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Yu AYX, Austin PC, Jackevicius CA, Chu A, Holodinsky JK, Hill MD, Kamal N, Kumar M, Lee DS, Vyas MV, Joundi RA, Khan NA, Kapral MK, McNaughton CD. Population Trends of New Prescriptions for Antihyperglycemics and Antihypertensives Between 2014 and 2022. J Am Heart Assoc 2024; 13:e034118. [PMID: 38563374 DOI: 10.1161/jaha.123.034118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In the wake of pandemic-related health decline and health care disruptions, there are concerns that previous gains for cardiovascular risk factors may have stalled or reversed. Population-level excess burden of drug-treated diabetes and hypertension during the pandemic compared with baseline is not well characterized. We evaluated the change in incident prescription claims for antihyperglycemics and antihypertensives before versus during the pandemic. METHODS AND RESULTS In this retrospective, serial, cross-sectional, population-based study, we used interrupted time series analyses to examine changes in the age- and sex-standardized monthly rate of incident prescriptions for antihyperglycemics and antihypertensives in patients aged ≥66 years in Ontario, Canada, before the pandemic (April 2014 to March 2020) compared with during the pandemic (July 2020 to November 2022). Incident claim was defined as the first prescription filled for any medication in these classes. The characteristics of patients with incident prescriptions of antihyperglycemics (n=151 888) or antihypertensives (n=368 123) before the pandemic were comparable with their pandemic counterparts (antihyperglycemics, n=97 015; antihypertensives, n=146 524). Before the pandemic, monthly rates of incident prescriptions were decreasing (-0.03 per 10 000 individuals [95% CI, -0.04 to -0.01] for antihyperglycemics; -0.14 [95% CI, -0.18 to -0.10] for antihypertensives). After July 2020, monthly rates increased (postinterruption trend 0.31 per 10 000 individuals [95% CI, 0.28-0.34] for antihyperglycemics; 0.19 [95% CI, 0.14-0.23] for antihypertensives). CONCLUSIONS Population-level increases in new antihyperglycemic and antihypertensive prescriptions during the pandemic reversed prepandemic declines and were sustained for >2 years. Our findings are concerning for current and future cardiovascular health.
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Affiliation(s)
- Amy Y X Yu
- Department of Medicine (Neurology) University of Toronto, Sunnybrook Health Sciences Centre Toronto ON Canada
- ICES Toronto ON Canada
| | - Peter C Austin
- ICES Toronto ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto ON Canada
| | - Cynthia A Jackevicius
- ICES Toronto ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto ON Canada
- College of Pharmacy, Western University of Health Sciences Pomona CA
| | | | - Jessalyn K Holodinsky
- Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary AB Canada
- Department of Emergency Medicine University of Calgary AB Canada
- Community Health Sciences University of Calgary AB Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary AB Canada
- Community Health Sciences University of Calgary AB Canada
| | - Noreen Kamal
- Department of Industrial Engineering Dalhousie University Halifax NS Canada
- Department of Community Health and Epidemiology, Department of Medicine (Neurology) Dalhousie University Halifax NS Canada
| | - Mukesh Kumar
- Department of Industrial Engineering Dalhousie University Halifax NS Canada
| | - Douglas S Lee
- ICES Toronto ON Canada
- Department of Medicine (Cardiology) University of Toronto, University Health Network Toronto ON Canada
| | - Manav V Vyas
- ICES Toronto ON Canada
- Department of Medicine (Neurology) Unity Health Toronto, University of Toronto ON Canada
| | - Raed A Joundi
- Department of Medicine McMaster University Hamilton ON Canada
| | - Nadia A Khan
- Department of Medicine University of British Columbia Vancouver BC Canada
| | - Moira K Kapral
- ICES Toronto ON Canada
- Department of Medicine (General Internal Medicine) University of Toronto, University Health Network Toronto ON Canada
| | - Candace D McNaughton
- ICES Toronto ON Canada
- Department of Medicine (Emergency Medicine) University of Toronto, Sunnybrook Health Sciences Centre Toronto ON Canada
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Yao J, Irvine MA, Klaver B, Zandy M, Dheri AK, Grafstein E, Smolina K. Changes in emergency department use in British Columbia, Canada, during the first 3 years of the COVID-19 pandemic. CMAJ 2023; 195:E1141-E1150. [PMID: 37669788 PMCID: PMC10480001 DOI: 10.1503/cmaj.221516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Previous studies have shown reductions in the volume of emergency department visits early in the COVID-19 pandemic, but few have evaluated the pandemic's impact over time or stratified analyses by reason for visits. We aimed to quantify such changes in British Columbia, Canada, cumulatively and during prominent nadirs, and by reason for visit, age and acuity. METHODS We included data from the National Ambulatory Care Reporting System for 30 emergency departments across BC from January 2016 to December 2022. We fitted generalized additive models, accounting for seasonal and annual trends, to the monthly number of visits to estimate changes throughout the pandemic, compared with the expected number of visits in the absence of the pandemic. We determined absolute and relative differences at various times during the study period, and cumulatively since the start of the pandemic until the overall volume of emergency department visits returned to expected levels. RESULTS Over the first 16 months of the pandemic, the volume of emergency department visits was reduced by about 322 300 visits, or 15% (95% confidence interval 12%-18%), compared with the expected volume. A sharp drop in pediatric visits accounted for nearly one-third of the reduction. The timing of the return to baseline volume of visits differed by subgroup. The largest and most sustained decreases were in respiratory-related emergency department visits, visits among children, visits among oldest adults and non-urgent visits. Later in the pandemic, we observed increased volumes of highest-urgency visits, visits among children and visits related to ear, nose and throat. INTERPRETATION We have extended evidence that the impact of the COVID-19 pandemic and associated mitigation strategies on emergency department visits in Canada was substantial. Both our findings and methods are relevant in public health surveillance and capacity planning for emergency departments in pandemic and nonpandemic times.
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Affiliation(s)
- Jiayun Yao
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Michael A Irvine
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Braeden Klaver
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Moe Zandy
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Aman K Dheri
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Eric Grafstein
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Kate Smolina
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
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Song E, Hwang J, Park SJ, Park MJ, Jang A, Choi KM, Baik SH, Yoo HJ. Impact of diabetes on emergency care of acute myocardial infarction patients during the coronavirus disease 2019 pandemic: a nationwide population-based study. Front Public Health 2023; 11:1151506. [PMID: 37181708 PMCID: PMC10169718 DOI: 10.3389/fpubh.2023.1151506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Background Although acute myocardial infarction (AMI) requires timely intervention, limited nationwide data is available regarding the association between disruption of emergency services and outcomes of patients with AMI during the coronavirus disease 2019 (COVID-19) pandemic. Moreover, whether diabetes mellitus (DM) adversely affects disease severity in these patients has not yet been investigated. Methods This nationwide population-based study analyzed 45,648 patients with AMI, using data from the national registry of emergency departments (ED) in Korea. Frequency of ED visits and disease severity were compared between the COVID-19 outbreak period (year 2020) and the control period (the previous year 2019). Results The number of ED visits by patients with AMI decreased during the first, second, and third waves of the outbreak period compared to the corresponding time period in the control period (all p-values < 0.05). A longer duration from symptom onset to ED visit (p = 0.001) and ED stay (p = 0.001) and higher rates of resuscitation, ventilation care, and extracorporeal membrane oxygen insertion were observed during the outbreak period than during the control period (all p-values < 0.05). These findings were exacerbated in patients with comorbid DM; Compared to patients without DM, patients with DM demonstrated delayed ED visits, longer ED stays, more intensive care unit admissions (p < 0.001), longer hospitalizations (p < 0.001), and higher rates of resuscitation, intubation, and hemodialysis (all p-values < 0.05) during the outbreak period. While in-hospital mortality was similar in AMI patients with and without comorbid DM during the two periods (4.3 vs. 4.4%; p = 0.671), patients with DM who had other comorbidities such as chronic kidney disease or heart failure or were aged ≥ 80 years had higher in-hospital mortality compared with those without any of the comorbidities (3.1 vs. 6.0%; p < 0.001). Conclusion During the pandemic, the number of patients with AMI presenting to the ED decreased compared with that of the previous year, while the disease severity increased, particularly in patients with comorbid DM.
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Affiliation(s)
- Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeongeun Hwang
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sung Joon Park
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Jeong Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ahreum Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Sedova P, Kent JA, Bryndziar T, Jarkovsky J, Tomek A, Sramek M, Skoda O, Sramkova T, Pokorová K, Littnerova S, Brown RD, Mikulik R. The decline in stroke hospitalization due to COVID-19 is unrelated to COVID-19 intensity. Eur J Neurol 2023; 30:943-950. [PMID: 36511840 PMCID: PMC9877601 DOI: 10.1111/ene.15664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE During the coronavirus disease 2019 (COVID-19) pandemic many countries reported a decline in stroke volumes. The aim of this study was to analyze if the decline was related to the intensity of the COVID-19 pandemic. METHODS The first pandemic year (1 March 2020 to 28 February 2021) overall and during the three COVID-19 waves were compared with the preceding year. Volumes of acute ischaemic stroke (AIS), subarachnoid hemorrhage, intracerebral hemorrhage and recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) were obtained from the National Register of Reimbursed Health Services. Door-to-needle time, onset-to-door time and National Institutes of Health Stroke Scale at admission were obtained from the Registry of Stroke Care Quality. RESULTS During the pandemic year compared to the preceding year there were 26,453 versus 28,771 stroke admissions, representing an 8.8% decline (p < 0.001). The declines (-10%, -11%, -19%) appeared in COVID-19 waves (spring 2020, autumn 2020, winter 2021) except for an increase (2%) during summer 2020. Admissions for AIS declined by 10.2% (p < 0.001), whilst hemorrhagic stroke volumes were minimally decreased. The absolute volumes of IVT and MT decreased by 9.4% (p < 0.001) and 5.7% (p = 0.16), respectively. However, the proportions of ischaemic stroke patients receiving IVT (18% vs. 18%; p = 0.72) and MT (6% vs. 6%; p = 0.28) remained unchanged. CONCLUSIONS There was a decline in stroke admissions, but such decline was not related to COVID-19 incidence. The frequency of use of recanalization procedures (IVT, MT) and times (onset-to-door time, door-to-needle time) in AIS were preserved in the Czech Republic during the first year of the pandemic.
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Affiliation(s)
- Petra Sedova
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- International Clinical Research CenterSt Anne's University HospitalBrnoCzech Republic
- Department of Internal Medicine and CardiologyUniversity Hospital Brno and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
- Department of NeurologySt Anne's University Hospital, and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
| | | | - Tomas Bryndziar
- International Clinical Research CenterSt Anne's University HospitalBrnoCzech Republic
- Department of NeurologySt Anne's University Hospital, and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
- Faculty of MedicineInstitute of Biostatistics and Analyses, Masaryk UniversityBrnoCzech Republic
| | - Ales Tomek
- Department of NeurologyCharles University in Prague, and Second Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Martin Sramek
- Department of NeurologyCharles University in Prague, and Second Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Ondrej Skoda
- Neurological Department and Stroke UnitJihlava HospitalJihlavaCzech Republic
- Department of NeurologyUniversity Hospital Kralovske Vinohrady and Charles University in PraguePragueCzech Republic
| | - Tereza Sramkova
- Department of NeurologyCharles University in Prague, and Second Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Kateřina Pokorová
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
- Faculty of MedicineInstitute of Biostatistics and Analyses, Masaryk UniversityBrnoCzech Republic
| | - Simona Littnerova
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
- Faculty of MedicineInstitute of Biostatistics and Analyses, Masaryk UniversityBrnoCzech Republic
| | | | - Robert Mikulik
- International Clinical Research CenterSt Anne's University HospitalBrnoCzech Republic
- Department of NeurologySt Anne's University Hospital, and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
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Prodan CI, Batra A, Ungvari Z, Liotta EM. Stringent public health measures during COVID-19 across ischemic stroke care systems: the potential impact of patient perceptions on health care-seeking behaviors. GeroScience 2022; 44:1255-1262. [PMID: 35467316 PMCID: PMC9035971 DOI: 10.1007/s11357-022-00566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Decreases in acute stroke presentations have been reported during the coronavirus disease 2019 (COVID-19) pandemic surges. A recent study by Bojti et al. (GeroScience. 2021;43:2231–2248) sought to understand the relationship of public health mandates in Hungary as they were implemented with acute ischemic stroke admissions and interventions during two separate COVID-19 waves. We sought to perform a similar analysis of changes in ischemic stroke care at two distinct medical institutions in the USA. Two separate institutions and systems of ischemic stroke care were evaluated through a regional comprehensive stroke center telestroke service and a Veterans Affairs (VA) inpatient stroke and neurorehabilitation service. Telestroke consultations in a single system in Chicago, IL, were significantly decreased during the first COVID-19 wave during severely restricted public health mandates (z-score < − 2), and were less depressed during a subsequent wave with less severe restrictions (z-score approaching − 1), which resembles findings in Hungary as reported by Bojti et al. In contrast, inpatient admissions during the first and second COVID-19 waves to a VA stroke and neurorehabilitation service in Oklahoma City remained unchanged. The Chicago and Hungary patterns of stroke presentations suggest that public perceptions, as informed by regional health mandates, might influence healthcare-seeking behavior. However, the VA experience suggests that specific patient populations may react differently to given public health mandates. These observations highlight that changes in stroke presentation during the COVID-19 pandemic may vary regionally and by patient population as well as by the severity of public health mandates implemented. Further study of COVID-19-related public health policies on acute stroke populations is needed to capture the long-term impact of such policies. Learning from the real-time impact of pandemic surges and public health policy on presentation of acute medical conditions, such as ischemic stroke, may prove valuable for designing effective policies in the future.
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Affiliation(s)
- Calin I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Ayush Batra
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, Suite 1150, Chicago, IL, 60611, USA
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Eric M Liotta
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, Suite 1150, Chicago, IL, 60611, USA.
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Toscano O, Cosentino N, Campodonico J, Bartorelli AL, Marenzi G. Acute Myocardial Infarction During the COVID-19 Pandemic: An Update on Clinical Characteristics and Outcomes. Front Cardiovasc Med 2022; 8:648290. [PMID: 35004867 PMCID: PMC8733166 DOI: 10.3389/fcvm.2021.648290] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic. On top of respiratory complications, COVID-19 is associated with major direct and indirect cardiovascular consequences, with the latter probably being even more relevant, especially in the setting of time-dependent cardiovascular emergencies. A growing amount of data suggests a dramatic decline in hospital admissions for acute myocardial infarction (AMI) worldwide during the COVID-19 pandemic, mostly since patients did not activate emergency medical systems because hospitals were perceived as dangerous places regarding the infection risk. Moreover, during the COVID-19 pandemic, patients with AMI had a significantly higher in-hospital mortality compared to those admitted before COVID-19, potentially due to late arrival to the hospital. Finally, no consensus has been reached regarding the most adequate healthcare management pathway for AMI and shared guidance on how to handle patients with AMI during the pandemic is still needed. In this review, we will provide an update on epidemiology, clinical characteristics, and outcomes of patients with AMI during the COVID-19 pandemic, with a special focus on its collateral cardiac impact.
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Affiliation(s)
- Olga Toscano
- Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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