The heart failure in Internal Medicine in Tuscany: the SMIT Study

The incidence and prevalence associated with the growing age of population have made heart failure (HF) a new epidemic. In Italy most of HF patients are admitted to Internal Medicine Departments (IMD). We conducted a 30-day cross-sectional study involving patients with HF admitted to IMD of Tuscany....

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Main Authors: Valerio Verdiani, Grazia Panigada, Alberto Fortini, Luca Masotti, Simone Meini, Paolo Biagi, for the SMIT Study Group
Format: Article
Language:English
Published: PAGEPress Publications 2015-12-01
Series:Italian Journal of Medicine
Subjects:
Online Access:http://www.italjmed.org/index.php/ijm/article/view/554
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spelling doaj-b1f2387d6f444cb0890d50949a8820d02020-11-25T03:41:44ZengPAGEPress PublicationsItalian Journal of Medicine1877-93441877-93522015-12-019434935510.4081/itjm.2015.554522The heart failure in Internal Medicine in Tuscany: the SMIT StudyValerio Verdiani0Grazia Panigada1Alberto Fortini2Luca Masotti3Simone Meini4Paolo Biagi5for the SMIT Study GroupInternal Medicine Department, Misericordia Hospital (GR)Internal Medicine Department, SS. Costa e Damiano Hospital, Pescia (PT)Internal Medicine Department, S. Giovanni di Dio Hospital, Scandicci (FI)Internal Medicine Department, S. Maria Nuova Hospital, FirenzeInternal Medicine Department, S. Maria Annunziata Hospital, Bagno a Ripoli (FI)Internal Medicine Department, Nottola Hospital, Montepulciano (SI)The incidence and prevalence associated with the growing age of population have made heart failure (HF) a new epidemic. In Italy most of HF patients are admitted to Internal Medicine Departments (IMD). We conducted a 30-day cross-sectional study involving patients with HF admitted to IMD of Tuscany. The aim of the study was to provide an updated snapshot of in-hospital management of HF in Tuscany and to analyze the differences in relation to the most recent guidelines. We have recruited 770 patients (M=45.4%) with a mean age of 82.5±8.9 years. Only 16.1% had a <em>de novo</em> HF. Most of them were re-admitted for decompensated HF. Hypertension and ischemic disease are the prevailing etiologies. <em>HF alone</em> was in less than 2%. 71.5% of patients had more than two comorbidities and 40.6% more than three concomitant diseases. The mean hospital stay (overall 8.6±5.5 days) correlated with the number of comorbidity. About 25% of patients had a creatinine clearance &lt;30 mL/min. Nearly 50% of patients had atrial fibrillation but only the half was anti-coagulated. <span>β</span>-blockers, angiotensin converting enzyme-inhibitors (ACE-I) or angiotensin receptor blockers (ARB) were prescribed in about two-thirds of the subjects. Echocardiography was performed in 64.1% of patients. BNP or NT-pro BNP was tested in 67% at the hospital admission and in 18.3% at the discharge. At the discharge 50.1% of patients had loss of autonomy, 57% a polypharmacy prescription (≥8 classes of medicines) and 21.2% needed domiciliary oxygen therapy, but despite these critical points only 8% of the patients were transferred to long-term/intermediate care settings. In conclusion, the main characteristics of patients with HF admitted to IMD in Tuscany are the advanced age (the patients are old and very old) and the presence of multiple comorbidities (HF <em>alone is a rarity indeed</em>). The use of echocardiography and the pharmacological therapy with ACE-I, ARB, <span>β</span>-blocker and anti-aldosterone agents is wider than previous surveys, but some diagnostic, therapeutic and prognostic aspects are not similar to that recommended by the most recent HF guidelines. This survey underscores again some differences between <em>HF trials world</em> and <em>HF real world</em>, where the management is probably also driven by a clinical holistic approach.http://www.italjmed.org/index.php/ijm/article/view/554Heart failureTuscany.
collection DOAJ
language English
format Article
sources DOAJ
author Valerio Verdiani
Grazia Panigada
Alberto Fortini
Luca Masotti
Simone Meini
Paolo Biagi
for the SMIT Study Group
spellingShingle Valerio Verdiani
Grazia Panigada
Alberto Fortini
Luca Masotti
Simone Meini
Paolo Biagi
for the SMIT Study Group
The heart failure in Internal Medicine in Tuscany: the SMIT Study
Italian Journal of Medicine
Heart failure
Tuscany.
author_facet Valerio Verdiani
Grazia Panigada
Alberto Fortini
Luca Masotti
Simone Meini
Paolo Biagi
for the SMIT Study Group
author_sort Valerio Verdiani
title The heart failure in Internal Medicine in Tuscany: the SMIT Study
title_short The heart failure in Internal Medicine in Tuscany: the SMIT Study
title_full The heart failure in Internal Medicine in Tuscany: the SMIT Study
title_fullStr The heart failure in Internal Medicine in Tuscany: the SMIT Study
title_full_unstemmed The heart failure in Internal Medicine in Tuscany: the SMIT Study
title_sort heart failure in internal medicine in tuscany: the smit study
publisher PAGEPress Publications
series Italian Journal of Medicine
issn 1877-9344
1877-9352
publishDate 2015-12-01
description The incidence and prevalence associated with the growing age of population have made heart failure (HF) a new epidemic. In Italy most of HF patients are admitted to Internal Medicine Departments (IMD). We conducted a 30-day cross-sectional study involving patients with HF admitted to IMD of Tuscany. The aim of the study was to provide an updated snapshot of in-hospital management of HF in Tuscany and to analyze the differences in relation to the most recent guidelines. We have recruited 770 patients (M=45.4%) with a mean age of 82.5±8.9 years. Only 16.1% had a <em>de novo</em> HF. Most of them were re-admitted for decompensated HF. Hypertension and ischemic disease are the prevailing etiologies. <em>HF alone</em> was in less than 2%. 71.5% of patients had more than two comorbidities and 40.6% more than three concomitant diseases. The mean hospital stay (overall 8.6±5.5 days) correlated with the number of comorbidity. About 25% of patients had a creatinine clearance &lt;30 mL/min. Nearly 50% of patients had atrial fibrillation but only the half was anti-coagulated. <span>β</span>-blockers, angiotensin converting enzyme-inhibitors (ACE-I) or angiotensin receptor blockers (ARB) were prescribed in about two-thirds of the subjects. Echocardiography was performed in 64.1% of patients. BNP or NT-pro BNP was tested in 67% at the hospital admission and in 18.3% at the discharge. At the discharge 50.1% of patients had loss of autonomy, 57% a polypharmacy prescription (≥8 classes of medicines) and 21.2% needed domiciliary oxygen therapy, but despite these critical points only 8% of the patients were transferred to long-term/intermediate care settings. In conclusion, the main characteristics of patients with HF admitted to IMD in Tuscany are the advanced age (the patients are old and very old) and the presence of multiple comorbidities (HF <em>alone is a rarity indeed</em>). The use of echocardiography and the pharmacological therapy with ACE-I, ARB, <span>β</span>-blocker and anti-aldosterone agents is wider than previous surveys, but some diagnostic, therapeutic and prognostic aspects are not similar to that recommended by the most recent HF guidelines. This survey underscores again some differences between <em>HF trials world</em> and <em>HF real world</em>, where the management is probably also driven by a clinical holistic approach.
topic Heart failure
Tuscany.
url http://www.italjmed.org/index.php/ijm/article/view/554
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