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

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

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

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

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 ≥65 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 41.5–45.7) 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 27.3–34.0%). 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

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

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Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients.

none318noAging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010-2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR <60 ml/min/1.73 m2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16-1.25, p <0.001) and with CKD end-stages (G4: 16.90, 11.38-25.12, p < 0.001; G5: 19.38, 11.51-32.64, p < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.openVincenzo Arcoraci, Maria Antonietta Barbieri, Michelangelo Rottura, Alessandro Nobili, Giuseppe Natoli, Christiano Argano, Giovanni Squadrito, Francesco Squadrito, Salvatore Corrao, Domenico Prisco, Elena Silvestri, Giacomo Emmi, Alessandra Bettiol, Irene Mattioli, Gianni Biolo, Michela Zanetti, Giacomo Bartelloni, Massimo Vanoli, Giulia Grignani, Edoardo Alessandro Pulixi, Graziana Lupattelli, Vanessa Bianconi, Riccardo Alcidi, Domenico Girelli, Fabiana Busti, Giacomo Marchi, Mario Barbagallo, Ligia Dominguez, Vincenza Beneduce, Federica Cacioppo, Massimo Raspanti, Marco Zoli, Maria Laura Matacena, Giuseppe Orio, Eleonora Magnolfi, Giovanni Serafini, Angelo Simili, Giuseppe Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Giovanna Fabio, Margherita Migone De Amicis, Giacomo De Luca, Natalia Scaramellini, Matteo Cesari, Paolo Dionigi Rossi, Sarah Damanti, Marta Clerici, Simona Leoni, Alessandra Danuta Di Mauro, Antonio Di Sabatino, Emanuela Miceli, Marco Vincenzo Lenti, Martina Pisati, Costanza Caccia Dominioni, Roberto Pontremoli, Valentina Beccati, Giulia Nobili, Giovanna Leoncini, Luigi Anastasio, Maria Carbone, Francesco Cipollone, Maria Teresa Guagnano, Ilaria Rossi, Gerardo Mancuso, Daniela Calipari, Mosè Bartone, Giuseppe Delitala, Maria Berria, Alessandro Delitala, Maurizio Muscaritoli, Alessio Molfino, Enrico Petrillo, Antonella Giorgi, Christian Gracin, Giuseppe Zuccalà, Gabriella D’Aurizio, Giuseppe Romanelli, Alessandra Marengoni, Andrea Volpini, Daniela Lucente, Antonio Picardi, Umberto Vespasiani Gentilucci, Paolo Gallo, Giuseppe Bellelli, Maurizio Corsi, Cesare Antonucci, Chiara Sidoli, Giulia Principato, Franco Arturi, Elena Succurro, Bruno Tassone, Federica Giofrè, Maria Grazia Serra, Maria Antonietta Bleve, Antonio Brucato, Teresa De Falco, Fabrizio Fabris, Irene Bertozzi, Giulia Bogoni, Maria Victoria Rabuini, Tancredi Prandini, Roberto Manfredini, Fabio Fabbian, Benedetta Boari, Alfredo De Giorgi, Ruana Tiseo, Giuseppe Paolisso, Maria Rosaria Rizzo, Claudia Catalano, Claudio Borghi, Enrico Strocchi, Eugenia Ianniello, Mario Soldati, Silvia Schiavone, Alessio Bragagni, Carlo Sabbà, Francesco Saverio Vella, Patrizia Suppressa, Giovanni Michele De Vincenzo, Alessio Comitangelo, Emanuele Amoruso, Carlo Custodero, Luigi Fenoglio, Andrea Falcetta, Anna L. Fracanzani, Silvia Tiraboschi, Annalisa Cespiati, Giovanna Oberti, Giordano Sigon, Flora Peyvandi, Raffaella Rossio, Giulia Colombo, Pasquale Agosti, Valter Monzani, Valeria Savojardo, Giuliana Ceriani, Francesco Salerno, Giada Pallini, Fabrizio Montecucco, Luciano Ottonello, Lara Caserza, Giulia Vischi, Nicola Lucio Liberato, Tiziana Tognin, Francesco Purrello, Antonino Di Pino, Salvatore Piro, Renzo Rozzini, Lina Falanga, Maria Stella Pisciotta, Francesco Baffa Bellucci, Stefano Buffelli, Giuseppe Montrucchio, Paolo Peasso, Edoardo Favale, Cesare Poletto, Carl Margaria, Maura Sanino, Francesco Violi, Ludovica Perri, Luigina Guasti, Luana Castiglioni, Andrea Maresca, Alessandro Squizzato, Leonardo Campiotti, Alessandra Grossi, Roberto Davide Diprizio, Marco Bertolotti, Chiara Mussi, Giulia Lancellotti, Maria Vittoria Libbra, Matteo Galassi, Yasmine Grassi, Alessio Greco, Angela Sciacqua, Maria Perticone, Rosa Battaglia, Raffaele Maio, Vincenzo Stanghellini, Eugenio Ruggeri, Sara del Vecchio, Andrea Salvi, Roberto Leonardi, Giampaolo Damiani, William Capeci, Massimo Mattioli, Giuseppe Pio Martino, Lorenzo Biondi, Pietro Pettinari, Riccardo Ghio, Anna Dal Col, Salvatore Minisola, Luciano Colangelo, Mirella Cilli, Giancarlo Labbadia, Antonella Afeltra, Benedetta Marigliano, Maria Elena Pipita, Pietro Castellino, Luca Zanoli, Alfio Gennaro, Agostino Gaudio, Valter Saracco, Marisa Fogliati, Carlo Bussolino, Francesca Mete, Miriam Gino, Carlo Vigorito, Antonio Cittadini, Guido Moreo, Silvia Prolo, Gloria Pina, Alberto Ballestrero, Fabio Ferrando, Roberta Gonella, Domenico Cerminara, Sergio Berra, Simonetta Dassi, Maria Cristina Nava, Bruno Graziella, Stefano Baldassarre, Salvatore Fragapani, Gabriella Gruden, Giorgio Galanti, Gabriele Mascherini, Cristian Petri, Laura Stefani, Margherita Girino, Valeria Piccinelli, Francesco Nasso, Vincenza Gioffrè, Maria Pasquale, Leonardo Sechi, Cristiana Catena, Gianluca Colussi, Alessandro Cavarape, Andea Da Porto, Nicola Passariello, Luca Rinaldi, Franco Berti, Giuseppe Famularo, Patrizia Tarsitani, Roberto Castello, Michela Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta Morganti, Andrea Artoni, Margherita Grossi, Stefano Del Giacco, Davide Firinu, Giulia Costanzo, Giacomo Argiolas, Giuseppe Montalto, Anna Licata, Filippo Alessandro Montalto, Francesco Corica, Giorgio Basile, Antonino Catalano, Federica Bellone, Concetto Principato, Lorenzo Malatino, Benedetta Stancanelli, Valentina Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella Caruso, Patrizia Mecocci, Carmelinda Ruggiero, Virginia Boccardi, Tiziana Meschi, Andrea Ticinesi, Antonio Nouvenne, Pietro Minuz, Luigi Fondrieschi, Giandomenico Nigro Imperiale, Mario Pirisi, Gian Paolo Fra, Daniele Sola, Mattia Bellan, Massimo Porta, Piero Riva, Roberto Quadri, Erica Larovere, Marco Novelli, Giorgio Scanzi, Caterina Mengoli, Stella Provini, Laura Ricevuti, Emilio Simeone, Rosa Scurti, Fabio Tolloso, Roberto Tarquini, Alice Valoriani, Silvia Dolenti, Giulia Vannini, Riccardo Volpi, Pietro Bocchi, Alessandro Vignali, Sergio Harari, Chiara Lonati, Federico Napoli, Italia Aiello, Raffaele Landolfi, Massimo Montalto, Antonio Mirijello, Francesco Purrello, Antonino Di Pino, Silvia Ghidoni, Teresa Salvatore, Lucio Monaco, Carmen Ricozzi, Alberto Pilotto, Ilaria Indiano, Federica Gandolfo.Arcoraci, Vincenzo; Antonietta Barbieri, Maria; Rottura, Michelangelo; Nobili, Alessandro; Natoli, Giuseppe; Argano, Christiano; Squadrito, Giovanni; Squadrito, Francesco; Corrao, Salvatore; Prisco, Domenico; Silvestri, Elena; Emmi, Giacomo; Bettiol, Alessandra; Mattioli, Irene; Biolo, Gianni; Zanetti, Michela; Bartelloni, Giacomo; Vanoli, Massimo; Grignani, Giulia; Alessandro Pulixi, Edoardo; Lupattelli, Graziana; Bianconi, Vanessa; Alcidi, Riccardo; Girelli, Domenico; Busti, Fabiana; Marchi, Giacomo; Barbagallo, Mario; Dominguez, Ligia; Beneduce, Vincenza; Cacioppo, Federica; Raspanti, Massimo; Zoli, Marco; Laura Matacena, Maria; Orio, Giuseppe; Magnolfi, Eleonora; Serafini, Giovanni; Simili, Angelo; Palasciano, Giuseppe; Ester Modeo, Maria; Di Gennaro, Carla; Domenica Cappellini, Maria; Fabio, Giovanna; Migone De Amicis, Margherita; De Luca, Giacomo; Scaramellini, Natalia; Cesari, Matteo; Dionigi Rossi, Paolo; Damanti, Sarah; Clerici, Marta; Leoni, Simona; Danuta Di Mauro, Alessandra; Di Sabatino, Antonio; Miceli, Emanuela; Vincenzo Lenti, Marco; Pisati, Martina; Caccia Dominioni, Costanza; Pontremoli, Roberto; Beccati, Valentina; Nobili, Giulia; Leoncini, Giovanna; Anastasio, Luigi; Carbone, Maria; Cipollone, Francesco; Teresa Guagnano, Maria; Rossi, Ilaria; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Delitala, Giuseppe; Berria, Maria; Delitala, Alessandro; Muscaritoli, Maurizio; Molfino, Alessio; Petrillo, Enrico; Giorgi, Antonella; Gracin, Christian; Zuccalà, Giuseppe; D’Aurizio, Gabriella; Romanelli, Giuseppe; Marengoni, Alessandra; Volpini, Andrea; Lucente, Daniela; Picardi, Antonio; Vespasiani Gentilucci, Umberto; Gallo, Paolo; Bellelli, Giuseppe; Corsi, Maurizio; Antonucci, Cesare; Sidoli, Chiara; Principato, Giulia; Arturi, Franco; Succurro, Elena; Tassone, Bruno; Giofrè, Federica; Grazia Serra, Maria; Antonietta Bleve, Maria; Brucato, Antonio; De Falco, Teresa; Fabris, Fabrizio; Bertozzi, Irene; Bogoni, Giulia; Victoria Rabuini, Maria; Prandini, Tancredi; Manfredini, Roberto; Fabbian, Fabio; Boari, Benedetta; DE GIORGI, Alfredo; Tiseo, Ruana; Paolisso, Giuseppe; Rosaria Rizzo, Maria; Catalano, Claudia; Borghi, Claudio; Strocchi, Enrico; Ianniello, Eugenia; Soldati, Mario; Schiavone, Silvia; Bragagni, Alessio; Sabbà, Carlo; Saverio Vella, Francesco; Suppressa, Patrizia; Michele De Vincenzo, Giovanni; Comitangelo, Alessio; Amoruso, Emanuele; Custodero, Carlo; Fenoglio, Luigi; Falcetta, Andrea; Fracanzani, Anna L.; Tiraboschi, Silvia; Cespiati, Annalisa; Oberti, Giovanna; Sigon, Giordano; Peyvandi, Flora; Rossio, Raffaella; Colombo, Giulia; Agosti, Pasquale; Monzani, Valter; Savojardo, Valeria; Ceriani, Giuliana; Salerno, Francesco; Pallini, Giada; Montecucco, Fabrizio; Ottonello, Luciano; Caserza, Lara; Vischi, Giulia; Lucio Liberato, Nicola; Tognin, Tiziana; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Rozzini, Renzo; Falanga, Lina; Stella Pisciotta, Maria; Baffa Bellucci, Francesco; Buffelli, Stefano; Montrucchio, Giuseppe; Peasso, Paolo; Favale, Edoardo; Poletto, Cesare; Margaria, Carl; Sanino, Maura; Violi, Francesco; Perri, Ludovica; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Campiotti, Leonardo; Grossi, Alessandra; Davide Diprizio, Roberto; Bertolotti, Marco; Mussi, Chiara; Lancellotti, Giulia; Vittoria Libbra, Maria; Galassi, Matteo; Grassi, Yasmine; Greco, Alessio; Sciacqua, Angela; Perticone, Maria; Battaglia, Rosa; Maio, Raffaele; Stanghellini, Vincenzo; Ruggeri, Eugenio; del Vecchio, Sara; Salvi, Andrea; Leonardi, Roberto; Damiani, Giampaolo; Capeci, William; Mattioli, Massimo; Pio Martino, Giuseppe; Biondi, Lorenzo; Pettinari, Pietro; Ghio, Riccardo; Dal Col, Anna; Minisola, Salvatore; Colangelo, Luciano; Cilli, Mirella; Labbadia, Giancarlo; Afeltra, Antonella; Marigliano, Benedetta; Elena Pipita, Maria; Castellino, Pietro; Zanoli, Luca; Gennaro, Alfio; Gaudio, Agostino; Saracco, Valter; Fogliati, Marisa; Bussolino, Carlo; Mete, Francesca; Gino, Miriam; Vigorito, Carlo; Cittadini, Antonio; Moreo, Guido; Prolo, Silvia; Pina, Gloria; Ballestrero, Alberto; Ferrando, Fabio; Gonella, Roberta; Cerminara, Domenico; Berra, Sergio; Dassi, Simonetta; Cristina Nava, Maria; Graziella, Bruno; Baldassarre, Stefano; Fragapani, Salvatore; Gruden, Gabriella; Galanti, Giorgio; Mascherini, Gabriele; Petri, Cristian; Stefani, Laura; Girino, Margherita; Piccinelli, Valeria; Nasso, Francesco; Gioffrè, Vincenza; Pasquale, Maria; Sechi, Leonardo; Catena, Cristiana; Colussi, Gianluca; Cavarape, Alessandro; Da Porto, Andea; Passariello, Nicola; Rinaldi, Luca; Berti, Franco; Famularo, Giuseppe; Tarsitani, Patrizia; Castello, Roberto; Pasino, Michela; Paolo Ceda, Gian; Giuseppe Maggio, Marcello; Morganti, Simonetta; Artoni, Andrea; Grossi, Margherita; Del Giacco, Stefano; Firinu, Davide; Costanzo, Giulia; Argiolas, Giacomo; Montalto, Giuseppe; Licata, Anna; Alessandro Montalto, Filippo; Corica, Francesco; Basile, Giorgio; Catalano, Antonino; Bellone, Federica; Principato, Concetto; Malatino, Lorenzo; Stancanelli, Benedetta; Terranova, Valentina; Di Marca, Salvatore; Di Quattro, Rosario; La Malfa, Lara; Caruso, Rossella; Mecocci, Patrizia; Ruggiero, Carmelinda; Boccardi, Virginia; Meschi, Tiziana; Ticinesi, Andrea; Nouvenne, Antonio; Minuz, Pietro; Fondrieschi, Luigi; Nigro Imperiale, Giandomenico; Pirisi, Mario; Paolo Fra, Gian; Sola, Daniele; Bellan, Mattia; Porta, Massimo; Riva, Piero; Quadri, Roberto; Larovere, Erica; Novelli, Marco; Scanzi, Giorgio; Mengoli, Caterina; Provini, Stella; Ricevuti, Laura; Simeone, Emilio; Scurti, Rosa; Tolloso, Fabio; Tarquini, Roberto; Valoriani, Alice; Dolenti, Silvia; Vannini, Giulia; Volpi, Riccardo; Bocchi, Pietro; Vignali, Alessandro; Harari, Sergio; Lonati, Chiara; Napoli, Federico; Aiello, Italia; Landolfi, Raffaele; Montalto, Massimo; Mirijello, Antonio; Purrello, Francesco; Di Pino, Antonino; Ghidoni, Silvia; Salvatore, Teresa; Monaco, Lucio; Ricozzi, Carmen; Pilotto, Alberto; Indiano, Ilaria; Gandolfo., Federic

Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI

The dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient