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Espíndola R, Vella V, Benito N, Mur I, Tedeschi S, Zamparini E, Hendriks JGE, Sorlí L, Murillo O, Soldevila L, Scarborough M, Scarborough C, Kluytmans J, Ferrari MC, Pletz MW, McNamara I, Escudero-Sanchez R, Arvieux C, Batailler C, Dauchy FA, Liu WY, Lora-Tamayo J, Praena J, Ustianowski A, Cinconze E, Pellegrini M, Bagnoli F, Rodríguez-Baño J, Del-Toro-López MD. Incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infection in European hospitals: the COMBACTE-NET ARTHR-IS multi-centre study. J Hosp Infect 2023; 142:9-17. [PMID: 37797656 DOI: 10.1016/j.jhin.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The aim of this study was to estimate the incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infections (SA-PJI) after primary hip and knee arthroplasty in European centres. METHODS This study was conducted in patients who underwent primary hip and knee arthroplasty in 19 European hospitals between 2014 and 2016. The global incidence of PJI and SA-PJI was calculated. The associated disease burden was measured indirectly as infection-related mortality plus loss of function. For healthcare utilization, number and duration of hospitalizations, number and type of surgical procedures, duration of antibiotic treatments, and number of outpatient visits were collected. Subgroup and regression analyses were used to evaluate the impact of SA-PJI on healthcare utilization, controlling for confounding variables. RESULTS The incidence of PJI caused by any micro-organism was 1.41%, and 0.40% for SA-PJI. Among SA-PJI, 20.7% were due to MRSA with substantial regional differences, and were more frequent in partial hip arthroplasty (PHA). Related deaths and loss of function occurred in 7.0% and 10.2% of SA-PJI cases, respectively, and were higher in patients with PHA. Compared with patients without PJI, patients with SA-PJI had a mean of 1.4 more readmissions, 25.1 more days of hospitalization, underwent 1.8 more surgical procedures, and had 5.4 more outpatient visits, controlling for confounding variables. Healthcare utilization was higher in patients who failed surgical treatment of SA-PJI. CONCLUSIONS This study confirmed that the SA-PJI burden is high, especially in PHA, and provided a solid basis for planning interventions to prevent SA-PJI.
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Affiliation(s)
- R Espíndola
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | - V Vella
- GlaxoSmithKline (GSK), Siena, Italy
| | - N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - I Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - S Tedeschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - E Zamparini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - J G E Hendriks
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands
| | - L Sorlí
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - O Murillo
- Department of Infectious Diseases, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - L Soldevila
- Department of Infectious Diseases, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - M Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M C Ferrari
- Prosthetic-Joint Replacement Unit, Humanitas Research Hospital, Milano, Italy
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - I McNamara
- Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK
| | - R Escudero-Sanchez
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Arvieux
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - C Batailler
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
| | - F-A Dauchy
- Department of Infectious and Tropical Diseases, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - W-Y Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, The Netherlands
| | - J Lora-Tamayo
- Department of Internal Medicine (CIBERINFEC-CIBER de Enfermedades Infecciosas), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Praena
- Clinical Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Ustianowski
- Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
| | | | | | | | - J Rodríguez-Baño
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Sevilla, Spain
| | - M-D Del-Toro-López
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Sevilla, Spain.
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Calabria S, Piccinni C, Ronconi G, Dondi L, Cinconze E, Pedrini A, Esposito I, Addesi A, Martini N, Maggioni AP. Secondary prevention of coronary artery disease: a retrospective observational analysis of italian healthcare administrative data. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ACARPIA Farmaceutici S.r.l.
Background/Introduction
Prevalence and mortality rates in patients with a documented coronary artery disease (CAD) are high, mainly due to the suboptimal adherence to the recommendations of current guidelines on secondary prevention strategies.
Purpose
This study aimed to describe patients with CAD and eligible to secondary prevention and assess their 1-year healthcare resource consumption and costs, from the perspective of the Italian National Health Service (INHS).
Methods
From our database of Italian healthcare administrative data, reliably representative of the whole Italian population, a cross-linkage of demographics, hospital discharges and exemption code for disease cost sharing, through a unique anonymized identifying code, was performed. Patients aged ≥35 in 2018 (accrual period) with CAD (index date) and eligible to secondary prevention (by excluding subjects with end-stage kidney disease/neoplasia) were selected. They were characterized in terms of age, gender and comorbidities (from index date back to 2015) and followed for 1 year to assess drug consumption, hospitalizations and healthcare integrated costs.
Results
Out of >5 million inhabitants in the database in 2018, 46,063 patients aged ≥35 (1.3%) with CAD and eligible for secondary prevention were selected (72.1% males; mean age [±SD] 70±12). About half of them had 3 or more comorbidities of interest: mostly hypertension (90%), dyslipidaemia (72%) and diabetes (33%). During 1-year follow-up, at least one drug for secondary prevention was supplied to 96.4% of patients: mainly antiplatelets (83%), lipid lowering agents (83%) and β-blockers (73%). At the same time, 95.8% of the cohort was treated with at least one non-cardiovascular drug. The 30.6% of subjects were hospitalized at least once: 11.4% due to relevant cardiovascular causes (mostly acute coronary syndrome and heart failure), 9.1% due to other cardiovascular events and 17.5% because of non-cardiovascular events. On average, the INHS yearly paid €6,078 per patient: hospitalizations accounted for the 70% of the whole expenditure.
Conclusions
This study showed an integrated view of the relevant burden of CAD for patients and the INHS. A multidisciplinary and a more adherent approach to current guidelines are compelling to improve patients’ outcomes and reduce costs for the INHS.
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Affiliation(s)
- S Calabria
- Fondazione Ricerca e Salute (ReS), Casalecchio Di Reno, Italy
| | - C Piccinni
- Fondazione Ricerca e Salute (ReS), Casalecchio Di Reno, Italy
| | - G Ronconi
- Fondazione Ricerca e Salute (ReS), Casalecchio Di Reno, Italy
| | - L Dondi
- Fondazione Ricerca e Salute (ReS), Casalecchio Di Reno, Italy
| | - E Cinconze
- Fondazione Ricerca e Salute (ReS), Casalecchio Di Reno, Italy
| | - A Pedrini
- Fondazione Ricerca e Salute (ReS), Casalecchio Di Reno, Italy
| | | | - A Addesi
- Drugs and Health srl, Rome, Italy
| | - N Martini
- Fondazione Ricerca e Salute (ReS), Casalecchio Di Reno, Italy
| | - AP Maggioni
- ANMCO Foundation For Your Heart, Heart Care Foundation, Florence, Italy
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Pagano E, De Rosa M, Rossi E, Cinconze E, Marchesini G, Miccoli R, Vaccaro O, Bonora E, Bruno G. The relative burden of diabetes complications on healthcare costs: The population-based CINECA-SID ARNO Diabetes Observatory. Nutr Metab Cardiovasc Dis 2016; 26:944-950. [PMID: 27289165 DOI: 10.1016/j.numecd.2016.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS In the present population-based study, we aimed to describe the per patient annual healthcare cost of people with diabetes in 2007-2012, to assess the relative burden of diabetes complications and other potential determinants on healthcare costs in the 2012 cohort, and to describe and analyse the determinants of the cost of incident cases diagnosed in 2012. METHODS AND RESULTS We analysed data from a retrospective cohort of residents in four Italian areas that were served by Local Health Units participating in the ARNO Observatory. Per patient annual healthcare costs (Euros) were estimated as the sum of all the resources supplied during that year (drugs, outpatient care, and hospitalisations). The mean per patient annual healthcare cost increased from €2752 in 2007 to €3191 in 2010, before decreasing to €2791 in 2012. The largest component of these costs was represented by hospitalisations (around €1550, on average; 51.7% of total cost), followed by outpatient care (€422; 14.6%) and drugs (€973; 33.7%). In 2012, the most relevant cost determinants were chronic diabetes complications, with an additional cost due to nephropathy/end stage renal disease (€4683), amputations (€5042), lower extremity revascularization (€4808), and cerebrovascular diseases (€3861). Costs associated with incidence cases were higher than those associated with prevalent. CONCLUSION The present study provides evidence on the excess of healthcare costs due to diabetes complications in both prevalent and incident cases.
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Affiliation(s)
- E Pagano
- Unit of Cancer Epidemiology, "Città della Salute e della Scienza" Hospital-University of Turin and CPO Piemonte, Turin, Italy.
| | - M De Rosa
- CINECA Interuniversity Consortium, Health Department, Bologna, Italy
| | - E Rossi
- CINECA Interuniversity Consortium, Health Department, Bologna, Italy
| | - E Cinconze
- CINECA Interuniversity Consortium, Health Department, Bologna, Italy
| | - G Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater Studiorum University, Bologna, Italy
| | - R Miccoli
- Department of Endocrinology and Metabolism, Section of Metabolic Diseases and Diabetes, University of Pisa, Italy
| | - O Vaccaro
- Department of Clinical Medicine and Surgery, University of Napoli Federico II, Napoli, Italy
| | - E Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Italy
| | - G Bruno
- Department of Medical Sciences, University of Turin, Italy
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Calabria S, Cinconze E, Rossini M, Rossi E, Maggioni AP, Pedrini A, De Rosa M. Adherence to alendronic or risedronic acid treatment, combined or not to calcium and vitamin D, and related determinants in Italian patients with osteoporosis. Patient Prefer Adherence 2016; 10:523-30. [PMID: 27143860 PMCID: PMC4844437 DOI: 10.2147/ppa.s95634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Osteoporosis is a chronic disease and an important health and social burden due to its worldwide prevalence. Literature and clinical experience report incomplete adherence to the therapy. This retrospective observational study aimed at assessing the adherence to first-line antiosteoporosis drugs (AODs; reimbursed by the National Health System, according to the Italian Medicine Agency recommendation number 79), alendronate or risedronate, with or without calcium and/or vitamin D supplements, in a real, Italian clinical setting. PATIENTS AND METHODS Analyses were carried out on data present in the ARNO Observatory, a population-based patient-centric Italian database. From a population of 5,808,832 inhabitants with available data, a cohort of 3.3 million of patients aged ≥40 years was selected. New users of first-line AODs as monotherapy (accrual period, 2007-2009) were followed up over 3 years to assess adherence at 6, 12, and 36 months to AODs and to supplements and related determinants. RESULTS Approximately 40,000 new users were identified: mostly women, aged on average (standard deviation) 71±10 years. Alendronate was the most prescribed (38.2% of patients), followed by risedronate (34.9%) and alendronate with colecalciferol as a fixed-dose combination (25.8%). Adherence at the 6-month follow-up was 54%, and this constantly and significantly decreased after 1 year to 46%, and after 3 years to 33% (P<0.01). Adherence to the fixed-dose combination was higher than to plain alendronate throughout the follow-up period. Similarly, adherence to supplements constantly decreased with the duration of treatment. Women and patients aged >50 years were more likely to adhere to treatment regimen (P<0.001). The use of drugs for peptic ulcer and gastroesophageal reflux disease and of corticosteroids for systemic use were significantly associated with high adherence at different times. Polytherapy (>5 drugs), cardiovascular, and neurological therapies were significantly associated with low adherence throughout the follow-up period. CONCLUSION In a huge clinical practice sample, this study highlights suboptimal adherence to first-line AODs and to supplements and important determinants, such as concomitant therapies.
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Affiliation(s)
- S Calabria
- CORE, Collaborative Outcome Research, Bologna, Italy
- Correspondence: S Calabria, Health Care Systems Department, CINECA, Via Magnanelli 6/3, 40033 Casalecchio di Reno, Bologna, Italy, Tel +39 051 716 1348, Fax +39 051 613 2198, Email
| | - E Cinconze
- Health Care Systems Department, CINECA, Interuniversity Consortium, Bologna, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - E Rossi
- Health Care Systems Department, CINECA, Interuniversity Consortium, Bologna, Italy
| | - AP Maggioni
- CORE, Collaborative Outcome Research, Bologna, Italy
- ANMCO Research Center, Firenze, Italy
| | - A Pedrini
- CORE, Collaborative Outcome Research, Bologna, Italy
| | - M De Rosa
- Health Care Systems Department, CINECA, Interuniversity Consortium, Bologna, Italy
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Affiliation(s)
- E Rossi
- CINECA Interuniversity Consortium, Casalecchio di Reno, Italy
| | - E Cinconze
- CINECA Interuniversity Consortium, Casalecchio di Reno, Italy
| | - Rosa M De
- CINECA Interuniversity Consortium, Casalecchio di Reno, Italy
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Vittorino Gaddi A, Benedetto D, Capello F, Di Pietro C, Cinconze E, Rossi E, De Sando V, Cevenini M, D'Alò G. Oral antidiabetic therapy in a large Italian sample: drug supply and compliance for different therapeutic regimens. Public Health 2013; 128:70-6. [PMID: 23969148 DOI: 10.1016/j.puhe.2013.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 01/23/2013] [Accepted: 05/24/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To define the main features of patients treated with oral antidiabetics, evaluating monotherapy (MT), loose-dose combination therapy (LDCT) and fixed-dose combination therapy (FDCT); to describe medication adherence to the different therapies; and to evaluate the differences in compliance with the prescribed therapy regimen among prevalent and incident patient cohorts. STUDY DESIGN This study was a retrospective cohort analysis based on the ARNO database, a national record that tracks reimbursable prescription claims submitted from selected pharmacies to the Italian national health system. In total, 169,375 subjects, from an overall population of 4,040,624 were included in this study. The patients represented 12 different local health units. Each patient had at least one oral antidiabetic prescription claim (A10B ATC code). METHODS Patients were divided into four groups according to their treatment regimen during the recruitment period (1 January 2008-31 December 2008): MT, FDCT, LDCT and switching therapy. A timespan of 5 years was considered, from 4 years before to 1 year after the index date (i.e. date of the prescription selected in the recruitment period). A medication possession ratio (MPR) with a cut-off value of 80% was used to measure medication adherence. Descriptive statistics and multiple logistic regression were used to define the objectives, while P < 0.05 was considered to indicate significance. RESULTS The median age of patients (n = 169,375, prevalence 4.2%) was 70 years [interquartile range (IQR) 17], and 49.1% were females. Considering the entire sample, the median MPRs for the treatment regimens were: MT, 0.73 (IQR 0.53; 43.9% compliant); FDCT, 1 (IQR 0.29, 68,5% compliant); and LDCT, 0.89 (IQR 0.33, 60.3% compliant). FDCT and LDCT were significantly correlated with MPR. Compliance was 48.9% in the prevalent patient cohort (i.e. patients prescribed oral antidiabetic therapy in both prerecruitment and recruitment periods); median MPRs for the treatment regimens were: MT, 0.73 (IQR 0.52); FDCT, 1 (IQR 0.28); and LDCT, 0.90 (IQR 0.32). Compliance was 43.0% in the incident patient cohort (i.e. patients who were first prescribed oral antidiabetic therapy in the recruitment period); median MPRs for the treatment regimens were: MT, 0.70 (IQR, 0.58); FDCT, 1 (IQR 0.34); and LDCT, 0.64 (IQR 0.39). CONCLUSIONS Compliance was better for FDCT than the other therapeutic regimens in the study population. The same trend was observed in both the prevalent and incident patient cohorts. As type 2 diabetes is a chronic lifelong pathology, and multiple agents are often required to achieve glycaemic control, the preference for FDCT in the population, when clinically applicable, could be an effective strategy for functional administration of clinical outcome and sources. Evaluation of specific population fractions (age, sex, compliance, etc.) and specific agents or drug combinations could also be relevant in order to reach the healthcare objectives.
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Affiliation(s)
- A Vittorino Gaddi
- Atherosclerosis and Metabolic Disease Research Unit, Internal Medicine, Aging and Kidney Disease Department, University of Bologna, Italy
| | - D Benedetto
- Atherosclerosis and Metabolic Disease Research Unit, Internal Medicine, Aging and Kidney Disease Department, University of Bologna, Italy.
| | | | | | | | | | - V De Sando
- Atherosclerosis and Metabolic Disease Research Unit, Internal Medicine, Aging and Kidney Disease Department, University of Bologna, Italy
| | - M Cevenini
- Atherosclerosis and Metabolic Disease Research Unit, Internal Medicine, Aging and Kidney Disease Department, University of Bologna, Italy
| | - G D'Alò
- Takeda Italia Farmaceutici S.p.A, Italy
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Denas G, Pengo V, Joppi R, Cinconze E, Mezzalira L, Pase D, Poggiani C, Rossi E, Padayattil Jose S, Prandoni P. Long-term use of vitamin K antagonists in patients with atrial fibrillation and cancer incidence: a pharmaco-epidemiological study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Joppi R, Cinconze E, Mezzalira L, Pase D, Poggiani C, Rossi E, Pengo V. Hospitalized patients with atrial fibrillation compared to those included in recent trials on novel oral anticoagulants: a population-based study. Eur J Intern Med 2013; 24:318-23. [PMID: 23528931 DOI: 10.1016/j.ejim.2013.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/22/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Nonvalvular atrial fibrillation is associated with a substantial risk of stroke. Novel oral anticoagulants (NOACs) with predictable anticoagulant effect and no need for routine coagulation monitoring have recently shown good results when compared with warfarin in phase III clinical trials. OBJECTIVE To describe clinical features and pharmacological treatments of a population-based cohort of patients with nonvalvular atrial fibrillation and ascertain whether they are comparable with those included in the three main phase III clinical trials on NOACs. RESULTS Of the 2,862,264 subjects considered for this study 13,360 patients (0.47%) were recently discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation. Mean age was 76.3 (SD 10.7), 49.8% were men and 64.6% were ≥75 years of age. 50% of patients were treated with warfarin and 44.1% with antiplatelet agents. The proportion of patients on antiplatelet therapy increased with age up to a rate of 54.3% in subjects ≥85 years. 92.9% of the studied cohort was on polypharmacy (mean 8 drugs/patient). Around 20% of the entire cohort was treated with amiodarone, a drug potentially interfering with NOACs, and 3.6% from a subgroup analysis had renal failure, which is an exclusion criterion in trials on NOACs. CONCLUSION In patients recently discharged from the hospital with the diagnosis of nonvalvular AF, warfarin use decreases and aspirin treatment increases with patients' age. These patients are older, more frequently female, and on multiple medications. The benefit of NOACs in these subjects needs to be confirmed in phase IV clinical studies.
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Affiliation(s)
- R Joppi
- Pharmaceutical Department, Local Health Unit of Verona, Via Salvo D'Acquisto 7, 37122 Verona, Italy.
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Cavallini M, Caterino S, Bellagamba R, Cinconze E, Ziparo V. [Solitary small bowel metastasis after resection of bile duct carcinoma]. Ann Ital Chir 2004; 75:265-8. [PMID: 15387001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Small bowel solitary metastases are a very rare occurrence and are more frequently recognized only in the presence of a severe complication, such as intestinal hemorrhage or occlusion. We report the case of a 75 year-old man who was admitted with a recent history of mechanical ileus developed one year after the surgical removal of an endoscopically intubated carcinoma of the extrahepatic biliary tree (pT3 pN0 Mx). A solitary metastasis of the small bowel, 30 cm from the ileo-cecal valve, was excised during the emergency laparotomy and a side-to-side anastomosis was performed to reconstruct the intestinal continuity. Patient was, thereafter, discharged in the 9th postoperative day. Local recurrence and intrabdominal dissemination are often observed in patients treated for bilio-pancreatic carcinoma. Preoperative invasive (ERCP, FNA, PTBD, etc.) diagnostic procedures and surgical tumor manipulation are associated with a greater risk of metastasis implantation and intraabdominal dissemination. In accordance to the literature, the authors propose, in cases with resectable bilio-pancreatic neoplasms, the use of standard external low dose radiotherapy prior to any invasive diagnostic procedure and/or surgical removal.
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Affiliation(s)
- M Cavallini
- Dipartimento di Chirurgia Pietro Valdoni, II Facoltà di Medicina e Chirurgia, Università degli Studi La Sapienza, Roma
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