942-42 Is Mitral Valve Prolapse with Significant Mitral Regurgitation a Different Condition from Uncomplicated Mitral Prolapse? Results of Family Studies

Mild instances of mitral valve prolapse (MVP) have been suggested to represent variants of normal, whereas individuals with complicated forms of MVP have a distinct medical condition. This hypothesis would predict different phenotypic features and patterns of inheritance in relatives of index cases with complicated or uncomplicated MVP. Accordingly, we performed clinical and echocardiographic assessment of 16 MVP patients with and 76 without moderate to severe mitral regurgitation (MR+and MR– probands) and 60 and 256, respectively, first-degree relatives (MR+ and MR– relatives). MR+ probands were older (p=0.01), more likely to be male (p=0.002), were more overweight (p=0.004) and had higher systolic blood pressures (p=0.05) and larger aortic roots (p=0.034) after the effects of age and body size were taken into account. MR+ and MR– relatives had similar prevalences (27 and 32%) and age distribution of MVP, but affected MR+ relatives were younger (expected because more children and fewer parents of MR+ probands could be evaluated). and more likely to be male. MR+ and MR- relatives were virtually identical in regard to body habitus, blood pressure, the prevalence of auscultatory findings, thoracic bony abnormalities and palpitations and all echo measurements including anterior mitral leaflet thickness. Four instances of significant MR and two MVP-related complications (infective endocarditis and transient ischemic attack) occurred in the 82 relatives of MR– probands as opposed to none among relatives of MR+ probands. In 20 families, one proband or relative with MVP had severe MR and at least one other with MVP (presumably due to the same gene) was free of MR or complications. Thus, MVP with severe MR does not represent a heritable phenotype and commonly coexists with mild forms of MVP in the same family, making their classification as separate conditions illogical and potentially misleading

Is there a role of statins in the prevention of aortic biological prostheses degeneration

It has been recently observed that statins might slow the progression of aortic stenosis or sclerosis. Preliminary reports suggested a similar positive effect in reducing the degeneration of aortic valve bioprostheses even though this hypothesis should be further proven and supported by new data. In this review the present evidences of the possible effects of statins in this field are discussed

Opposite trends in hospitalization and mortality after implementation of a chronic care model-based regional program for the management of patients with heart failure in primary care

Abstract Background The chronic care model (CCM) is an established framework for the management of patients with chronic illness at the individual and population level. Its application has been previously shown to improve clinical outcome in several conditions, but the prognostic impact of CCM-based programs for the management of patients with chronic heart failure (HF) in primary care is still to be elucidated. Methods We assessed the prognostic impact of a primary-care, CCM-based project applied in Tuscany, Italy, in 1761 patients with chronic HF enrolled in a retrospective matched cohort study. The project was based on predefined working teams including general practitioners and nurses, proactively scheduled regular follow-up visitations for each patient, counseling for therapy adherence and lifestyle modifications, appropriate diagnostic and therapeutic pathways according to international guidelines, and a key supporting role of the nurses, who were responsible for the practical coordination of the follow-up. A matched group of 3522 HF subjects assisted by general practitioners not involved in the project was considered as control group. The endpoints of this study were HF hospitalization and all-cause mortality. Results Over a 4-year follow-up period, HF hospitalization rate was higher in the CCM group than the controls (12.1 vs 10.3 events/100 patient-years; incidence rate ratio 1.15[1.05-1.27], p = 0.0030). Mortality was lower in the CCM group than the controls (10.8 vs 12.6 events/100 patient-years; incidence rate ratio 0.82[0.75-0.91], p < 0.0001). In multivariable analysis, the CCM status was associated with a 34% higher risk of HF hospitalization and 18% lower risk of death (p < 0.0001 for both). The effect on HF hospitalization was mostly driven by a 50% higher rate of planned HF hospitalization. Conclusions Implementation of a CCM-based program for the management of HF patients in primary care led to reduced mortality and increased HF hospitalization. These findings support the hypothesis that the beneficial effects of CCM on survival might be extended to patients with chronic HF followed in primary care, but also support the need for further strategies aimed at improving the management of these patients in terms of hospitalizations

Changes in diabetes care introduced by a Chronic Care Model-based programme in Tuscany: a 4-year cohort study

Background: In 2010, Tuscany (Italy) implemented a Chronic Care Model (CCM)-based programme for the management of chronic diseases. The study's objective was to evaluate its impact on the care of patients with type 2 diabetes. Methods: A population-based cohort study was performed on patients with diabetes, identified by an administrative data algorithm, exposed to a CCM-based programme versus patients not exposed (8486 patients in each group). The groups were matched using a propensity score approach and observed from 2011 to 2014. The outcomes measured were: mortality rate and hazard ratio (HR), hospitalisation incidence rate (IR) (all causes and diabetes-related diseases) and incidence rate ratio (IRR), and Guideline Composite Indicator (GCI) as proxy of adherence to guidelines (IR and IRR). Stratified Cox regression analysis and conditional fixed effect Poisson regression analyses were performed to compute HR and IRR. Results: A significant improvement was observed for GCI (IRR 1.58; 95% CI 1.53-1.62) and for cardiovascular long-term complications (IRR 1.11; 95% CI 1.04-1.18). A protective effect was observed for neurological long-term complications (IRR 0.85; 95% CI 0.76-0.95), acute cardio-cerebrovascular long-term complications-stroke and ST segment elevation myocardial infarction-(IRR 0.81; 95% CI 0.71-0.92) and mortality (HR 0.88; 95% CI 0.81-0.96). Conclusion: The implementation of a CCM-based programme was followed by better management and benefits for the health status of patients. The increase in hospitalisations for cardiovascular long-term complications could engender cost-efficacy issues, but a better integrated care (GPs and specialists) and a more appropriate specialist outpatient services organisation could avoid a part of these, while still maintaining the benefits seen