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Alessandro Sona,
Guido Maggiani,
Marco Astengo, Monica Comba,
Valentina Chiusano,
Gianluca Isaia,
Chiara Merlo,
Larisa Pricop,
Eleonora Quagliotti,
Corrado Moiraghi,
Gianfranco Fonte,
Mario Bo
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ABSTRACT: All over Europe, an increased use of public health services has been noticed, particularly referring to access and hospitalization among elderly in the emergency department (ED).
Prospective study at a university teaching hospital in Turin, northern Italy, recruiting subjects aged >65 years consecutively attending the medical ED during 1 month. Demography, functional and cognitive status, comorbidity, severity of acute critical illness, previous ED accesses and hospitalization, diagnosis and other relevant data for ED admission and hospitalization were considered.
Data were collected for 1632 patients (average age 77.6 years), 89% of the 1834 older subjects who attended the ED during the study period (29.3% of the patients attending the ED). Six hundred and fifty older subjects were admitted to the hospital (62.2% of the hospital admissions). Severity of acute critical illness, presence of chronic obstructive pulmonary disease and heart failure, a high number of drugs being taken, functional dependence and advanced age were independently associated with hospital admission. One-third of the patients appeared to be frequent users of health services with more than two visits/admissions. Higher comorbidity, partial or complete functional dependence, chronic diseases (arrhythmia, pulmonary neoplasm, diseases of the large intestine) and politherapy were associated either with frequent use of the ED and multiple admissions.
Elderly account for a high proportion of hospitalizations, mainly determined by critical health conditions, advanced age and functional dependence. Poor health conditions (high comorbidity and presence of chronic multi-organ diseases), functional dependence but not critical social factors were the main determinants of multiple hospital admissions.
The European Journal of Public Health 03/2011; 22(1):76-80. · 2.73 Impact Factor
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ABSTRACT: Blood pressure (BP) variations occurring after hospital discharge in a population of older hypertensives have not been previously investigated.
elderly (≥65 years) hypertensives admitted to the geriatric acute ward of a university-teaching hospital were enrolled in this prospective observational study.
Exclusion criteria were terminal illness, discharge to institution, and changes in antihypertensive regimen. BP was recorded in the emergency room, at ward admission, daily during hospital stay, and at discharge. Home self blood pressure measurement was performed after discharge.
The study population included 106 patients. There was a significant decrease in systolic BP (SBP) and diastolic BP (DBP) throughout the study time points. SBP and DBP decreased after discharge (from 135.1 ± 15.0 to 131.5 ± 16.1 mmHg and from 77.2 ± 8.4 to 71.6 ± 8.7 mmHg, respectively), the difference being significant only for DBP (p = 0.000). We further observed higher prevalence of critically low BP values (SBP <120 mmHg and DBP <70 mmHg) at home (23.6% and 48.1%, respectively) compared to discharge (8.5% and 9.4%, p = 0.006 and p = 0.000, respectively).
We observed a decrease in BP values, and particularly DBP values, after hospital discharge, in a sample of older hypertensives. Critically low BP values were observed at home in a high proportion of subjects, suggesting wise use of antihypertensive therapy at discharge and early monitoring of BP values at home.
European journal of preventive cardiology. 03/2011; 19(3):460-6.
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Journal of the American Geriatrics Society 07/2010; 58(7):1406-7. · 3.74 Impact Factor
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ABSTRACT: Low (< or = 90) Ankle Brachial Index (ABI) values identify patients at high risk for cardiovascular (CV) disease and mortality. Implications for CV risk classification from routinely measuring ABI in the context of a Lipid Clinic have not been fully investigated. We aimed to evaluate whether and to what extent routine ABI determination on top of conventional risk prediction models may modify CV risk classification.
Consecutive asymptomatic non-diabetic individuals free from previous CV events attending for a first visit at a Lipid Clinic underwent routine ABI determination and conventional CV risk classification according either to national CUORE model (including age, gender, smoking, total and high density lipoprotein cholesterol, systolic blood pressure and current use of blood pressure lowering drugs) and SCORE model for low risk countries.
In the overall sample (320 subjects, mean age 64.8 years) 77 subjects (24.1%) were found to have low ABI value. Forty-two of 250 subjects (16.8%) and 47 of 215 individuals (21.3%) at low or moderate risk according to the CUORE and SCORE models, respectively, were found to have low ABI values, and should be reclassified at high risk.
In a series of consecutive asymptomatic individuals in a Lipid Clinic, we observed a high prevalence of low ABI values among subjects deemed at low or moderate risk on conventional prediction models, leading to CV high-risk reclassification of roughly one fifth of patients. These findings reinforce recommendations for routine determination of ABI at least within referral primary prevention settings.
European Journal of Internal Medicine 06/2009; 20(3):296-300. · 2.00 Impact Factor
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ABSTRACT: We evaluated clinical implications of the white-coat effect (WCE) in cardiovascular (CV) risk stratification in the primary prevention setting of a Lipid Clinic. We compared home self blood pressure measurement (SBPM) with office blood pressure (BP) readings and BP measured by a nurse before and after the visit on consecutive subjects, free of previous CV diseases, attending at a Lipid Clinic for a first visit. Additionally, we evaluated whether and to what extent the difference between these measurements affect the 10-year cardiovascular risk calculated according to current guidelines. Mean home self-measured systolic and diastolic BP values were significantly lower than physician's and nurse's readings (p=0.000). A WCE was observed in 60.3% of patients during the physician's visit, and in 33.9% and 36.6% of nurse's measurements before and after visit, respectively. Compared with computation of SBPM, inclusion in risk predictive model of systolic BP values obtained by physician and nurse (before or after visit) resulted in significantly higher calculated CV risk (p=0.000) and in a higher risk-class allocation in 16.5%, 8.5% and 9.4% of patients, respectively (p=0.000). Our findings show that among patients attending at a Lipid Clinic there is a high prevalence of WCE, which is roughly halved when nurse's BP measurements were considered. Nurse's BP measurements before or after the doctor's visit may reduce, but not eliminate at all, the clinic overestimation of BP. The WCE associated with physician's office visit carries a substantial probability of 10-year CV risk overestimation in the primary prevention setting.
Atherosclerosis 05/2008; 197(2):904-9. · 3.79 Impact Factor
