein antibody (ACPA) - modified score (mFRS and mSCORE).
RESULTS:Mean (±SD) age was 62.8 ± 8.9 years, 23.6% were males and BP amounted to 130.6 ± 17.4/ 75.6 ± 8.9 mmHg. Mean DAS28 ESR, CDAI and SDAI were 3.3 ± 1.3, 8,9 ± 9.7 and 9.7 ± 10.1 respectively, indicating a low disease activity. The majority of patients showed a low CV risk employing mFRS, mSCORE and ESH/ESC (percent values67.9, 94.3 and 58.4, respectively). When patients were divided according to their low, medium or high risk, the different groups didn’t show any significant difference regarding DAS28ESR, CDAI, SDAI and age of RA. Only with FRS a significant difference in DAS28ESR was found with greater values in the high risk group. Moreover the only significant correlation was found between both FRS and mFRS with DAS28ESR (r = -0.3, P = 0.02).
CONCLUSIONS:In RA patients only FRS risk score significantly correlates with the disease activity index both with and without EULAR correcting factor. On the contrary no significant correlation was found SCORE and ESH/ESC models, which thus appear to less sensitivitive in categoriziing Cv risk in RA patients.
OBJECTIVE:Cardiac Rehabilitation (CR) improves the functional capacity and the prognosis of patients with Coronary Artery Disease (CAD). Similar results have also been found in patients with Dilated ...Cardiomyopathy (DCM). Our study was aimed at assessing the relationship between functional improvement (evaluated with 6-Minute Walking Test – 6MWT) and the improvement in Left Ventricular Ejection Fraction (LVEF) after CR.Methodswe collected data from 260 patients that performed CR after an Acute Coronary Syndrome (ACS). The functional improvement after CR was expressed as the delta between distance covered at the final versus the initial 6MWT normalized for the initial 6MWT, while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR.
DESIGN AND METHOD:We collected data from 260 patients that performed CR after an Acute Coronary Syndrome (ACS). The functional improvement after CR was expressed as the delta between distance covered at the final versus the initial 6MWT normalized for the initial 6MWT, while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR.
RESULTS:In the whole population functional improvement was 44.07 % (baseline 6MWT 421.22 m vs follow-up 6MWT 597.28 m, p = < 0.05) while EF improvement was 2.48 % (baseline EF 53.37% vs follow-up EF 55.91%, p= < 0.05). No significant correlation between the normalized delta meter and delta EF was founded. When patients were divided accordingly to their pre-rehab LVEF (>=55, 40–55 and < 50%) we found a lower baseline 6MWT distance in the second and the third group with a higher improvement only in the second group (40 vs 50 vs 43% respectively, p=0.001). This latter group is also the one that presents the higher improvement in EF in comparison with the EF < 40% group (5 vs 3%, p = 0.04). No significant correlation between the normalized delta meter and delta EF was founded also when analysis was repeated in the different group depending on the EF values.
CONCLUSIONS:Our data confirm the CR related functional improvement that is not related to the relative increase in LVEF.
OBJECTIVE:The role of classic cardiovascular risk factors on the progression of arterial stiffness has not yet been extensively evaluated particularly regarding Metabolic Syndrome (MS). The aim of ...the current longitudinal study was to evaluate the determinants of the Pulse Wave Velocity(PWV) progression over a 3.7 years follow-up period in hypertensive subjects focusing on metabolic syndrome.
DESIGN AND METHOD:We enrolled 448 consecutive hypertensive outpatients 18–80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). At baseline anamnestic, Blood Pressure (BP) and laboratory data as well as cf-PWV were assessed. We performed PWV again at a follow-up examination with a median time amounting to 3.7 ± 0.5 years. NCPET-ATPIII criteria were used to define MS as the presence of three or more item. Data are reported as mean ± SE.
RESULTS:At T0 the mean age was 53.7 ± 1.1 years, SBP and DBP were 141.3 ± 1.7 and 86.4 ± 1.2 mmHg and PWV was 8.5 ± 0.15 m/s. 125 patients (27.9%) meet the criteria for MS. Those patients were older (56.3 ± 1.0 vs 52.7 ± 0.7, p = 0.007) with superimposable baseline SBP and DBP values (141.4 ± 1/87.2 ± 0.6 vs 142.4 ± 1.6/86 ± 1, p > 0.05 for both comparison) as well as PWV values (8.7 ± 0.18 vs 8.58 ± 0.1, p = 0.43). At follow-up examination MS subjects showed a lower decreas in SBP/DBP (SBP−4.7 ± 1.7 vs −10.2 ± 1.1; DBP−5.1 ± 1.1 vs −8.3 ± 0.7, p < 0.01 for both comparison) with a higher increase in PWV values (1.1 ± 0.2 vs 0.39 ± 0.1, p = 0.03). This difference remain significant also in a multivariate model with age, sex, smoking, baseline PWV and delta MBP as covariates.
CONCLUSIONS:arterial aging and BP values in treated hypertensive subjects during a 3.7 years follow-up seems to be influenced by the presence of MS. In fact subjects with MS showed a worse BP control and an increase in PWV values during the follow-up. PWV changes over time would probably give important information that need further future research studies.
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