The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Misure dell'occupazione temporanea: consistenza, dinamica e caratteristiche di uno stock eterogeneo

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Attorno al lavoro nero in Veneto. Una ricognizione

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Durabilita' delle opere in calcestruzzo

SIGLEITItal

Norme elementari per la tecnologia del calcestruzzo nei lavori in amministrazione diretta

SIGLEITItal

Incidence of renal replacement therapy in Veneto for 2008, 2009 and 2010.

This section of the report of the Veneto Dialysis and Transplantation Registry (VDTR) provides data on the incidence of patients receiving renal replacement therapy (RRT) in the region from 2008 to 2010. Its purpose is to provide health authorities with the information they need to plan the delivery of RRT in Veneto. Data were obtained from the VDTR, defining incident patients according to the recommendations of the Italian Dialysis and Transplantation Registry. The incidence rate was calculated per million population (pmp). Variability by province and treatment center was studied by applying multilevel modeling methods. An age-period-cohort model was used to forecast the incidence rate of RRT over the years to come. The incidence of patients on RRT was 114.23 pmp in 2008, 120.15 pmp in 2009 and 107.08 pmp in 2010. The patients' median age at the time of starting RRT was 70.5 in 2008, 68.7 in 2009 and 69.5 in 2010. During these 3 years, 66.3% of patients were male, and 33.7% were female. Incidence rates were not uniformly distributed between the provinces in the region, but were significantly higher in 2. The incidence rate of patients needing RRT seems likely to remain stable in the future, until 2015 at least. Renal vascular disease was the primary cause of end-stage renal disease (ESRD), followed closely by diabetes, while the proportion due to primary glomerulonephritis has gradually decreased. Initial dialysis modality was hemodialysis (HD) for 78% of patients, while about 20% started RRT on peritoneal dialysis (PD), and a negligible proportion had a preemptive kidney transplantation. About 35% patients began dialysis with a temporary vascular catheter; this percentage remained fairly constant until 2010. The incidence of RRT in Veneto is one of the lowest in Italy and remained substantially stable over the period 1998-2010, despite the population of patients with ESRD becoming older and more severely ill. This finding could mean a heavier burden on the welfare system in the future

Prevalence of renal replacement therapy in Veneto for 2008, 2009 and 2010.

The aim of this section is to provide descriptive data for end-stage renal disease (ESRD) in the Veneto Region (Italy). Data were obtained from the Veneto Dialysis and Transplantation Registry (VDTR). Patients were considered to be prevalent renal replacement therapy (RRT) patients if alive on 31 December of each year examined. Prevalence is expressed per million population (pmp). The trend for prevalence of each treatment in the period examined was estimated by random effects longitudinal logistic regression. Prevalence of RRT in Veneto in the years 2008, 2009 and 2010 was 888, 923 and 950 pmp, respectively. The prevalence of RRT patients by treatment modality showed a slight increase for hemodialysis, notable stability for peritoneal dialysis and a more pronounced increase for transplantation. Every year, about 10% of peritoneal dialysis patients shifted to hemodialysis, and 12% received a transplant. The transition probability from hemodialysis to peritoneal dialysis was negligible, and less than 5% of hemodialysis patients received a transplant. The probability of returning to hemodialysis after having received a transplant was less than 2% a year. Bicarbonate hemodialysis slowly increased from 1998 to 2010, both in percentage and in prevalence per million population; conversely, hemodiafiltration (HDF) showed a mild but constant decrease. Automated peritoneal dialysis (APD), which was quantitatively almost negligible in 1998, reached the same level as continuous ambulatory peritoneal dialysis (CAPD) in 2010. The prevalence of patients undergoing living donor transplants almost doubled in the period 1998-2010. The increase of prevalence over time was not proportional for the 3 modalities of RRT: hemodialysis prevalence grew slowly, peritoneal dialysis prevalence remained stable, and renal transplant prevalence quickly increased

Mortality in the Veneto population on renal replacement therapy.

This section reports survival rates for patients on renal replacement therapy (RRT). The data obtained from the Veneto Dialysis and Transplantation Registry (VDTR) cover the whole population in the region. Patients on RRT alive on 31 December of each year were assumed to be at risk of dying in the following year. Furthermore, time-to-event analysis was used to describe the complete history of patients from when they started RRT until they died, including transitions between the 3 main treatment modalities - hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation. The cohort of patients starting RRT from 1998 to 2010 was followed up until 31 December 2010. Survival rates from the first treatment to death were calculated according to the life table method. Relative survival and excess mortality rates were estimated according to the Ederer II method. A multistate model was used to describe changes in a patient's condition (changes of treatment, or death) over time. Among prevalent patients on RRT, the annual risk of death was 10.65% in 2008, 9.35% in 2009 and 8.86% in 2010. The overall mortality rate was 12.5 per 100 patient-years (95% confidence interval [95% CI], 12.1-13.0). The 5-year relative survival was 59% (95% CI, 57%-60%), and at 10 years relative survival was 41% (95% CI, 39%-43%); the estimated excess mortality rate was very high at the start of RRT (18 per 100 patient-years) but gradually decreased after the second year. On multivariate analysis, excess mortality was associated with age and primary renal diseases. Less than 10% of patients starting on PD shifted to HD in the first year of RRT, and a considerable proportion received a transplant, amounting to 6% in the first year, and thereafter increasing steadily: at the end of the fifth year, 34% of patients starting RRT on PD had received a transplant. HD patients behaved differently: any shift to PD was negligible, and the patients receiving a transplant amounted to only 2% in the first year and about 16% by the end of the fifth year. Cumulative mortality among HD patients was particularly high (already 18% at 1 year, and 70% at 10 years) by comparison with those on PD (8% at 1 year, 54% at 10 years). Although mortality on RRT is not particularly high in Veneto by comparison with countries other than Italy, this result is mainly due to an increasing number of patients receiving transplants, which makes them a favorably selected population. The mortality rate was high among those on HD, particularly in the first year. Our population on RRT is rather heterogeneous, and a description of the outcomes based only on the whole population may be misleading