Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Independent determinants of hepatic iron accumulation in 216 patients with NAFLD at multivariate logistic regression analysis.

<p>95% c.i.: 95% confidence interval; <i>HFE</i> genotypes at risk: p.Cys282Tyr positive and p.His63Asp/His63Asp.</p><p>In this model, the effect of the p.Ala736Val <i>TMPRSS6</i> variant was adjusted for age, gender, BMI and the other genetic factors.</p

Frequency distribution of genetic factors influencing iron metabolism in patients with and without hepatic iron accumulation.

<p>Patients positive for the beta-thalassemia trait were classified as “Beta-trait”, next if negative for “Beta-trait” and positive for <i>HFE</i> genotypes at risk as “HFE at risk”, and among the remaining patients those homozygous for the 736V/V TMPSS6 as “736VV”, and the rest as “none”.</p

Demographic, clinical, and genetic features of 216 Italian patients with NAFLD with available re-evaluation of histological siderosis and of 271 healthy controls with normal iron parameters, liver function tests, and metabolic parameters.

<p>(): % values; BMI: body mass index; Hb: hemoglobin concentration; TS%: transferrin saturation %; wt: wild-type variant;</p>*<p>p<0.05 vs. healthy controls;</p>∧<p>beta-thalassemia trait was a <i>criterium</i> for exclusion from blood donation.</p

Effect of <i>TMPRSS6</i> p.A736V genotype on hepcidin levels (hepcidin <3 nM, median value, panel A) and the hepcidin/ferritin ratio (panel B) in 55 patients with NAFLD (25.5% of the whole series).

<p>Effect of <i>TMPRSS6</i> p.A736V genotype on hepcidin levels (hepcidin <3 nM, median value, panel A) and the hepcidin/ferritin ratio (panel B) in 55 patients with NAFLD (25.5% of the whole series).</p

Clinical features of 216 Italian patients with NAFLD subdivided according to the p.Ala736Val <i>TMPRSS6</i> status.

<p>(): % values; BMI: body mass index; Hb: hemoglobin concentration; MCV mean corpuscular volume;</p>°<p>evaluated in cases negative for the beta-thalassemia trait (72 Ala/Ala, 91 Ala/Val, 31 Val/Val);</p>*<p>p<0.05 for Val/Val vs. Ala/Ala and Ala/Val (recessive model).</p

Relationship between clinical and genetic variables considered in the study with hepatic iron accumulation in 216 patients with NAFLD (univariate analysis).

<p>ALT: alanine aminotransferases; BMI: body mass index; CRP: C reactive protein; TS%: transferrin saturation %; <i>HFE</i> genotypes at risk: p.Cys282Tyr positive and p.His63Asp/His63Asp.</p

Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people

Aims: Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. Methods: Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged 6565 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. Results: Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5\u201345.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3\u201334.0%). Conclusions: This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention