Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Muscular and cardiac adenosine-induced pain is mediated by A1receptors

AbstractObjectives. This study attempted to establish whether bamiphylline, a selective antagonist of A1adenosine receptors, prevents the algogenic effects of adenosine in humans.Background. Experimental findings indicate that the sympathoexcitatory response elicited by adenosine is mediated by A1receptors.Methods. An intrailiac infusion of increasing doses (from 125 to 2,000 μg/min) of adenosine was given to 20 patients. Adenosine infusion was then repeated after intrailiac infusion of either bamiphylline or saline solution. In 14 other patients with angina, increasing doses of adenosine (from 108 to 1,728 μg/min) were infused into the left coronary artery. Adenosine infusion was then repeated after the intravenous infusion of either bamiphylline or placebo. Coronary blood flow velocity was monitored by a Doppler catheter. Data relative to pain severity are expressed as median and all other data as mean value ± 1 SD.Results. Bamiphylline prolonged the time to pain onset caused by the intrailiac adenosine infusion from 444 ± 96 to 749 ± 120 s (p < 0.001) and reduced pain severity from 45 to 24 mm (p < 0.01). After placebo infusion, the time to pain onset and pain severity were similar to that of baseline (428 ± 112 vs. 430 ± 104 s, p = 0.87 and 44 vs. 43 mm, p = 0.67, respectively). Bamiphylline prolonged the time to pain onset caused by intracoronary adenosine infusion from 519 ± 128 to 603 ± 146 s (p < 0.01) and reduced pain severity from 58 to 28 mm (p < 0.02). After placebo infusion, the time to pain onset and pain severity were similar to that at baseline (542 ± 87 vs. 551 ± 79 s, p = 0.14 and 55 vs. 50 mm, p = 0.61). Maximal coronary blood flow velocities before and after bamiphylline administration were similar (47 ± 22 vs. 49 ± 24 cm/s, p = 0.36) as well as before and after placebo administration (40 ± 20 vs. 41 ± 20 cm/s, p = 0.07).Conclusions. Bamiphylline reduces adenosine-induced muscular and cardiac pain but does not affect adenosine-induced coronary vasodilation. These findings indicate that at the dose used in this study, bamiphylline does not detectably block vascular A2-receptor-mediated adenosine effects in humans, which suggests that the muscular and cardiac algogenic effects of adenosine are mediated mainly by A1receptors

Work-related stress assessment in a population of Itlaian workers. The Stress Questionnaire

The present study shows detailed information about the reliability and validity of the psychosocial risk scale included in the Stress Questionnaire (SQ) developed by our research group. The primary purpose of this work is to test the factor structure of the psychosocial risk scale through a first-order confirmatory factor analysis (CFA) using a large pooled dataset obtained from a population of 2026 employees of 15 Italian medium–large companies. Data were collected by a team of researchers who examined demographic variables, work-related stress, workplace bullying, mental health and other constructs. In addition to these substantive issues, the survey was designed to better understand response bias. After the evaluation of the results we conclude that the psychosocial risk scale reported a satisfactory reliability and validity. In addition, it allowed a careful measurement of work related stress, considering both leader's and follower's perspectives

PERCEIVED STRESS AND HEPATIC PARAMETERS

Introduction: The aim of the study is to evaluate work-related subjective stress in a group of employees, of both sexes, operating in the healthcare and welfare, through the administration of a questionnaire (HSE "Indicator Tool"), specifically developed and officially validated, and to analyze any possible correlations between stress levels taken from the questionnaire scores and the concentrations of three main hepatic parameters (GOT, GPT, GGT). Materials and Methods: We studied a final sample of 232 subjects (143 males and 89 females) operating in the health and welfare sector. For research purposes during the medical examination each subject underwent the HSE indicator tool, a collection of information about relevant clinical and medical history and a venous blood sample for the assay of GOT, GPT and GGT. All questionnaires were analyzed using special software provided by the HSE. The results obtained from the questionnaires were statistically compared with the blood concentrations of hepatic parameters. Results: The dimensions found to be critical, associated with a stressful condition (yellow area) or a highly stressful condition (red area), are: managers support, colleagues support, quality of relationships and changes. The Pearson’s correlation showed a statistically significant negative correlation (p &lt;0.05) between the mean values of all the critical dimensions and the concentrations of the hepatic parameters, both on the total sample and after subdivision by gender. These results were confirmed in the multiple linear regression analysis, which indicated that the critical dimensions are the main significant variables contributing to the liver parameters alterations. Discussion: Preliminary results indicate that a critical perception of stress at work can be statistically associated with increases in mean concentrations of GOT, GPT and GGT in a working asymptomatic population. These results provide a starting point for future studies on this topic, to a greater definition of the link between stress and liver injury, to confirm the effects on the parameters of liver injury (GOT, GPT, GGT) and to investigate possible correlations with the cholestasis parameters (bilirubin, alkaline phosphatase) and serum albumin

What changed in the Italian internal medicine and geriatric wards during the lockdown

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Comparison between drug therapy-based comorbidity indices and the Charlson Comorbidity Index for the detection of severe multimorbidity in older subjects.

Background: To know burden disease of a patient is a key point for clinical practice and research, especially in the elderly. Charlson's Comorbidity Index (CCI) is the most widely used rating system, but when diagnoses are not available therapy-based comorbidity indices (TBCI) are an alternative. However, their performance is debated. This study compares the relations between Drug Derived Complexity Index (DDCI), Medicines Comorbidity Index (MCI), Chronic Disease Score (CDS), and severe multimorbidity, according to the CCI classification, in the elderly. Methods: Logistic regression and Receiver Operating Characteristic (ROC) analysis were conducted on two samples from Italy: 2579 nursing home residents (Korian sample) and 7505 older adults admitted acutely to geriatric or internal medicine wards (REPOSI sample). Results: The proportion of subjects with severe comorbidity rose with TBCI score increment, but the Area Under the Curve (AUC) for the CDS (Korian: 0.70, REPOSI: 0.79) and MCI (Korian: 0.69, REPOSI: 0.81) were definitely better than the DDCI (Korian: 0.66, REPOSI: 0.74). All TBCIs showed low Positive Predictive Values (maximum: 0.066 in REPOSI and 0.317 in Korian) for the detection of severe multimorbidity. Conclusion: CDS and MCI were better predictors of severe multimorbidity in older adults than DDCI, according to the CCI classification. A high CCI score was related to a high TBCI. However, the opposite is not necessarily true probably because of non-evidence-based prescriptions or physicians' prescribing attitudes. TBCIs did not appear selective for detecting of severe multimorbidity, though they could be used as a measure of disease burden, in the absence of other solutions

Impact of Diabetes Mellitus and Its Comorbidities on Elderly Patients Hospitalized in Internal Medicine Wards: Data from the RePoSi Registry.

Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. Methods: In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSi) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. Results: Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes