Postoperative atrial fibrillation: etiopathogenesis, prevention and therapy

Atrial fibrillation is the most frequent complication after cardiac surgery. Its onset leads to a threefold higher risk for stroke compared with patients in sinus rhythm and other adverse events such as thromboembolic events and heart failure. The direct consequence is an increased length of hospital stays with obvious economic implications. These reasons have led the attention of many investigators to point out the rule of possible predisposing factors and underlining mechanisms in order to establish an effective preventive treatment. The present paper is aimed to review the state-ofthe- art knowledge about post-operative atrial fibrillation and its complex etiopathogenesis which is in turn responsible for the lack of consensus regarding routine prophylaxis

Secondary Cardiovascular Prevention in the Elderly: beyond clinical aspects

Aging is one of the strongest risk factors for cardiovascular events and even elderly patients with established disease are likely to derive benefits from secondary prevention programs. Unfortunately, few clinical trials have been specificately addressed to older population. However, since this population is rising and presents with intrinsic characteristics, it is worthwhile to consider the problems of the elderly with a sociological and ethical approach too and not only from a medical point of view

n-3 fatty acids and coronary artery disease

n-3 Poliunsaturated Fatty Acids (PUFA) are essential; foods rich in n-3 are fat fish and some vegetal oil. PUFA are precursors of Eicosanoids, involved in the processes of inflammation, thrombosis and immunity. Firstly, observational studies measured reduction of cardiovascular disease (CVD) incidence with greater PUFA dietary intake. Experimental studies discovered antiahrrhytmic, antiatherogenic, antiaggregating and antiinflammatory properties. Retrospective analysis found lower incidence of sudden death (SD) in fish consumers. Randomized, prospective trials after myocardial infarction showed, in people either eating fish or receiving an n-3 PUFA supplement, a reduction of SD, explained by specific effect on membrane ion channels. The lack of results on atherothrombosis do not match with most experimental results, and should better be evaluated in absence of aspirin therapy. Low evidence supports use of n-3 PUFA in angina or revascularization procedures. Recent observations denote positive effect on endothelial function of large and resistance arteries. Actually evidence-based medicine suggest: improve of fish consumption for primary prevention of CVD; n-3 PUFA supplementation for hypertrigliceridemia and secondary prevention of SD after myocardial infarction, which is also cost-effectiveness

Assessing patients needs in outpatients with advanced heart failure

Background. Because of the progressive ageing of the population and the extensive use of recommended drugs, the number of patients with advanced heart failure (AHF) constantly increases. AHF is the most common cause of acute hospital admission. The outcome and quality of life are generally poor for repeated hospital readmission. Objective. To assess a mixed method approach: face-to-face semi-structured qualitative interview incorporating quantitative analysis of demographic data and qualitative exploration of perception of needs in outpatients AHF, plus Barthel score [BS], Short Portable Mental Status Questionnaire [SPMSQ] and Moriski Medication Adherence Scale [MS]). Methods. Longitudinal prospective study in 50 elderly (age > 75 years) patients with AHF (stage C and D AHA/ACC plus almost two hospital admission in the last 12 months with main diagnosis of HF). Patients and caregivers were asked what they considered to be their main needs, including social support and the provision of practical care, psychological support; and information and choice. In the same time, BS, SPMSQ and MS were delivered. Main Results. The main areas of needs identified by patients were knowledge of available social and health services (80%) and disease and lifestyle habits (respectively 66% and 72% of patients), clear identification of the care-manager (70%), awareness of alarm and worsening symptoms (60%). Patients experienced difficulty in communication and information exchange, and fragmented co-ordination between social and care services was identified. The quality of life was generally poor for repeated hospital readmission, mainly for poor adherence to drugs and lifestyle, lacking attention to new onset or worsening symptoms, no planning of hospital discharge and for inadequate social support. Conclusions. The semi-structured interview is a useful tool to identify the patient information and educational needs. The main care needs identified by advanced HF outpatients relate to the everyday social and practical aspects of care. There is a need to reform the delivery of care to address the educational and lifestyle support

Clinical Characteristics and Course of Patients Entering Cardiac Rehabilitation with Chronic Kidney Disease: Data from the Italian Survey on Cardiac Rehabilitation

This survey shows the clinical risk profile, resource utilization, pharmacologic treatment, and course of cardiac rehabilitation (CR) programs in patients with chronic kidney disease (CKD). Data from 165 CR units in Italy were collected online from January 28 to February 10, 2008. The study cohort consisted of 2281 patients: 200 CKD patients and 2081 non-CKD patients. CKD patients were older and showed more comorbidity and complications during CR, a more complex clinical course and interventions with less functional evaluation, and a different pattern of drug therapy at hospital discharge. CKD patients had higher mortality during CR programs due to heart failure, respiratory insufficiency, and cognitive impairment. These findings suggest that patients with CKD should not be denied access to CR, provided careful attention to clinical status, possible complications, optimization of drug therapy, and close followup

Clinical Characteristics and Course of Patients Entering Cardiac Rehabilitation with Chronic Kidney Disease: Data from the Italian Survey on Cardiac Rehabilitation

This survey shows the clinical risk profile, resource utilization, pharmacologic treatment, and course of cardiac rehabilitation (CR) programs in patients with chronic kidney disease (CKD). Data from 165 CR units in Italy were collected online from January 28 to February 10, 2008. The study cohort consisted of 2281 patients: 200 CKD patients and 2081 non-CKD patients. CKD patients were older and showed more comorbidity and complications during CR, a more complex clinical course and interventions with less functional evaluation, and a different pattern of drug therapy at hospital discharge. CKD patients had higher mortality during CR programs due to heart failure, respiratory insufficiency, and cognitive impairment. These findings suggest that patients with CKD should not be denied access to CR, provided careful attention to clinical status, possible complications, optimization of drug therapy, and close followup

FIRST INTERCEPTION OF TRICHOFERUS CAMPESTRIS (FALDERMANN, 1835) (COLEOPTERA CERAMBYCIDAE CERAMBYCINAE) IN ITALY

The Velvet Longhorned Beetle Trichoferus campestris (Faldermann, 1835) was intercepted for the first time in Italy, in the Naples harbour, during monitoring activities at entry points carried out in the context of the national project ASPROPI. T. campestris is widely polyphagous and able to colonize several woody species in both agricultural and forest environments. Moreover timber and solid wood items can be equally attractive to this pest. This additional report, in an area where other alien insect species had been identified in the past, emphasises how the national monitoring network represents a key element of the alert system designed to quickly counter the accidental introduction and spreading of exotic insect pests

Italian survey on CArdiac RehabilitatiOn and Secondary prevention after cardiac revascularization: ICAROS study. A survey from the italian cardiac rehabilitation network: rationale and design

In this paper, the Italian Association for Cardiac Prevention and Rehabilitation (GICR) presents the rationale and design of the "Italian survey on CArdiac RehabilitatiOn and Secondary prevention after cardiac revascularization (ICAROS)". The survey is a prospective, longitudinal, multicentric survey, with a on-line web-based data collection. Its design corresponds to the survey's goal, i.e. to describe accurately in the Italian cardiological setting, through a representative number of cardiac rehabilitation centers belonging to the GICR national network, the characteristics, content and effects in the medium term of cardiac rehabilitation (CRP) inpatient or outpatient programs offered to patients after coronary artery bypass (CABG) or percutaneous revascularization (PTCA). The primary aims of the study are: a) to define the principal clinical characteristics of patients who have undergone PTCA or CABG and have been admitted to a CRP program; b) to identify the components of the CRP programs in terms of diagnostic procedures and assessment tests performed, treatments administered, educational programs and physical exercise interventions employed; c) to identify and analyze drug treatments prescribed at discharge from the acute facility and those prescribed at the end of the CRP program; d) to verify the clinical outcome during the course of the CRP program and at 6 months and 1 year after the end of the post-acute CRP program, as well as patients' adherence to the prescribed pharmacological therapy and to the recommended life styles, and the achievement and maintenance of the targets in relation to the modifiable risk factors; e) to define the consumption of major healthcare resources (major cardiac events, hospital re-admission, emergency care access, specialist visits) during the first year following a CRP program. The survey population will consist of all patients consecutively discharged in the period November 3 - 30, 2008 at the end of an inpatient, day-hospital or outpatient CRP programme after CABG (isolated or associated to valve or ascending aorta surgery) or PTCA (rescue, primary or elective). There are no age, sex or other patient selection criteria. Based on ISYDE 2008 data analysis, we plan to recruit approximately 1300-1400 patients, 75% of whom with post CABG diagnosis and 25% with post PTCA diagnosis. Preliminary results of the survey are expected in the late winter 2009