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Chiara MUSSI

Professore Associato
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze sede ex-Medicina, Endocrinologia, Metabolismo e Geriatria


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Pubblicazioni

2022 - Combining L-Arginine with vitamin C improves long-COVID symptoms: The LINCOLN Survey [Articolo su rivista]
Izzo, Raffaele; Trimarco, Valentina; Mone, Pasquale; Aloè, Teresita; Capra Marzani, Massimo; Diana, Antonio; Fazio, Giovanni; Mallardo, Mario; Maniscalco, Mauro; Marazzi, Giuseppe; Messina, Nunzia; Mininni, Simone; Mussi, Chiara; Pelaia, Girolamo; Pennisi, Alfio; Santus, Pierachille; Scarpelli, Francesco; Tursi, Francesco; Zanforlin, Alessandro; Santulli, Gaetano; Trimarco, Bruno
abstract

Recent evidence suggests that oxidative stress and endothelial dysfunction play critical roles in the pathophysiology of COVID-19 and Long-COVID. We hypothesized that a supplementation combining L-Arginine (to improve endothelial function) and Vitamin C (to reduce oxidation) could have favorable effects on Long-COVID symptoms.


2022 - Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial [Articolo su rivista]
LA PORTA, Fabio; Lullini, Giada; Caselli, Serena; Valzania, Franco; Mussi, Chiara; Tedeschi, Claudio; Pioli, Giulio; Bondavalli, Massimo; Bertolotti, Marco; Banchelli, Federico; D'Amico, Roberto; Vicini, Roberto; Puglisi, Silvia; Clerici, Pierina Viviana; Chiari, Lorenzo; and PRECISA Group members, ; LA PORTA, Fabio; Caselli, Serena; Clerici, Pierina Viviana; Cavazza, Stefano; Serraglio, Valeria; Vannini Maria Cristina, ; Bovolenta, Federica; Lullini, Giada; Puglisi, Silvia; Gallo, Angela; Mussi, Chiara; Bertolotti, Marco; Scotto, Roberto; Lancellotti, Giulia; Franco, Valzania; Francesca, Falzone; Monica, Montanari; Maria Luisa De Luca, ; Malagoli, Emanuela; Elisa, Franchini; Luisa, Palmisano; Franca, Serafini; Tedeschi, Claudio; Gioacchino, Anselmi; Valentina, D’Alleva; Mariangela Di Matteo, ; Rosalinda, Ferrari; Costi, Stefania; Filomena, Simeone; Giulia, D’Apote; Alessandra, Rizzica; Galavotti, Maria Beatrice; Marta, Ghirelli; Giulio, Pioli; Bendini, Chiara; Lancellotti, Giulia; Massimo, Bondavalli; Eleni, Georgopoulos; D'Amico, Roberto; Balduzzi, Sara; Vicini, Roberto; Banchelli, Federico; Lorenzo, Chiari; Sabato, Mellone; Alice, Coni
abstract

Fall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge.


2022 - Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis [Articolo su rivista]
Ungar, A.; Ceccofiglio, A.; Mussi, C.; Bo, M.; Rivasi, G.; Rafanelli, M.; Martone, A. M.; Bellelli, G.; Nicosia, F.; Riccio, D.; Boccardi, V.; Tonon, E.; Curcio, F.; Landi, F.; Abete, P.; Mossello, E.
abstract

Objective: To compare one-year mortality risk associated with syncope and unexplained fall in older adults with dementia. Methods: 522 patients (aged >65 years) with dementia and history of transient loss of consciousness and/or unexplained falls were evaluated. The diagnosis of syncope was based on European Society of Cardiology guidelines. A “Syncopal Fall” was defined in patients with an initial clinical presentation of unexplained fall, but a final diagnosis of syncope after complete assessment. A “Truly Unexplained Fall” was defined in patients with an initial clinical presentation of unexplained fall, in whom a diagnosis of syncope had been excluded after the diagnostic work-up. One-year follow-up was assessed by phone interview. Results: Follow-up data were available for 501 participants (mean age 83 ± 6 years, 65% female). After a mean follow-up of 324 ± 93 days, death from any cause was reported in 188 participants (24%). Advanced age, male sex, cognitive and functional impairment were associated with a higher mortality rate. Patients with “Truly Unexplained Falls” had a higher mortality risk compared with syncope and “Syncopal Fall”. A diagnosis of “Truly Unexplained Falls” remained an independent predictor of one-year all-cause mortality in multivariate model. Conclusions: We propose the novel diagnostic category of “Truly Unexplained Fall”, resulting from the application of syncope guidelines to subjects with unexplained falls. This condition in older adults with dementia is a predictor of one-year all-cause mortality. For this new high risk profile, we advice a comprehensive geriatric assessment focused on risk factors for fall, aimed at a possible improvement of prognosis.


2021 - Cognitive impairment in patients with atrial fibrillation: Implications for outcome in a cohort study [Articolo su rivista]
Malavasi, Vincenzo Livio; Zoccali, Cristina; Brandi, Maria Chiara; Micali, Giulia; Vitolo, Marco; Imberti, Jacopo Francesco; Mussi, Chiara; Schnabel, Renate B; Freedman, Ben; Boriani, Giuseppe
abstract

The impact of cognitive status on outcomes of patients with atrial fibrillation (AF) is not well defined.


2021 - Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry [Articolo su rivista]
Corrao, S.; Nobili, A.; Natoli, G.; Mannucci, P. M.; Perticone, F.; Pietrangelo, A.; Argano, C.; Licata, G.; Violi, F.; Corazza, G. R.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Tettamanti, M.; Pasina, L.; Franchi, C.; Franchi, C.; Cortesi, L.; Tettamanti, M.; Miglio, G.; Tettamanti, M.; Cortesi, L.; Ardoino, I.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Caterina, C.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Chiuch, M.; Zaccari, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Lupattelli, G.; Mannarino, E.; Bianconi, V.; Paciullo, F.; Alcidi, R.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Mularo, S.; Raspanti, M.; Zoli, M.; Lazzari, I.; Brunori, M.; Fabbri, E.; Magalotti, D.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Bonini, G.; Ottolini, B. B.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Murialdo, G.; Marra, A.; Cattaneo, F.; Pontremoli, R.; Beccati, V.; Nobili, G.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Valeriani, E.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Pes, C.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Marengoni, A.; Zucchelli, A.; Manzoni, F.; Volpini, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'Unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Tassone, B.; Sesti, G.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Scarinzi, P.; Amabile, A.; Omenetto, E.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; De Giorgio, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Sabba, C.; Vella, F. S.; Suppressa, P.; Schilardi, A.; Loparco, F.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Fenoglio, L.; Falcetta, A.; Bracco, C.; Fargion, A. L. F. S.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Ferrari, B.; Colombo, G.; Agosti, P.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Salerno, F.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Peasso, P.; Favale, E.; Poletto, C.; Salmi, R.; Gaudenzi, P.; Violi, F.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Galassi, M.; Grassi, Y.; Perticone, M.; Battaglia, R.; Filice, M.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Gabrielli, A.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Pignataro, S.; Gennaro, A.; Blanco, J.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden,
abstract

Aims: The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods: Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results: Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions: The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.


2021 - Pattern of comorbidities and 1-year mortality in elderly patients with COPD hospitalized in internal medicine wards: data from the RePoSI Registry [Articolo su rivista]
Argano, C.; Scichilone, N.; Natoli, G.; Nobili, A.; Corazza, G. R.; Mannucci, P. M.; Perticone, F.; Corrao, S.; Pietrangelo, A.; Licata, G.; Violi, F.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Tettamanti, M.; Pasina, L.; Franchi, C.; Miglio, G.; Cortesi, L.; Ardoino, I.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Caterina, C.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Chiuch, M.; Zaccari, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Lupattelli, G.; Mannarino, E.; Bianconi, V.; Paciullo, F.; Alcidi, R.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Corrao, S.; Mularo, S.; Raspanti, M.; Cavallaro, F.; Zoli, M.; Lazzari, I.; Brunori, M.; Fabbri, E.; Magalotti, D.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Bonini, G.; Ottolini, B. B.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Murialdo, G.; Marra, A.; Cattaneo, F.; Pontremoli, R.; Beccati, V.; Nobili, G.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Valeriani, E.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Pes, C.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Zucchelli, A.; Manzoni, F.; Volpini, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'Unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Tassone, B.; Sesti, G.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Scarinzi, P.; Amabile, A.; Omenetto, E.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; De Giorgio, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Sabba, C.; Vella, F. S.; Suppressa, P.; Schilardi, A.; Loparco, F.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Fenoglio, L.; Falcetta, A.; Bracco, C.; Fracanzani Silvia Fargion, A. L.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Ferrari, B.; Colombo, G.; Agosti, P.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Salerno, F.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Peasso, P.; Favale, E.; Poletto, C.; Salmi, R.; Gaudenzi, P.; Violi, F.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Galassi, M.; Grassi, Y.; Perticone, M.; Battaglia, R.; Filice, M.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Gabrielli, A.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Pignataro, S.; Gennaro, A.; Blanco, J.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.;
abstract

Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worldwide with significant economic burden. Comorbidities increase in number and severity with age and are identified as important determinants that influence the prognosis. In this observational study, we retrospectively analyzed data collected from the RePoSI register. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients with the clinical diagnosis of COPD. Socio-demographic, clinical characteristics and laboratory findings were considered. The association between variables and in-hospital, 3-month and 1-year follow-up were analyzed. Among 4696 in-patients, 932 (19.8%) had a diagnosis of COPD. Patients with COPD had more hospitalization, a significant overt cognitive impairment, a clinically significant disability and more depression in comparison with non-COPD subjects. COPD patients took more drugs, both at admission, in-hospital stay, discharge and 3-month and 1-year follow-up. 14 comorbidities were more frequent in COPD patients. Cerebrovascular disease was an independent predictor of in-hospital mortality. At 3-month follow-up, male sex and hepatic cirrhosis were independently associated with mortality. ICS-LABA therapy was predictor of mortality at in-hospital, 3-month and 1-year follow-up. This analysis showed the severity of impact of COPD and its comorbidities in the real life of internal medicine and geriatric wards.


2021 - The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry [Articolo su rivista]
De Vincentis, A.; Vespasiani-Gentilucci, U.; Costanzo, L.; Novella, A.; Cortesi, L.; Nobili, A.; Mannucci, P. M.; Incalzi, R. A.; Mannucci, P. M.; Nobili, A.; Pietrangelo, A.; Perticone, F.; Licata, G.; Violi, F.; Corazza, G. R.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Tettamanti, M.; Pasina, L.; Franchi, C.; Franchi, C.; Cortesi, L.; Tettamanti, M.; Miglio, G.; Tettamanti, M.; Cortesi, L.; Ardoino, I.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Mattioli, I.; Biolo, G.; Zanetti, M.; Bartelloni, G.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Lupattelli, G.; Bianconi, V.; Alcidi, R.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Beneduce, V.; Cacioppo, F.; Corrao, S.; Natoli, G.; Mularo, S.; Raspanti, M.; Zoli, M.; Matacena, M. L.; Orio, G.; Magnolfi, E.; Serafini, G.; Simili, A.; Palasciano, G.; Modeo, M. E.; Gennaro, C. D.; Cappellini, M. D.; Fabio, G.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Leoni, S.; Di Mauro, A. D.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Pontremoli, R.; Beccati, V.; Nobili, G.; Leoncini, G.; Anastasio, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Giorgi, A.; Gracin, C.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Marengoni, A.; Volpini, A.; Lucente, D.; Picardi, A.; Gentilucci, U. V.; Bellelli, G.; Corsi, M.; Antonucci, C.; Sidoli, C.; Principato, G.; Arturi, F.; Succurro, E.; Tassone, B.; Giofre, F.; Serra, M. G.; Bleve, M. A.; Brucato, A.; De Falco, T.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; Paolisso, G.; Rizzo, M. R.; Catalano, C.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Schiavone, S.; Bragagni, A.; Sabba, C.; Vella, F. S.; Suppressa, P.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Custodero, C.; Fenoglio, L.; Falcetta, A.; Fracanzani, A. L.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Colombo, G.; Agosti, P.; Monzani, V.; Savojardo, V.; Ceriani, G.; Salerno, F.; Pallini, G.; Montecucco, F.; Ottonello, L.; Caserza, L.; Vischi, G.; Liberato, N. L.; Tognin, T.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Pisciotta, M. S.; Bellucci, F. B.; Buffelli, S.; Montrucchio, G.; Peasso, P.; Favale, E.; Poletto, C.; Margaria, C.; Sanino, M.; Violi, F.; Perri, L.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Diprizio, R. D.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Galassi, M.; Grassi, Y.; Greco, A.; Sciacqua, A.; Perticone, M.; Battaglia, R.; Maio, R.; Stanghellini, V.; Ruggeri, E.; Del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Gennaro, A.; Gaudio, A.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Vigorito, C.; Cittadini, A.; Moreo, G.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Gonella, R.; Cerminara, D.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Sechi, L.; Catena, C.; Colussi, G.; Cavarape, A.; Da Porto, A.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Tarsitani, P.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Grossi, M.; Del Giacco, S.; Firinu, D.; Costanzo, G.; Argiolas, G.; Montalto, G.; Licata, A.; Montalto, F. A.; Corica, F.; Basile, G.; Catalano, A.; Bellone, F.; Principato, C.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Di Quattro, R.; Malfa, L. L
abstract

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.


2021 - Underdiagnosis and undertreatment of osteoporotic patients admitted in internal medicine wards in Italy between 2010 and 2016 (the REPOSI Register) [Articolo su rivista]
Pepe, J.; Agosti, P.; Cipriani, C.; Tettamanti, M.; Nobili, A.; Colangelo, L.; Santori, R.; Cilli, M.; Minisola, S.; Mannucci, P. M.; Pietrangelo, A.; Perticone, F.; Violi, F.; Corazza, G. R.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Pasina, L.; Cortesi, C. F. L.; Miglio, G.; Ardoino, I.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Mattioli, I.; Biolo, G.; Zanetti, M.; Bartelloni, G.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Lupattelli, G.; Bianconi, V.; Alcidi, R.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Beneduce, V.; Cacioppo, F.; Corrao, S.; Natoli, G.; Mularo, S.; Raspanti, M.; Zoli, M.; Matacena, M. L.; Orio, G.; Magnolfi, E.; Serafini, G.; Simili, A.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Fabio, G.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Leoni, S.; Di Mauro, A. D.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Pontremoli, R.; Beccati, V.; Nobili, G.; Leoncini, G.; Anastasio, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Giorgi, A.; Gracin, C.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Volpini, A.; Lucente, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Bellelli, G.; Corsi, M.; Antonucci, C.; Sidoli, C.; Principato, G.; Arturi, F.; Succurro, E.; Tassone, B.; Giofre, F.; Serra, M. G.; Bleve, M. A.; Brucato, A.; De Falco, T.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; Paolisso, G.; Rizzo, M. R.; Catalano, C.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Schiavone, S.; Bragagni, A.; Sabba, C.; Vella, F. S.; Suppressa, P.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Custodero, C.; Fenoglio, L.; Falcetta, A.; Fracanzani, A. L.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Colombo, G.; Monzani, V.; Savojardo, V.; Ceriani, G.; Salerno, F.; Pallini, G.; Montecucco, F.; Ottonello, L.; Caserza, L.; Vischi, G.; Liberato, N. L.; Tognin, T.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Pisciotta, M. S.; Bellucci, F. B.; Buffelli, S.; Montrucchio, G.; Peasso, P.; Favale, E.; Poletto, C.; Margaria, C.; Sanino, M.; Perri, L.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Diprizio, R. D.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Galassi, M.; Grassi, Y.; Greco, A.; Sciacqua, A.; Perticone, M.; Battaglia, R.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Gennaro, A.; Gaudio, A.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Vigorito, C.; Cittadini, A.; Moreo, G.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Gonella, R.; Cerminara, D.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Sechi, L.; Catena, C.; Colussi, G.; Cavarape, A.; Da Porto, A.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Tarsitani, P.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Grossi, M.; Del Giacco, S.; Firinu, D.; Costanzo, G.; Argiolas, G.; Montalto, G.; Licata, A.; Montalto, F. A.; Corica, F.; Basile, G.; Catalano, A.; Bellone, F.; Principato, C.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Di Quattro, R.; La Malfa, L.; Caruso, R.; Mecocci, P.; Ruggiero, C.; Boccardi, V.; Meschi, T.; Ticinesi, A.; Nouvenne, A.; Minuz, P.; Fondrieschi, L.; Imperiale, G. N.; Pirisi, M.; Fra, G. P.; Sol
abstract

Purpose: To evaluate clinical features, treatments, and outcomes of osteoporotic patients admitted to internal medicine and geriatric wards compared with non-osteoporotic patients (REPOSI registry). Methods: We studied 4714 patients hospitalized between 2010 and 2016. We reported age, sex, educational level, living status, comorbidities and drugs taken, Cumulative Illness Rating Scale (CIRS), Barthel Index, Short-Blessed Test, 4-item Geriatric Depression Scale, serum hemoglobin, creatinine, and clinical outcomes. Osteoporosis was defined based on the diagnoses recorded at admission, according to the following ICD9: 733, 805–813, 820–823. Results: Twelve percent of the patients had a preadmission diagnosis of osteoporosis. Only 20% of these had been prescribed oral bisphosphonates; 34% were taking vitamin D supplements. Osteoporotic patients were significantly older, with lower BMI, higher CIRS, and taking more drugs. They were significantly more depressed, less independent, with a higher severity of cognitive impairment compared with non-osteoporotic patients. At discharge, the number of patients receiving treatment for osteoporosis did not change. Length of stay and inhospital mortality did not differ between groups. Osteoporotic patients were more frequently nonhome discharged compared with those without osteoporosis (14.8 vs. 7.9%, p = 0.0007), mostly discharged to physical therapy or rehabilitation (8.8 vs. 2.5% of patients, p < 0.0001). Among osteoporotic patients deceased 3 months after discharge, the number of those treated with vitamin D, with or without calcium supplements, was significantly lower compared with survivors (12 vs. 32%, p = 0.0168). Conclusions: The diagnosis of osteoporosis is poorly considered both during hospital stay and at discharge; osteoporotic patients are frailer compared to non-osteoporotic patients.


2021 - Use of lipid-lowering drugs and associated outcomes according to health state profiles in hospitalized older patients [Articolo su rivista]
Franchi, C.; Lancellotti, G.; Bertolotti, M.; Di Salvatore, S.; Nobili, A.; Mannucci, P. M.; Mussi, C.; Ardoino, I.
abstract

Objective: To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles. Design: This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI – Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards. Setting and Participants: A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018. Methods: Socio-demographic characteristics, functional abilities, cognitive skills, labora-tory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients’ health state profiles and with short-term mortality. Results: Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76–5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44–0.80). Conclusion: The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients’ health state profiles.


2021 - What changed in the Italian internal medicine and geriatric wards during the lockdown [Articolo su rivista]
D'Avanzo, B.; Nobili, A.; Tettamanti, M.; Pasina, L.; Mannucci, P. M.; Pietrangelo, A.; Perticone, F.; Violi, F.; Corazza, G. R.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Franchi, C.; Cortesi, L.; Miglio, G.; Ardoino, I.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Mattioli, I.; Biolo, G.; Zanetti, M.; Bartelloni, G.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Lupattelli, G.; Bianconi, V.; Alcidi, R.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Beneduce, V.; Cacioppo, F.; Natoli, G.; Mularo, S.; Raspanti, M.; Zoli, M.; Matacena, M. L.; Orio, G.; Magnolfi, E.; Serafini, G.; Simili, A.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Fabio, G.; de Amicis, M. M.; de Luca, G.; Scaramellini, N.; Rossi, P. D.; Damanti, S.; Clerici, M.; Leoni, S.; Di Mauro, A. D.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Pontremoli, R.; Beccati, V.; Nobili, G.; Leoncini, G.; Anastasio, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Giorgi, A.; Gracin, C.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Volpini, A.; Lucente, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Bellelli, G.; Corsi, M.; Antonucci, C.; Sidoli, C.; Principato, G.; Arturi, F.; Succurro, E.; Tassone, B.; Giofre, F.; Serra, M. G.; Bleve, M. A.; Brucato, A.; de Falco, T.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; de Giorgi, A.; Tiseo, R.; Paolisso, G.; Rizzo, M. R.; Catalano, C.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Schiavone, S.; Bragagni, A.; Sabba, C.; Vella, F. S.; Suppressa, P.; de Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Custodero, C.; Fenoglio, L.; Falcetta, A.; Fracanzani, A. L.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Colombo, G.; Agosti, P.; Monzani, V.; Savojardo, V.; Ceriani, G.; Pallini, G.; Montecucco, F.; Ottonello, L.; Caserza, L.; Vischi, G.; Liberato, N. L.; Tognin, T.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Pisciotta, M. S.; Bellucci, F. B.; Buffelli, S.; Montrucchio, G.; Peasso, P.; Favale, E.; Poletto, C.; Margaria, C.; Sanino, M.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Diprizio, R. D.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Galassi, M.; Grassi, Y.; Greco, A.; Sciacqua, A.; Perticone, M.; Battaglia, R.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Dal Col, A.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Gennaro, A.; Gaudio, A.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Vigorito, C.; Cittadini, A.; Moreo, G.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Gonella, R.; Cerminara, D.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Sechi, L.; Catena, C.; Colussi, G.; Cavarape, A.; da Porto, A.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Tarsitani, P.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Grossi, M.; Del Giacco, S.; Firinu, D.; Costanzo, G.; Argiolas, G.; Montalto, G.; Licata, A.; Montalto, F. A.; Corica, F.; Basile, G.; Catalano, A.; Bellone, F.; Principato, C.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Di Quattro, R.; la Malfa, L.; Caruso, R.; Mecocci, P.; Ruggiero, C.; Boccardi, V.; Meschi, T.; Ticinesi, A.; Nouvenne, A.; Minuz, P.; Fondrieschi, L.; Imperiale, G. N.; Pirisi, M.; Fra, G. P.; Sola, D.; Bellan, M.; Porta, M.; Riva, P.; Quadri, R.; Larovere, E
abstract


2020 - Atrial Fibrillation in Older Patients with Syncope and Dementia: Insights from the Syncope and Dementia Registry [Articolo su rivista]
Ceccofiglio, A.; Fumagalli, S.; Mussi, C.; Mossello, E.; Bo, M.; Martone, A. M.; Bellelli, G.; Nicosia, F.; Riccio, D.; Langellotto, A.; Tava, G.; Boccardi, V.; Tonon, E.; Abete, P.; Ungar, A.
abstract

Objectives: To evaluate the clinical characteristics and the long-term outcome of atrial fibrillation (AF) patients with dementia and history of syncope or falls. Design: Observational: analysis of a prospective registry. Setting and Participants: Between 2012 and 2016, the Syncope and Dementia Registry enrolled patients in 12 geriatric departments. Follow-up evaluation was at 12 months. Measures: Clinical, functional, and cognitive assessment. Results: Of the 522 patients (women, 62.1%; Mini-Mental State Examination 17 ± 6), 26.4% have or presented an AF history. Patients with AF were older (85 ± 6 vs 83 ± 6 years, P = .012), with higher heart rate (78 ± 17 vs. 73 ± 14 bpm, P < .001), prescribed drugs (6.9 ± 2.9 vs 5.9 ± 2.7, P < .001), and an increased number (3.9 ± 2.0 vs 3.0 ± 1.8, P < .001) and severity of comorbidities. Oral anticoagulant therapy was underprescribed (39.9%). Cardiac syncope was more frequently diagnosed (18.8 vs 4.9%, P < .001). At multivariate analysis, AF patients were characterized by advanced age, a higher severity of comorbidities, a greater number of prescribed drugs, an increased heart rate, and a more frequent presence of cardiac symptoms. One-year mortality differed little between patients with and without AF (27.7 vs 22.1%, P = .229). In the arrhythmia group, multivariate predictors of prognosis were disability (number of lost BADLs; P = .020) and a higher heart rate (P = .006). Conclusions and Implications: AF and postural stability-related issues often co-exist in persons with dementia. This complex of conditions is associated with an intricate clinical picture, underprescription of oral anticoagulants, and high long-term mortality. Future studies are needed to evaluate the effects of therapy optimization in this population.


2020 - Memantine Induces Reflex Syncope in Elderly Patients With Dementia: Results From the Syncope and Dementia Study (SYD-Study) [Articolo su rivista]
Curcio, F.; Testa, G.; Ceccofiglio, A.; Martone, A. M.; Riccio, D.; Nicosia, F.; Noro, G.; Bellelli, G.; Bo, M.; Mussi, C.; Landi, F.; Ungar, A.; Abete, P.
abstract


2020 - Pain and Frailty in Hospitalized Older Adults [Articolo su rivista]
Ardoino, I.; Franchi, C.; Nobili, A.; Mannucci, P. M.; Corli, O.; Pietrangelo, A.; Perticone, F.; Licata, G.; Violi, F.; Corazza, G. R.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Tettamanti, M.; Pasina, L.; Franchi, C.; Franchi, C.; Cortesi, L.; Tettamanti, M.; Miglio, G.; Tettamanti, M.; Cortesi, L.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Mattioli, I.; Biolo, G.; Zanetti, M.; Bartelloni, G.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Lupattelli, G.; Bianconi, V.; Alcidi, R.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Beneduce, V.; Cacioppo, F.; Corrao, S.; Natoli, G.; Mularo, S.; Raspanti, M.; Zoli, M.; Matacena, M. L.; Orio, G.; Magnolfi, E.; Serafini, G.; Simili, A.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Fabio, G.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Leoni, S.; Di Mauro, A. D.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Pontremoli, R.; Beccati, V.; Nobili, G.; Leoncini, G.; Anastasio, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Giorgi, A.; Gracin, C.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Marengoni, A.; Volpini, A.; Lucente, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Bellelli, G.; Corsi, M.; Antonucci, C.; Sidoli, C.; Principato, G.; Arturi, F.; Succurro, E.; Tassone, B.; Giofre, F.; Serra, M. G.; Bleve, M. A.; Brucato, A.; De Falco, T.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; Paolisso, G.; Rizzo, M. R.; Catalano, C.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Schiavone, S.; Bragagni, A.; Sabba, C.; Vella, F. S.; Suppressa, P.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Custodero, C.; Fenoglio, L.; Falcetta, A.; Fracanzani, A. L.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Colombo, G.; Agosti, P.; Monzani, V.; Savojardo, V.; Ceriani, G.; Salerno, F.; Pallini, G.; Montecucco, F.; Ottonello, L.; Caserza, L.; Vischi, G.; Liberato, N. L.; Tognin, T.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Pisciotta, M. S.; Bellucci, F. B.; Buffelli, S.; Montrucchio, G.; Peasso, P.; Favale, E.; Poletto, C.; Margaria, C.; Sanino, M.; Violi, F.; Perri, L.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Diprizio, R. D.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Galassi, M.; Grassi, Y.; Greco, A.; Sciacqua, A.; Perticone, M.; Battaglia, R.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Gennaro, A.; Gaudio, A.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Vigorito, C.; Cittadini, A.; Moreo, G.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Gonella, R.; Cerminara, D.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Sechi, L.; Catena, C.; Colussi, G.; Cavarape, A.; Da Porto, A.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Tarsitani, P.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Grossi, M.; Del Giacco, S.; Firinu, D.; Costanzo, G.; Argiolas, G.; Montalto, G.; Licata, A.; Montalto, F. A.; Corica, F.; Basile, G.; Catalano, A.; Bellone, F.; Principato, C.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Di Quattro, R.; La Malfa, L.; Caruso, R.; Mecocci, P.; Ruggiero, C.; Boccardi, V.; Meschi, T.; Ticinesi, A
abstract

Introduction: Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. Methods: In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. Results: The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38–2.07). Somatic pain (OR = 1.59, 95% CI 1.23–2.07) and widespread pain (OR = 1.60, 95% CI 0.93–2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28–0.85). Conclusions: Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people.


2020 - Prevalence and management of delirium in community dwelling older people with dementia referred to a memory clinic [Articolo su rivista]
Manni, B.; Federzoni, L.; Zucchi, P.; Mussi, C.; Inzitari, M.; Carda, C. A.; Fabbo, A.; Morandi, A.
abstract

Objective: Our aim was to measure the prevalence of delirium, its clinical features, and outcomes in older patients referred to a memory clinic. Methods: A retrospective cohort study of 109 older outpatients with delirium referred to a memory clinic with a home care service. Delirium was diagnosed using the confusion assessment method and dementia with the DSM-5 criteria. We collected information on cognitive and functional status, mortality, institutionalization, and hospitalization during 6 months following the delirium episode. Results: Delirium prevalence was 3.6%, mostly of hyperactive type. Delirium worsened functional (ADL 2.95 ± 1.95 vs. 2.16 ± 1.84) and cognitive (MMSE 13.88 ± 8.96 vs.11.0 ± 9.49) status after 6 months compared to the baseline. The mortality rate was 29.4%, and 28.3% were admitted to a long-term facility after the episode of delirium. Of these patients, more than half were hospitalized during the follow-up. Of the 109 patients with delirium, 85 were managed at home and 24 were hospitalized. Patients who were hospitalized had more severe behavioral symptoms during the delirium episode. There was no difference in mortality and institutionalization according to the home or hospital management. Conclusions: This retrospective cohort study adds novel information to the existing literature of an understudied setting and population. The study supports the need to further investigate the feasibility and efficacy of the hospital at home models for the prevention and management of delirium in a high-risk population.


2020 - Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients [Articolo su rivista]
Ferrara, M. C.; Andreano, A.; Tassistro, E.; Rapazzini, P.; Zurlo, A.; Volpato, S.; Mussi, C.; Corsi, M.; Lunardelli, M. L.; Martini, E.; Castoldi, G.; De Filippi, F.; Pizzonia, M.; Monacelli, F.; Barone, A.; Pilotto, A.; March, A.; Ungar, A.; Capelli, R.; Galmarini, V.; Franzoni, S.; Terragnoli, F.; Bianchetti, A.; Cazzulani, I.; Gandossi, C.; Valsecchi, M. G.; Bellelli, G.
abstract

Background: Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. Methods: The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. Results: The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80–90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23–62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators (“pre-surgical cognitive assessment”, “bone protection prescription”, “use of urinary catheter” and “start of physiotherapy”), moderate in two indicators (“surgery performed ≤ 48 h from fracture” and “discharge toward rehabilitation” and low in one (“absence of delirium on day following surgery”). Comparison with international studies suggests very different ways of providing care to HF Italian patients. Conclusions: The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.


2019 - Compression of frailty in adults living with HIV [Articolo su rivista]
Guaraldi, G.; Francesco, D. D.; Malagoli, A.; Zona, S.; Franconi, I.; Santoro, A.; Mussini, C.; Mussi, C.; Cesari, M.; Theou, O.; Rockwood, K.
abstract

Background: Contemporary HIV care may reduce frailty in older adults living with HIV (OALWH). Objective of the study was to estimate prevalence of frailty at the age of 50 and 75 years, and build a model to quantify the burden of frailty in the year 2030. Methods: This study included OALWH attending Modena HIV Metabolic Clinic between 2009 and 2015. Patients are referred from more than 120 HIV clinics well distributed across Italy, therefore being country representative. Our model forecasts the new entries on yearly basis up to 2030. Changes in frailty over a one-year period using a 37-variable frailty index (FI) and death rates were modelled using a validated mathematical algorithm with parameters adjusted to best represent the changes observed at the clinic. In this study, we assessed the number of frailest individuals (defined with a FI > 0.4) at the age of 50 and at the age 75 by calendar year. Results: In the period 2015-2030 we model that frailest OALWH at age 50 will decrease from 26 to 7%, and at the age of 75 years will increase from 43 to 52%. This implies a shift of the frailty prevalence at an older age. Conclusion: We have presented projections of how the burden of frailty in older adults, living with HIV will change. We project fewer people aged 50+ with severe frailty, most of whom will be older than now. These results suggest a compression of age-related frailty.


2019 - Drug prescription and delirium in older inpatients: Results from the nationwide multicenter Italian Delirium Day 2015-2016 [Articolo su rivista]
Aloisi, G.; Marengoni, A.; Morandi, A.; Zucchelli, A.; Cherubini, A.; Mossello, E.; Bo, M.; Di Santo, S. G.; Mazzone, A.; Trabucchi, M.; Cappa, S.; Fimognari, F. L.; Incalzi, R. A.; Gareri, P.; Perticone, F.; Campanini, M.; Montorsi, M.; Latronico, N.; Zambon, A.; Bellelli, G.; Rispoli, V.; Malara, A.; Spadea, F.; Di Cello, S.; Ceravolo, F.; Fabiano, F.; Chiaradia, G.; Gabriele, A.; Lenino, P.; Andrea, T.; Settembrini, V.; Capomolla, D.; Citrino, A.; Scriva, A.; Bruno, I.; Secchi, R.; De Martino, E.; Muccinelli, R.; Villa Del Sole, R. S. A.; Lupi, G.; Paonessa, P.; Fabbri, A.; Passuti, M. T.; Castellari, S.; Po, A.; Gaggioli, G.; Varesi, M.; Moneti, P.; Capurso, S.; Latini, V.; Ghidotti, S.; Riccardelli, F.; Macchi, M.; Rigo, R.; Claudio, P.; Angelo, B.; Flavio, C.; Benedetta, B.; Boffelli, S.; Cassinadri, A.; Franzoni, S.; Spazzini, E.; Andretto, D.; Tonini, G.; Andreani, L.; Coralli, M.; Balotta, A.; Cancelliere, R.; Ballardini, G.; Simoncelli, M.; Mancini, A.; Strazzacapa, M.; Fabio, S.; De Filippi, F.; Giudice, C.; Dentizzi, C.; Azzini, M.; Cazzadori, M.; Mastroeni, V.; Bertassello, P.; Benati, H. S. C.; Nesta, E.; Tobaldini, C.; Guerini, F.; Elena, T.; Mombelloni, P.; Fontanini, F.; Gabriella, L.; Pizzorni, C.; Oliverio, M.; Del Grosso, L. L.; Giavedoni, C.; Bidoli, G.; Mazzei, B.; Corsonello, A.; Fusco, S.; Vena, S.; De Vuono, T.; Maiuri, G.; Luca, F. F.; Andrea, A.; Giovanni, S.; Rossella, N.; Castegnaro, E.; De Rosa, S.; Benvenuti, E.; Del Lungo, I.; Giardini, S.; Giulietti, C.; Mauro, D. B.; Eleonora, B.; Martina, P.; Irene, F.; Riccardo, B.; Federica, S.; Bertoletti, E.; D'Amico, F.; Caronzolo, F.; Grippa, A.; Lombardo, G.; Pipicella, T.; Antonino, S.; Francesco, C.; Valeria, P. G.; Daniela, L.; Domenico, C.; Giorgio, B.; March, A.; Nitti, M. T.; Felici, A.; Pavan, S.; Piazzani, F.; Lunelli, A.; Dimori, S.; Margotta, A.; Soglia, T.; Postacchini, D.; Brunelli, R.; Santini, S.; Francavilla, M.; Macchiati, I.; Sorvillo, F.; Giuli, C.; Mecocci, P.; Longo, A.; Addesi, D.; Rosa, P. C.; Bencardino, G.; Falbo, T.; Grillo, N.; Marco, F.; Mirella, F.; Fanto, F.; Isaia, G.; Pezzilli, S.; Bergamo, D.; Furno, E.; Rrodhe, S.; Lucarini, S.; Dijk, B.; Dall'Acqua, F.; Calvani, D.; Becheri, D.; Giuseppe, M.; Costanza, M.; Vito, A.; Francesca, B.; Magherini, L.; Novella, M.; Franca, B.; Gambardella, P. M. L.; Valente, C.; Ospedale, N.; Ilaria, B.; Alice, F.; Porrino, P.; Ceci, G.; Giuliana, B.; Michela, T.; Eleonora, C.; Ettore, E.; Camellini, C.; Servello, A.; Grassi, A.; Rozzini, R.; Tironi, S.; Grassi, M. G.; Troisi, E.; Carlo, C.; Gabriella, D. S. S.; Flaminia, F.; Federica, R.; Beatrice, P.; Sofia, T.; Gabutto, A.; Quazzo, L.; Rosatello, A.; Suraci, D.; Tagliabue, B.; Perrone, C.; Ferrara, L.; Castagna, A.; Tremolada, M. L.; Giuseppe, C.; Stefano, B.; Davide, O.; Piano, S.; Serviddio, G.; Lo Buglio, A.; Gurrera, T.; Merlo, V.; Rovai, C.; Cotroneo, A. M.; Carlucci, R.; Abbaldo, A.; Monzani, F.; Qasem, A. A.; Bini, G.; Tafuto, S.; Galli, G.; Bruni, A. C.; Mancuso, G.; Mancuso, G.; Calipari, D.; Bernardini, B.; Corsini, C.; Michele, C.; Sara, D. F.; Cagnin, A.; Fragiacomo, F.; Pompanin, S.; Piero, A.; Marco, C.; Zurlo, A.; Guerra, G.; Pala, M.; Menozzi, L.; Delli Gatti, C.; Magon, S.; Roberto, M.; Alfredo, D. G.; Fabio, F.; Ruana, T.; Elisa, M.; Benedetta, B.; Christian, M.; Marco, P.; Massimo, G.; Di Francesco, V.; Faccioli, S.; Pellizzari, L.; Giorgia, F.; Barbagallo, G.; Lunardelli, M. L.; Martini, E.; Ferrari, E.; Macchiarulo, M.; Corneli, M.; Bacci, M.; Battaglia, G.; Anastasio, L.; Lo Storto, M. S.; Seresin, C.; Simonato, M.; Loreggian, M.; Cestonaro, F.; Durando, M.; Latella, R.; Mazzoleni, M.; Russo, G.; Ponte, M.; Valchera, A.; Salustri, G.; Petritola, D.; Costa, A.; Sinforiani, E.; Cotta, M. R.; Piano, S.; Pizio, R. N.; Cester, A.; Formilan, M.; Pietro, B.; Carbone, P.; Cazzaniga, I.; Appollonio, I.; Cereda, D.; Stabile, A.; Xhani, R.; Acampora, R.; Tremolizzo, L.; Federico, P.; Antonio, C.; Valerio, P.; Cesare, B.; Zhirajr
abstract

Objective: This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods: Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results: Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P =.009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions: Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship.


2019 - Hospital Care of Older Patients With COPD: Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids [Articolo su rivista]
Proietti, Marco; Agosti, Pasquale; Lonati, Chiara; Corrao, Salvatore; Perticone, Francesco; Mannucci, Pier Mannuccio; Nobili, Alessandro; Harari, SERGIO ALFONSO; Tettamanti, Mauro; Pasina, Luca; Franchi, Carlotta; Marengoni, Alessandra; Salerno, Francesco; Cesari, Matteo; Licata, Giuseppe; Violi, Francesco; Corazza, Gino Roberto; Cortesi, Laura; Ardoino, Ilaria; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Zanetti, Michela; Guadagni, Martina; Zaccari, Michele; Vanoli, Massimo; Grignani, Giulia; Pulixi, Edoardo Alessandro; Bernardi, Mauro; Bassi, Silvia Li; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Lupattelli, Graziana; Bianconi, Vanessa; Paciullo, Francesco; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Olivieri, Oliviero; Girelli, Domenico; Matteazzi, Thomas; Barbagallo, Mario; Dominguez, Ligia; Cocita, Floriana; Beneduce, Vincenza; Plances, Lidia; Zoli, Marco; Lazzari, Ilaria; Brunori, Mattia; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Palasciano, Giuseppe; Modeo, Maria Ester; Di Gennaro, Carla; Cappellini, Maria Domenica; Maira, Diletta; Di Stefano, Valeria; Fabio, Giovanna; Seghezzi, Sonia; Mancarella, Marta; Rossi, Paolo Dionigi; Damanti, Sarah; Clerici, Marta; Conti, Federica; Miceli, Emanuela; Lenti, Marco Vincenzo; Pisati, Martina; Dominioni, Costanza Caccia; Murialdo, Giovanni; Marra, Alessio; Cattaneo, Federico; Pontremoli, Roberto; Secchi, Maria Beatrice; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Cipollone, Francesco; Guagnano, Maria Teresa; Angelucci, Ermanno; Valeriani, Emanuele; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Delitala, Giuseppe; Berria, Maria; Muscaritoli, Maurizio; Molfino, Alessio; Petrillo, Enrico; Zuccalà, Giuseppe; D'Aurizio, Gabriella; Romanelli, Giuseppe; Zucchelli, Alberto; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Gallo, Paolo; Dell'Unto, Chiara; Annoni, Giorgio; Corsi, Maurizio; Bellelli, Giuseppe; Zazzetta, Sara; Mazzola, Paolo; Szabo, Hajnalka; Bonfanti, Alessandra; Arturi, Franco; Succurro, Elena; Rubino, Mariangela; Serra, Maria Grazia; Bleve, Maria Antonietta; Gasbarrone, Laura; Sajeva, Maria Rosaria; Brucato, Antonio; Ghidoni, Silvia; Fabris, Fabrizio; Bertozzi, Irene; Bogoni, Giulia; Rabuini, Maria Victoria; Cosi, Elisabetta; Manfredini, Roberto; Fabbian, Fabio; Boari, Benedetta; De Giorgi, Alfredo; Tiseo, Ruana; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Borghi, Claudio; Strocchi, Enrico; De Sando, Valeria; Pareo, Ilenia; Sabbà, Carlo; Vella, Francesco Saverio; Suppressa, Patrizia; Schilardi, Andrea; Loparco, Francesca; Fenoglio, Luigi; Bracco, Christian; Giraudo, Alessia Valentina; Fargion, Silvia; Periti, Giulia; Porzio, Marianna; Tiraboschi, Slivia; Peyvandi, Flora; Rossio, Raffaella; Ferrari, Barbara; Colombo, Giulia; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Ceriani, Giuliana; Pallini, Giada; Dallegri, Franco; Ottonello, Luciano; Liberale, Luca; Caserza, Lara; Salam, Kassem; Liberato, Nicola Lucio; Tognin, Tiziana; Bianchi, Giovanni Battista; Giaquinto, Sabrina; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Rozzini, Renzo; Falanga, Lina; Spazzini, Elena; Ferrandina, Camillo; Montrucchio, Giuseppe; Petitti, Paolo; Salmi, Raffaella; Gaudenzi, Piergiorgio; Perri, Ludovica; Landolfi, Raffaele; Montalto, Massimo; Mirijello, Antonio; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Molaro, Marta; Grossi, Alessandra; Bertolotti, Marco; Mussi, Chiara; Libbra, Maria Vittoria; Dondi, Giulia; Pellegrini, Elisa; Carulli, Lucia; Colangelo, Lidia; Falbo, Tania; Stanghellini, Vincenzo; De Giorgio, Roberto; Ruggeri, Eugenio; Vecchio, Sara del; Salvi, Andrea; Leonardi, Roberto; Damiani, Giampaolo; Gabrielli, Armando; Capeci, William; Mattioli, Massimo; Martino, Giuseppe Pio; Biondi, Lorenzo; Pettinari, Pietro; Ghio, Riccardo; Col, Anna Dal; Minisola, Salvatore; Cola
abstract

Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged ≥65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (≥5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to improve adherence to guidelines in treating COPD patients, with the ultimate goal of reducing clinical events.


2019 - Increasing Prevalence of Orthostatic Hypotension as a Cause of Syncope With Advancing Age and Multimorbidity [Articolo su rivista]
Ceccofiglio, A.; Mussi, C.; Rafanelli, M.; Rivasi, G.; Bo, M.; Mossello, E.; Martone, A. M.; Abete, P.; Ungar, A.
abstract


2019 - Management of high cholesterol levels in older people [Articolo su rivista]
Bertolotti, M.; Lancellotti, G.; Mussi, C.
abstract

The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol-lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug-related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid-lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375-383.


2019 - Mortality rate and risk factors for gastrointestinal bleeding in elderly patients [Articolo su rivista]
Lenti, M. V.; Pasina, L.; Cococcia, S.; Cortesi, L.; Miceli, E.; Dominioni, C. C.; Pisati, M.; Mengoli, C.; Perticone, F.; Nobili, A.; Di Sabatino, A.; Corazza, G. R.; Mannucci, P. M.; Tettamanti, M.; Franchi, C.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Licata, G.; Violi, F.; Ardoino, I.; Prisco, D.; Silvestri, E.; Cenci, C.; Emmi, G.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Olivieri, O.; Girelli, D.; Matteazzi, T.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Zoli, M.; Lazzari, I.; Brunori, M.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Murialdo, G.; Marra, A.; Cattaneo, F.; Pontremoli, R.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Angelucci, E.; Valeriani, E.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; ZuccalA, G.; D'aurizio, G.; Romanelli, G.; Zucchelli, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; De Sando, V.; Pareo, I.; SabbA, C.; Vella, F. S.; Suppressa, P.; Agosti, P.; Schilardi, A.; Loparco, F.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Fargion, S.; Periti, G.; Porzio, M.; Tiraboschi, S.; Peyvandi, F.; Rossio, R.; Ferrari, B.; Colombo, G.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Salmi, R.; Gaudenzi, P.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Molaro, M.; Grossi, A.; Bertolotti, M.; Mussi, C.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Colangelo, L.; Falbo, T.; Stanghellini, V.; Giorgio, R. D.; Ruggeri, E.; Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Gabrielli, A.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Blanco, J.; Zanoli, L.; Pignataro, S.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; GioffrA, V.; Pasquale, M.; Scattolin, G.; Martinelli, S.; Turrin, M.; Sechi, L.; Catena, C.; Colussi, G.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Patrizia, T.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Giacco, S. D.; Firinu, D.; Losa, F.; Paoletti, G.; Montalto, G.; Licata, A.; Malerba, V.; Antonino, L.; Basile, G.; Antonino, C.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Mecocci, P.; Ruggiero, C.; Boccardi, V.; Meschi, T.; Lauretani, F.; Ticinesi, A.; Minuz, P.; Fondrieschi, L.; Pirisi, M.; Fra, G. P.; Sola, D.; Porta, M.; Riva, P.; Quadri, R.; S
abstract

Background: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients. Methods: Since 2008, samples of elderly patients (age ≥ 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed. Results: 3872 patients were included (mean age 79 ± 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 ± 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 ± 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 ± 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 ± 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51–12.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23–5.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16–4.98) were associated with GIB (p < 0.05). Conclusions: A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity.


2019 - Need for deprescribing in hospital elderly patients discharged with a limited life expectancy: The REPOSI study [Articolo su rivista]
Pasina, L.; Ottolini, B. B.; Cortesi, L.; Tettamanti, M.; Franchi, C.; Marengoni, A.; Mannucci, P. M.; Nobili, A.; Corrao, S.; Salerno, F.; Cesari, M.; Perticone, F.; Licata, G.; Violi, F.; Corazza, G. R.; Ardoino, I.; Prisco, D.; Silvestri, E.; Cenci, C.; Emmi, G.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Olivieri, O.; Girelli, D.; Matteazzi, T.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Zoli, M.; Lazzari, I.; Brunori, M.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Angelucci, E.; Valeriani, E.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Zucchelli, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'Unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; De Sando, V.; Pareo, I.; Sabba, C.; Vella, F. S.; Suppressa, P.; Agosti, P.; Schilardi, A.; Loparco, F.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Fargion, S.; Periti, G.; Porzio, M.; Tiraboschi, S.; Peyvandi, F.; Rossio, R.; Ferrari, B.; Colombo, G.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Salmi, R.; Gaudenzi, P.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Molaro, M.; Grossi, A.; Bertolotti, M.; Mussi, C.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Colangelo, L.; Falbo, T.; Stanghellini, V.; De Giorgio, R.; Ruggeri, E.; Del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Gabrielli, A.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Dal Col, A.; Minisola, S.; Colangelo, L.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Blanco, J.; Zanoli, L.; Pignataro, S.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Scattolin, G.; Martinelli, S.; Turrin, M.; Sechi, L.; Catena, C.; Colussi, G.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Patrizia, T.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Del Giacco, S.; Firinu, D.; Losa, F.; Paoletti, G.; Montalto, G.; Licata, A.; Malerba, V.; Antonino, L.; Basile, G.; Antonino, C.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Mecocci, P.; Ruggiero, C.; Boccardi, V.; Meschi, T.; Lauretani, F.; Ticinesi, A.; Minuz, P.; Fondrieschi, L.; Pirisi, M.; Fra, G. P.; Sola, D.; Porta, M.; Riva, P.; Quadri, R.; Scanzi, G.; Mengoli, C.; Provini, S.;
abstract

Objective: Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs. The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI). Materials and Methods: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with a limited life expectancy. Results: The study sample comprised 55 patients discharged with a limited life expectancy. Patients with at least 1 preventive medication that could be considered for deprescription at the end of life were significantly fewer from admission to discharge (n = 30; 54.5% vs. n = 21; 38.2%; p = 0.02). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (67.3%) patients were also exposed to at least 1 potentially severe DDI at discharge. Conclusion: Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription.


2019 - Patterns of infections in older patients acutely admitted to medical wards: data from the REPOSI register [Articolo su rivista]
Rossio, R.; Ardoino, I.; Franchi, C.; Nobili, A.; Mannuccio Mannucci, P.; Peyvandi, F.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Caterina, C.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Chiuch, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Lupattelli, G.; Mannarino, E.; Bianconi, V.; Paciullo, F.; Alcidi, R.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Corrao, S.; Natoli, G.; Mularo, S.; Raspanti, M.; Cavallaro, F.; Zoli, M.; Lazzari, I.; Brunori, M.; Fabbri, E.; Magalotti, D.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Bonini, G.; Ottolini, B. B.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Murialdo, G.; Marra, A.; Cattaneo, F.; Pontremoli, R.; Beccati, V.; Nobili, G.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Valeriani, E.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Pes, C.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Marengoni, A.; Zucchelli, A.; Manzoni, F.; Volpini, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'Unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Tassone, B.; Sesti, G.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Scarinzi, P.; Amabile, A.; Omenetto, E.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; De Giorgio, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Sabba, C.; Vella, F. S.; Suppressa, P.; Agosti, P.; Schilardi, A.; Loparco, F.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Fenoglio, L.; Falcetta, A.; Bracco, C.; Fracanzani Silvia Fargion, A. L.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Ferrari, B.; Colombo, G.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Salerno, F.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Peasso, P.; Favale, E.; Poletto, C.; Salmi, R.; Gaudenzi, P.; Violi, F.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Galassi, M.; Grassi, Y.; Perticone, F.; Perticone, M.; Battaglia, R.; Filice, M.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Gabrielli, A.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Pignataro, S.; Gennaro, A.; Blanco, J.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Scattolin, G.; Martinelli, S.; Turrin, M.; Sechi, L.; Catena, C.; Colussi, G.; Passariello, N.; Rin
abstract

In older adults infections are among the leading causes of emergency department visits, hospitalization, morbidity and mortality. Infections are frequent events diagnosed in older hospitalized patients with a high number of comorbidities and on polypharmacy, respiratory tract infections being the most frequent followed by urinary tract infections


2019 - Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients [Articolo su rivista]
Carlotta, F.; Raffaella, R.; Ilaria, A.; Alessandro, N.; Mannuccio, M. P.; Mannucci, P. M.; Nobili, A.; Pietrangelo, A.; Perticone, F.; Licata, G.; Violi, F.; Corazza, G. R.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Tettamanti, M.; Pasina, L.; Franchi, C.; Cortesi, L.; Miglio, G.; Ardoino, I.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Caterina, C.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Chiuch, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Lupattelli, G.; Mannarino, E.; Bianconi, V.; Paciullo, F.; Alcidi, R.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Natoli, G.; Mularo, S.; Raspanti, M.; Cavallaro, F.; Zoli, M.; Lazzari, I.; Brunori, M.; Fabbri, E.; Magalotti, D.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Gennaro, C. D.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Bonini, G.; Ottolini, B. B.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Murialdo, G.; Marra, A.; Cattaneo, F.; Pontremoli, R.; Beccati, V.; Nobili, G.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Valeriani, E.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Pes, C.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Zucchelli, A.; Manzoni, F.; Volpini, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'Unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Tassone, B.; Sesti, G.; Interna, M.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Scarinzi, P.; Amabile, A.; Omenetto, E.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; Giorgi, A. D.; Tiseo, R.; De Giorgio, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Sabba, C.; Vella, F. S.; Suppressa, P.; Schilardi, A.; Loparco, F.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Fenoglio, L.; Falcetta, A.; Bracco, C.; Fracanzani, A. L.; Fargion, S.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Ferrari, B.; Colombo, G.; Agosti, P.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Peasso, P.; Favale, E.; Poletto, C.; Salmi, Rudy; Gaudenzi, P.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Galassi, M.; Grassi, Y.; Perticone, M.; Battaglia, R.; Filice, M.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Gabrielli, A.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Pignataro, S.; Gennaro, A.; Blanco, J.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G
abstract

N/A


2019 - Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope [Articolo su rivista]
Bo, M.; Ceccofiglio, A.; Mussi, C.; Bellelli, G.; Nicosia, F.; Riccio, D.; Martone, A. M.; Langellotto, A.; Tonon, E.; Tava, G.; Boccardi, V.; Abete, P.; Tibaldi, M.; Aurucci, M. L.; Fonte, G.; Falcone, Y.; Ungar, A.
abstract

Background: Long QT and use of QT-prolonging drugs are common among older patients receiving polytherapies, but real-world evidence on their impact in clinical practice is controversial. We investigated prevalence, variables associated and clinical implications of prolonged corrected QT (QTc) among patients from the Syncope and Dementia study. Methods: Observational, prospective, multicenter study. Patients≥65 years with dementia and fall suspected for syncope in the previous three months were enrolled. Several clinical variables and the complete list of medications were recorded for each patient. A 12‑lead ECG was obtained and corrected QT was calculated by the Bazett's formula. One-year followup for death and recurrent syncope was performed. Results: Prolonged QTc was observed in 25% of the 432 enrolled patients (mean age 83.3), and was significantly associated with male gender (OR 2.09; 95% CI 1.34–3.26) and diuretics use (OR 1.85; 95% CI 1.18–2.90). At one-year 23.3% of patients died and 30.4% reported at least one recurrent event. Variables associated with one-year mortality were: age, male gender, atrial fibrillation (AF), use of calcium channel blockers and prolonged QTc (OR 1.80; 95% CI 1.01–3.20). Among patients with prolonged QTc a significant interaction for mortality was found with AF. Recurrent events were associated with the use of antiplatelets, cholinesterase. inhibitors and antipsychotics, but not with prolonged QTc. Conclusions: We documented a high prevalence of prolonged QTc, that was associated with male gender and diuretics but not with psychoactive medications. Patients with prolonged QTc had higher one-year mortality, that was four-fold increased in those with concomitant AF.


2019 - The Management of Geriatric and Frail HIV Patients. A 2017 Update from the Italian Guidelines for the Use of Antiretroviral Agents and the Diagnostic Clinical Management of HIV-1 Infected Persons [Articolo su rivista]
Guaraldi, G; Marcotullio, S; Maserati, R; Gargiulo, M; Milic, J; Franconi, I; Chirianni, A; Andreoni, M; Galli, M; Lazzarin, A; D'Arminio Monforte, A; Di Perri, G; Perno, C-F; Puoti, M; Vella, S; Di Biagio, A; Maia, L; Mussi, C; Cesari, M; Antinori, A
abstract

This article deals with the attempt to join HIV and geriatric care management in the 2017 edition of the Italian guidelines for the use of antiretrovirals and the diagnostic-clinical management of HIV-1 infected persons.


2018 - Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation [Articolo su rivista]
Franchi, Carlotta; Antoniazzi, Stefania; Proietti, Marco; Nobili, Alessandro; Mannucci, Pier Mannuccio; Santalucia, Paola; Monzani, Valter; Marcucci, Maura; Antoniazzi, Stefania; Bosari, Silvano; Mannucci, Pier Mannuccio; Franchi, Carlotta; Brignolo, Barbara; Proietti, Marco; Nicolis, Enrico; Ardoino, Ilaria; Fenoglio, Luigi M.; Melchio, Remo; Fabris, Fabrizio; Sartori, Maria Teresa; Manfredini, Roberto; De Giorgi, Alfredo; Fabbian, Fabio; Biolo, Gianni; Zanetti, Michela; Altamura, Nicola; Sabbà, Carlo; Suppressa, Patrizia; Bandiera, Francesco; Usai, Carlo; Murialdo, Giovanni; Fezza, Francesca; Marra, Alessio; Castelli, Francesca; Cattaneo, Federico; Beccati, Valentina; di Minno, Giovanni; Tufano, Antonella; Contaldi, Paola; Lupattelli, Graziana; Bianconi, Vanessa; Cappellini, Domenica; Hu, Cinzia; Minonzio, Francesca; Fargion, Silvia; Burdick, Larry; Francione, Paolo; Peyvandi, Flora; Rossio, Raffaella; Colombo, Giulia; Ceriani, Giuliana; Lucchi, Tiziano; Manfellotto, Dario; Caridi, Irene; Corazza, Gino Roberto; Miceli, Emanuela; Padula, Donatella; Fraternale, Giacomo; Guasti, Luigina; Squizzato, Alessandro; Maresca, Andrea; Liberato, Nicola Lucio; Tognin, Tiziana; Rozzini, Renzo; Bellucci, Francesco Baffa; Muscaritoli, Maurizio; Molfino, Alessio; Petrillo, Enrico; Dore, Maurizio; Mete, Francesca; Gino, Miriam; Franceschi, Francesco; Gabrielli, Maurizio; Perticone, Francesco; Perticone, Maria; Bertolotti, Marco; Mussi, Chiara; Borghi, Claudio; Strocchi, Enrico; Durazzo, Marilena; Fornengo, Paolo; Dallegri, Franco; Ottonello, Luciano Carlo; Salam, Kassem; Caserza, Lara; Barbagallo, Mario; Di Bella, Giovanna; Annoni, Giorgio; Bruni, Adriana Antonella; Odetti, Patrizio; Nencioni, Alessio; Monacelli, Fiammetta; Napolitano, Armando; Brucato, Antonio; Valenti, Anna; Castellino, Pietro; Zanoli, Luca; Mazzeo, Marco
abstract

Aims: Although oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), they are often underused in this particularly high-risk population. The aim of the present study was to assess the appropriateness of OAC prescription and its associated factors in hospitalized patients aged 65 years or older. Methods: Data were obtained from the retrospective phase of Simulation-based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients With Atrial Fibrillation (SIM-AF) study, held in 32 Italian internal medicine and geriatric wards. The appropriateness of OAC prescription was assessed, grouping patients in those who were and were not prescribed OACs at hospital discharge. Multivariable logistic regression was used to establish factors independently associated with the appropriateness of OAC prescription. Results: A total of 328 patients were included in the retrospective phase of the study. Of these, almost 44% (N = 143) were inappropriately prescribed OACs, being mainly underprescribed or prescribed an inappropriate antithrombotic drug (N = 88). Among the patients prescribed OACs (N = 221), errors in the prescribed doses were the most frequent cause of inappropriate use (N = 55). Factors associated with a higher degree of patient frailty were inversely associated with the appropriateness of OAC prescription. Conclusions: In hospitalized older patients with AF, there is still a high prevalence of inappropriate OAC prescribing. Characteristics usually related to frailty are associated with the inappropriate prescribing. These findings point to the need for targeted interventions designed for internists and geriatricians, aimed at improving the appropriate prescribing of OACs in this complex and high-risk population.


2018 - Biomarkers of monitoring and functional reserve of physiological systems over time in HIV: Expert opinions for effective secondary prevention [Articolo su rivista]
Andreoni, M.; Mussi, C.; Bellagamba, R.; Di Campli, F.; Montinaro, V.; Babiloni, C.
abstract

HIV-positive individuals are more vulnerable to poor health than HIV-negative individuals. This vulnerability is characterized by a higher risk of several common, age-related health problems, even after adjustment for established risk factors. This expert opinion report aims at identifying the optimal biomarkers for monitoring the structural integrity and function of physiological systems at risk across aging in HIV-seropositive subjects. These biomarkers, readily available locally and relatively cost-effective for clinicians in primary and secondary care, should allow early detection of the first preclinical structural and functional changes in renal, brain, cardiovascular, and skeleton systems or apparatus in HIV subjects across aging. A particular interest of this report is the definition of the concept of biomarker of the "organ functional reserve". This definition emphasizes the fact that some biomarkers for monitoring the molecular, structural and functional integrity of a given organ reflect a level of impairment that is basically irremediable despite effective pharmacological or nonpharmacological intervention.


2018 - Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study [Articolo su rivista]
Paciullo, Francesco; Proietti, Marco; Bianconi, Vanessa; Nobili, Alessandro; Pirro, Matteo; Mannucci, Pier Mannuccio; Lip, Gregory Y. H.; Lupattelli, Graziana; Tettamanti, Mauro; Pasina, Luca; Franchi, Carlotta; Perticone, Francesco; Salerno, Francesco; Corrao, Salvatore; Marengoni, Alessandra; Licata, Giuseppe; Violi, Francesco; Corazza, Gino Roberto; Marcucci, Maura; Eldin, Tarek Kamal; Di Blanca, Maria Pia Donatella; Lanzo, Giovanna; Astuto, Sarah; Ardoino, Ilaria; Cortesi, Laura; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Guarnieri, Gianfranco; Zanetti, Michela; Fernandes, Giovanni; Chiuch, Massimiliano; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Pulixi, Edoardo Alessandro; Bernardi, Mauro; Bassi, Silvia Li; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Salvatore, Teresa; Sasso, Ferdinando Carlo; Girelli, Domenico; Olivieri, Oliviero; Matteazzi, Thomas; Barbagallo, Mario; Plances, Lidia; Alcamo, Roberta; Calvo, Luigi; Valenti, Maria; Zoli, Marco; Arnò, Raffaella; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Palasciano, Giuseppe; Modeo, Maria Ester; Peragine, Maria; Pappagallo, Fabrizio; Pugliese, Stefania; Di Gennaro, Carla; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Cappellini, MARIA DOMENICA; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Mancarella, Marta; Mari, Daniela; Rossi, Paolo Dionigi; Damanti, Sarah; Ottolini, Barbara Brignolo; Bonini, Giulia; Miceli, Emanuela; Lenti, Marco Vincenzo; Padula, Donatella; Murialdo, Giovanni; Marra, GIUSEPPE ALESSIO; Cattaneo, Federico; Secchi, Maria Beatrice; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria Maddalena; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Meroni, Maria Rachele; Perin, Paolo Cavallo; Lorenzati, Bartolomeo; Gruden, Gabriella; Bruno, Graziella; Amione, Cristina; Fornengo, Paolo; Tassara, Rodolfo; Melis, Deborah; Rebella, Lara; Delitala, Giuseppe; Pretti, Vincenzo; Masala, Maristella Salvatora; Pes, Chiara; Bolondi, Luigi; Rasciti, Leonardo; Serio, Ilaria; Fanelli, Filippo Rossi; Amoroso, Antonio; Molfino, Alessio; Petrillo, Enrico; Zuccalà, Giuseppe; Franceschi, Francesco; De Marco, Guido; Chiara, Cordischi; Marta, Sabbatini; D’Aurizio, Gabriella; Romanelli, Giuseppe; Amolini, Claudia; Chiesa, Deborah; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Gallo, Paolo; Annoni, Giorgio; Corsi, Maurizio; Zazzetta, Sara; Bellelli, Giuseppe; Szabo, Hajnalka; Arturi, Franco; Succurro, Elena; Rubino, Mariangela; Sesti, Giorgio; Loria, Paola; Becchi, Maria Angela; Martucci, Gianfranco; Fantuzzi, Alessandra; Maurantonio, Mauro; Serra, Maria Grazia; Bleve, Maria Antonietta; Gasbarrone, Laura; Sajeva, Maria Rosaria; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Agnelli, Giancarlo; Marchesini, Emanuela; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baritusso, Aldo; Amabile, Annalisa; Omenetto, Elisabetta; Scarinzi, Paolo; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Boari, Benedetta; De Giorgi, Alfredo; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Borghi, Claudio; Strocchi, Enrico; De Sando, Valeria; Pareo, Ilaria; Sabbà, Carlo; Vella, Francesco Saverio; Suppressa, Patrizia; Valerio, Raffaella; Agosti, Pasquale; Fontana, Flavia; Loparco, Francesca; Capobianco, Caterina; Fenoglio, Luigi; Bracco, Christian; Giraudo, Alessia Valentina; Testa, Elisa; Serraino, Cristina; Fargion, Silvia; Bonara, Paola; Periti, Giulia; Porzio, Marianna; Tiraboschi, Slivia; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Ferrari, Barbara; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Conca, Alessio; Gobbo, Giulia; Pallini, G
abstract

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the ‘Registro Politerapie SIMI’ study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26–0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34–0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.


2018 - Correction to: Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study (Internal and Emergency Medicine, (2018), 13, 5, (651-660), 10.1007/s11739-018-1835-9) [Articolo su rivista]
Raparelli, Valeria; Pastori, Daniele; Pignataro, Serena Francesca; Vestri, Anna Rita; Pignatelli, Pasquale; Cangemi, Roberto; Proietti, Marco; Davì, Giovanni; Hiatt, William Robert; Lip, Gregory Yoke Hong; Corazza, Gino Roberto; Perticone, Francesco; Violi, Francesco; Basili, Stefania; Alessandri, C.; Serviddio, G.; Palange, P.; Greco, E.; Bruno, G.; Averna, M.; Giammanco, A.; Sposito, P.; De Cristofaro, R.; Carulli, L.; Di Gennaro, L.; Pellegrini, E.; Cominacini, L.; Mozzini, C.; Pasini, A. F.; Sprovieri, M.; Spagnuolo, V.; Cerqua, G.; Cerasola, G.; Mulé, G.; Barbagallo, M.; Lo Sciuto, S.; Monteverde, A.; Saitta, A.; Lo Gullo, A.; Malatino, L.; Cilia, C.; Terranova, V.; Pisano, M.; Pinto, A.; Di Raimondo, D.; Tuttolomondo, A.; Conigliaro, R.; Signorelli, S.; De Palma, D.; Galderisi, M.; Cudemo, G.; Galletti, F.; Fazio, V.; De Luca, N.; Meccariello, A.; Caputo, D.; De Donato, M. T.; Iannuzi, A.; Bresciani, A.; Giunta, R.; Utili, R.; Iorio, V.; Adinolfi, L. E.; Sellitto, C.; Iuliano, N.; Bellis, P.; Tirelli, P.; Sacerdoti, D.; Vanni, D.; Iuliano, L.; Ciacciarelli, M.; Pacelli, A.; Palazzuoli, A.; Cacciafesta, M.; Gueli, N.; Lo Iacono, C.; Brusco, S.; Verrusio, W.; Nobili, L.; Tarquinio, N.; Pellegrini, F.; Vincentelli, G. M.; Ravallese, F.; Santini, C.; Letizia, C.; Petramala, L.; Zinnamosca, L.; Minisola, S.; Cilli, M.; Colangelo, L.; Falaschi, P.; Martocchia, A.; Pastore, F.; Bertazzoni, G.; Attalla El Halabieh, E.; Paradiso, Maria Bruna; Lizzi, E. M.; Timmi, S.; Battisti, P.; Cerci, S.; Ciavolella, M.; Di Veroli, C.; Malci, F.; De Ciocchis, A.; Abate, D.; Castellino, P.; Zanoli, L.; Fidone, F.; Mannarino, E.; Pasqualini, L.; Oliverio, G.; Pende, A.; Artom, N.; Ricchio, R.; Fimognari, F. L.; Alletto, M.; Messina, S.; Sesti, G.; Arturi, F.; Succurro, E.; Fiorentino, T. V.; Pedace, E.; Scarpino, P. E.; Carullo, G.; Maio, R.; Sciacqua, A.; Frugiuele, P.; Spagnuolo, V.; Battaglia, G.; Atzori, S.; Delitala, G.; Angelucci, E.; Sestili, S.; Traisci, G.; De Feudis, L.; Di Michele, D.; Fava, A.; Balsano, C.; De Ciantis, P.; Desideri, G.; Camerota, A.; Mezzetti, M.; Gresele, P.; Vedovati, C.; Fierro, T.; Puccetti, L.; Bertolotti, M.; Mussi, C.; Boddi, M.; Savino, A.; Contri, S.; Degl’Innocenti, G.; Saller, A.; Fabris, F.; Pesavento, R.; Filippi, L.; Vedovetto, V.; Puato, M.; Fabris, F.; Treleani, M.; De Luca, E.; De Zaiacomo, F.; Giantin, V.; Semplicini, A.; Minuz, P.; Romano, S.; Fantin, F.; Manica, A.; Stockner, I.; Pattis, P.; Gutmann, B.; Catena, Chiara; Colussi, G.; Sechi, L. A.; Annoni, G.; Bruni, A. A.; Castagna, A.; Spinelli, D.; Miceli, E.; Padula, D.; Schinco, G.; Spreafico, S.; Secchi, B.; Vanoli, M.; Casella, G.; Pulixi, E. A.; Sansone, L.; Serra, M. G.; Longo, S.; Antonaci, S.; Belfiore, A.; Frualdo, M.; Palasciano, G.; Ricci, L.; Ventrella, F.; Bianco, C.; Santovito, D.; Cipollone, F.; Nicolai, S.; Salvati, F.; Rini, G. B.; Scozzari, F.; Muiesan, M. L.; Salvetti, M.; Bazza, A.; Picardi, A.; Vespasiani-Gentilucci, U.; De Vincentis, Alessia; Cosio, P.; Terzolo, M.; Madaffari, B.; Parasporo, B.; Fenoglio, L.; Bracco, C.; Melchio, R.; Gentili, T.; Salvi, A.; Nitti, C.; Gabrielli, A.; Martino, G. P.; Capucci, A.; Brambatti, M.; Sparagna, A.; Tirotta, D.; Andreozzi, P.; Ettorre, E.; Viscogliosi, G.; Servello, A.; Musumeci, M.; Delfino, M.; Giorgi, A.; Glorioso, N.; Melis, G.; Marras, G.; Matta, M.; Sacco, A.; Stellitano, E.; Scordo, A.; Russo, F.; Caruso, A. A.; Porreca, E.; Tana, M.; Ferri, C.; Cheli, P.; Portincasa, P.; Muscianisi, G.; Giordani, S.; Stanghellini, V.; Sabbà, C.; Mancuso, G.; Bartone, M.; Calipari, D.; Arcidiacono, G.; Bellanuova, I.; Ferraro, M.; Marigliano, G.; Cozzolino, D.; Lampitella, A.; Acri, V.; Galasso, D.; Mazzei, F.; Buratti, A.; Galasso, S.; Porta, M.; Brizzi, M. F.; Fattorini, A.; Sampietro, F.; D’Angelo, A.; Manfredini, R.; Pala, M.; Fabbian, F.; Moroni, C.; Valente, L.; Lopreiato, F.
abstract

In the original publication, one of the ARAPACIS collaborators Dr. “Leonardo Di Gennaro” name has been erroneously mentioned as “Leonardo De Gennaro”.


2018 - Differential diagnosis of unexplained falls in dementia: Results of “Syncope & Dementia” registry [Articolo su rivista]
Mossello, E.; Ceccofiglio, A.; Rafanelli, M.; Riccardi, A.; Mussi, C.; Bellelli, G.; Nicosia, F.; Bo, M.; Riccio, D.; Martone, A. M.; Langellotto, A.; Tonon, E.; Noro, G.; Abete, P.; Ungar, A.
abstract

Background: Dementia patients have an increased risk of fall, and some of them might suffer from undiagnosed syncope. The present analysis aimed at identifying predictors of differential diagnosis between syncopal and non-syncopal fall in patients with dementia included in the “Syncope & Dementia” registry. Methods: We enrolled patients aged 65 + with a diagnosis of dementia and a history of syncope and/or unexplained fall. All subjects underwent a comprehensive geriatric assessment, including the syncope protocol of the European Society of Cardiology. Subjects whose syncope diagnosis was confirmed were labeled as “Confirmed Syncope” (CS). Patients with unexplained fall were labeled as “Syncopal Fall” (SF), if a final diagnosis of syncope was performed, or as “Non-Syncopal Fall” (NSF), if syncope was excluded. Results: We included 372 subjects (mean age 84, 61% females). Mini Mental State Examination score was higher among SF (18.5 ± 4.9) compared to NSF patients (15.6 ± 5.8, p = 0.02). In a multinomial logistic regression model with NSF as the reference group, CS patients less often suffered injuries and more often reported history of syncope, while patients with SF had a better cognitive status and were more often exposed to precipitating factors, including postural changes and neck movements. The absence of prodromes and the intake of benzodiazepines and insulin was highest in NSF patients. A simple score including main clinical predictors showed an 82% sensitivity with a 56% specificity in discriminating SF from NSF patients. Conclusion: Simple clinical markers can aid in the differential diagnosis of unexplained falls in dementia, separating syncopal from non-syncopal falls.


2018 - Hypotensive Drugs and Syncope Due to Orthostatic Hypotension in Older Adults with Dementia (Syncope and Dementia Study) [Articolo su rivista]
Testa, G.; Ceccofiglio, A.; Mussi, C.; Bellelli, G.; Nicosia, F.; Bo, M.; Riccio, D.; Curcio, F.; Martone, A. M.; Noro, G.; Landi, F.; Ungar, A.; Abete, P.
abstract

OBJECTIVES: To determine whether hypotensive drugs may play a pivotal role in inducing orthostatic hypotension (OH)-related syncope. DESIGN: Prospective, observational, multicenter study. SETTING: Acute care wards, syncope units, and centers for the diagnosis of dementia. PARTICIPANTS: Individuals aged 65 and older with a diagnosis of dementia and 1 or more episodes of transient loss of consciousness of a suspected syncopal nature or unexplained falls during the previous 3 months. MEASUREMENTS: Blood pressure was measured in the supine position and in the orthostatic position after 1 and 3 minutes. OH was defined as a decrease in systolic blood pressure of 20 mmHg or more and in diastolic blood pressure of 10 mmHg or more within 3 minutes of standing. Univariate and multivariate analyses were used to evaluate associations between hypotensive drugs and their combinations with OH-related syncope. RESULTS: The mean age of the study population (n=522; women, n=324) was 83.5±6.1, and the most frequent comorbidity was arterial hypertension (74.5%); 324 (67.8%) participants had had a syncopal fall and 168 (32.2%) a nonsyncopal fall. The mean number of hypotensive drugs administered (2.9±3.1) did not differ between the two groups. Syncopal falls was OH-related in 170 participants (48.0%). OH-related syncopal falls were more frequent in participants receiving nitrates (15.3% vs 9.8%, p=.06), alpha-blockers (16.5% vs 9.8%, p=.04), or combinations of angiotensin-converting enzyme inhibitors (ACE-Is) and diuretics (20.6% vs 13.0%, p=.04), alpha-blockers and diuretics (8.2% vs 3.3%, p=0.036), and ACE-Is and nitrates (8.2% vs 3.3%, p=.10). Multivariate analysis confirmed a greater risk of OH-related syncopal fall for nitrates (relative risk (RR)=1.77), combinations of ACE-Is and diuretics (RR=1.66), and combinations of ACE-Is and nitrates (RR=2.32). CONCLUSION: In older adults with dementia, OH-related syncopal falls are significantly related to treatment with nitrates, combinations of ACE-Is and diuretics, and combinations of ACE-Is and nitrates.


2018 - Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register [Articolo su rivista]
Cesari, M.; Franchi, C.; Cortesi, L.; Nobili, A.; Ardoino, I.; Mannucci, P. M.; Tettamanti, M.; Pasina, L.; Perticone, F.; Salerno, F.; Corrao, S.; Marengoni, A.; Licata, G.; Violi, F.; Corazza, G. R.; Eldin, T. K.; Di Blanca, M. P. D.; Lanzo, G.; Astuto, S.; Prisco, D.; Silvestri, E.; Cenci, C.; Emmi, G.; Biolo, G.; Guarnieri, G.; Zanetti, M.; Fernandes, G.; Chiuch, M.; Vanoli, M.; Grignani, G.; Casella, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Salvatore, T.; Sasso, F. C.; Girelli, D.; Olivieri, O.; Matteazzi, T.; Barbagallo, M.; Plances, L.; Alcamo, R.; Calvo, L.; Valenti, M.; Zoli, M.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Bicchi, M.; Palasciano, G.; Modeo, M. E.; Peragine, M.; Pappagallo, F.; Pugliese, S.; Gennaro, C. D.; Postiglione, A.; Barbella, M. R.; De Stefano, F.; Cappellini, M. D.; Fabio, G.; Seghezzi, S.; De Amicis, M. M.; Mancarella, M.; Mari, D.; Rossi, P. D.; Damanti, S.; Ottolini, B. B.; Bonini, G.; Miceli, E.; Lenti, M. V.; Padula, D.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Davi, G.; Guagnano, M. T.; Sestili, S.; Mancuso, G.; Calipari, D.; Bartone, M.; Meroni, M. R.; Perin, P. C.; Lorenzati, B.; Gruden, G.; Bruno, G.; Amione, C.; Fornengo, P.; Tassara, R.; Melis, D.; Rebella, L.; Delitala, G.; Pretti, V.; Masala, M. S.; Pes, C.; Bolondi, L.; Rasciti, L.; Serio, I.; Fanelli, F. R.; Amoroso, A.; Molfino, A.; Petrillo, E.; Zuccala, G.; Franceschi, F.; De Marco, G.; Chiara, C.; Marta, S.; D'aurizio, G.; Romanelli, G.; Amolini, C.; Chiesa, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Annoni, G.; Corsi, M.; Zazzetta, S.; Bellelli, G.; Szabo, H.; Arturi, F.; Succurro, E.; Rubino, M.; Sesti, G.; Loria, P.; Becchi, M. A.; Martucci, G.; Fantuzzi, A.; Maurantonio, M.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Di Corato, P.; Agnelli, G.; Marchesini, E.; Fabris, F.; Carlon, M.; Turatto, F.; Baritusso, A.; Amabile, A.; Omenetto, E.; Scarinzi, P.; Manfredini, R.; Molino, C.; Pala, M.; Fabbian, F.; Boari, B.; De Giorgi, A.; Paolisso, G.; Rizzo, M. R.; Laieta, M. T.; Rini, G.; Mansueto, P.; Pepe, I.; Borghi, C.; Strocchi, E.; De Sando, V.; Pareo, I.; Sabba, C.; Vella, F. S.; Suppressa, P.; Valerio, R.; Agosti, P.; Fontana, F.; Loparco, F.; Capobianco, C.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Testa, E.; Serraino, C.; Fargion, S.; Bonara, P.; Periti, G.; Porzio, M.; Tiraboschi, S.; Peyvandi, F.; Tedeschi, A.; Rossio, R.; Monzani, V.; Savojardo, V.; Folli, C.; Magnini, M.; Conca, A.; Gobbo, G.; Pallini, G.; Valenti, M.; Balduini, C. L.; Bertolino, G.; Provini, S.; Quaglia, F.; Dallegri, F.; Ottonello, L.; Liberale, L.; Chin, W. S.; Carassale, L.; Caporotundo, S.; Traisci, G.; De Feudis, L.; Di Carlo, S.; Liberato, N. L.; Buratti, A.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Montrucchio, G.; Greco, E.; Tizzani, P.; Petitti, P.; Perciccante, A.; Coralli, A.; Salmi, R.; Gaudenzi, P.; Gamberini, S.; Semplicini, A.; Gottardo, L.; Vendemiale, G.; Serviddio, G.; Forlano, R.; Masala, C.; Mammarella, A.; Raparelli, V.; Basili, S.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Vallone, C.; Bellusci, M.; Setti, D.; Pedrazzoli, F.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Molaro, M.; Bertolotti, M.; Mussi, C.; Libbra, M. V.; Miceli, A.; Pellegrini, E.; Carulli, L.; Veltri, F.; Sciacqua, A.; Quero, M.; Bagnato, C.; Colangelo, L.; Falbo, T.; De Giorgio, R.; Serra, M.; Grasso, V.; Ruggeri, E.; Ilaria, B.; Salvi, A.; Leonardi, R.; Grassini, C.; Mascherona, I.; Minelli, G.; Maltese, F.; Damiani, G.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Ormas, M.; Pettinari, P.; Romiti, R.; Messina, S.; Cavallaro, F.; Ghio, R.; Favorini, S.; Col, A. D.; Minisola, S.; Colange
abstract

Background: Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related accumulation of deficit model) in a large cohort of hospitalized older persons, in order to benefit from its capacity to comprehensively weight the risk profile of the individual. Methods: Patients aged 65 and older enrolled in the REPOSI register from 2010 to 2016 were considered in the present analyses. Variables recorded at the hospital admission (including socio-demographic, physical, cognitive, functional and clinical factors) were used to compute the FI. The prognostic impact of the FI on in-hospital and 12-month mortality was assessed. Results: Among the 4488 patients of the REPOSI register, 3847 were considered eligible for a 34-item FI computation. The median FI in the sample was 0.27 (interquartile range 0.21–0.37). The FI was significantly predictive of both in-hospital (OR 1.61, 95%CI 1.38–1.87) and overall (HR 1.46, 95%CI 1.32–1.62) mortality, also after adjustment for age and sex. Conclusions: The FI confirms its strong predictive value for negative outcomes. Its implementation in cohort studies (including those conducted in the hospital setting) may provide useful information for better weighting the complexity of the older person and accordingly design personalized interventions.


2018 - Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients [Articolo su rivista]
Agosti, P.; Tettamanti, M.; Vella, F. S.; Suppressa, P.; Pasina, L.; Franchi, C.; Nobili, A.; Mannucci, P. M.; Sabba, C.; Corrao, S.; Marengoni, A.; Marcucci, M.; Salerno, F.; Perticone, F.; Licata, G.; Violi, F.; Corazza, G. R.; Cortesi, L.; Ardoino, I.; Prisco, D.; Silvestri, E.; Cenci, C.; Emmi, G.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Olivieri, O.; Girelli, D.; Matteazzi, T.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Zoli, M.; Lazzari, I.; Brunori, M.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Angelucci, E.; Valeriani, E.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Zuccala, G.; D'aurizio, G.; Romanelli, G.; Zucchelli, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; De Sando, V.; Pareo, I.; Schilardi, A.; Loparco, F.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Fargion, S.; Periti, G.; Porzio, M.; Tiraboschi, S.; Peyvandi, F.; Rossio, R.; Ferrari, B.; Colombo, G.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Salmi, R.; Gaudenzi, P.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Molaro, M.; Grossi, A.; Bertolotti, M.; Mussi, C.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Colangelo, L.; Falbo, T.; Stanghellini, V.; De Giorgio, R.; Ruggeri, E.; Del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Gabrielli, A.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Dal Col, A.; Minisola, S.; Colangelo, L.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Blanco, J.; Zanoli, L.; Pignataro, S.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Scattolin, G.; Martinelli, S.; Turrin, M.; Sechi, L.; Catena, C.; Colussi, G.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Patrizia, T.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Del Giacco, S.; Firinu, D.; Losa, F.; Paoletti, G.; Montalto, G.; Licata, A.; Malerba, V.; Antonino, L.; Basile, G.; Catalano, A.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Mecocci, P.; Ruggiero, C.; Boccardi, V.; Meschi, T.; Lauretani, F.; Ticinesi, A.; Minuz, P.; Fondrieschi, L.; Pirisi, M.; Fra, G. P.; Sola, D.; Porta, M.; Riva, P.; Quadri, R.; Scanzi, G.; Mengoli, C.; Provini, S.; Ric
abstract


2018 - Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study [Articolo su rivista]
Raparelli, Valeria; Pastori, Daniele; Pignataro, Serena Francesca; Vestri, Anna Rita; Pignatelli, Pasquale; Cangemi, Roberto; Proietti, Marco; Davì, Giovanni; Hiatt, William Robert; Lip, Gregory Yoke Hong; Corazza, Gino Roberto; Perticone, Francesco; Violi, Francesco; Basili, Stefania; Alessandri, C.; Serviddio, G.; Palange, P.; Greco, E.; Bruno, G.; Averna, M.; Giammanco, A.; Sposito, P.; De Cristofaro, R.; Carulli, L.; De Gennaro, L.; Pellegrini, E.; Cominacini, L.; Mozzini, C.; Pasini, A. F.; Sprovieri, M.; Spagnuolo, V.; Cerqua, G.; Cerasola, G.; Mulé, G.; Barbagallo, M.; Lo Sciuto, S.; Monteverde, A.; Saitta, A.; Lo Gullo, A.; Malatino, L.; Cilia, C.; Terranova, V.; Pisano, M.; Pinto, A.; Di Raimondo, D.; Tuttolomondo, A.; Conigliaro, R.; Signorelli, S.; De Palma, D.; Galderisi, M.; Cudemo, G.; Galletti, F.; Fazio, V.; De Luca, N.; Meccariello, A.; Caputo, D.; De Donato, M. T.; Iannuzi, A.; Bresciani, A.; Giunta, R.; Utili, R.; Iorio, V.; Adinolfi, L. E.; Sellitto, C.; Iuliano, N.; Bellis, P.; Tirelli, P.; Sacerdoti, D.; Vanni, D.; Iuliano, L.; Ciacciarelli, M.; Pacelli, A.; Palazzuoli, A.; Cacciafesta, M.; Gueli, N.; Lo Iacono, C.; Brusco, S.; Verrusio, W.; Nobili, L.; Tarquinio, N.; Pellegrini, F.; Vincentelli, G. M.; Ravallese, F.; Santini, C.; Letizia, C.; Petramala, L.; Zinnamosca, L.; Minisola, S.; Cilli, M.; Colangelo, L.; Falaschi, P.; Martocchia, A.; Pastore, F.; Bertazzoni, G.; Attalla El Halabieh, E.; Paradiso, M.; Lizzi, E. M.; Timmi, S.; Battisti, P.; Cerci, S.; Ciavolella, M.; Di Veroli, C.; Malci, F.; De Ciocchis, A.; Abate, D.; Castellino, P.; Zanoli, L.; Fidone, F.; Mannarino, E.; Pasqualini, L.; Oliverio, G.; Pende, A.; Artom, N.; Ricchio, R.; Fimognari, F. L.; Alletto, M.; Messina, S.; Sesti, G.; Arturi, F.; Succurro, E.; Fiorentino, T. V.; Pedace, E.; Scarpino, P. E.; Carullo, G.; Maio, R.; Sciacqua, A.; Frugiuele, P.; Spagnuolo, V.; Battaglia, G.; Atzori, S.; Delitala, G.; Angelucci, E.; Sestili, S.; Traisci, G.; De Feudis, L.; Di Michele, D.; Fava, A.; Balsano, C.; De Ciantis, P.; Desideri, G.; Camerota, A.; Mezzetti, M.; Gresele, P.; Vedovati, C.; Fierro, T.; Puccetti, L.; Bertolotti, M.; Mussi, C.; Boddi, M.; Savino, A.; Contri, S.; Degl’Innocenti, G.; Saller, A.; Fabris, F.; Pesavento, R.; Filippi, L.; Vedovetto, V.; Puato, M.; Fabris, F.; Treleani, M.; De Luca, E.; De Zaiacomo, F.; Giantin, V.; Semplicini, A.; Minuz, P.; Romano, S.; Fantin, F.; Manica, A.; Stockner, I.; Pattis, P.; Gutmann, B.; Catena, C.; Colussi, G.; Sechi, L. A.; Annoni, G.; Bruni, A. A.; Castagna, A.; Spinelli, D.; Miceli, E.; Padula, D.; Schinco, G.; Spreafico, S.; Secchi, B.; Vanoli, M.; Casella, G.; Pulixi, E. A.; Sansone, L.; Serra, M. G.; Longo, S.; Antonaci, S.; Belfiore, A.; Frualdo, M.; Palasciano, G.; Ricci, L.; Ventrella, F.; Bianco, C.; Santovito, D.; Cipollone, F.; Nicolai, S.; Salvati, F.; Rini, G. B.; Scozzari, F.; Muiesan, M. L.; Salvetti, M.; Bazza, A.; Picardi, A.; Vespasiani-Gentilucci, U.; De Vincentis, A.; Cosio, P.; Terzolo, M.; Madaffari, B.; Parasporo, B.; Fenoglio, L.; Bracco, C.; Melchio, R.; Gentili, T.; Salvi, A.; Nitti, C.; Gabrielli, A.; Martino, G. P.; Capucci, A.; Brambatti, M.; Sparagna, A.; Tirotta, D.; Andreozzi, P.; Ettorre, E.; Viscogliosi, G.; Servello, A.; Musumeci, M.; Delfino, M.; Giorgi, A.; Glorioso, N.; Melis, G.; Marras, G.; Matta, M.; Sacco, A.; Stellitano, E.; Scordo, A.; Russo, F.; Caruso, A. A.; Porreca, E.; Tana, M.; Ferri, C.; Cheli, P.; Portincasa, P.; Muscianisi, G.; Giordani, S.; Stanghellini, V.; Sabbà, C.; Mancuso, G.; Bartone, M.; Calipari, D.; Arcidiacono, G.; Bellanuova, I.; Ferraro, M.; Marigliano, G.; Cozzolino, D.; Lampitella, A.; Acri, V.; Galasso, D.; Mazzei, F.; Buratti, A.; Galasso, S.; Porta, M.; Brizzi, M. F.; Fattorini, A.; Sampietro, F.; D’Angelo, A.; Manfredini, R.; Pala, M.; Fabbian, F.; Moroni, C.; Valente, L.; Lopreiato, F.; Parente, F.
abstract

Chronic obstructive pulmonary disease (COPD) increases the risk of mortality in non-valvular atrial fibrillation (NVAF) patients. Data on the relationship of COPD to major cardiovascular events (MACE) in AF have not been defined. The aim of the study is to assess the predictive value of COPD on incident MACE in NVAF patients over a 3-year follow-up. In the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study (ARAPACIS) cohort, we evaluate the impact of COPD on the following clinical endpoints: MACE (including vascular death, fatal/non-fatal MI and stroke/TIA), cardiovascular (CV) death and all-cause mortality. Among 2027 NVAF patients, patients with COPD (9%) are more commonly male, elderly and at higher thromboembolic risk. During a median 36.0 months follow-up, 186 patients experienced MACE: vascular death (n = 72), MI (n = 57), stroke/TIA (n = 57). All major outcomes (including stroke/TIA, MI, vascular death, and all-cause death) are centrally adjudicated. Kaplan–Meier curves show that NVAF patients with COPD are at higher risk for MACE (p < 0.001), CV death (p < 0.001) and all-cause death (p < 0.001). On Cox proportional hazard analysis, COPD is an independent predictor of MACE (Hazard ratio [HR] 1.77, 95% Confidence Intervals [CI] 1.20–2.61; p = 0.004), CV death (HR 2.73, 95% CI 1.76–4.23; p < 0.0001) and all-cause death (HR 2.16, 95% CI 1.48–3.16; p < 0.0001). COPD is an independent predictor of MACE, CV death and all-cause death during a long-term follow-up of NVAF patients.


2018 - Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register [Articolo su rivista]
Mannucci, Pier Mannuccio; Nobili, Alessandro; Pasina, Luca; Mannucci, Pier Mannuccio; Tettamanti, Mauro; Franchi, Carlotta; Corrao, Salvatore; Marengoni, Alessandra; Salerno, Francesco; Cesari, Matteo; Perticone, Francesco; Licata, Giuseppe; Violi, Francesco; Corazza, Gino Roberto; Franchi, Carlotta; Cortesi, Laura; Tettamanti, Mauro; Cortesi, Laura; Ardoino, Ilaria; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Zanetti, Michela; Guadagni, Martina; Zaccari, Michele; Vanoli, Massimo; Grignani, Giulia; Pulixi, Edoardo Alessandro; Bernardi, Mauro; Bassi, Silvia Li; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Lupattelli, Graziana; Bianconi, Vanessa; Paciullo, Francesco; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Olivieri, Oliviero; Girelli, Domenico; Matteazzi, Thomas; Barbagallo, Mario; Dominguez, Ligia; Cocita, Floriana; Beneduce, Vincenza; Plances, Lidia; Zoli, Marco; Lazzari, Ilaria; Brunori, Mattia; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Palasciano, Giuseppe; Modeo, Maria Ester; Di Gennaro, Carla; Cappellini, Maria Domenica; Maira, Diletta; Di Stefano, Valeria; Fabio, Giovanna; Seghezzi, Sonia; Mancarella, Marta; Cesari, Matteo; Rossi, Paolo Dionigi; Damanti, Sarah; Clerici, Marta; Conti, Federica; Corazza, Gino Roberto; Miceli, Emanuela; Lenti, Marco Vincenzo; Pisati, Martina; Dominioni, Costanza Caccia; Murialdo, Giovanni; Marra, Alessio; Cattaneo, Federico; Secchi, Maria Beatrice; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Cipollone, Francesco; Guagnano, Maria Teresa; Angelucci, Ermanno; Valeriani, Emanuele; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Delitala, Giuseppe; Berria, Maria; Muscaritoli, Maurizio; Molfino, Alessio; Petrillo, Enrico; Zuccalà, Giuseppe; D’Aurizio, Gabriella; Romanelli, Giuseppe; Marengoni, Alessandra; Zucchelli, Alberto; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Gallo, Paolo; Dell’Unto, Chiara; Annoni, Giorgio; Corsi, Maurizio; Bellelli, Giuseppe; Zazzetta, Sara; Mazzola, Paolo; Szabo, Hajnalka; Bonfanti, Alessandra; Arturi, Franco; Succurro, Elena; Rubino, Mariangela; Serra, Maria Grazia; Bleve, Maria Antonietta; Gasbarrone, Laura; Sajeva, Maria Rosaria; Brucato, Antonio; Ghidoni, Silvia; Fabris, Fabrizio; Bertozzi, Irene; Bogoni, Giulia; Rabuini, Maria Victoria; Cosi, Elisabetta; Manfredini, Roberto; Fabbian, Fabio; Boari, Benedetta; De Giorgi, Alfredo; Tiseo, Ruana; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Borghi, Claudio; Strocchi, Enrico; De Sando, Valeria; Pareo, Ilenia; Sabbà, Carlo; Vella, Francesco Saverio; Suppressa, Patrizia; Agosti, Pasquale; Schilardi, Andrea; Loparco, Francesca; Fenoglio, Luigi; Bracco, Christian; Giraudo, Alessia Valentina; Fargion, Silvia; Periti, Giulia; Porzio, Marianna; Tiraboschi, Slivia; Peyvandi, Flora; Rossio, Raffaella; Ferrari, Barbara; Colombo, Giulia; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Ceriani, Giuliana; Salerno, Francesco; Pallini, Giada; Dallegri, Franco; Ottonello, Luciano; Liberale, Luca; Caserza, Lara; Salam, Kassem; Liberato, Nicola Lucio; Tognin, Tiziana; Bianchi, Giovanni Battista; Giaquinto, Sabrina; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Rozzini, Renzo; Falanga, Lina; Spazzini, Elena; Ferrandina, Camillo; Montrucchio, Giuseppe; Petitti, Paolo; Salmi, Raffaella; Gaudenzi, Piergiorgio; Violi, Francesco; Perri, Ludovica; Landolfi, Raffaele; Montalto, Massimo; Mirijello, Antonio; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Molaro, Marta; Grossi, Alessandra; Bertolotti, Marco; Mussi, Chiara; Libbra, Maria Vittoria; Dondi, Giulia; Pellegrini, Elisa; Carulli, Lucia; Perticone, Francesco; Colangelo, Lidia; Falbo, Tania; Stanghellini, Vincenzo; De Giorgio, Roberto; Ruggeri, Eugenio; del Vecchio, Sara; Salvi, Andrea; Leonardi, Roberto; Damiani, Giampaolo; Gabrielli, Armando; Capeci, William; Mattioli,
abstract

As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug–drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.


2018 - The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years [Articolo su rivista]
Guaraldi, G; Malagoli, A; Calcagno, A; Mussi, C; Celesia, B M; Carli, F; Piconi, S; De Socio, G V; Cattelan, A M; Orofino, G; Riva, A; Focà, E; Nozza, S; Di Perri, G
abstract

Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort.


2018 - Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards [Articolo su rivista]
Proietti, Marco; Antoniazzi, Stefania; Monzani, Valter; Santalucia, Paola; Franchi, Carlotta; Fenoglio, Luigi M.; Melchio, Remo; Fabris, Fabrizio; Sartori, Maria Teresa; Manfredini, Roberto; De Giorgi, Alfredo; Fabbian, Fabio; Biolo, Gianni; Zanetti, Michela; Altamura, Nicola; Sabbà, Carlo; Suppressa, Patrizia; Bandiera, Francesco; Usai, Carlo; Murialdo, Giovanni; Fezza, Francesca; Marra, Alessio; Castelli, Francesca; Cattaneo, Federico; Beccati, Valentina; di Minno, Giovanni; Tufano, Antonella; Contaldi, Paola; Lupattelli, Graziana; Bianconi, Vanessa; Cappellini, Domenica; Hu, Cinzia; Minonzio, Francesca; Fargion, Silvia; Burdick, Larry; Francione, Paolo; Peyvandi, Flora; Rossio, Raffaella; Colombo, Giulia; Monzani, Valter; Ceriani, Giuliana; Lucchi, Tiziano; Brignolo, Barbara; Manfellotto, Dario; Caridi, Irene; Corazza, Gino Roberto; Miceli, Emanuela; Padula, Donatella; Fraternale, Giacomo; Guasti, Luigina; Squizzato, Alessandro; Maresca, Andrea; Liberato, Nicola Lucio; Tognin, Tiziana; Rozzini, Renzo; Bellucci, Francesco Baffa; Muscaritoli, Maurizio; Molfino, Alessio; Petrillo, Enrico; Dore, Maurizio; Mete, Francesca; Gino, Miriam; Franceschi, Francesco; Gabrielli, Maurizio; Perticone, Francesco; Perticone, Maria; Bertolotti, Marco; Mussi, Chiara; Borghi, Claudio; Strocchi, Enrico; Durazzo, Marilena; Fornengo, Paolo; Dallegri, Franco; Ottonello, Luciano Carlo; Salam, Kassem; Caserza, Lara; Barbagallo, Mario; Di Bella, Giovanna; Annoni, Giorgio; Bruni, Adriana Antonella; Odetti, Patrizio; Nencioni, Alessio; Monacelli, Fiammetta; Napolitano, Armando; Brucato, Antonio; Valenti, Anna Chiara; Castellino, Pietro; Zanoli, Luca; Mazzeo, Marco
abstract

Atrial fibrillation is independently associated with a higher risk of morbidity and mortality, in particular with an increased risk of thromboembolic events. Use of oral anticoagulant (OAC) drugs reduces the risk of stroke and systemic embolism, as well as mortality among patients with AF. With the aim to provide evidences about use of OAC and NOACs in older hospitalized patients, we here report data about the retrospective observational phase of the “ Simulation-Based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation” (SIM-AF) Trial


2017 - Carotid plaque detection improves the predictve value of CHA2DS2-VASc score in patients with non-valvular atrial fibrilation: The ARAPACIS Study [Articolo su rivista]
Basili, S.; Loffredo, L.; Pastori, D.; Proieti, M.; Farcomeni, A.; Vesti, A. R.; Pignatelli, P.; Davi, G.; Hiatt, W. R.; Lip, G. Y. H.; Corazza, G. R.; Perticone, F.; Violi, F.; Alessandri, C.; Serviddio, G.; Fascetti, S.; Palange, P.; Greco, E.; Bruno, G.; Averna, M.; Giammanco, A.; Sposito, P.; De Cristofaro, R.; De Gennaro, L.; Carulli, L.; Pellegrini, E.; Cominacini, L.; Mozzini, C.; Pasini, A. F.; Sprovieri, M.; Spagnuolo, V.; Cerqua, G.; Cerasola, G.; Mule, G.; Barbagallo, M.; Lo Sciuto, S.; Monteverde, A.; Saitta, A.; Lo Gullo, A.; Malatino, L.; Ciia, C.; Terranova, V.; Pisano, M.; Pinto, A.; Di Raimondo, D.; Tuttolomondo, A.; Conigliaro, R.; Signorelli, S.; De Palma, D.; Galderisi, M.; Cudemo, G.; Galletti, F.; Fazio, V.; De Luca, N.; Meccariello, A.; Caputo, D.; De Donato, M. T.; Iannuzi, A.; Bresciani, A.; Giunta, R.; Utili, R.; Iorio, V.; Adinolfi, L. E.; Sellitto, C.; Iuliano, N.; Bellis, P.; Tirelli, P.; Sacerdoti, D.; Vanni, D.; Iuliano, L.; Ciacciarelli, M.; Pacelli, A.; Palazzuoli, A.; Cacciafesta, M.; Gueli, N.; Lo Iacono, G.; Brusco, S.; Verrusio, W.; Nobili, L.; Tarquinio, N.; Pellegrini, F.; Vincentelli, G. M.; Ravallese, F.; Santini, C.; Letizia, C.; Petramala, L.; Zinnamosca, L.; Minisola, S.; Cilli, M.; Savoriti, C.; Colangelo, L.; Falaschi, P.; Martocchia, A.; Pastore, F.; Bertazzoni, G.; Attalla El Halabieh, E.; Paradiso, M.; Lizzi, E. M.; Timmi, S.; Battisti, P.; Cerci, S.; Ciavolella, M.; Di Veroli, C.; Malei, F.; De Ciocchis, A.; Abate, D.; Castellino, P.; Zanoli, L.; Fidone, F.; Mannarino, E. T.; Pasqualini, L.; Oliverio, G.; Pende, A.; Aitom, N.; Ricchio, R.; Fimognari, F. L.; Alletto, M.; Messina, S.; Sesti, G.; Arturi, F.; Fiorentino, T. V.; Pedace, E.; Scarpino, P. E.; Carullo, G.; Maio, R.; Sciacqua, A.; Frugiuele, P.; Spagnuolo, V.; Battaglia, G.; Atzori, S.; Delitala, G.; Angelucci, E.; Sestili, S.; Traisci, G.; De Feudis, L.; Di Michele, D.; Fava, A.; Balsano, C.; De Ciantis, P.; Desideri, G.; Camerota, A.; Mezzetti, M.; Gresele, P.; Vedovati, C.; Fierro, T.; Puccetti, L.; Bertolotti, M.; Mussi, C.; Boddi, M.; Savino, A.; Contri, S.; Degl'Innocenti, G.; Sailer, A.; Fabris, F.; Pesavento, R.; Filippi, L.; Vedovetto, V.; Puato, M.; Fabris, F.; Treleani, M.; De Luca, E.; De Zaiacomo, F.; Giantin, V.; Semplicini, A.; Minuz, P.; Romano, S.; Fantin, F.; Manica, A.; Stockner, I.; Pattis, P.; Gutmann, B.; Catena, C.; Colussi, G.; Sechi, L. A.; Annoni, G.; Bruni, A. A.; Castagna, A.; Spinelli, D.; Miceli, E.; Paduia, D.; Schinco, G.; Spreafico, S.; Secchi, B.; Vanoli, M.; Casella, G.; Pulixi, E. A.; Sansone, L.; Serra, M. G.; Longo, S.; Antonaci, S.; Belfiaore, A.; Frualdo, M.; Palasciano, G.; Ricci, L.; Ventrella, F.; Bianco, C.; Santovito, D.; Cipollone, F.; Nicolai, S.; Salvati, F.; Rini, G. B.; Scozzari, F.; Muiesan, M. L.; Salvetti, M.; Bazza, A.; Picardi, A.; Vespasiani-Gentilucci, U.; De Vincentis, A.; Cosio, P.; Terzolo, M.; Madaffari, B.; Parasporo, B.; Fenoglio, L.; Bracco, C.; Melchio, R.; Gentili, T.; Salvi, A.; Nitti, C.; Gabrielli, A.; Martino, G. P.; Capucci, A.; Brambatti, M.; Sparagna, A.; Tirotta, D.; Andreozzi, P.; Ettorre, E.; Viscogliosi, G.; Servello, A.; Musumeci, M.; Rossi Fanelli, F.; Delfino, M.; Giorgi, A.; Glorioso, N.; Melis, G.; Marras, G.; Matta, M.; Sacco, A.; Stellitano, E.; Scordo, A.; Russo, F.; Caruso, A. A.; Porreca, E.; Tana, M.; Ferri, C.; Cheli, P.; Portincasa, P.; Muscianisi, G.; Giordani, S.; Stanghellini, V.; Sabba, C.; Mancuso, G.; Bartone, M.; Calipari, D.; Arcidiacono, G.; Bellanuova, I.; Ferraro, M.; Marigliano, G.; Cozzolino, D.; Lampitella, A.; Acri, V.; Galasso, D.; Mazzei, F.; Galasso, S.; Buratti, A.; Porta, M.; Brizzi, M. F.; Fattorini, A.; Sampietro, F.; D'Angelo, A.; Manfredini, R.; Pala, M.; Fabbian, F.; Moroni, C.; Valente, L.; Lopreiato, F.; Parente, F.; Granata, M.; Moia, M.; Braham, S.; Rossi, M.; Pesce, M.; Gentile, A.; Catozzo, V.; Baciarello, G.; Cosimati, A.; Ageno, W.; Rancan, E.; Guasti, L.; Ciccaglioni, A.; Negri, S.; Polselli, M.; P
abstract

Background and aims: Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA2DS2-VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA2DS2-VASC score. Methods: We analysed data from the ARAPACIS study, an observational study including 2027 Ialian patents with non-valvular AF, in whom CP was detected using Doppler Ultrasonography. Results: VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patents. Adding CP to the VD definition leaded to higher VD prevalence (30.9%). During a median [IQR] follow-up time of 36 months, 56 (2.8%) stroke/TIA events were recorded. Survival analysis showed that conventional VD alone did not increase the risk of stroke (Log-Rank: 0.009, p = 0.924), while addition of CP to conventional VD was significantly associated to an increased risk of stroke (LR: 5.730, p = 0.017). Cox regression analysis showed that VD + CP was independently associated with stroke (HR: 1.78, 95% CI: 1.05-3.01, p = 0.0318). Reclassification analysis showed that VD + CP allowed a significant risk reclassification when compared to VD alone in predicting stroke at 36 months (NRI: 0.192, 95% CI: 0.028-0.323, p = 0.032). Conclusions: In non-valvular AF patients the addition of ultrasound detection of carotid plaque to conventional VD significantly increases the pedictive value of CHA2DS2-VASc score for stroke.


2017 - Case of an old man with aortic dissection type A and enlarging meningioma [Articolo su rivista]
Lancellotti, Giulia; Rontauroli, Caterina; Turrini, Elisabete; Bertolotti, Marco; Mussi, Chiara
abstract

In this paper we describe a clinical case of an old man with a large meningioma and a concomitant diagnosis of atypa A aortic dissection.


2017 - Defining aging phenotypes and related outcomes: Clues to recognize frailty in hospitalized older patients [Articolo su rivista]
Marcucci, M.; Franchi, C.; Nobili, A.; Mannucci, P. M.; Ardoino, I.; Tettamanti, M.; Pasina, L.; Perticone, F.; Salerno, F.; Corrao, S.; Marengoni, A.; Licata, G.; Violi, F.; Corazza, G. R.; Eldin, T. K.; Di Blanca, M. P. D.; Djade, C. D.; Cortesi, L.; Prisco, D.; Silvestri, E.; Cenci, C.; Emmi, G.; Biolo, G.; Guarnieri, G.; Zanetti, M.; Fernandes, G.; Vanoli, M.; Grignani, G.; Casella, G.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Salvatore, T.; Sasso, F. C.; Girelli, D.; Olivieri, O.; Matteazzi, T.; Barbagallo, M.; Plances, L.; Alcamo, R.; Calvo, L.; Valenti, M.; Zoli, M.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Bicchi, M.; Palasciano, G.; Modeo, M. E.; Peragine, M.; Pappagallo, F.; Pugliese, S.; Di Gennaro, C.; Postiglione, A.; Barbella, M. R.; De Stefano, F.; Cappellini, M. D.; Fabio, G.; Seghezzi, S.; De Amicis, M. M.; Mari, D.; Rossi, P. D.; Damanti, S.; Ottolini, B. B.; Miceli, E.; Lenti, M. V.; Padula, D.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Davi, G.; Guagnano, M. T.; Sestili, S.; Mancuso, G.; Calipari, D.; Bartone, M.; Meroni, M. R.; Perin, P. C.; Lorenzati, B.; Gruden, G.; Bruno, G.; Amione, C.; Fornengo, P.; Tassara, R.; Melis, D.; Rebella, L.; Delitala, G.; Pretti, V.; Masala, M. S.; Bolondi, L.; Rasciti, L.; Serio, I.; Fanelli, F. R.; Amoroso, A.; Molfino, A.; Petrillo, E.; Zuccala, G.; Franceschi, F.; De Marco, G.; Chiara, C.; Marta, S.; Romanelli, G.; Amolini, C.; Chiesa, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Annoni, G.; Corsi, M.; Zazzetta, S.; Bellelli, G.; Arturi, F.; Succurro, E.; Rubino, M.; Sesti, G.; Loria, P.; Becchi, M. A.; Martucci, G.; Fantuzzi, A.; Maurantonio, M.; Carta, S.; Atzori, S.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Di Corato, P.; Agnelli, G.; Marchesini, E.; Fabris, F.; Carlon, M.; Turatto, F.; Baritusso, A.; Manfredini, R.; Molino, C.; Pala, M.; Fabbian, F.; Boari, B.; De Giorgi, A.; Paolisso, G.; Rizzo, M. R.; Laieta, M. T.; Rini, G.; Mansueto, P.; Pepe, I.; Borghi, C.; Strocchi, E.; De Sando, V.; Sabba, C.; Vella, F. S.; Suppressa, P.; Valerio, R.; Capobianco, C.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Testa, E.; Serraino, C.; Fargion, S.; Bonara, P.; Periti, G.; Porzio, M.; Peyvandi, F.; Tedeschi, A.; Rossio, R.; Monzani, V.; Savojardo, V.; Folli, C.; Magnini, M.; Conca, A.; Gobbo, G.; Balduini, C. L.; Bertolino, G.; Provini, S.; Quaglia, F.; Dallegri, F.; Ottonello, L.; Liberale, L.; Chin, W. S.; Carassale, L.; Caporotundo, S.; Traisci, G.; De Feudis, L.; Di Carlo, S.; Liberato, N. L.; Buratti, A.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Montrucchio, G.; Greco, E.; Tizzani, P.; Petitti, P.; Perciccante, A.; Coralli, A.; Salmi, R.; Gaudenzi, P.; Gamberini, S.; Semplicini, A.; Gottardo, L.; Vendemiale, G.; Serviddio, G.; Forlano, R.; Masala, C.; Mammarella, A.; Raparelli, V.; Basili, S.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Vallone, C.; Bellusci, M.; Setti, D.; Pedrazzoli, F.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Molaro, M.; Bertolotti, M.; Mussi, C.; Libbra, M. V.; Miceli, A.; Pellegrini, E.; Carulli, L.; Sciacqua, A.; Quero, M.; Bagnato, C.; Corinaldesi, R.; De Giorgio, R.; Serra, M.; Grasso, V.; Ruggeri, E.; Salvi, A.; Leonardi, R.; Grassini, C.; Mascherona, I.; Minelli, G.; Maltese, F.; Gabrielli, A.; Mattioli, M.; Capeci, W.; Martino, G. P.; Messina, S.; Ghio, R.; Favorini, S.; Dal Col, A.; Minisola, S.; Colangelo, L.; Afeltra, A.; Alemanno, P.; Marigliano, B.; Castellino, P.; Blanco, J.; Zanoli, L.; Cattaneo, M.; Fracasso, P.; Amoruso, M. V.; Saracco, V.; Fogliati, M.; Bussolino, C.; Durante, V.; Eusebi, G.; Tirotta, D.; Mete, F.; Gino, M.; Cittadini, A.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.;
abstract

Background: Because frailty is a complex phenomenon associated with poor outcomes, the identification of patient profiles with different care needs might be of greater practical help than to look for a unifying definition. This study aimed at identifying aging phenotypes and their related outcomes in order to recognize frailty in hospitalized older patients. Methods: Patients aged 65 or older enrolled in internal medicine and geriatric wards participating in the REPOSI registry. Relationships among variables associated to sociodemographic, physical, cognitive, functional, and medical status were explored using a multiple correspondence analysis. The hierarchical cluster analysis was then performed to identify possible patient profiles. Multivariable logistic regression was used to verify the association between clusters and outcomes (in-hospital mortality and 3-month postdischarge mortality and rehospitalization). Results: 2,841 patients were included in the statistical analyses. Four clusters were identified: the healthiest (I); those with multimorbidity (II); the functionally independent women with osteoporosis and arthritis (III); and the functionally dependent oldest old patients with cognitive impairment (IV). There was a significantly higher in-hospital mortality in Cluster II (odds ratio [OR] = 2.27, 95% confidence interval [CI] = 1.15-4.46) and Cluster IV (OR = 5.15, 95% CI = 2.58-10.26) and a higher 3-month mortality in Cluster II (OR = 1.66, 95% CI = 1.13-2.44) and Cluster IV (OR = 1.86, 95% CI = 1.15-3.00) than in Cluster I. Conclusions: Using alternative analytical techniques among hospitalized older patients, we could distinguish different frailty phenotypes, differently associated with adverse events. The identification of different patient profiles can help defining the best care strategy according to specific patient needs.


2017 - Effects of cholecalciferol supplementation in patients with stable heart failure and low vitamin D levels (ECSPLOIT-D). A double-blind, randomized, placebo-controlled pilot study [Articolo su rivista]
Turrini, Fabrizio; Scarlini, Stefania; Giovanardi, Paolo; Messora, Roberto; Roli, Laura; Chester, Johanna Mary; Mussi, Chiara; Bertolotti, Marco; Trenti, Tommaso; Bondi, Marco
abstract

The aim of this study was to investigate the effects of vitamin D (VD) on the interaction among functional, echocardiographic and hormonal parameters in patients with heart failure (HF) and VD deficiency.


2017 - Impact of polypharmacy on antiretroviral prescription in people living with HIV. [Articolo su rivista]
Guaraldi, Giovanni; Menozzi, Marianna; Zona, Stefano; Calcagno, Andrea; Domingues Da Silva, Ana Rita; Santoro, Antonella; Malagoli, Andrea; Dolci, Giovanni; Mussi, Chiara; Mussini, Cristina; Cesari, Matteo; Khoo Saye, H.
abstract

OBJECTIVES: To evaluate the relationship between polypharmacy and ART, delivered as conventional multi-tablet three-drug regimens, single-tablet regimens or less-drug regimens (simplified mono or dual regimens). METHODS: We conducted a cross-sectional analysis of electronic data from the prospective Modena HIV Metabolic Clinic Cohort Study. We included the last clinical observation for each patient from January 2006 to December 2015. Polypharmacy was defined as the use of five or more medications (excluding ART). Multi-morbidity was classified as the presence of two or more non-infectious comorbidities. Factors associated with different ART regimens were analysed using multivariable multinomial logistic regression analyses with multi-tablet three-drug regimens as the reference. RESULTS: A total of 2944 patients (33.7% females) were included in the analysis. Multinomial logistic regression analysis identified polypharmacy to be negatively associated with single-tablet regimens [relative risk reduction (RRR) = 0.48, 95% CI = 0.28-0.81] independently from frailty (RRR = 0.68, 95% CI = 0.59-0.78), after correction for age, gender, HIV infection duration, current and nadir CD4 and calendar year. This association was not found comparing multi-tablet three-drug regimens and less-drug regimens. CONCLUSIONS: Single-tablet regimens are less likely to be prescribed in patients with polypharmacy. Single-tablet regimens are perceived to be less flexible in patients with multi-morbidity and at higher risk of drug-drug interaction.


2017 - Pattern of in-hospital changes in drug use in the older people from 2010 to 2016 [Articolo su rivista]
Franchi, C.; Ardoino, I.; Nobili, A.; Pasina, L.; Mannucci, P. M.; Marengoni, A.; Perticone, F.; Tettamanti, M.; Salerno, F.; Corrao, S.; Licata, G.; Violi, F.; Corazza, G. R.; Marcucci, M.; Eldin, T. K.; Donatella Di Blanca, M. P.; Lanzo, G.; Astuto, S.; Cortesi, L.; Prisco, D.; Silvestri, E.; Cenci, C.; Emmi, G.; Biolo, G.; Guarnieri, G.; Zanetti, M.; Fernandes, G.; Chiuch, M.; Vanoli, M.; Grignani, G.; Casella, G.; Pulixi, E. A.; Bernardi, M.; Li Bassi, S.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Salvatore, T.; Sasso, F. C.; Girelli, D.; Olivieri, O.; Matteazzi, T.; Barbagallo, M.; Plances, L.; Alcamo, R.; Calvo, L.; Valenti, M.; Zoli, M.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Bicchi, M.; Palasciano, G.; Modeo, M. E.; Peragine, M.; Pappagallo, F.; Pugliese, S.; Di Gennaro, C.; Postiglione, A.; Barbella, M. R.; De Stefano, F.; Cappellini, M. D.; Fabio, G.; Seghezzi, S.; De Amicis, M. M.; Mancarella, M.; Mari, D.; Rossi, P. D.; Damanti, S.; Ottolini, B. B.; Bonini, G.; Miceli, E.; Lenti, M. V.; Padula, D.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Davi, G.; Guagnano, M. T.; Sestili, S.; Mancuso, G.; Calipari, D.; Bartone, M.; Meroni, M. R.; Perin, P. C.; Lorenzati, B.; Gruden, G.; Bruno, G.; Amione, C.; Fornengo, P.; Tassara, R.; Melis, D.; Rebella, L.; Delitala, G.; Pretti, V.; Masala, M. S.; Pes, C.; Bolondi, L.; Rasciti, L.; Serio, I.; Fanelli, F. R.; Amoroso, A.; Molfino, A.; Petrillo, E.; Zuccala, G.; Franceschi, F.; De Marco, G.; Chiara, C.; Marta, S.; D'Aurizio, G.; Romanelli, G.; Amolini, C.; Chiesa, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Annoni, G.; Corsi, M.; Zazzetta, S.; Bellelli, G.; Szabo, H.; Arturi, F.; Succurro, E.; Rubino, M.; Sesti, G.; Loria, P.; Becchi, M. A.; Martucci, G.; Fantuzzi, A.; Maurantonio, M.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Di Corato, P.; Agnelli, G.; Marchesini, E.; Fabris, F.; Carlon, M.; Turatto, F.; Baritusso, A.; Amabile, A.; Omenetto, E.; Scarinzi, P.; Manfredini, R.; Molino, C.; Pala, M.; Fabbian, F.; Boari, B.; De Giorgi, A.; Paolisso, G.; Rizzo, M. R.; Laieta, M. T.; Rini, G.; Mansueto, P.; Pepe, I.; Borghi, C.; Strocchi, E.; De Sando, V.; Pareo, I.; Sabba, C.; Vella, F. S.; Suppressa, P.; Valerio, R.; Agosti, P.; Fontana, F.; Loparco, F.; Capobianco, C.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Testa, E.; Serraino, C.; Fargion, S.; Bonara, P.; Periti, G.; Porzio, M.; Tiraboschi, S.; Peyvandi, F.; Tedeschi, A.; Rossio, R.; Monzani, V.; Savojardo, V.; Folli, C.; Magnini, M.; Conca, A.; Gobbo, G.; Pallini, G.; Valenti, M.; Balduini, C. L.; Bertolino, G.; Provini, S.; Quaglia, F.; Dallegri, F.; Ottonello, L.; Liberale, L.; Chin, W. S.; Carassale, L.; Caporotundo, S.; Traisci, G.; De Feudis, L.; Di Carlo, S.; Liberato, N. L.; Buratti, A.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Montrucchio, G.; Greco, E.; Tizzani, P.; Petitti, P.; Perciccante, A.; Coralli, A.; Salmi, R.; Gaudenzi, P.; Gamberini, S.; Semplicini, A.; Gottardo, L.; Vendemiale, G.; Serviddio, G.; Forlano, R.; Masala, C.; Mammarella, A.; Raparelli, V.; Basili, S.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Vallone, C.; Bellusci, M.; Setti, D.; Pedrazzoli, F.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Molaro, M.; Bertolotti, M.; Mussi, C.; Libbra, M. V.; Miceli, A.; Pellegrini, E.; Carulli, L.; Veltri, F.; Sciacqua, A.; Quero, M.; Bagnato, C.; Colangelo, L.; Falbo, T.; De Giorgio, R.; Serra, M.; Grasso, V.; Ruggeri, E.; Ilaria, B.; Salvi, A.; Leonardi, R.; Grassini, C.; Mascherona, I.; Minelli, G.; Maltese, F.; Damiani, G.; Capeci, W.; Mattioli, M.; Martino, G. P.; Biondi, L.; Ormas, M.; Pettinari, P.; Romiti, R.; Messina, S.; Cavallaro, F.; Ghio, R.; Favorini, S.; Dal Col, A.; Minisola, S
abstract

Purpose: To assess the pattern of in-hospital changes in drug use in older patients from 2010 to 2016. Methods: People aged 65 years or more acutely hospitalized in those internal medicine and geriatric wards that did continuously participate to the REgistro POliterapie Società Italiana di Medicina Interna register from 2010 to 2016 were selected. Drugs use were categorized as 0 to 1 drug (very low drug use), 2 to 4 drugs (low drug use), 5 to 9 drugs (polypharmacy), and 10 or more drugs (excessive polypharmacy). To assess whether or not prevalence of patients in relation to drug use distribution changed overtime, adjusted prevalence ratios (PRs) was estimated with log-binomial regression models. Results: Among 2120 patients recruited in 27 wards continuously participating to data collection, 1882 were discharged alive and included in this analysis. The proportion of patients with very low drug use (0-1 drug) at hospital discharge increased overtime, from 2.7% in 2010 to 9.2% in 2016. Results from a log-logistic adjusted model confirmed the increasing PR of these very low drug users overtime (particularly in 2014 vs 2012, PR 1.83 95% CI 1.14-2.95). Moreover, from 2010 to 2016, there was an increasing number of patients who, on polypharmacy at hospital admission, abandoned it at hospital discharge, switching to the very low drug use group. Conclusion: This study shows that in internal medicine and geriatric wards continuously participating to the REgistro POliterapie Società Italiana di Medicina Interna register, the proportion of patients with a very low drug use at hospital discharge increased overtime, thus reducing the therapeutic burden in this at risk population.


2017 - Physical exercise for late life depression: effects on cognition and disability [Articolo su rivista]
Neviani, Francesca; Belvederi Murri, Martino; Mussi, Chiara; Triolo, Federico; Toni, Giulio; Simoncini, Elisabetta; Tripi, Ferdinando; Menchetti, Marco; Ferrari, Silvia; Ceresini, Graziano; Cremonini, Alessandro; Bertolotti, Marco; Neri, Giovanni; Squatrito, Salvatore; Amore, Mario; Zanetidou, Stamatula; Neri, Mirco
abstract

Background:: Late-life depression is often associated with cognitive impairments and disability, which may persist even after adequate antidepressant drug treatment. Physical exercise is increasingly recognized as an effective antidepressant agent, and may exert positive effects on these features too. However, few studies examined this issue, especially by comparing different types of exercises. Methods:: We performed secondary analyses on data from the Safety and Efficacy of Exercise for Depression in Seniors study, a trial comparing the antidepressant effectiveness of sertraline (S), sertraline plus thrice-weekly non-progressive exercise (S+NPE), and sertraline plus thrice-weekly progressive aerobic exercise (S+PAE). Exercise was conducted in small groups and monitored by heart rate meters. Patients with late-life depression without severe cognitive impairment were recruited from primary care and assessed at baseline and 24 weeks, using the Montreal Cognitive Assessment (MOCA, total and subdomain scores) and Brief Disability Questionnaire. Analyses were based on Generalized Linear Models. Results:: In total, 121 patients (mean age 75, 71% females) were randomized to the study interventions. Compared with the S group, patients in the S+PAE group displayed greater improvements of MOCA total scores (p=0.006, effect size=0.37), visuospatial/executive functions (p=0.001, effect size=0.13), and disability (p=0.02, effect size=−0.31). Participants in the S+NPE group did not display significant differences with the control group. Conclusions:: Adding aerobic, progressive exercise to antidepressant drug treatment may offer significant advantages over standard treatment for cognitive abilities and disability. These findings suggest that even among older patients exercise may constitute a valid therapeutic measure to improve patients’ outcomes.


2017 - Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study [Articolo su rivista]
Bertolotti, Marco; Franchi, Carlotta; Rocchi, Marco Bruno; Miceli, Andrea; Libbra, Maria Vittoria; Nobili, Alessandro; Lancellotti, Giulia; Carulli, Lucia; Mussi, Chiara
abstract

BACKGROUND: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. AIM: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. METHODS: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. RESULTS: 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. CONCLUSIONS: In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen.


2017 - Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients [Articolo su rivista]
Riva, E.; Colombo, R.; Moreo, G.; Mandelli, S.; Franchi, C.; Pasina, L.; Tettamanti, M.; Lucca, U.; Mannucci, P. M.; Nobili, A.; Perticone, F.; Salerno, F.; Corrao, S.; Marengoni, A.; Licata, G.; Violi, F.; Corazza, G. R.; Marcucci, M.; Eldin, T. K.; Di Blanca, M. P. D.; Djade, C. D.; Ardoino, I.; Cortesi, L.; Prisco, D.; Silvestri, E.; Cenci, C.; Emmi, G.; Biolo, G.; Guarnieri, G.; Zanetti, M.; Fernandes, G.; Vanoli, M.; Grignani, G.; Casella, G.; Bernardi, M.; Li Bassi, S.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Salvatore, T.; Sasso, F. C.; Girelli, D.; Olivieri, O.; Matteazzi, T.; Barbagallo, M.; Plances, L.; Alcamo, R.; Licata, G.; Calvo, L.; Valenti, M.; Zoli, M.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Bicchi, M.; Palasciano, G.; Modeo, M. E.; Peragine, M.; Pappagallo, F.; Pugliese, S.; Di Gennaro, C.; Postiglione, A.; Barbella, M. R.; De Stefano, F.; Cappellini, M. D.; Fabio, G.; Seghezzi, S.; De Amicis, M. M.; Mari, D.; Rossi, P. D.; Damanti, S.; Ottolini, B. B.; Damanti, S.; Corazza, G. R.; Miceli, E.; Lenti, M. V.; Padula, D.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Davi, G.; Guagnano, M. T.; Sestili, S.; Mancuso, G.; Calipari, D.; Bartone, M.; Meroni, M. R.; Perin, P. C.; Lorenzati, B.; Gruden, G.; Bruno, G.; Amione, C.; Fornengo, P.; Tassara, R.; Melis, D.; Rebella, L.; Delitala, G.; Pretti, V.; Masala, M. S.; Bolondi, L.; Rasciti, L.; Serio, I.; Fanelli, F. R.; Amoroso, A.; Molfino, A.; Petrillo, E.; Zuccala, G.; Franceschi, F.; De Marco, G.; Chiara, C.; Marta, S.; Romanelli, G.; Amolini, C.; Chiesa, D.; Marengoni, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Annoni, G.; Corsi, M.; Zazzetta, S.; Bellelli, G.; Arturi, F.; Succurro, E.; Rubino, M.; Sesti, G.; Loria, P.; Becchi, M. A.; Martucci, G.; Fantuzzi, A.; Maurantonio, M.; Delitala, G.; Carta, S.; Atzori, S.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Di Corato, P.; Agnelli, G.; Marchesini, E.; Fabris, F.; Carlon, M.; Turatto, F.; Baritusso, A.; Turatto, F.; Manfredini, R.; Molino, C.; Pala, M.; Fabbian, F.; Boari, B.; De Giorgi, A.; Paolisso, G.; Rizzo, M. R.; Laieta, M. T.; Rini, G.; Mansueto, P.; Pepe, I.; Borghi, C.; Strocchi, E.; De Sando, V.; Sabba, C.; Vella, F. S.; Suppressa, P.; Valerio, R.; Pugliese, S.; Capobianco, C.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Testa, E.; Serraino, C.; Fargion, S.; Bonara, P.; Periti, G.; Porzio, M.; Peyvandi, F.; Tedeschi, A.; Rossio, R.; Monzani, V.; Savojardo, V.; Folli, C.; Magnini, M.; Salerno, F.; Conca, A.; Gobbo, G.; Conca, A.; Balduini, C. L.; Bertolino, G.; Provini, S.; Quaglia, F.; Dallegri, F.; Ottonello, L.; Liberale, L.; Chin, W. S.; Carassale, L.; Caporotundo, S.; Traisci, G.; De Feudis, L.; Di Carlo, S.; Liberato, N. L.; Buratti, A.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Montrucchio, G.; Greco, E.; Tizzani, P.; Petitti, P.; Perciccante, A.; Coralli, A.; Salmi, R.; Gaudenzi, P.; Gamberini, S.; Semplicini, A.; Gottardo, L.; Vendemiale, G.; Serviddio, G.; Forlano, R.; Masala, C.; Mammarella, A.; Raparelli, V.; Violi, F.; Basili, S.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Vallone, C.; Bellusci, M.; Setti, D.; Pedrazzoli, F.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Molaro, M.; Bertolotti, M.; Mussi, C.; Libbra, M. V.; Miceli, A.; Pellegrini, E.; Carulli, L.; Perticone, F.; Sciacqua, A.; Quero, M.; Bagnato, C.; Corinaldesi, R.; De Giorgio, R.; Serra, M.; Grasso, V.; Ruggeri, E.; Salvi, A.; Leonardi, R.; Grassini, C.; Mascherona, I.; Minelli, G.; Maltese, F.; Gabrielli, A.; Mattioli, M.; Capeci, W.; Martino, G. P.; Corrao, S.; Messina, S.; Ghio, R.; Favorini, S.; Dal Col, A.; Minisola, S.; Colangelo, L.; Afeltra, A.; Alemanno, P.; Marigliano, B.; Castellino, P.; Blanco, J.; Zanoli, L.; Cattan
abstract

Study objective This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge. Methods A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0–11.9 g/dL in women; 10.0–12.9 g/dL in men) and group 3 with moderately-severely reduced Hb (<10 g/dL in women and men). Results Patients (2678; mean age 79.2 ± 7.4 y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR = 1.62; 95%CI 1.21–2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR = 1.82;95%CI 1.25–2.67; group 3: OR = 2.78;95%CI 1.82–4.26) and discharge (group 2: OR = 2.37;95%CI 1.48–3.93; group 3: OR = 3.70;95%CI 2.14–6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes. Conclusions Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia.


2017 - Syncope and Epilepsy coexist in 'possible' and 'drug-resistant' epilepsy (Overlap between Epilepsy and Syncope Study - OESYS). [Articolo su rivista]
Ungar, Andrea; Ceccofiglio, Alice; Pescini, Francesca; Mussi, Chiara; Tava, Giovanni; Rafanelli, Martina; Langellotto, Assunta; Marchionni, Niccolò; van Dijk, J. Gert; Galizia, Gianluigi; Bonaduce, Domenico; Abete, Pasquale
abstract

BACKGROUND AND AIM: Syncope and related falls are one of the main causes and the predominant cause of hospitalization in elderly patients with dementia. However, the diagnostic protocol for syncope is difficult to apply to patients with dementia. Thus, we developed a "simplified" protocol to be used in a prospective, observational, and multicenter study in elderly patients with dementia and transient loss of consciousness suspected for syncope or unexplained falls. Here, we describe the protocol, its feasibility and the characteristics of the patients enrolled in the study. METHODS: Patients aged ≥65 years with a diagnosis of dementia and one or more episodes of transient loss of consciousness during the previous 3 months, subsequently referred to a Geriatric Department in different regions of Italy, from February 2012 to May 2014, were enrolled. A simplified protocol was applied in all patients. Selected patients underwent a second-level evaluation. RESULTS: Three hundred and three patients were enrolled; 52.6% presented with episodes suspected to be syncope, 44.5% for unexplained fall and 2.9% both. Vascular dementia had been previously diagnosed in 53.6% of participants, Alzheimer's disease in 23.5% and mixed forms in 12.6%. Patients presented with high comorbidity (CIRS score = 3.6 ± 2), severe functional impairment, (BADL lost = 3 ± 2), and polypharmacy (6 ± 3 drugs). CONCLUSION: Elderly patients with dementia enrolled for suspected syncope and unexplained falls have high comorbidity and disability. The clinical presentation is often atypical and the presence of unexplained falls is particularly frequent.


2017 - The relationship between age and fat infiltration in liver and muscle [Articolo su rivista]
Dondi, Giulia; Lancellotti, Giulia; Bertolotti, Marco; Mussi, Chiara
abstract

The relationship between sarcopenia and non-alcoholic fatty liver disease (NAFLD) is intriguing and extremely topical, when we consider the increasing prevalence of the manifestations of NAFLD and non-alcoholic steatohepatitis (NASH) worldwide, together with the overwhelming burden of aging-related disease conditions such as sarcopenia. Such an association was described mainly in Eastern Asian populations and different indices of fat infiltration, including computed tomography (CT) were utilized. On the other hand, the evidence in the industrialized countries of the Western world is rather limited. The present findings replicate the association between liver and muscle fat infiltration in an older Western population, and using a densitometric definition. Such an association suggests the presence of common pathogenic mechanisms in the two conditions, and among these insulin resistance might play a crucial role; nonetheless, in older populations the epidemiological pattern is likely more complex and diseases such as NAFLD and sarcopenia may not necessarily coexist in the same subject.


2016 - "Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool [Articolo su rivista]
Bellelli, G.; Morandi, A.; Di Santo, S. G.; Mazzone, A.; Cherubini, A.; Mossello, E.; Bo, M.; Bianchetti, A.; Rozzini, R.; Zanetti, E.; Musicco, M.; Ferrari, A.; Ferrara, N.; Trabucchi, M.; Boffelli, S.; Stefano, F. D.; Filippi, F. D.; Guerini, F.; Bertoletti, E.; March, A.; Margiotta, A.; Mecocci, P.; Addesi, D.; Fanto, F.; Dijik, B.; Porrino, P.; Cotroneo, A. M.; Galli, G.; Bruni, A. C.; Bernardini, B.; Corsini, C.; Cagnin, A.; Zurlo, A.; Barbagallo, G.; Lunardelli, M. L.; Martini, E.; Battaglia, G.; Latella, R.; Petritola, D.; Sinforiani, E.; Cester, A.; Formilan, M.; Carbone, P.; Appollonio, I.; Cereda, D.; Tremolizzo, L.; Bottacchi, E.; Lucchetti, L.; Mariani, C.; Rapazzini, P.; Romanelli, G.; Marengoni, A.; Zuliani, G.; Bianchi, L.; Suardi, T.; Muti, E.; Bottura, R.; Sgro, G.; Mandas, A.; Serchisu, L.; Crippa, P.; Ivaldi, C.; Ungar, A.; Villani, D.; Raimondi, C.; Mussi, C.; Isaia, G.; Provenzano, G.; Mari, D.; Odetti, P.; Monacelli, F.; Incalzi, R. A.; Pluderi, A.; Bellamoli, C.; Terranova, L.; Scarpini, E.; D'Amico, G.; Cavallini, M. C.; Guerrini, G.; Scotuzzi, A. M.; Chiarello, A.; Pilotto, A.; Tognini, S.; Dell'Aquila, G.; Toigo, G.; Ceschia, G.; Piccinini, M.; Fabbo, A.; Zoli, M.; Forti, P.; Wenter, C.; Basile, G.; Lasagni, A.; Padovani, A.; Rozzini, L.; Cottino, M.; Vitali, S.; Tripi, G.; Avanzi, S.; Annoni, G.; Ruotolo, G.; Boschi, F.; Bonino, P.; Marchionni, N.; Fascendini, S.; Noro, G.; Turco, R.; Ubezio, M. C.; Serrati, C.; Infante, M.; Gentile, S.; Pernigotti, L. M.; Biagini, C. A.; Canonico, E.; Bonati, P.; Gareri, P.; Caffarra, P.; Ceretti, A.; Castiglia, R.; Gabelli, C.; Storto, M. L.; Putzu, P.; Santo, S. D.; Malara, A.; Spadea, F.; Di Cello, S.; Ceravolo, F.; Fabiano, F.; Rispoli, V.; Chiaradia, G.; Gabriele, A.; Settembrini, V.; Capomolla, D.; Citrino, A.; Scriva, A.; Bruno, I.; Secchi, R.; De Martino, E.; Muccinelli, R.; Lupi, G.; Paonessa, P.; Fabbri, A.; Castellari, S.; Po, A.; Gaggioli, G.; Varesi, M.; Moneti, P.; Capurso, S.; Latini, V.; Ghidotti, S.; Riccardelli, F.; Macchi, M.; Cassinadri, A.; Tonini, G.; Andreani, L.; Coralli, M.; Balotta, A.; Cancelliere, R.; Strazzacapa, M.; Cavallino, P.; Fabio, S.; De Filippi, F.; Giudice, C.; Floris, P.; Dentizzi, C.; D'Elia, K.; Azzini, M.; Cazzadori, M.; Benati, C.; Tobaldini, C.; Antonioli, A.; Mombelloni, P.; Fontanini, F.; Oliverio, M.; Del Grosso, L.; Giavedoni, C.; Bidoli, G.; Mazzei, B.; Corsonello, A.; Fusco, S.; Vena, S.; De Vuono, T.; Maiuri, G.; Castegnaro, E.; De Rosa, S.; Sechi, R. B.; Benvenuti, E.; Del Lungo, I.; Giardini, S.; Giulietti, C.; D'Amico, F.; Caronzolo, F.; Grippa, A.; Lombardo, G.; Pipicella, T.; Nitti, M. T.; Felici, A.; Pavan, S.; Lunelli, A.; Dimori, S.; Magnani, A.; Soglia, T.; Postacchini, D.; Brunelli, R.; Santini, S.; Francavilla, M.; Macchiati, I.; Sorvillo, F.; Giuli, C.; Perticone, F.; Rosa, P. C.; Bencardino, G.; Falbo, T.; Grillo, N.; Pezzilli, S.; Bergamo, D.; Furno, E.; Rrodhe, S.; Lucarini, S.; Dall'Acqua, F.; Cappelletto, F.; Calvani, D.; Becheri, D.; Gambardella, L.; Valente, C.; Ceci, G.; Ettorre, E.; Tironi, S.; Grassi, M. G.; Troisi, E.; Gabutto, A.; Baglietto, N.; Quazzo, L.; Rosatello, A.; Suraci, D.; Tagliabue, B.; Perrone, C.; Ferrara, L.; Castagna, A.; Tremolada, M.; Piano, S.; Serviddio, G.; Lo Buglio, A.; Gurrera, T.; Merlo, V.; Rovai, C.; Carlucci, R.; Abbaldo, A.; Monzani, F.; Qasem, A.; Bini, G.; Tafuto, S.; Mancuso, G.; Fragiacomo, F.; Pompanin, S.; Guerra, G.; Pala, M.; Menozzi, L.; Gatti, C. D.; Magon, S.; Di Francesco, V.; Faccioli, S.; Pellizzari, L.; Lia Lunardelli, M.; Macchiarulo, M.; Corneli, M.; Bacci, M.; Lo Storto, M.; Seresin, C.; Simonato, M.; Loreggian, M.; Cestonaro, F.; Durando, M.; Mazzoleni, M.; Russo, G.; Ponte, M.; Valchera, A.; Salustri, G.; Costa, A.; Cotta, M. R.; Pizio, R. N.; Perego, G.; Bucciantini, E.; Di Giovanni, M.; Franchi, F.; Claudio Mariani, S. B.; Grande, G.; Fugazza, L.; Guerrini, C.; De Paduanis, G.; Iallonardo, L.; Palumbo, P.; Ortolani, B.; Capatti, E.; Soavi, C
abstract

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.


2016 - Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study [Articolo su rivista]
Marco, Proietti; Alessandro, Nobili; Valeria, Raparelli; Laura, Napoleone; Pier Mannuccio, Mannucci; Gregory Y. H., Lip; On behalf of REPOSI, Investigators; Carulli, Lucia; Bertolotti, Marco; Mussi, Chiara
abstract

Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan–Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients


2016 - Disability in HIV [Capitolo/Saggio]
Mussi, C.
abstract


2016 - Etiology of Syncope and Unexplained Falls in Elderly Adults with Dementia: Syncope and Dementia (SYD) Study. [Articolo su rivista]
Ungar, Andrea; Mussi, Chiara; Ceccofiglio, Alice; Bellelli, Giuseppe; Bo, Mario; Riccio, Daniela; Guadagno, Livia; Noro, Gabriele; Ghidoni, Giulia; Rafanelli, Martina; Marchionni, Niccolò; Abete, Pasquale
abstract

Objectives: To investigate the etiology of transient loss of consciousness (T-LOC) suspected to be syncope and unexplained falls in elderly adults with dementia. Design: Prospective, observational, multicenter study. Setting: Acute care wards, syncope units or centers for the diagnosis of dementia. Participants: Individuals aged 65 and older with a diagnosis of dementia and one or more episodes of T-LOC of a suspected syncopal nature or unexplained falls during the previous 3 months were enrolled. Measurements: The causes of T-LOC suspected to be syncope and unexplained falls were evaluated using a simplified protocol based on European Society of Cardiology guidelines. Results: Of 357 individuals enrolled, 181 (50.7%) had been referred for T-LOC suspected to be syncope, 166 (46.5%) for unexplained falls, and 10 (2.8%) for both. An initially suspected diagnosis of syncope was confirmed in 158 (87.3%), and syncope was identified as the cause of the event in 75 (45.2%) of those referred for unexplained falls. Orthostatic hypotension was the cause of the event in 117 of 242 (48.3%) participants with a final diagnosis of syncope. Conclusion: The simplified syncope diagnostic protocol can be used in elderly people with dementia referred for suspected syncope or unexplained falls. Unexplained falls may mask a diagnosis of syncope or pseudosyncope in almost 50% of cases. Given the high prevalence of orthostatic syncope in participants (~50%), a systematic reappraisal of drugs potentially responsible for orthostatic hypotension is warranted.


2016 - Geriatric Syndromes [Capitolo/Saggio]
Mussi, C.
abstract


2016 - Managing the Older Adult Patient with HIV [Monografia/Trattato scientifico]
Silva, A. R.; Mussi, C.; Falutz, J.; Guaraldi, G.
abstract

This concise, clinically focused pocket guide offers a complete overview of HIV in the older patient and reviews the latest guidelines, treatment options, clinical trials, and management of HIV within this subgroup. The easily accessible text offers infectious disease specialists and other health care professionals with an excellent quick reference tool, with full color tables and figures enhancing the text further. HIV is a chronic disease that affects the immune system, leading to AIDS. As treatments have progressed and patients with HIV are living longer a new aspect has to be taken in to consideration when treating HIV and other conditions. Comorbidities are rife within older adults with HIV, as many of the treatments for HIV cause long-term side effects, such as heart conditions and cancer. Special consideration must be taken to ensure no toxic drug-drug interactions between treatments.


2016 - Nutrition and physical exercise in older patients with HIV [Capitolo/Saggio]
Mussi, C.
abstract


2016 - Physical Exercise for Late-Life Depression: Effects on Heart Rate Variability. [Articolo su rivista]
Toni, G; Belvederi Murri, M; Piepoli, M; Zanetidou, S; Cabassi, A; Squatrito, S; Bagnoli, L; Piras, A; Mussi, Chiara; Senaldi, R; Menchetti, M; Zocchi, D; Ermini, G; Ceresini, G; Tripi, F; Rucci, P; Alexopoulos, Gs; Amore, M.
abstract

OBJECTIVES: Late-life major depression is associated with increased cardiovascular risk and impaired autonomic control of the heart, as evident from reduced heart rate variability (HRV). Moreover, antidepressant drug therapy also might be associated with further reductions of HRV. In the SEEDS study, we investigated whether sertraline associated with physical exercise protocols led to improvements of HRV, compared with antidepressant drug therapy alone. DESIGN: Single-blind randomized controlled trial. SETTING: Psychiatric consultation-liaison program for primary care. PARTICIPANTS: Patients aged 65-85 years with major depression, recruited from primary care. INTERVENTIONS: Sertraline plus structured, tailored group physical exercise (S + EX) versus sertraline alone (S) for 24 weeks. MEASUREMENTS: HRV indices (RR, percentage of NN intervals greater than 50 msec [pNN50], square root of the mean squared differences of successive NN intervals [RMSSD], standard deviation of heart rate [SDHR], standard deviation of the NN interval [SDNN], high-frequency band [HF], low-frequency band [LF], and their ratio [LF/HF]) were measured at baseline, week 12, and week 24. Psychiatric and medical assessments. RESULTS: Participants displayed significant improvements of most HRV indices over time, irrespective of the group assignment (pNN50, RMSSD, SDHR, SDNN, HF, LF, and LF/HF). Moreover, patients in the S + EX group displayed greater increases of different HRV indices(RR, pNN50, RMSSD, SDHR, SDNN, HF, and LF) compared with those in the S group. CONCLUSIONS: The combination of structured physical exercise and sertraline might exert positive effects on the autonomic control of the heart among older patients with major depression.


2016 - Safety and tolerability of Tilt Testing and Carotid Sinus Massage in the octogenarians [Articolo su rivista]
Ungar, Andrea; Rivasi, Giulia; Rafanelli, Martina; Toffanello, Giulia; Mussi, Chiara; Ceccofiglio, Alice; Mcdonagh, Ruth; Drumm, Breffni; Marchionni, Niccolò; Alboni, Paolo; Kenny, Rose Anne
abstract

OBJECTIVE: to evaluate the safety and tolerability of Tilt Testing (TT) and Carotid Sinus Massage (CSM) in octogenarians with unexplained syncope. METHODS: patients consecutively referred for transient loss of consciousness to the 'Syncope Units' of three hospitals were enrolled. TT and CSM were performed according to the European Society of Cardiology guidelines on syncope. Complications were evaluated in each group. An early interruption of TT was defined as 'intolerance' and considered as a non-diagnostic response. RESULTS: one thousand four hundred and one patients were enrolled (mean age 72 ± 16 years, male 40.8%). Six hundred and ninety-four patients (49.5%) were 80 years old or older (mean age 83 ± 3 years) and 707 (50.5%) were younger (mean age 60 ± 17 years). Complications after TT occurred in 4.5% of older patients and in 2.1% of the younger ones (P = 0.01). All complications were 'minor/moderate', as prolonged hypotension, observed in ∼3% of patients ≥80 years. Major complications such as sustained ventricular tachycardia, ventricular fibrillation, asystole requiring cardiac massage, transient ischaemic attack, stroke and death were not observed in any patient. The presence of orthostatic hypotension and the mean number of syncopal episodes were predictors of TT complications. Intolerance was reported in 2.4% of older patients and 1% of the younger ones (P = 0.08), mainly due to orthostatic intolerance. No complications occurred after CSM. CONCLUSIONS: TT and CSM appear to be safe and well tolerated in octogenarians, who should not be excluded by age from the diagnostic work-up of syncope.


2015 - A frailty index predicts survival and incident multimorbidity independent of markers of HIV disease severity [Articolo su rivista]
Guaraldi, Giovanni; Brothers, Thomas D.; Zona, Stefano; Stentarelli, Chiara; Carli, Federica; Malagoli, Andrea; Santoro, Antonella; Menozzi, Marianna; Mussi, Chiara; Mussini, Cristina; Kirkland, Susan; Falutz, Julian; Rockwood, Kenneth
abstract

Objectives: Aging with HIV is associated with multisystem vulnerability that might be well characterized by frailty. We sought to construct a frailty index based on health deficit accumulation in a large HIV clinical cohort and evaluate its validity including the ability to predict mortality and incident multimorbidity. Design and methods: This is an analysis of data from the prospective Modena HIV Metabolic Clinic cohort, 2004–2014. Routine health variables were screened for potential inclusion in a frailty index. Content, construct, and criterion validity of the frailty index were assessed. Multivariable regression models were built to investigate the ability of the frailty index to predict survival and incident multimorbidity (at least two chronic disease diagnoses) after adjusting for known HIV-related and behavioral factors. Results: Two thousand, seven hundred and twenty participants (mean age 46!8; 32% women) provided 9784 study visits; 37 non-HIV-related variables were included in a frailty index. The frailty index exhibited expected characteristics and met validation criteria. Predictors of survival were frailty index (0.1 increment, adjusted hazard ratio 1.63, 95% confidence interval 1.05–2.52), current CD4þ cell count (0.48, 0.32–0.72), and injection drug use (2.51, 1.16–5.44). Predictors of incident multimorbidity were frailty index (adjusted incident rate ratio 1.98, 1.65–2.36), age (1.07, 1.05–1.09), female sex (0.61, 0.40–0.91), and current CD4þ cell count (0.71, 0.59–0.85). Conclusion: Among people aging with HIV in northern Italy, a frailty index based on deficit accumulation predicted survival and incident multimorbidity independently of HIV-related and behavioral risk factors. The frailty index holds potential value in quantifying vulnerability among people aging with HIV.


2015 - Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia [Articolo su rivista]
Rossio, Raffaella; Franchi, Carlotta; Ardoino, Ilaria; Djade, Codjo D.; Tettamanti, Mauro; Pasina, Luca; Salerno, Francesco; Marengoni, Alessandra; Corrao, Salvatore; Marcucci, Maura; Peyvandi, Flora; Biganzoli, Elia M.; Nobili, Alessandro; Mannucci, Pier Mannuccio; Sparacio, Eleonora; Alborghetti, Stefania; Di Costanzo, Rosa; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Barnini, Tommaso; Delitala, Giuseppe; Carta, Stefano; Atzori, Sebastiana; Guarnieri, Gianfranco; Zanetti, Michela; Spalluti, Annalisa; Serra, Maria Grazia; Bleve, Maria Antonietta; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Gasbarrone, Laura; Maniscalco, Giorgio; Gunelli, Massimo; Tirotta, Daniela; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Bernardi, Mauro; Li Bassi, Silvia; Santi, Luca; Agnelli, Giancarlo; Iorio, Alfonso; Marchesini, Emanuela; Mannarino, Elmo; Lupattelli, Graziana; Rondelli, Pamela; Paciullo, Francesco; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baroni, Maria Cristina; Zardo, Marianna; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Salvatore, Teresa; Sasso, Ferdinando Carlo; Utili, Riccardo; Mangoni, Emanuele Durante; Pinto, Daniela; Olivieri, Oliviero; Stanzial, Anna Maria; Fellin, Renato; Volpato, Stefano; Fotini, Sioulis; Barbagallo, Mario; Dominguez, Ligia; Plances, Lidia; D'Angelo, Daniela; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Borghi, Claudio; Strocchi, Enrico; Rinaldi, Elisa Rebecca; Zoli, Marco; Fabbri, Elisa; Magalotti, Donatella; Auteri, Alberto; Pasqui, Anna Laura; Puccetti, Luca; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Sabbà, Carlo; Vella, Francesco Saverio; Marseglia, Alessandro; Luglio, Chiara Valentina; Palasciano, Giuseppe; Modeo, Maria Ester; Aquilino, Annamaria; Raffaele, Pallante; Pugliese, Stefania; Capobianco, Caterina; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Fenoglio, Luigi; Brignone, Chiara; Bracco, Christian; Giraudo, Alessia; Musca, Giuseppe; Cuccurullo, Olga; Cricco, Luigi; Fiorentini, Alessandra; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Fargion, Silvia; Bonara, Paola; Bulgheroni, Mara; Lombardi, Rosa; Magrini, Fabio; Massari, Ferdinando; Tonella, Tatiana; Tedeschi, Alberto; Moreo, Guido; Ferrari, Barbara; Roncari, Luisa; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Mari, Daniela; Rossi, Paolo Dionigi; Damanti, Sarah; Prolo, Silvia; Lilleri, Maria Sole; Micale, Giuliana; Podda, Mauro; Selmi, Carlo; Meda, Francesca; Accordino, Silvia; Conca, Alessio; Monti, Valentina; Corazza, Gino Roberto; Miceli, Emanuela; Lenti, Marco Vincenzo; Padula, Donatella; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Murialdo, Giovanni; Bovio, Marta; Dallegri, Franco; Ottonello, Luciano; Quercioli, Alessandra; Barreca, Alessandra; Secchi, Maria Beatrice; Ghelfi, Davide; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Bergami, Elisabetta; Rizzioli, Emanuela; Cagnoni, Carlo; Bertone, Luca; Manucra, Antonio; Buratti, Alberto; Tognin, Tiziana; Liberato, Nicola Lucio; Bernasconi, Giordano; Nardo, Barbara; Bianchi, Giovanni Battista; Benetti, Giampiero; Quagliolo, Michela; Centenaro, Giuseppe Riccardo; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Gullo, Francesco; Cortellaro, Michele; Magenta, Marina; Perego, Francesca; Meroni, Maria Rachele; Cicardi, Marco; Magenta, Antonio Gidaro Marina; Sacco, Andrea; Bonelli, Antonio; Dentamaro, Gaetano; Rozzini,
abstract

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.


2015 - Ageing with HIV: a multidisciplinary review [Articolo su rivista]
Calcagno, A; Nozza, S; Mussi, C; Celesia, B M; Carli, F; Piconi, S; De Socio, G V; Cattelan, A M; Orofino, G; Ripamonti, D; Riva, A; Di Perri, G
abstract

Introduction: After the introduction of highly active antiretroviral treatment, the course of HIV infection turned into a chronic disease and most of HIV-positive patients will soon be over 50 years old. Material and methods: This paper reviews the multiple aspects that physicians have to face while taking care of HIV-positive ageing patients including the definitions of frailty and the prevalence and risk factors of concomitant diseases. From a therapeutic point of view pharmacokinetic changes and antiretroviral-specific toxicities associated with ageing are discussed; finally therapeutic approaches to frailty are reviewed both in HIV-positive and negative patients. Conclusion and discussion: We conclude by suggesting that the combined use of drugs with the least toxicity potential and the promotion of healthy behaviours (including appropriate nutrition and exercise) might be the best practice for ageing HIV-positive subjects.


2015 - Erratum to: Ageing with HIV: a multidisciplinary review(Infection, Doi:10.1007/s15010-015-0795-5) [Articolo su rivista]
Calcagno, A; Nozza, S.; Mussi, Chiara; Celesia, B. M.; Carli, Federica; Piconi, S.; De Socio, G. V.; Cattelan, A. M.; Orofino, G.; Ripamonti, D.; Riva, A.; Di Perri, G.
abstract

INTRODUCTION: After the introduction of highly active antiretroviral treatment, the course of HIV infection turned into a chronic disease and most of HIV-positive patients will soon be over 50 years old. MATERIAL AND METHODS: This paper reviews the multiple aspects that physicians have to face while taking care of HIV-positive ageing patients including the definitions of frailty and the prevalence and risk factors of concomitant diseases. From a therapeutic point of view pharmacokinetic changes and antiretroviral-specific toxicities associated with ageing are discussed; finally therapeutic approaches to frailty are reviewed both in HIV-positive and negative patients. CONCLUSION AND DISCUSSION: We conclude by suggesting that the combined use of drugs with the least toxicity potential and the promotion of healthy behaviours (including appropriate nutrition and exercise) might be the best practice for ageing HIV-positive subjects


2015 - Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation [Articolo su rivista]
Proietti, M.; Marra, A. M.; Tassone, E. J.; de Vuono, S.; Corrao, S.; Gobbi, P.; Perticone, F.; Corazza, G. R.; Basili, S.; Lip, G. Y. H.; Violi, F.; Raparelli, V.; Alessandri, C.; Serviddio, G.; Fascetti, S.; Serra, P.; Palange, P.; Greco, E.; Bruno, G.; Averna, M.; Giammanco, A.; Sposito, P.; de Cristofaro, R.; de Gennaro, L.; Loria, P.; Pellegrini, E.; Cominacini, L.; Mozzini, C.; Sprovieri, M.; Spagnuolo, V.; Cerqua, G.; Cerasola, G.; Mule, G.; Barbagallo, M.; Lo Sciuto, S.; Monteverde, A.; Saitta, A.; Lo Gullo, A.; Malatino, L.; Cilia, C.; Licata, G.; Tuttolomondo, A.; Conigliaro, R.; Pinto, A.; Di Raimondo, D.; Signorelli, S.; Anzaldi, M.; de Palma, D.; Galderisi, M.; Cudemo, G.; Galletti, F.; Fazio, V.; de Luca, N.; Meccariello, A.; Caputo, D.; de Donato, M. T.; Iannuzi, A.; Bresciani, A.; Giunta, R.; Cimini, C.; Durante, M. E.; Agrusta, F.; Iorio, F.; Adinolfi, L. E.; Sellitto, A.; Restivo, L.; Bellis, P.; Tirelli, P.; Sacerdoti, D.; Pesce, P.; Vanni, D.; Iuliano, L.; Ciacciarelli, M.; Pacelli, A.; Palazzuoli, A.; Cacciafesta, M.; Gueli, N.; Capeci, W.; Tarquinio, N.; Pellegrini, F.; Vincentelli, G. M.; Ravallese, F.; Santini, C.; Letizia, C.; Petramala, L.; Zinnamosca, L.; Cilli, M.; Savoriti, C.; Falaschi, P.; Martocchia, A.; Stefanelli, M.; Marigliano, V.; Lo Iacono, C.; Brusco, S.; Bertazzoni, G.; Attalla El Halabieh, E.; Paradiso, M.; Lizzi, E. M.; Timmi, S.; Battisti, P.; Cerci, S.; Ciavolella, M.; Di Veroli, C.; Malci, F.; de Ciocchis, A.; Abate, D.; Castellino, P.; Curto, I.; Vecchio, C. R.; Mannarino, E.; Pasqualini, L.; Fattori, C.; Pende, A.; Denegri, A.; Artom, N.; Ricchio, R.; Fimognari, F. L.; Alletto, M.; Messina, S.; Sesti, G.; Arturi, F.; Grembiale, A.; Maio, R.; Scarpino, P. E.; Carullo, G.; Sciacqua, A.; Frugiuele, P.; Battaglia, G.; Vidili, G.; Atzori, S.; Delitala, G.; Davi, G.; Angelucci, E.; Sestili, S.; Traisci, G.; de Feudis, L.; Di Michele, D.; Fava, A.; Balsano, C.; de Ciantis, P.; Desideri, G.; Camerota, A.; Migliacci, R.; Porciello, G.; Mezzetti, M.; Gresele, P.; Vedovati, C.; Fierro, T.; Puccetti, L.; Scarpini, F.; Bertolotti, M.; Mussi, C.; Boddi, M.; Savino, A.; Contri, S.; Saller, A.; Fabris, F.; Pesavento, R.; Filippi, L.; Vedovetto, V.; Puato, M.; Treleani, M.; de Luca, E.; de Zaiacomo, F.; Giantin, V.; Semplicini, A.; Minuz, P.; Calabria, S.; Romano, S.; Fantin, F.; Manica, A.; Stockner, I.; Pattis, P.; Gutmann, B.; Catena, C.; Colussi, G.; Annoni, G.; Bruni, A. A.; Castagna, A.; Spinelli, D.; Miceli, E.; Padula, D.; Schinco, G.; Spreafico, S.; Secchi, B.; Vanoli, M.; Casella, G.; Serra, M. G.; Longo, S.; Antonaci, S.; Belfiore, A.; Ricci, L.; Ventrella, F.; Iamele, L.; Bianco, C.; Santovito, D.; Cipollone, F.; Nicolai, S.; Salvati, F.; Rini, G. B.; Scozzari, F.; Muiesan, M. L.; Salvetti, M.; Bazza, A.; Picardi, A.; de Vincentis, A.; Cosio, P.; Terzolo, M.; Madaffari, B.; Parasporo, B.; Fenoglio, L.; Bracco, C.; Melchio, R.; Gentili, T.; Salvi, A.; Nitti, C.; Falsetti, L.; Gabrielli, A.; Paglione, I.; Capucci, A.; Brambatti, M.; Sparagna, A.; Tirotta, D.; Andreozzi, P.; Ettorre, E.; Viscogliosi, G.; Rossi, F. F.; Delfino, M.; Glorioso, N.; Melis, G.; Marras, G.; Matta, M.; Sacco, A.; Stellitano, E.; Scordo, A.; Russo, F.; Caruso, A. A.; Porreca, E.; Santilli, F.; Tana, M.; Ferri, C.; Grassi, D.; Cheli, P.; Portincasa, P.; Muscianisi, G.; Giordani, S.; Stanghellini, V.; Sabba, C.; Suppressa, P.; Mancuso, G.; Bartone, M.; Calipari, D.; Arcidiacono, G.; Bellanuova, I.; Ferraro, M.; Scalzo, A.; Marigliano, G.; Cozzolino, D.; Lampitella, A.; Acri, V.; Galasso, D.; Mazzei, F.; Galasso, S.; Buratti, A.; Porta, M.; Brizzi, M. F.; Fattorini, A.; Sampietro, F.; D'Angelo, A.; Pala, M.; Fabbian, F.; Manfredini, R.; Moroni, C.; Valente, L.; Lopreiato, F.; Parente, F.; Granata, M.; Moia, M.; Braham, S.; Rossi, M.; Pesce, M.; Gentile, A.; Catozzo, V.; Di Napoli, M.; Baciarello, G.; Rancan, E.; Ageno, W.; Guasti, L.; Ciccaglioni, A.; Negri, S.; Polselli, M.; Abbate, R.; Marcucci, R.; Cangemi, R.; Pi
abstract

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 ± 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index ≤0.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc ≥2 seen in 93% of LVH and in 73% of patients without LVH (p &lt;0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p &lt;0.0001), age (OR 1.03 per year, p &lt;0.001), hypertension (OR 2.30, p &lt;0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention.


2015 - Lights and shadows in the management of old and new oral anticoagulants in the real world of atrial fibrillation by Italian internists. A survey from the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study [Articolo su rivista]
Pignatelli, P.; Pastori, D.; Perticone, F.; Corazza, G. R.; Violi, F.; Cominacini, L.; Mozzini, C.; De Palma, D.; Galderisi, M.; Cudemo, G.; Galletti, F.; Fazio, V.; Adinolfi, L. E.; Sellitto, A.; Restivo, L.; Cacciafesta, M.; Gueli, N.; Castellino, P.; Curto, I.; Vecchio, C.; Sesti, G.; Arturi, F.; Grembiale, A.; Scarpino, P. E.; Carullo, G.; Vidili, G.; Atzori, S.; Delitala, G.; Di Michele, D.; Fava, A.; Bertolotti, M.; Mussi, C.; De Luca, E.; De Zaiacomo, F.; Giantin, V.; Miceli, E.; Padula, D.; Santovito, D.; Cipollone, F.; Andreozzi, P.; Ettorre, E.; Viscogliosi, G.; Glorioso, N.; Melis, G.; Marras, G.; Matta, M.; Porta, M.; Brizzi, M. F.; Moroni, C.; Valente, L.; Lopreiato, F.; Gentile, A.; Catozzo, V.; Rancan, E.; Ageno, W.; Guasti, L.; Cangemi, R.; Pignataro, F. S.; Ferro, D.; Loffredo, L.; Perri, L.; Catasca, E.; Raparelli, V.; Napoleone, L.; Bucci, T.; Baratta, F.; Talerico, G.; Calvieri, C.; Vicario, T.; Russo, R.; Saliola, M.; Del Ben, M.; Angelico, F.; Vestri, A. R.; Farcomeni, A.; Di Tanna, G.; Davi', G.; Basili, S.; Mannucci, P. M.; Lip, G. Y.; Hiatt, W.; Licata, G.; Gobbi, P.; Corrao, S.
abstract

The lights and shadows in the management of old and new oral anticoagulants are described in the real world of atrial fibrillation by Italian internists.


2015 - The "syncope and dementia" study: a prospective, observational, multicenter study of elderly patients with dementia and episodes of "suspected" transient loss of consciousness. [Articolo su rivista]
Ungar, Andrea; Mussi, Chiara; Nicosia, F; Ceccofiglio, Alice; Bellelli, Giuseppe; Bo, Mario; Riccio, D; Landi, Francesco; Martone, Am; Langellotto, A; Ghidoni, Giulia; Noro, Gabriele; Abete, Pasquale
abstract

BACKGROUND AND AIM: Syncope and related falls are one of the main causes and the predominant cause of hospitalization in elderly patients with dementia. However, the diagnostic protocol for syncope is difficult to apply to patients with dementia. Thus, we developed a "simplified" protocol to be used in a prospective, observational, and multicenter study in elderly patients with dementia and transient loss of consciousness suspected for syncope or unexplained falls. Here, we describe the protocol, its feasibility and the characteristics of the patients enrolled in the study. METHODS: Patients aged ≥65 years with a diagnosis of dementia and one or more episodes of transient loss of consciousness during the previous 3 months, subsequently referred to a Geriatric Department in different regions of Italy, from February 2012 to May 2014, were enrolled. A simplified protocol was applied in all patients. Selected patients underwent a second-level evaluation. RESULTS: Three hundred and three patients were enrolled; 52.6 % presented with episodes suspected to be syncope, 44.5 % for unexplained fall and 2.9 % both. Vascular dementia had been previously diagnosed in 53.6 % of participants, Alzheimer's disease in 23.5 % and mixed forms in 12.6 %. Patients presented with high comorbidity (CIRS score = 3.6 ± 2), severe functional impairment, (BADL lost = 3 ± 2), and polypharmacy (6 ± 3 drugs). CONCLUSION: Elderly patients with dementia enrolled for suspected syncope and unexplained falls have high comorbidity and disability. The clinical presentation is often atypical and the presence of unexplained falls is particularly frequent.


2014 - Age-associated alterations in cholesterol homeostasis: evidence from a cross-sectional study in a Northern Italy population. [Articolo su rivista]
Bertolotti, Marco; Mussi, Chiara; Pellegrini, E; Magni, A; Del Puppo, M; Ognibene, Silvia; Carulli, Lucia; Anzivino, C; Baldelli, Enrica; Loria, Paola; Carulli, N.
abstract

BACKGROUND: The modifications of cholesterol metabolism associated with aging are ill-defined. The objective of this study was to define age-associated alterations of the different metabolic pathways controlling cholesterol homeostasis by analyzing circulating sterols. METHODS: We analyzed serum samples collected from 201 adult (75 male, 126 female) subjects within the epidemiological MICOL study (Multicentrica Italiana Colelitiasi). The age range was 38-79 years; 103 had evidence of gallstones. The concentrations of the different sterols, recognized as markers of the main pathways of cholesterol homeostasis, were analyzed by gas chromatography-mass spectrometry, including lathosterol (synthesis), campesterol and sitosterol (absorption), and 7α-hydroxy-4-cholesten-3-one (degradation to bile acids). RESULTS: A significant direct correlation was detected between age and cholesterol levels (r =0.34, P<0.01). The lathosterol/cholesterol ratio was lower in older age quartiles (P<0.05 by analysis of variance), with an inverse correlation between the lathosterol/cholesterol ratio and age (r=-0.32, P<0.01). Such correlation was particularly evident in females. The campesterol/cholesterol and sitosterol/cholesterol ratios were inversely correlated with aging in control, but not in gallstone patients. The levels of 7α-hydroxy-4-cholesten-3-one were not correlated with age. CONCLUSION: These data show a reduction of cholesterol synthesis with aging which is associated with increased circulating cholesterol levels. The finding might be related to a reduced metabolic need for cholesterol in advancing age, leading to a downregulation of the main mechanisms of cholesterol intake in the liver. A different age-related behavior was observed in gallstone-free versus gallstone patients regarding cholesterol absorption. The possible implications in terms of the pharmacological management of hypercholesterolemia in the elderly remain to be defined.


2014 - Gender-differences in disease distribution and outcome in hospitalized elderly: Data from the REPOSI study [Articolo su rivista]
Corrao, S.; Santalucia, P.; Argano, C.; Djade, C. D.; Barone, E.; Tettamanti, M.; Pasina, L.; Franchi, C.; Kamal Eldin, T.; Marengoni, A.; Salerno, F.; Marcucci, M.; Mannucci, P. M.; Nobili, A.; Sparacio, Eleonora; Alborghetti, Stefania; Di Costanzo, Rosa; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Barnini, Tommaso; Delitala, Giuseppe; Carta, Stefano; Atzori, Sebastiana; Guarnieri, Gianfranco; Zanetti, Michela; Spalluti, Annalisa; Serra, Maria Grazia; Bleve, Maria Antonietta; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Gasbarrone, Laura; Maniscalco, Giorgio; Gunelli, Massimo; Tirotta, Daniela; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Bernardi, Mauro; Li Bassi, Silvia; Santi, Luca; Agnelli, Giancarlo; Iorio, Alfonso; Marchesini, Emanuela; Mannarino, Elmo; Lupattelli, Graziana; Rondelli, Pamela; Paciullo, Francesco; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baroni, Maria Cristina; Zardo, Marianna; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Salvatore, Teresa; Sasso, Ferdinando Carlo; Utili, Riccardo; Mangoni, Emanuele Durante; Pinto, Daniela; Olivieri, Oliviero; Stanzial, Anna Maria; Fellin, Renato; Volpato, Stefano; Fotini, Sioulis; Barbagallo, Mario; Dominguez, Ligia; Plances, Lidia; D'Angelo, Daniela; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Borghi, Claudio; Strocchi, Enrico; Rinaldi, Elisa Rebecca; Zoli, Marco; Fabbri, Elisa; Magalotti, Donatella; Auteri, Alberto; Pasqui, Anna Laura; Puccetti, Luca; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Sabbà, Carlo; Vella, Francesco Saverio; Marseglia, Alessandro; Luglio, Chiara Valentina; Palasciano, Giuseppe; Modeo, Maria Ester; Aquilino, Annamaria; Raffaele, Pallante; Pugliese, Stefania; Capobianco, Caterina; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Fenoglio, Luigi; Brignone, Chiara; Bracco, Christian; Giraudo, Alessia; Musca, Giuseppe; Cuccurullo, Olga; Cricco, Luigi; Fiorentini, Alessandra; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Fargion, Silvia; Bonara, Paola; Bulgheroni, Mara; Lombardi, Rosa; Magrini, Fabio; Massari, Ferdinando; Tonella, Tatiana; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Moreo, Guido; Ferrari, Barbara; Roncari, Luisa; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Mari, Daniela; Rossi, Paolo Dionigi; Damanti, Sarah; Prolo, Silvia; Lilleri, Maria Sole; Micale, Giuliana; Podda, Mauro; Selmi, Carlo; Meda, Francesca; Accordino, Silvia; Conca, Alessio; Monti, Valentina; Corazza, Gino Roberto; Miceli, Emanuela; Lenti, Marco Vincenzo; Padula, Donatella; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Murialdo, Giovanni; Bovio, Marta; Dallegri, Franco; Ottonello, Luciano; Quercioli, Alessandra; Barreca, Alessandra; Secchi, Maria Beatrice; Ghelfi, Davide; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Bergami, Elisabetta; Rizzioli, Emanuela; Cagnoni, Carlo; Bertone, Luca; Manucra, Antonio; Buratti, Alberto; Tognin, Tiziana; Liberato, Nicola Lucio; Bernasconi, Giordano; Nardo, Barbara; Bianchi, Giovanni Battista; Benetti, Giampiero; Quagliolo, Michela; Centenaro, Giuseppe Riccardo; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Gullo, Francesco; Cortellaro, Michele; Magenta, Marina; Perego, Francesca; Meroni, Maria Rachele; Cicardi, Marco; Magenta, Antonio Gidaro Marina; Sacco, Andrea; Bonelli, Antonio; Dentamaro, Gaetano; Rozzini, Renzo; Falanga, Lina; Giordano, Ale
abstract

Background and purpose Women live longer and outnumber men. On the other hand, older women develop more chronic diseases and conditions such as arthritis, osteoporosis and depression, leading to a greater number of years of living with disabilities. The aim of this study was to describe whether or not there are gender differences in the demographic profile, disease distribution and outcome in a population of hospitalized elderly people. Methods Retrospective observational study including all patients recruited for the REPOSI study in the year 2010. Analyses are referred to the whole group and gender categorization was applied. Results A total of 1380 hospitalized elderly subjects, 50.5% women and 49.5% men, were considered. Women were older than men, more often widow and living alone or in nursing homes. Disease distribution showed that malignancy, diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease were more frequent in men, but hypertension, osteoarthritis, anemia and depression were more frequent in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment evaluated by the Short Blessed Test (SBT), mood disorders by the Geriatric Depression Scale (GDS) and disability in daily life measured by Barthel Index (BI) were worse in women. In-hospital and 3-month mortality rates were higher in men. Conclusions Our study showed a gender dimorphism in the demographic and morbidity profiles of hospitalized elderly people, emphasizing once more the need for a personalized process of healthcare.


2014 - Heart failure and chronic kidney disease in a registry of internal medicine wards [Articolo su rivista]
Mannucci, P. M.; Nobili, A.; Tettamanti, M.; Pasina, L.; Franchi, C.; Salerno, F.; Corrao, S.; Marengoni, A.; Iorio, A.; Marcucci, M.; Sparacio, E.; Alborghetti, S.; Di Costanzo, R.; Djade, C. D.; Prisco, D.; Silvestri, E.; Cenci, C.; Barnini, T.; Delitala, G.; Carta, S.; Atzori, S.; Guarnieri, G.; Zanetti, M.; Spalluti, A.; Serra, M. G.; Bleve, M. A.; Vanoli, M.; Grignani, G.; Casella, G.; Gasbarrone, L.; Maniscalco, G.; Gunelli, M.; Tirotta, D.; Brucato, A.; Ghidoni, S.; Di Corato, P.; Bernardi, M.; Li Bassi, S.; Santi, L.; Agnelli, G.; Marchesini, E.; Mannarino, E.; Lupattelli, G.; Rondelli, P.; Paciullo, F.; Fabris, F.; Carlon, M.; Turatto, F.; Baroni, M. C.; Zardo, M.; Manfredini, R.; Molino, C.; Pala, M.; Fabbian, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Paolisso, G.; Rizzo, M. R.; Laieta, M. T.; Salvatore, T.; Sasso, F. C.; Utili, R.; Mangoni, E. D.; Pinto, D.; Olivieri, O.; Stanzial, A. M.; Fellin, R.; Volpato, S.; Fotini, S.; Barbagallo, M.; Dominguez, L.; Plances, L.; D'Angelo, D.; Rini, G.; Mansueto, P.; Pepe, I.; Licata, G.; Calvo, L.; Valenti, M.; Borghi, C.; Strocchi, E.; Rinaldi, E. R.; Zoli, M.; Fabbri, E.; Magalotti, D.; Auteri, A.; Pasqui, A. L.; Puccetti, L.; Pasini, F. L.; Capecchi, P. L.; Bicchi, M.; Sabba, C.; Vella, F. S.; Marseglia, A.; Luglio, C. V.; Palasciano, G.; Modeo, M. E.; Aquilino, A.; Raffaele, P.; Pugliese, S.; Capobianco, C.; Postiglione, A.; Barbella, M. R.; De Stefano, F.; Fenoglio, L.; Brignone, C.; Bracco, C.; Giraudo, A.; Musca, G.; Cuccurullo, O.; Cricco, L.; Fiorentini, A.; Cappellini, M. D.; Fabio, G.; Seghezzi, S.; De Amicis, M. M.; Fargion, S.; Bonara, P.; Bulgheroni, M.; Lombardi, R.; Magrini, F.; Massari, F.; Tonella, T.; Peyvandi, F.; Tedeschi, A.; Rossio, R.; Moreo, G.; Ferrari, B.; Roncari, L.; Monzani, V.; Savojardo, V.; Folli, C.; Magnini, M.; Mari, D.; Rossi, P. D.; Damanti, S.; Prolo, S.; Lilleri, M. S.; Micale, G.; Podda, M.; Selmi, C.; Meda, F.; Accordino, S.; Conca, A.; Monti, V.; Corazza, G. R.; Miceli, E.; Lenti, M. V.; Padula, D.; Balduini, C. L.; Bertolino, G.; Provini, S.; Quaglia, F.; Murialdo, G.; Bovio, M.; Dallegri, F.; Ottonello, L.; Quercioli, A.; Barreca, A.; Secchi, M. B.; Ghelfi, D.; Chin, W. S.; Carassale, L.; Caporotundo, S.; Anastasio, L.; Sofia, L.; Carbone, M.; Traisci, G.; De Feudis, L.; Di Carlo, S.; Davi, G.; Guagnano, M. T.; Sestili, S.; Bergami, E.; Rizzioli, E.; Cagnoni, C.; Bertone, L.; Manucra, A.; Buratti, A.; Tognin, T.; Liberato, N. L.; Bernasconi, G.; Nardo, B.; Bianchi, G. B.; Ospedale, S. G.; Benetti, G.; Quagliolo, M.; Centenaro, G. R.; Purrello, F.; Di Pino, A.; Piro, S.; Mancuso, G.; Calipari, D.; Bartone, M.; Gullo, F.; Cortellaro, M.; Magenta, M.; Perego, F.; Meroni, M. R.; Cicardi, M.; Magenta, A. G. M.; Sacco, A.; Bonelli, A.; Dentamaro, G.; Rozzini, R.; Falanga, L.; Giordano, A.; Perin, P. C.; Lorenzati, B.; Gruden, G.; Bruno, G.; Montrucchio, G.; Greco, E.; Tizzani, P.; Fera, G.; Di Luca, M. L.; Renna, D.; Perciccante, A.; Coralli, A.; Tassara, R.; Melis, D.; Rebella, L.; Menardo, G.; Bottone, S.; Sferrazzo, E.; Ferri, C.; Striuli, R.; Scipioni, R.; Salmi, R.; Gaudenzi, P.; Gamberini, S.; Ricci, F.; Morabito, C.; Fava, R.; Semplicini, A.; Gottardo, L.; Vendemiale, G.; Serviddio, G.; Forlano, R.; Bolondi, L.; Rasciti, L.; Serio, I.; Masala, C.; Mammarella, A.; Raparelli, V.; Fanelli, F. R.; Delfino, M.; Amoroso, A.; Violi, F.; Basili, S.; Perri, L.; Serra, P.; Fontana, V.; Falcone, M.; Landolfi, R.; Grieco, A.; Gallo, A.; Zuccala, G.; Franceschi, F.; De Marco, G.; Chiara, C.; Marta, S.; Bellusci, M.; Setti, D.; Pedrazzoli, F.; Romanelli, G.; Pirali, C.; Amolini, C.; Rosei, E. A.; Rizzoni, D.; Castoldi, L.; Picardi, A.; Gentilucci, U. V.; Mazzarelli, C.; Gallo, P.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Contini, S.; Molaro, M.; Annoni, G.; Corsi, M.; Zazzetta, S.; Bertolotti, M.; Mussi, C.; Scotto, R.; Ferri, M. A.; Veltri, F.; Arturi, F.; Succurro, E.; Sesti, G.; Gualtieri, U.; Perticone, F.; Sciacqua
abstract

Background: The aim of the present study was to evaluate the association between heart failure (HF) and chronic kidney disease (CKD) in tertiary care centers using the clinical records of patients enrolled in internal medicine departments.Patients and methods: We used the clinical records of 1380 elderly patients to identify patients with a history of HF and CKD using admission ICD codes and glomerular filtration rate (GFR) formulas. Magnitude and strength of such associations were investigated by univariable and multivariable analysis.Results: Of the 1380 patients enrolled, 27.9% had HF (age 80 ± 7, BMI 27 ± 6 kg/m2) and 17.4% CKD (age 81 ± 7, BMI 26.8 ± 6 kg/m2). Both groups were significantly older (P &lt;' 0.0001) with BMI higher than the patients without those diagnosis (P &lt; 0.02). Patients with a history of CKD showed higher non-fasting glycaemia (140 ± 86 vs. 125 ± 63 mg/dL, P &lt; 0.001). CKD was significantly associated with HF (P &lt; 0.0001). Patients with HF had an estimated GFR lower than patients without HF (P &lt; 0.0001). Comorbidity and severity indices were significantly higher in subjects with HF (P &lt; 0.0001) and CKD (P &lt; 0.0001) than in those without. Multivariable analysis showed a significant association between HF and age (for five years increase OR 1.13, P &lt; 0.009), BMI (for each 3 kg/m2 increase OR 1.15, P &lt; 0.001), GFR (for each decrease of 10 mL/min increase OR 0.92, P &lt; 0.002) and severity index (IS) (for each 0.25 units increase OR 1.43, P &lt; 0.001).Conclusion: HF on admission is strongly associated with CKD, older age, BMI, and SI. These data focus the value of epidemiological studies such REPOSI in identifying and monitoring multimorbidity in elderly.


2014 - Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI [Articolo su rivista]
Mannucci, Pier Mannuccio; Nobili, Alessandro; Mannucci, Pier Mannuccio; Nobili, Alessandro; Tettamanti, Mauro; Pasina, Luca; Franchi, Carlotta; Sparacio, Eleonora; Alborghetti, Stefania; Di Costanzo, Rosa; Eldin, Tarek Kamal; Tettamanti, Mauro; Djade, Codjo Djignefa; Salerno, Francesco; Corrao, Salvatore; Marengoni, Alessandra; Marcucci, Maura; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Barnini, Tommaso; Delitala, Giuseppe; Carta, Stefano; Atzori, Sebastiana; Guarnieri, Gianfranco; Zanetti, Michela; Spalluti, Annalisa; Serra, Maria Grazia; Bleve, Maria Antonietta; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Gasbarrone, Laura; Maniscalco, Giorgio; Gunelli, Massimo; Tirotta, Daniela; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Bernardi, Mauro; Bassi, Silvia Li; Santi, Luca; Agnelli, Giancarlo; Iorio, Alfonso; Marchesini, Emanuela; Mannarino, Elmo; Lupattelli, Graziana; Rondelli, Pamela; Paciullo, Francesco; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baroni, Maria Cristina; Zardo, Marianna; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Salvatore, Teresa; Sasso, Ferdinando Carlo; Utili, Riccardo; Mangoni, Emanuele Durante; Pinto, Daniela; Olivieri, Oliviero; Stanzial, Anna Maria; Fellin, Renato; Volpato, Stefano; Fotini, Sioulis; Barbagallo, Mario; Dominguez, Ligia; Plances, Lidia; D’Angelo, Daniela; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Borghi, Claudio; Strocchi, Enrico; Rinaldi, Elisa Rebecca; Zoli, Marco; Fabbri, Elisa; Magalotti, Donatella; Auteri, Alberto; Pasqui, Anna Laura; Puccetti, Luca; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Sabbà, Carlo; Vella, Francesco Saverio; Marseglia, Alessandro; Luglio, Chiara Valentina; Palasciano, Giuseppe; Modeo, Maria Ester; Aquilino, Annamaria; Raffaele, Pallante; Pugliese, Stefania; Capobianco, Caterina; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Fenoglio, Luigi; Brignone, Chiara; Bracco, Christian; Giraudo, Alessia; Musca, Giuseppe; Cuccurullo, Olga; Cricco, Luigi; Fiorentini, Alessandra; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Fargion, Silvia; Bonara, Paola; Bulgheroni, Mara; Lombardi, Rosa; Magrini, Fabio; Massari, Ferdinando; Tonella, Tatiana; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Moreo, Guido; Ferrari, Barbara; Roncari, Luisa; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Mari, Daniela; Rossi, Paolo Dionigi; Damanti, Sarah; Prolo, Silvia; Lilleri, Maria Sole; Cricco, Luigi; Fiorentini, Alessandra; Micale, Giuliana; Podda, Mauro; Selmi, Carlo; Meda, Francesca; Salerno, Francesco; Accordino, Silvia; Conca, Alessio; Monti, Valentina; Corazza, Gino Roberto; Miceli, Emanuela; Lenti, Marco Vincenzo; Padula, Donatella; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Murialdo, Giovanni; Bovio, Marta; Dallegri, Franco; Ottonello, Luciano; Quercioli, Alessandra; Barreca, Alessandra; Secchi, Maria Beatrice; Ghelfi, Davide; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Bergami, Elisabetta; Rizzioli, Emanuela; Cagnoni, Carlo; Bertone, Luca; Manucra, Antonio; Buratti, Alberto; Tognin, Tiziana; Liberato, Nicola Lucio; Bernasconi, Giordano; Nardo, Barbara; Bianchi, Giovanni Battista; Ospedale, Sabrina Giaquinto; Benetti, Giampiero; Quagliolo, Michela; Centenaro, Giuseppe Riccardo; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Gullo, Francesco; Cortellaro, Michele; Magenta, Marina; Perego, ;
abstract

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.


2014 - Nonalcoholic fatty liver disease and aging: epidemiology to management [Articolo su rivista]
Bertolotti, Marco; Lonardo, Amedeo; Mussi, Chiara; Baldelli, Enrica; Pellegrini, Elisa; Ballestri, Stefano; Romagnoli, Dante; Loria, Paola
abstract

Nonalcoholic fatty liver disease (NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic (nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications (cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment (diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.


2014 - Poor diagnostic performance of tilt testing in hypertensive patients with unexplained syncope. [Articolo su rivista]
Ungar, A; Rafanelli, M; Cellai, T; Ceccofiglio, A; Del Rosso, A; Mussi, Chiara; Marchionni, N.
abstract

Syncope is a common condition. Tilt testing with sublingual nitroglycerin (TT-TNT) provides a test with good specificity and positivity rate in young and old patients. Its use in hypertensive patients with unexplained syncope has not been validated. The aims of this study were to evaluate the positivity rate, specificity and tolerability of TT-TNT in hypertensive patients with unexplained syncope. Five hundred and ten subjects (mean age 55 years) were enrolled, 388 patients with unexplained syncope (73 hypertensive and 315 normotensive) and 122 controls (59 hypertensive and 63 normotensive). All subjects underwent TT-TNT. The responses were classified as positive, negative or exaggerated (aspecific). In hypertensive patients, the usual hypotensive therapy was taken on the day of the test. In hypertensive controls, the positive responses were higher than in normotensives (19% vs 6%, P<0.001). The overall specificity was 81% in hypertensives and 94% in normotensives. The positivity rate was significantly lower in hypertensives (55% vs 72%, P<0.03). There was no significant difference between young patients and patients >65 years. TT was well tolerated, and no serious side effects occurred. TT potentiated with TNT has a lower positivity rate and specificity in hypertensive than in normotensive patients with syncope.


2014 - The management of hip fracture in the older population. Joint position statement by Gruppo Italiano Ortogeriatria (GIOG). [Articolo su rivista]
Pioli, G; Barone, A; Mussi, Chiara; Tafaro, L; Bellelli, G; Falaschi, P; Trabucchi, M; Paolisso, G.
abstract

This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Società Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture.


2013 - Choose wisely in geriatrics [Articolo su rivista]
Mussi, C.; Salvioli, G.
abstract


2013 - Differential diagnosis between epilepsy and syncope. The Oesys study (overlapping between epilepsy and syncope study): Preliminary results [Relazione in Atti di Convegno]
La Licata, A.; Pescini, F.; Ceccofiglio, A.; Rafanelli, M.; Mussi, C.; Tava, G.; Noro, G.; Langellotto, A.; Abete, P.; Ruffolo, E.; Chisciotti, V. M.; Brunetti, M. A.; Toffanello, G.; Tesi, F.; Marchionni, N.; Paganini, M.; Ungar, A.
abstract

There are few studies in literature regarding the differential diagnosis between syncope and epilepsy in patients with transient loss of consciousness (T-LOC) of uncertain etiology. Data obtained on few patients, however, seem to show a common "misdiagnosis" of epilepsy (20-30%) in patients with episodes of T-LOC likely to be syncope. For this reason the Italian Group of Syncope in the elderly (GIS) of the Italian Society of Gerontology and Geriatrics has started multicenter study (Overlapping Between Epilepsy and Syncope Study), with the primary purpose to evaluate the efficiency of cardiovascular tests and neuroautonomic assessments in patients diagnosed with T-LOC of epileptic origin and recurrences despite drug therapy, and as a secondary aim, to evaluate the diagnostic and therapeutic impact of the intervention in terms of recurrence of loss of consciousness.


2013 - Hypertensive disease in the elderly: Predictors of clinical evolution in a follow-up study [Abstract in Rivista]
Mussi, C.; Venturelli, F.; Finelli, M. E.; Neviani, F.; Martini, E.; Scotto, R.; Vedele, C.; Patti, C.; Lancellotti, G.; Bertolotti, M.; Neri, M.
abstract

Aims.– Hypertension is the first etiological factor of cerebrovascular disease in the elderly. Aims of the study: – to assess at the follow-up the rates of mortality, morbidity, disability, cognitive deficits; – to identify the major predictors of clinical outcomes. Materials and methods.– Sixty-six patients were recruited in a follow-up study of 2.5 years, (inclusion criteria: age &gt; 60 years, hypertension; MMSE &gt; 15/30; exclusion criteria: high comorbidity index, diabetes, psychiatric disease, severe sensorial impairments), and they were matched with a sample of InChianty Longitudinal Study. Results.– Mortality: no significant differences between expected and observed data (vascularity index (VI) in neuroimaging: main predictor of mortality). Comorbidities: significant reduction of the classes with lower comorbidity, paralleled by an increase of the higher levels of comorbidity. Disability: same trend of comorbidity, namely the significant shifting toward the lowest of the three levels of competence considered; an high VI was a predictor of functional decline as well as the level of cognitive impairment, of arterial stiffness and BMI. Cognitive performance: trend to decline of the overall performance, in both the “bedside” MMSE and the most complex CAMCOG; only long-term memory showed a statistically significant impairment. VI, ApoE and hypercholesterolemia, were the strongest predictors of worsening of cognitive performance. Conclusions.– Hypertensive disease in the elderly could be the source of a significant worsening of the considered outcomes. It is remarkable the reduction of competence in daily activities, explained by the convergence of the condition of frailty and difficulties of adequate response of the health-care system.


2013 - Unexplained falls are frequent in patients with fall-related injury admitted to Orthopaedic wards: the UFO Study (Unexplained Falls in Older patients) [Articolo su rivista]
Mussi, Chiara; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Salvioli, Gianfranco; Niccolò, Marchionni; Andrea, Ungar
abstract

To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.


2012 - DIABETES AND CARDIOVASCULAR EVENTS: USEFULNESS AND LIMITS OF RISK FUNCTIONS [Articolo su rivista]
Bertolotti, Marco; Elisa, Pellegrini; Mauro, Maurantonio; Silvia, Venturi; Ganazzi, Dorval; Carulli, Lucia; Mussi, Chiara; Anzivino, Claudia; Loria, Paola; Carulli, Nicola
abstract

Cardiovascular diseases represent a leading cause of death and disability worldwide. Risk functions and algorithms have been constructed to estimate cardiovascular risk as the weighed sum of different variables, considered as risk factors. Basically all utilized functions consider age, gender, cigarette smoking status, some estimate of systemic blood pressure and of plasma lipid profile, and diabetes. The functions derived from the Framingham study are the most commonly utilized worldwide, even if their applicability to some geographical areas has been heavily questioned. Furthermore, almost all functions, including Framingham’s, consider diabetes only as a dichotomous (yes / no) variable, despite its heavy impact on cardiovascular risk. On the other hand, the risk engine developed by the United Kingdom Prevention of Diabetes Study (UKPDS) takes into account some variables which characterize diabetes and its severity.Evidence from an outpatient population of diabetic subjects in northern Italy has underlined the extreme variability of risk stratification when utilizing different risk functions; whereas anglo-american functions overestimate cardiovascular risk, Italian charts and functions tend to underestimate risk, particularly in women. Estimation of cardiovascular risk is largely dependent on the function adopted, and on the baseline risk of each cohort. Functions should be designed which are geographically homogeneous for a selected population, and which take into account variables that are specific for diabetes. This should hopefully allow appropriate identification of high risk subjects, and ultimately help to optimize the allocation of health care resources.


2012 - Low Muscle Mass in HIV+ Patients: Prevalence, Predictors, and Clinical Implication. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Zona, Stefano; A., Silva; Orlando, Gabriella; Carli, Federica; A., Santoro; N., Crupi; Ligabue, Guido; Mussi, Chiara; L., Ferruci
abstract

In HIV+ patients, muscle mass measured as fat free mass index (FFMi = FFM/h2) in DXA has never been characterized in large epidemiological cohorts. We aimed: to describe the prevalence of low muscle mass using t- and z-score, per age decades, defined as <–2 SD from the mean FFMi for an Italian Caucasian population, respectively, for the same age or in the age strata 30 to 39 years; to identify predictors of FFMi change; and to assess the association between FFMi and all-cause mortality in a large HIV+ cohort.


2012 - Tenofovir accelerates bone mass loss of the lumbar spine in the first years of menopause in HIV infected women. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Garlassi, Elisa; Stentarelli, Chiara; Zona, Stefano; Vescini, F; Mussi, Chiara; Orlando, Gabriella; Carli, Federica; Menozzi, Marianna; Santoro, A; Mussini, Cristina
abstract

Previous studies haveshown that HIV-infected postmenopausal women have higer rates of bone loss than HIV negative women. No studies so far have analyzed the slope of bone loss across the menopausal transition period. We hypothesized that in HIV infected women BMD decreases in the postmenopausal period and Tenofovir exposure may contribute to this impairment. The aim of the study was to identify predictors of BMD in HIV infected women entering menopause and to evaluate the pre- and post- menopausal BMD change.


2011 - Associated factors to post-operative delirium in patients with hip fractures: an orthogeriatric experience. [Abstract in Rivista]
Bertolotti, Marco; Facchini, Mc; Garutti, Anna; Guerzoni, Valentina; Lancellotti, Giulia; Manfredini, Ilenia; Mussi, Chiara; Patti, Corrado; Resta, Gianluca; Scotto, Roberto; Squarzina, Pb; Vedele, Carmen
abstract

The aim of the study was to evaluate the incidence of post-operative delirium and associated factors in patients with hip fracture admitted to an orthogeriatric ward.


2011 - Confusione mentale e delirium [Capitolo/Saggio]
Mussi, Chiara; Salvioli, Gianfranco
abstract

Il capitolo descrive secondo schemi ed algoritmi diagnostici e terapeutici il problema del delirium nell'anziano.


2011 - Health care for older people in Italy: The U.L.I.S.S.E. project (Un Link Informatico sui Servizi Sanitari Esistenti per l'anziano - a computerized network on health care services for older people) [Articolo su rivista]
Lattanzio, F.; Mussi, C.; Scafato, E.; Ruggiero, C.; Dell'Aquila, G.; Cupido, M. G.; Pedone, C.; Mammarella, F.; Galluzzo, L.; Salvioli, G.; Senin, U.; Carbonin, P. U.; Bernabei, R.; Cherubini, A.
abstract

Introduction. The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study aimed at describing older patients cared for in hospitals, home care or nursing homes in Italy. Methods. Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. The only exclusion criterion was age lower than 65 years. The patient's evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results. The older subjects who are in need of acute and long term care in Italy have similar characteristics: mean age is higher than 80 years, they have a high level of disability in ADL, complex multimorbidity, and receive several drugs. The prevalence of cognitive impairment is especially high in nursing homes, where almost 70% of residents suffer from it and 40% have severe impairment. On the other hand, there is a shortage of health care services, which appear heterogeneous and fragmented. Discussion. Health care services for older people in Italy are currently inadequate to manage the complexity of older patients. An important effort should be undertaken to create a more integrated health care system.


2011 - Invecchiamento e alterazioni dell’omeosatsi del colesterolo: studio dei livelli plasmatici degli steroli idrossilati come markers metabolici. [Articolo su rivista]
Bertolotti, Marco; P., Loria; Mussi, Chiara; E., Pellegrini; M., del Puppo; C., Galbusera; S., Ognibene; Carulli, Lucia; Carulli, Nicola
abstract

Objectives: The modifications of cholesterol metabolism which associate with aging are ill-defined. The objective of this study is to define aging-associated alterations of the different metabolic pathways controlling cholesterol homeostasis by analysis of circulating levels of hydroxylated sterols.Methods: We analyzed serum samples from 123 adult subjects (45 male, 78 female, age range 38-78) from the epidemiological M.I.COL. study (Multicentrica Italiana Colelitiasi). The concentrations of the different hydroxysterols, recognized as markers of the main metabolic pathways of cholesterol homeostasis, were determined: synthesis (lathosterol), absorption (campesterol and sitosterol), degradation to bile acids (7alpha-hydroxy-4-cholesten-3-one). Analysis was performed by gas-chromatography - mass spectrometry.Results: a significant correlation was detected between age and cholesterol levels. The lathosterol/cholesterol ratio (an index of cholesterol synthesis) was lower in older (age &gt; 65), compared to younger subjects (10239 vs 12662 microg/100 microg cholesterol; P &lt; 0.05, t test for independent data). A significant inverse correlation was present between the lathosterol/cholesterol ratio and age. The remaining markers did not show significant modifications with aging, even if a trend toward a reduction of cholesterol markers was present.Conclusions: These data, although preliminary, show a reduction of cholesterol synthesis with aging. The finding might be related with a reduced metabolic need for cholesterol in advancing age, leading to a down-regulation of the main mechanisms of cholesterol uptake in the liver. The possible implications in terms of pharmacological management of hypercholesterolemia remain to be defined.


2011 - La valutazione multidimensionale geriatrica. [Capitolo/Saggio]
Mussi, Chiara; Salvioli, Gianfranco
abstract

Il capitolo si propone una dettagliata e schematica descrizione della valutazione multidimensionale geriatrica.


2011 - Two-year morbidity and mortality in elderly patients with syncope. [Articolo su rivista]
A., Ungar; G., Galizia; A., Morrione; Mussi, Chiara; G., Noro; L., Ghirelli; G., Masotti; F., Rengo; N., Marchionni; P., Abete
abstract

BACKGROUND: syncope is a common cause of hospitalisation in the elderly. However, morbidity and mortality in elderly patients with syncope is not well established.METHODS: two-hundred and forty-two patients older than 65 years consecutively referred to the participating centres for evaluation of transient loss of consciousness were enrolled in a multicentre 2-year longitudinal observational study. Mortality and syncope recurrences were recorded and multidimensionally evaluated at 6, 12, 18 and 24 months. Findings: at 24 months, total mortality was 17.2% and syncope recurrence was 32.5%. Cardiac syncope was more frequent in deceased than in survivor patients (21.7 versus 12.3%; P = 0.03), whereas neuro-mediated (62.1 versus 66.2%; P = 0.357) and unexplained syncope (10.8 versus 11.8%; P = 0.397) did not differ between the two groups. Drug-induced and/or multifactorial syncope was less frequent in patients with syncope recurrence (5.7 versus 10.7%; P = 0.02). Kaplan-Meyer curves indicated that mortality and syncope recurrence increased significantly with age (P = 0.006 and P = 0.008, respectively). At multivariate analysis, mortality was significantly predicted by age and comorbidity (hazard ratios: 1.17 and 1.39, and 95% confidence interval 1.01-1.37 and 1.01-1.93, respectively), and syncope recurrence by age and disability (hazard ratio: 1.13 and 1.04, 95% confidence interval 1.01-1.25 and 1.04-2.25, respectively). Depression increased from baseline to the end of follow-up (from 28.3 to 41.4%; P = 0.001).CONCLUSIONS: in our patients, mortality was related to increasing age and comorbidity, whereas recurrence was related to increasing age and disability. Cardiac syncope was more frequent in deceased than in survivor patients, and syncope recurrence was high despite a low incidence of unexplained syncope.


2011 - Usefullness of a “cardiogeriatric” outpatient clinic in a third world country: an experience in Tanzania. [Abstract in Rivista]
Bertolotti, Marco; Garutti, Anna; Manfredini, Ilenia; Mussi, Chiara; Patti, Corrado; Resta, Gianluca; Scotto, Roberto; Vedele, Carmen
abstract

The aim of the study was to describe the usefullness of a “cardiogeriatric” outpatient clinic in a third world country, in particular in a developing country like Tanzania.


2010 - Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study. [Articolo su rivista]
Ungar, A; Del Rosso, A; Giada, F; Bartoletti, A; Furlan, R; Quartieri, F; Lagi, A; Morrione, A; Mussi, Chiara; Lunati, M; De Marchi, G; De Santo, T; Marchionni, N; Brignole, M.
abstract

ims We evaluated the early (1 month) and late (2 years) death rate and syncopal relapses of patients referred for syncope to 11 general hospitals emergency departments. Patients were enrolled in the Evaluation of Guidelines in SYncope Study 2 (EGSYS 2) study. The guidelines of the European Society of Cardiology were strictly followed in the management of patients. Methods and results Out of the 465 patients enrolled in the EGSYS 2 study, 398 (86%) underwent a complete follow-up. We excluded 18 patients with non-syncopal attacks. Among the remaining 380 patients, death of any cause occurred in 35 (9.2%). The mean follow-up was 614 +/- 73 days. Six deaths (17% of total) occurred during the first month of follow-up. Patients who died were older, had a higher incidence of structural heart disease and/or abnormal ECG, had injuries related to syncope and higher EGSYS score. Syncope recurred in 63 (16.5%) patients. Syncopal relapses occurred in only one patient during the first month of follow-up. The incidence of syncopal recurrences was unrelated to the mechanism of syncope. No clinical differences were found between patients with or without syncopal recurrence and in patients with EGSYS score < or >/=3. Conclusion A peak of cardiovascular mortality but not of syncopal recurrences was observed in patients attending to the emergency department for syncope within the first month. Late unfavourable outcomes were caused by associated cardiovascular diseases rather than by the mechanism of syncope. The causes of syncope did not determine the recurrence rate.


2010 - Health care for older people in Italy: The ULISSE project (Un Link Informatico sui Servizi Sanitari Esistenti per l'anziano - a computerized network on health care services for older people) [Articolo su rivista]
Lattanzio, F; Mussi, Chiara; Scafato, E; Ruggiero, C; Dell'Aquila, G; Pedone, C; Mammarella, F; Galluzzo, L; Salvioli, Gianfranco; Senin, U; Carbonin, Pu; Bernabei, R; Cherubini, A.
abstract

he U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy.The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study.Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study.The patient's evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires.The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented.Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system.


2010 - Invecchiamento ed alterazioni dell’omeostasi del colesterolo: studi dei livelli plasmatici degli steroli idrossilati come markers metabolici. [Abstract in Rivista]
Bertolotti, Marco; Loria, Paola; Pellegrini, E; Mussi, Chiara; Del Puppo, M; Galbusera, G; Ognibene, S; Carulli, Lucia; Carulli, Nicola
abstract

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2010 - Lancellotti G, Bergamini L, Finelli ME, Guerzoni V, Mannina M, Zanasi A, Facchini MC, Squarzina PB, Bertolotti M, Mussi C. Fattori associati al delirium post-chirurgico in pazienti fratturati di femore: l’esperienza in ortogeriatria. [Abstract in Rivista]
Lancellotti, Giulia; Bergamini, Lucia; Finelli, Maria Elisa; Guerzoni, Valentina; Mannina, Massimo; Zanasi, Andrea; Facchini, Mc; Squarzina, Pb; Bertolotti, Marco; Mussi, Chiara
abstract

Il lavoro si propone di studiare le caratteristiche cliniche del delirium post-chirurgico nei pazienti anziani con frattura di femore secondaria a caduta.


2010 - Principali malattie cardiovascolari nell'anziano. [Capitolo/Saggio]
Mussi, Chiara
abstract

Il capitolo si propone di fornire informazioni utili agli operatori sanitari, in particolare agli infermieri, riguardanti gli aspetti dell'assistenza all'anziano in riferimento a specifiche patologie cardiovascolari (fibrillazione atriale, tromboembolia, sincope, ecc.).


2009 - Falls in the elderly in various curative-medical care environment: Is it possible to prevent them? [Relazione in Atti di Convegno]
Belloi, L.; Isaia, G.; Mussi, C.
abstract


2009 - I farmaci utilizzati nella pratica clinica nei pazienti con fibrillazione atriale cronica: luci e ombre. [Abstract in Rivista]
Scotto, Roberto; Manfredini, Ilenia; Minnucci, Alessandra; Resta, Gianluca; Vaccina, Antonella Rita; Vedele, Carmen; Mussi, Chiara
abstract

Il lavoro si propone di valutare l'adesione alle linee guida della prescrizione della terapia anticoagulante orale nella fibrillazione atriale cronica in una popolazione anziana afferente all'ambulatorio di Cardiogeriatria.


2009 - Ipotensione ortostatica: diagnosi e terapia. [Capitolo/Saggio]
R., Furlan; G., Micieli; Mussi, Chiara
abstract

Il capitolo tratta della diagnosi e terapia delle sincopi da ipotensione ortostatica.


2009 - La trombocitopenia nell’anziano: prevalenza e implicazioni cliniche in una popolazione anziana ospedalizzata in un reparto di Ortogeriatria. [Abstract in Rivista]
Manfredini, Ilenia; Vedele, Carmen; Scotto, Roberto; Resta, Gianluca; Minnucci, Alessandra; Vaccina, Antonella Rita; Mussi, Chiara
abstract

Il lavoro studia la prevalenza e le caratteristiche cliniche dei pazienti con trombocitopenia indotta dalle eparine a basso PM in una popolazione anziana ricoverata nel reparto di Ortopedia per frattura di femore conseguente a caduta.


2009 - La variabilità della frequenza cardiaca: un importante predittore di mortalità nella popolazione anziana ambulatoriale. [Abstract in Rivista]
Minnucci, Alessandra; Scotto, Roberto; Resta, Gianluca; Manfredini, Ilenia; Vaccina, Antonella Rita; Vedele, Carmen; Mussi, Chiara
abstract

Il lavoro si propone di studiare le caratteristiche cliniche dei pazienti con bassa variabilità della frequenza cardiaca reclutati in un ambulatoro di cardiogeriatria e la mortalità ad un anno di questa popolazione.


2009 - Le cadute in ospedale; uno studio osservazionale presso il Nuovo Ospedale S.Agostino-Estense di Modena. [Abstract in Rivista]
Resta, Gianluca; Scotto, Roberto; Manfredini, Ilenia; Minnucci, Alessandra; Vedele, Carmen; Vaccina, Antonella Rita; Mussi, Chiara
abstract

Lo studio osservazionale si propone di rilevare l'incidenza di cadute in una popolazione anziana ricoverata in reparti per acuti e le caratteristiche cliniche dei pazienti con caduta.


2009 - Orthostatic Hypotension As Cause of Syncope in Patients Older Than 65 Years Admitted to Emergency Departments for Transient Loss of Consciousness. [Articolo su rivista]
Mussi, Chiara; Ungar, A; Salvioli, Gianfranco; Menozzi, C; Bartoletti, A; Giada, F; Lagi, A; Ponassi, I; Re, G; Furlan, R; Maggi, R; Brignole, M.
abstract

Syncope due to orthostatic hypotension (OH) refers to loss of consciousness caused by hypotension induced by the upright position; it is an important risk factor for fall-related physical injuries, especially in the elderly adults. We evaluated the prevalence of OH syncope and the clinical characteristics of patients older than 65 years with syncope due to OH in the Evaluation of Guidelines in Syncope Study 2 group population.Two hundred fifty nine patients older than 65 years consecutively admitted to the emergency department because of loss of consciousness in a period of a month were submitted to a standardized protocol approved by the European Task Force for the diagnosis of syncope; all the patients were studied by a trained physician who interacted with a central supervisor as the management of syncope was concerned, using a decision-making software.Prevalence of OH syncope was 12.4%. Patients with OH syncope were more likely to be affected by Parkinson's disease and by other neurological diseases. ST changes and longer values of QTc were found in OH syncope group, and they took a greater number of diuretics, nitrates, and digoxin. In multivariate analysis, Parkinson's disease (p = .001) and use of nitrates (p = .001) and diuretics (p = .020) were independently related to OH syncope.In patients older than 65 years, Parkinson's disease and neurological comorbidity are strictly related to OH syncope. Moreover, this study suggests the independent link between OH syncope and the use of vasoactive drugs, identifying the majority of cases as adverse drug reaction, a preventable risk factor for syncope and falls in the older population.


2009 - Potentially Inappropriate Medications and Functional Decline in Elderly Hospitalized Patients [Articolo su rivista]
Corsonello, A; Pedone, C; Lattanzio, F; Lucchetti, M; Garasto, S; Di Muzio, M; Giunta, S; Onder, G; Di Iorio, A; Volpato, S; Corica, F; Mussi, Chiara; Antonelli Incalzi, A.
abstract

To verify whether the use of potentially inappropriate medications (PIMs) is associated with loss of independence in elderly in-patients by promoting adverse drug reactions (ADRs).Prospective observational study.Five hundred six patients aged 65 and older admitted to 11 acute care medical wards.In-hospital loss of one or more activities of daily living (ADLs) and three or more ADLs. PIMs were identified according to diagnosis-independent Beers criteria and ascertained by study physicians based on daily review of medical and nurse records. The relationship between risk factors and outcomes was assessed using logistic regression.Overall, 104 patients (20.6%) were taking at least one PIM at the time of admission (baseline users), and 49 (9.7%) were newly prescribed at least one PIM during their hospital stay. The loss of one or more ADLs occurred in 9.6% of baseline users, 16.3% of new users, and 8.5% of nonusers (P=.21) and that of three or more ADLs in 7.7% of baseline users, 12.2% of new users, and 4.8% of nonusers (P=.10). The lack of association was confirmed after correction for potential confounders, including ADRs. The occurrence of ADRs was strongly associated with both outcomes (odds ratio (OR)=7.80, 95% confidence interval (CI)=3.53-17.3 for the loss of >= 1 ADLs; OR=3.98, 95% CI=1.50-10.5 for the loss of >= 3 ADLs), but PIMs caused only six of 106 ADRs.ADRs to any drugs more than the use of PIMs might be associated with functional decline in elderly hospitalized patients, but because the power of this study was too limited to definitively exclude a direct relationship between PIMs and functional decline, this merits further investigation.


2009 - Role of Early Symptoms in Assessment of Syncope in Elderly People: Results from the Italian Group for the Study of Syncope in the Elderly. [Articolo su rivista]
Galizia, G; Abete, P; Mussi, Chiara; Noro, G; Morrione, A; Langellotto, A; Landi, A; Cacciatore, F; Masotti, G; Rengo, F; Marchionni, N; Ungar, A.
abstract

To assess the ability of specific early symptoms to predict cardiac and noncardiac syncope in elderly people.Multicenter cross-sectional observational study.Inpatient geriatric acute care departments and outpatient clinics.Two hundred forty-two patients with syncope (mean age 79 +/- 8) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the Italian Group for the Study of Syncope in the Elderly (GIS Study).All patients were assessed according to European Society of Cardiology Syncope guidelines and interviewed about symptoms and signs present before syncope.One hundred seventy-four of 242 patients (75.4%) had noncardiac syncope, and 34 (14.7%) had cardiac syncope; 165 patients (71.1%) related symptoms before the loss of consciousness. When elderly patients with syncope were stratified for the presence and absence of symptoms, noncardiac syncope showed the highest prevalence of symptoms (75.3%, P <.01). Awareness of being about to faint, sweating, blurred vision, and nausea are more prevalent in noncardiac syncope. Dyspnea is more prevalent in cardiac syncope. All symptoms except awareness of being about to faint and weakness had good specificity, but sensitivity was low for all symptoms considered. Multivariate regression analysis adjusted for sex and age indicated that nausea (relative risk (RR)=3.7, 95% confidence interval (CI)=1.26-11.2), blurred vision (RR=3.5, 95% CI=1.34-9.59), and sweating (RR=2.8, 95% CI=.21-6.89) were predictive of noncardiac syncope. Dyspnea (RR=5.5, 95% CI=1.0-30.2) was the only symptom predictive of cardiac syncope.


2009 - Situazioni cliniche particolari: sincope in pazienti anziani. [Capitolo/Saggio]
Mussi, Chiara; A., Ungar; E., Ruffolo; A., Lagi
abstract

Il capitolo riguarda la sincope nel paziente anziano, con particolare riferimento agli effetti avversi dei farmaci.


2009 - Situazioni cliniche particolari: sincope ipotensiva ed ipertensione. [Capitolo/Saggio]
A., Lagi; Mussi, Chiara; Cortelli, Pietro
abstract

Il capitolo descrive come definire e gestire situazioni cliniche particolari, come l'associazione tra ipertensione arteriosa e ipotensione ortostatica.


2008 - Elderly and emergency department: The Triage [Articolo su rivista]
Mussi, C.; Pinelli, G.; Annoni, G.
abstract


2008 - Geriatrics in the primary care [Articolo su rivista]
Mussi, C.; Salvioli, G.
abstract


2008 - Il cateterismo vescicale nella pratica clinica geriatrica. [Abstract in Rivista]
Manfredini, Ilenia; Scotto, Roberto; Maurizio, Luca; Mussi, Chiara
abstract

Lo studio osservazionale si propone di valutare l'aderenza alle linee guida per il posizionamento del catetere vescicale in una popolazione anziana ospedalizzata.


2008 - Il protocollo ortogeriatrico intraospedaliero: valutazione della sua efficacia. [Relazione in Atti di Convegno]
Lancellotti, Giulia; Maria Cristina, Facchini; Scotto, Roberto; Mussi, Chiara
abstract

La relazione descrive le caratteristiche, l'organizzazione e i risultati preliminari del Progetto Ortogeriatria del Nuovo Ospedale S. Agostino Estense a Baggiovara.


2008 - Influence of comorbidity and cognitive status on instrumental activities of daily living in amnestic mild cognitive impairment: Results from the ReGA1 project [Articolo su rivista]
Mariani, E.; Monastero, R.; Ercolani, S.; Rinaldi, P.; Mangialasche, F.; Costanzi, E.; Vitale, D. F.; Senin, U.; Mecocci, P.; Gabelli, C.; Codemo, A.; Marinelli, K.; Capurso, A.; Cucinotta, D.; Reggiani, A.; Ellena, L.; Zanetti, O.; Putzu, P.; Del Prete, M.; Spaccamento, S.; Abate, G.; Di Iorio, A.; Cester, A.; Formilan, M.; Busonera, F.; Anzivino, F.; Masotti, G.; Cavallini, C.; Mossello, E.; Odetti, P.; Cataldi, A. G.; Pippi, M.; Estraneo, A.; Sica, G.; Renna, S.; Nicita-Mauro, V.; Basile, G.; Salvioli, G.; Mussi, C.; Ascari, S.; Casale, R.; Frazzitta, G.; Scognamiglio, M.; Di Palma, A.; Rengo, F.; Canonico, V.; Fortunato, F.; Enzi, G.; Giordano, M.; Vitrano Catania, T.; Ferrari, E.; Cuzzoni, G.; Del Re, M. L.; Guizzardi, G.; Biagini, C.; Bavazzano, A.; Ferrari, A.; Dallari, A.; Carbonin, P.; Bernabei, R.; Silveri, M. C.; Bartorelli, L.; Gandolfi, B.; Cerqua, R.; Pilotto, A.; Cascavilla, L.; Chiaranti, A.; Marinelli, M.; Tripi, G.; Gallucci, M.; Marchetti, C.; Masiello, V.; Sacco, D.; Ricci, G.
abstract

Objectives: To investigate whether amnestic mild cognitive impairment (aMCI) is characterised by restriction in instrumental activities of daily living (IADL). Further, to examine the role of comorbidity and cognitive performance on IADL changes in aMCI subjects. Methods: The study included 132 subjects with aMCI and 249 subjects with no cognitive impairment (NCI), consecutively enrolled as outpatients in a multicentric Italian clinical-based study, the ReGAl Project. All subjects underwent a comprehensive evaluation including clinical examination, laboratory screening, neuroimaging and cognitive and behavioral assessments. Functional status was evaluated by the Lawton's Instrumental Activities of Daily Living (IADL) scale. Comorbidity was evaluated by the Comulative Illness Rating Scale (CIRS). Cognitive evaluation included tests assessing episodic memory, language, attention/ executive functioning and praxis, as well as the the Mini-Mental State Examination (MMSE) as a measure of global cogniton. Results: Subjects with aMCI had higher IADL changes than NCI. Among IADL items, aMCI subjects showed a significant impairment in shopping, taking drugs, and handling economy; however also NCI had minor IADL changes regarding cooking, washing and cleaning. IADL restriction in aMCI subjects was significantly associated with cognitive performance, mainly related to executive functioning, but not with comorbidity. On the contrary, in NCI sensory impairment accounts for slight IADL changes. Conclusion: In aMCI subjects a mild degree of cognitive deterioration has a stronger impact on IADL than somatic comorbidity. Current diagnostic criteria for MCI should include a mild impairment in IADL. Copyright © 2007 John Wiley &amp; Sons, Ltd.


2008 - Personal Digital Assistant-PDA: un nuovo strumento per una corretta terapia nel paziente anziano con scompenso cardiaco congestizio. [Articolo su rivista]
Zanasi, Andrea; Salvioli, Gianfranco; Mussi, Chiara
abstract

Il lavoro si propone di dimostrare l'utilità di metodiche i-tech, come il Personal Digitant Assistant, nella gestione del paziente anziano con patologie croniche, con particolare riferimento allo scompenso cardiaco.


2008 - Personal Digital Assistant: A new tool for appropriate prescription in older patients with heart failure [Articolo su rivista]
Zanasi, A.; Salvioli, G.; Mussi, C.
abstract


2008 - Technology at patient's bed: Usefulness in Geriatric Medicine [Articolo su rivista]
Mussi, C.; Salvioli, G.
abstract


2007 - A retrospective study on heat-related mortality in an elderly population during the 2003 heat wave in Modena, Italy: the Argento Project. [Articolo su rivista]
Foroni, M; Salvioli, Gianfranco; Rielli, R; Goldoni, Ca; Orlandi, G; Zauli Sajani, S; Guerzoni, A; Maccaferri, C; Daya, G; Mussi, Chiara
abstract

BACKGROUND: Summer 2003 witnessed an excess in heat-related mortality in the elderly population. The Argento Project was planned to define risk factors for heat-related death in Modena, Italy, during the hottest month of 2003 (August).METHODS: We performed a retrospective, case-control study of a cohort of 394 older persons living in Modena, 197 dead (cases) and 197 survivors (controls). A questionnaire to collect information about demographic, social, environmental, and clinical characteristics and about causes of death was completed.RESULTS: Cases were more likely to be living in a nursing home and needing assistance (p =.024, and p <.001, respectively). Survivors were living on higher level floors (p =.046). Spending the summer in Modena was significantly related to poor outcomes (p <.01). A higher number of cases were using public health services (p <.001). Individuals who died had a greater degree of comorbidity and dependence (p <.001); they were cognitively impaired (p <.001), took a larger number of drugs (p <.001), and had a greater number of hospital admissions (p <.001). Multivariate analysis showed that patients who spent the summer in Modena had a higher mortality. Other predictors of death were the use of home public-integrated assistance, a higher comorbidity and a higher degree of disability; the loss of at least 1 Activity of Daily Living (ADL) represents the strongest risk factor of heat-related death.CONCLUSIONS: Our study identifies the major risk factors of heat-related death in the elderly population. With the creation of an up-to-date database, when a new heat wave will come, it will be possible to identify frail persons for preventive targeted strategies.


2007 - La valutazione antropometrica e il fabbisogno calorico nell’anziano nei diversi setting curativi ed assistenziali: sono indispensabili nella pratica clinica? [Articolo su rivista]
Foroni, Micaela; M., Luca; C., Pifferi; Mussi, Chiara
abstract

Il lavoro si propone di descrivere l'importanza della valutazione antropometrica e della corretta valutazione nutrizionale in una popolazione anziana.


2007 - Relation of neurocardiovascular instability to cognitive, emotional and functional domains [Articolo su rivista]
Bendini, Chiara; Angelini, A; Salsi, F; Finelli, Me; Martini, E; Neviani, Francesca; Mussi, Chiara; Neri, Mirco
abstract

There is bulk of evidence suggesting that blood pressure dysregulation, as low blood pressure (LBP) or hypotension, orthostatic hypotension (OH) and high blood pressure (HPB) or hypertension are associated with alterations in cognitive and emotional domains. Some studies suggest that LBP, neurocardiovascular instability, like the OH, and atherosclerosis resulting from long standing HBP, reduces cerebral blood flow, increasing the risk of cognitive impairment, morbidity and mortality. This study aims to evaluate whether patients with cognitive impairment and cardiovascular disease would show any differences in some anamnestic indicators and/or psychometric measures of cognitive performance and affective symptoms. We recruited 36 patients over 65 years of age admitted to both psycho- and cardio-geriatric ambulatories of our hospital during the last year. The population (mean age of 80.5 years, 72.2% females, 27.8% males) was divided in 2 groups, with OH (25%), and without OH (75%). The first group was subdivided in subgroups: patients with HBP, normal BP and LBP, respectively. Cognitive and depressive domains were assessed with the mini mental state examination (MMSE) and the Italian "scala di valutazione del benessere emotivo nell'anziano" (SVEBA). Information about the present status, comorbidities (cumulative illness rating scale = CIRS), functional ability (activities of daily living = ADL, instrumental ADL = IADL) and drugs were collected during clinical examination. BP was measured 4 times, at the beginning of examination, then with the patient in clinostatic and orthostatic position (1(st) and 3(rd) minute). Data were analyzed by MANCOVA, considering age and gender as covariates, MMSE, SVEBA, CIRS, ADL, IADL and drugs as dependent variables, and presence/absence of OH as factor. Covariates were not significant sources of variance, as well as overall factor. Due to the heuristic aim of the study, we considered of interest the results of subsequent ANOVAs showing significant differences in SVEBA and ADL with respect to the factor. These data give us the basis to develop a longitudinal study to confirm the detrimental effect of OH on a wide range of health domains.


2007 - Subject classification obtained by cluster analysis and principal component analysis applied to flow cytometric data [Articolo su rivista]
Lugli, Enrico; Pinti, Marcello; Nasi, Milena; Troiano, Leonarda; Ferraresi, Roberta; Mussi, Chiara; Salvioli, Gianfranco; Patsekin, V; Robinson, Jp; Durante, Caterina; Cocchi, Marina; Cossarizza, Andrea
abstract

BACKGROUND: Polychromatic flow cytometry (PFC) allows the simultaneous determination of multiple antigens in the same cell, resulting in the generation of a high number of subsets. As a consequence, data analysis is the main difficulty with this technology. Here we show the use of cluster analysis (CA) and principal component analyses (PCA) to simplify multicolor data visualization and to allow subjects' classification. METHODS: By eight-colour cytofluorimetric analysis, we investigated the T cell compartment in donors of different age (young, middle-aged, and centenarians). T cell subsets were identified by combining positive and negative expression of antigens. The resulting data set was organized into a matrix and subjected to CA and PCA. RESULTS: CA clustered people of different ages on the basis of cytofluorimetric profile. PCA of the cellular subsets identified centenarians within a different cluster from young donors, while middle-aged donors were scattered between these groups. These approaches identified T cell phenotypes that changed with increasing age. In young donors, memory T cell subsets tended to be CD127+ and CD95- whereas CD127-, CD95+ phenotypes were found at higher frequencies in people with advanced age. CONCLUSIONS: Our data suggest the use of bioinformatic approaches to analyze large data-sets generated by PFC and to obtain the rapid identification of key populations that best characterize a group of subjects. (c) 2007 International Society for Analytical Cytology.


2007 - The oral cavity [Articolo su rivista]
Ferrari, E.; Salvioli, P.; Mussi, C.
abstract

According to WHO the health of the mouth, teeth and associated structures and their functional viability should be improved in the old people; oral conditions can have serious, disabling effects. Dental status is associated with high overall mortality. A more in depth attention to oral status and pathologies should be reccomended in older people; in particular infections, xerostomia, swallowing disorders should be avoided or prevented with appropriated and some time omitted intervention. The problems are more important in nursing homes.


2006 - A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. [Articolo su rivista]
Brignole, M; Menozzi, C; Bartoletti, A; Giada, F; Lagi, A; Ungar, A; Ponassi, I; Mussi, Chiara; Maggi, R; Re, G; Furlan, R; Rovelli, G; Ponzi, P; Scivales, A.
abstract

Aims. The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting. Methods and results Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3-9). Apart from the initial evaluation, a mean of 1.9 +/- 1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%). Conclusion. The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope.


2006 - Diagnosis and characteristics of syncope in older patients referred to geriatric departments [Articolo su rivista]
Ungar, Andrea; Mussi, Chiara; Del Rosso, Attilio; Noro, Gabriele; Abete, Pasquale; Ghirelli, Loredana; Cellai, Tommaso; Landi, Annalisa; Salvioli, Gianfranco; Rengo, Franco; Marchionni, Niccolò; Masotti, Giulio
abstract

OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients. DESIGN: Multicenter cross-sectional observational study. SETTING: In-hospital geriatric acute care departments and outpatient clinics. PARTICIPANTS: Two hundred forty-two patients (aged>or=65, mean+/-standard deviation=79+/-7, range 65-98) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the study. Of these, 11 had a syncope-like condition (5 transient ischemic attack; 6 seizures), and 231 had syncope (aged 65-74, n=71; aged>or=75, n=160). MEASUREMENTS: Protocol designed to define etiology and clinical characteristics of syncope derived from European Society of Cardiology Guidelines on syncope. RESULTS: No major complication occurred with use of the protocol. Neurally mediated was the more prevalent form of syncope in this population (66.6%). Cardiac causes accounted for 14.7% of all cases. The neuroreflex form of syncope (vasovagal, situational, and carotid sinus syndrome) was more common in younger than in older patients (62.3% vs 36.2%; P=.001), whereas orthostatic syncope was more frequent in the older than in the younger group (30.5% vs 4.2%; P<.001). In only 10.4% of cases, syncope remained of unexplained origin. After initial evaluation, a definite diagnosis was possible in 40.1% of the cases, and a suspected diagnosis was obtained in 57.9%. Syncope of suspected cardiac origin after initial evaluation was confirmed in 43.7% of cases, and neuromediated causes were confirmed in 83.5% of the cases. CONCLUSION: The protocol is applicable even beyond the age of 90 in geriatric departments. The standardized protocol is associated with a reduction in the frequency of unexplained syncope to about 10%.


2006 - Frailty of older age: The role of the endocrine - Immune interaction [Articolo su rivista]
Paganelli, R; Di Iorio, A; Cherubini, A; Lauretani, F; Mussi, Chiara; Volpato, S; Abate, M; Abate, G; Ferrucci, L.
abstract

The so-called demographic transition has changed the age structure of the population worldwide, with profound effects on societal organization. The growing number and percentage of old and very old people has compelled the scientific community to focus on age related diseases and peculiar consequences of aging itself such as disability and frailty. Understanding the pathophysiology of frailty, a syndrome characterized by a reduced functional reserve and impaired adaptive capacity that results from cumulative declines of multiple subsystems, and causes increased vulnerability to adverse outcomes, is a major topic in aging research. Aging processes induce multiple changes in the hormones network (menopause, andropause, somatopause and adrenopause), in the immune system, and can modulate their efficiency and effectiveness in determining a response to stressors. These triggering events can unmask frailty-in older people. Starting from these assumptions, we analyzed the relationship of the endocrine and immune networks in aging and in the different domains that are characteristically associated with the frailty syndrome, such as disability and sarcopenia, as well as in diseases related to aging such as Alzheimer's dementia and Congestive Heart Failure.


2006 - Ipotensione ortostatica iatrogena: difficoltà diagnostiche e problemi culturali. [Articolo su rivista]
Mussi, Chiara
abstract

Il lavoro si propone di descrivere l'ipotensione ortostatica come effetto avverso da farmaci e potenziale fattore di rischio di caduta in una popolazione anziana.


2006 - L’anziano fragile e il paziente anziano fragile: solo problema terminologico? G Gerontol 2006; 54: 255-259. [Articolo su rivista]
Foroni, Micaela; Mussi, Chiara; E., Erzili; Salvioli, Gianfranco
abstract

Il lavoro si propone di descrivere il conceto di fragilità in relazione al paziente anziano in termini non solo semantici, ma clinici e fisiopatologici.


2006 - Role of renal failure in the pathogenesis of adverse drug reactions in the elderly [Articolo su rivista]
Corsonello, A.; Pedone, C.; Corica, F.; Mazzei, B.; Mussi, C.; Di Iorio, A.; Incalzi, R. A.
abstract

The high prevalence of multiple chronic disorders and polypharmacotherapy expose elderly patient to an increased risk of adverse drug reactions. Aging is associated with relevant morphological and functional changes in the kidney, with consequent changes in the pharmacokinetics of hydrosoluble drugs. Changes in renal function are not always clinically evident, and a concealed renal failure can lead to an increased risk of adverse drug reactions to hydrosoluble drugs. Targeting these at-risk patients could contribute to reduce the risk of adverse drug reactions with relevant cost saving.


2006 - Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals [Articolo su rivista]
Brignole, M; Ungar, A; Bartoletti, A; Ponassi, I; Lagi, A; Mussi, Chiara; Ribani, Ma; Tava, G; Disertori, M; Quartieri, F; Alboni, P; Raviele, A; Ammirati, F; Scivales, A; De Santo, T.
abstract

Aims. The study hypothesis was that a decision-making approach improves diagnostic yield and reduces resource consumption for patients with syncope who present as emergencies at general hospitals. Methods and results. This was a prospective, controlled, multi-centre study. Patients referred from 5 November to 7 December 2001 were managed according to usual practice, whereas those referred from 4 October to 5 November 2004 were managed according to a standardized-care pathway in strict adherence to the recommendations of the guidelines of the European Society of Cardiology. In order to maximize its application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correct application. The 'usual-care' group comprised 929 patients and the 'standardized-care' group 745 patients. The baseline characteristics of the two study populations were similar. At the end of the evaluation, the standardized-care group was seen to have a lower hospitalization rate (39 vs. 47%, P = 0.001), shorter in-hospital stay (7.2 +/- 5.7 vs. 8.1 +/- 5.9 days, P = 0.04), and fewer tests performed per patient (median 2.6 vs. 3.4, P = 0.001) than the usual-care group. More standardized-care patients had a diagnosis of neurally mediated (65 vs. 46%, P = 0.001) and orthostatic syncope (10 vs. 6%, P = 0.002), whereas fewer had a diagnosis of pseudo-syncope (6 vs. 13%, P = 0.001) or unexplained syncope (5 vs. 20%, P = 0.001). The mean cost per patient and the mean cost per diagnosis were 19 and 29% lower in the standardized-care group (P = 0.001). Conclusion. A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.


2006 - The association between anemia and physical disability in older patients: the role of comorbidity. [Articolo su rivista]
Maraldi, C; Ble, A; Zuliani, G; Guralnik, Jm; Mussi, Chiara; Fellin, R; Volpato, S.
abstract

Background and aims: In older persons, anemia is a common medical disorder and is often associated with comorbidity and poor health outcomes. We evaluated the relationship between anemia and physical disability in a sample of older hospitalized patients, taking into account the role of comorbidity. Methods: Cross-sectional analysis of the baseline data of the Italian Group of Pharmacoepidemiology in the Elderly Study. Patients aged 65 years or older (n=10,903), admitted to participating centers in the 1993-1998 survey period, were included. Anemia was defined according to the World Health Organization (WHO) criteria; physical disability was defined as need for assistance in performing at least one Activity of Daily Living (ADL) in the week before admission. Comorbidity was ascertained using the Charlson Index. Results: Prevalence of anemia was 41.1%. In the unadjusted analysis, anemia was associated with increased likelihood of disability, in both women (Odds Ratio [OR]: 1.54; 95% Confidence Interval [Cl]: 1.38-1.71) and men (OR 1.70; CI 1.52-1.90). After inclusion of demographics and life-style factors in multiuariate analysis, the strength of association was only modestly attenuated, whereas nutritional factors and disease-related variables resulted in a greater reduction of the strength of association. In analyses stratified by comorbidity severity, the association between anemia and disability was statistically significant only in patients with the lowest comorbidity levels (p for anemia*Charlson Index interaction term < 0.05, in both women and men). Conclusions: Among hospitalized subjects, anemia is associated with ADL disability. The disablement process associated with anemia may be partially explained by nutritional and disease-related factors. However, anemia appears to have an independent effect, particularly in subjects with low comorbidity.


2006 - Thymic output and functionality of the IL-7/IL-7 receptor system in centenarians: implications for the neolymphogenesis at the limit of human life [Articolo su rivista]
Nasi, Milena; Troiano, Leonarda; E., Lugli; Pinti, Marcello; Ferraresi, Roberta; Monterastelli, Elena; Mussi, Chiara; Salvioli, Gianfranco; Franceschi, Claudio; Cossarizza, Andrea
abstract

During aging, the thymus undergoes a marked involution that is responsible for profound changes in the T-cell compartment. To investigate the capacity of the thymus to produce new cells at the limit of human lifespan, we analyzed some basic mechanisms responsible for the renewal and maintenance of peripheral T lymphocytes in 44 centenarians. Thymic functionality was analyzed by the quantification of cells presenting the T-cell receptor rearrangement excision circles (TREC). A new method based upon real-time PCR was used, and we found that most centenarians (84%) had undetectable levels of TREC+ cells. Six-color cytofluorimetric analysis revealed that centenarians had an extremely low number of naive T cells; central memory and effector memory T cells were greatly increased, while terminally differentiated cells were as numerous as in young (aged 20-45) or middle-aged (aged 58-62) donors. Interleukin (IL)-7 and IL-7 receptor alpha-chain (CD127) levels were the same at all ages, as shown by ELISA, flow cytometry and real-time PCR. However, IL-7 plasma levels were higher in centenarian females than males. The presence of TREC+ cells and of very few naive T lymphocytes suggests that in centenarians such cells could either derive from residues of thymic lymphopoietic islets, or even represent long-living lymphocytes that have not yet encountered their antigen. IL-7 could be one of the components responsible, among others, for the higher probability of reaching extreme ages typical of females.


2005 - Accuracy of eight-polar bioelectrical impedance analysis for the assessment of total and appendicular body composition in peritoneal dialysis patients [Articolo su rivista]
G., Medici; Mussi, Chiara; Al, Fantuzzi; Malavolti, Marcella; Albertazzi, Alberto; G., Bedogni
abstract

Objective: To establish the accuracy of bioelectrical impedance analysis (BIA) for the assessment of total and appendicular body composition in peritoneal dialysis (PD) patients. Design: Cross-sectional study. Setting: University Nephrology Clinic. Subjects: In all, 20 PD patients and 77 healthy controls matched for gender, age and body mass index. Methods: Whole-body fat-free mass (FFM) and appendicular lean tissue mass (LTM) were measured by dual-energy X-ray absorptiometry. Resistance ( R) of arms, trunk and legs was measured by eight-polar BIA at frequencies of 5, 50, 250 and 500 kHz. Whole-body resistance was calculated as the sum of R of arms, trunk and legs. The resistance index ( RI) was calculated as the ratio between squared height and whole-body or segmental R. Results: RI at 500 kHz was the best predictor of FFM, LTMarm and LTMleg in both PD patients and controls. Equations developed on controls overestimated FFM and LTMarm and underestimated LTMleg when applied to PD patients. Specific equations were thus developed for PD patients. Using these equations, the percent root mean-squared errors of the estimate for PD patients vs controls were 5 vs 6% for FFM, 8 vs 8% for LTMarm and 7 vs 8% for LTMleg. Conclusion: Eight-polar BIA offers accurate estimates of total and appendicular body composition in PD patients, provided that population-specific equations are used.


2005 - Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. [Articolo su rivista]
Corsonello, A; Pedone, C; Corica, F; Mussi, Chiara; Carbonin, P; ANTONELLI INCALZI, R; FOR THE GRUPPO ITALIANO DI FARMACOVIGILANZA NELLANZIANO GIFA, Investigators
abstract

Background: Adverse drug reactions (ADRs) are common causes of in-hospital complications for elderly people. The purpose of the present study is to verify whether concealed renal insufficiency, that is, reduction of the estimated glomerular filtration rate (GFR) in people with normal serum creatinine levels, is a risk factor for ADRs in elderly hospitalized patients.Methods: We used data on 11687 hospitalized patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. The outcomes of the study were any ADR, ADR to hydrosoluble drugs, and ADR to any other drug during the hospital stay. We compared 3 groups: normal renal function (normal serum creatinine levels and normal estimated GFRs), concealed (normal serum creatinine levels and reduced estimated GFRs), or overt (increased creatinine levels and reduced estimated GFRs) renal insufficiency. The relationship between renal function and ADR was evaluated using contingency tables and multiple regression analysis including potential confounders.Results: Concealed renal insufficiency was detected ' in 1631 (13.9%) patients and was frequently associated with male sex and poor nutritional status. Hydrosoluble drugs were responsible for 301 of the 941 recorded ADRs. After adjusting for potential confounders, both concealed (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.15-1.25) and overt (OR, 2.02; 95% Cl, 1.54-2.65) renal failure were associated with ADR to hydrosoluble drugs, but not with ADR to other drugs (OR, 0.83 [95% Cl, 0.65-1.08], and OR, 1.01 [95%CI, 0.83-1.23], respectively).Conclusion: Older hospitalized patients frequently have impaired renal function despite normal serum creatinine levels and are exposed to an increased risk of ADRs to hydrosoluble drugs.


2005 - Postgraduate medical schools: Shortage of geriatricians [Articolo su rivista]
Mussi, C.; Foroni, M.; Salvioli, G.
abstract


2005 - The sistemic inflammatory reaction syndrome and the multiple organ dysfunction in geriatric medicine [Articolo su rivista]
Mussi, C.
abstract

The presence of (Systemic Inflammatory Response Syndrome) SIRS in the elderly, who has a high comorbidity, represents a relevant problem, but it is not always evaluated promptly, and treated wisely. The most frequent cause of SIRS in the old patient is sepsis, that is a SIRS caused by an infective agent. The diagnosis is based on the presence of very simple simptoms; the early identification of risk factors and of the correct therapy allows the improvement of prognosis also in a frail population like the geriatric one.


2004 - Balanced regulation of mRNA production for Fas and Fas ligand in lymphocytes from centenarians: how the immune system starts its second century. [Articolo su rivista]
Pinti, Marcello; Troiano, Leonarda; Nasi, Milena; Ferraresi, Roberta; Mussi, Chiara; Bellodi, C; Salvioli, Gianfranco; Cossarizza, Andrea
abstract

The functionality of the immune system during aging is crucial for protection against the most common age-related diseases. Apoptosis plays a central role in the senescence of the immune system, as evidenced by the increased plasma membrane expression of a key molecule like Fas protein. We analyzed the mRNA levels of different forms of Fas (total [tFas] and membrane [mFas]) and of its ligand (FasL) in peripheral blood lymphocytes from centenarians, the best example of successful aging, who were compared with young and middle-aged donors.


2004 - How to do diagnosis [Articolo su rivista]
Mussi, C.
abstract

Delirium is a common and serious syndrome for the older patient, but it is frequently not diagnosed; in fact, it is rarely present in the discharge diagnosis after hospitalization. The prevalence of delirium is 11-42%; it causes a longer hospital stay, a higher risk of hospitalization, and a higher mortality. The DSM-IV definition is still the diagnostic gold standard, but many screening test have been proposed, since this syndrome is important, but not diagnosed; the Confusion Assessment Method, the Delirium Rating Scale, the Delirium Index, and the Neecham Confusion Scale allow easily and quickly the recognition of delirium, also by the nurse staff. It is desirable that this topic will be adequately teached, and that the diagnostic guidelines will be costantly implemented.


2004 - I fattori di rischio cardiovascolare nell'anziano [Articolo su rivista]
Ventura, Paolo; Mussi, Chiara; G., Salvioli
abstract

L'articolo approfondisce gli spetti e il significato nella popolazione anziana dei fattori di rischio cardiovascolare, con particolare riferimento alle differenze rigurado alla popolazione generale


2004 - Impact factor of Geriatrics & Gerontology Journals in 2003 [Articolo su rivista]
Foroni, M.; Mussi, C.; Salvioli, G.
abstract

The changes of Impact Factor (IF) values reported by Journal of Citation Reports (JCR) regarding the Journals of Geriatrics &amp; Gerontology and those of Medicine, General and Internal are considered in the period from 2000 to 2003. The last category shows greater values of IF which are also more stable in the time with respect to Geriatrics &amp; Gerontology. A faster transition of the research results into clinical geriatric practice is to advise in the next future.


2004 - La parete arteriosa durante l'invecchiamento: problemi anatomofisiologici e clinici [Articolo su rivista]
Mussi, Chiara; Ventura, Paolo; Salvioli, Gianfranco
abstract

Il lavoro analizza le modificazioni della parete arteriosa durante l'invecchiamento e le conseguenze fisiopatologiche che ne derivano


2004 - La prevenzione cardiovascolare: come implementare le conoscenze e i comportamenti in una società che invecchia ? [Articolo su rivista]
Mussi, Chiara; Ventura, Paolo; Salvioli, Gianfranco
abstract

IL lavoro affronta le problematiche relative ai8 fattori dei rischio cardiovascolare e alla prevenzione della malattia cardiovascolare con l'invecchiamento


2004 - Primary care, geriatrics and education [Articolo su rivista]
Salvioli, G.; Mussi, C.
abstract


2004 - Syncope and falls in the older patient [Articolo su rivista]
Ungar, A.; Mussi, C.
abstract


2004 - The "nondipper" elderly: a clinical entity or a bias? [Articolo su rivista]
Pasqualini, Rita; Foroni, Micaela; Salvioli, Gianfranco; Mussi, Chiara
abstract

OBJECTIVES: To determine the prevalence of nondipper (ND) blood pressure profile in the elderly and to ascertain whether the ND pattern of ambulatory blood pressure in the elderly is an artifact or represents a specific clinical entity. DESIGN: Cross-sectional, observational study. SETTING: Cardiovascular diagnostic center, division of geriatrics, secondary care, institutional practice. PARTICIPANTS: Sixty-five consecutive community-dwelling elderly hypertensive patients referred to the cardiovascular center. MEASUREMENTS: The patients underwent actigraphy and ambulatory blood pressure monitoring and completed a sleep assessment questionnaire. Patients were divided based on the night-time decrease in blood pressure (>10%: dippers (n=19); <10%: NDs (n=46)). RESULTS: Nondippers displayed poorer quality of sleep, as demonstrated objectively by actigraphic data; they obtained a higher mean score+/-standard deviation on the sleep questionnaire (4.6+/-2.9 vs 3.0+/-1.1, P=.030) and were taking more benzodiazepines (33.1% vs 10.7%, P=.035), indicating that their usual sleep quality was worse than that of dippers. Multivariate analysis showed a strong correlation between nondipper profile and quality of sleep and also with comorbidity, total number of drugs being taken, and pulse pressure. CONCLUSION: Actigraphy demonstrates impaired sleep in the nondipper elderly. Nevertheless, the nondipping pattern seems independent of the discomfort of cuff-inflation during the night and occurs in association with higher comorbidity and polypharmacy; therefore, it cannot be considered a bias, but is related to detrimental clinical conditions that should be studied in depth.


2003 - Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21-82 years. [Articolo su rivista]
Malavolti, Marcella; Mussi, Chiara; Poli, Marco; Fantuzzi, Anna Laura; Salvioli, Gianfranco; Battistini, Nino Carlo; G., Bedogni
abstract

Aim: To calibrate eight-polar bioelectrical impedance analysis (BIA) against dual-energy X-ray absorptiometry (DXA) for the assessment of total and appendicular body composition in healthy adults.Research design: A cross-sectional study was carried out.Subjects: Sixty-eight females and 42 males aged 21-82 years participated in the study.Methods: Whole-body fat-free mass (FFM) and appendicular lean tissue mass (LTM) were measured by DXA; resistance (R) of arms, trunk and legs was measured by eight-polar BIA at frequencies of 5, 50, 250 and 500 kHz; whole-body resistance was calculated as the sum R of arms, trunk and legs.Results: The resistance index (RI), i.e. the height(2)/resistance ratio, was the best predictor of FFM and appendicular LTM. As compared with weight (Wt), RI at 500 kHz explained 35% more variance of FFM (R-adj(2) =0.92 vs 0.57), 45% more variance of LTMarm (R-adj(2) = 0.93 vs 0.48) and 36% more variance of LTleg (R-adj(2) = 0.86 vs 0.50) (p &lt; 0.001 for all). The contribution of age to the unexplained variance of FFM and appendicular LTM was nil or negligible and the RI x sex interactions were either not significant or not important on practical grounds. The percent root mean square error of the estimate was 6% for FFM and 8% for LTMarm and LTMleg.Conclusion: Eight-polar BIA offers accurate estimates of total and appendicular body composition. The attractive hypothesis that eight-polar BIA is influenced minimally by age and sex should be tested on larger samples including younger individuals.


2003 - Development of real time PCR assays for the quantification of Fas and FasL mRNA levels in lymphocytes: studies on centenarians [Articolo su rivista]
Pinti, Marcello; Troiano, Leonarda; Nasi, Milena; Monterastelli, Elena; L., Moretti; C., Bellodi; A., Mazzacani; Mussi, Chiara; Salvioli, Gianfranco; Cossarizza, Andrea
abstract

Apoptosis plays a central role in the homeostasis of the immune system. During aging, there is an altered regulation of pivotal molecules that are responsible for the regulation of this type of cell death, such as those of the Fas/FasL system. Understanding the regulation of these genes can help to clarify, at least in part, the age-related changes that occur in immune cells. We have developed an original real time PCR assay for quantification of mRNA for Fas and FasL, and have studied a group of young donors, middle aged subjects and centenarians. We have found that the production of Fas mRNA is greatly increased in resting lymphocytes from centenarians; such an increase follows an age-related trend. On the contrary, the production of mRNA for the molecule, which is the natural ligand of Fas, i.e. FasL, is consistently reduced. Our preliminary results suggest that during aging a subtle balance in the production of molecules that cause apoptosis could exist, and that, in order to avoid an excessive death of immune cells, a still unknown mechanism could compensate the increase of Fas with the reduction of FasL. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.


2003 - Health care in the future: Is the geriatric division appropriate? [Articolo su rivista]
Mussi, C.; Salvioli, G.
abstract


2003 - Impact factor changes of geriatrics & gerontology journals [Articolo su rivista]
Palazzi, C.; Mussi, C.
abstract


2003 - Old people and heat: Death in loneliness? [Articolo su rivista]
Salvioli, G.; Mussi, C.
abstract


2003 - The clinical examination of the old patient [Articolo su rivista]
Salvioli, G.; Mussi, C.
abstract


2002 - Accuracy of an eight-point tactile-electrode impedance method in the assessment of total body water. [Articolo su rivista]
Bedogni, G.; Malavolti, Marcella; Severi, S.; Poli, M.; Mussi, Chiara; Fantuzzi, A. L.; Battistini, Nino Carlo
abstract

OBJECTIVE: To establish the accuracy of an eight-polar tactile-electrode impedance method in the assessment of total body water (TBW). DESIGN: Transversal study. SETTING: University department. SUBJECTS: Fifty healthy subjects (25 men and 25 women) with a mean (s.d.) age of 40 (12) y. METHODS: TBW measured by deuterium oxide dilution; resistance (R) of arms, trunk and legs measured at frequencies of 5, 50, 250 and 500 kHz with an eight-polar tactile-electrode impedance-meter (InBody 3.0, Biospace, Seoul, Korea). RESULTS: An algorithm for the prediction of TBW from the whole-body resistance index at 500 kHz (height (2)/R(500) where R is the sum of the segmental resistances of arms, trunk and legs) was developed in a randomly chosen subsample of 35 subjects. This algorithm had an adjusted coefficient of determination (r2(adj)) of 0.81 (P<0.0001) and a root mean square error (RMSE) of 3.6 l (9%). Cross-validation of the predictive algorithm in the remaining 15 subjects gave an r2(adj) of 0.87 (P<0.0001) and an RMSE of 3.0 l (8%). The precision of eight-polar BIA, determined by measuring R three times a day for five consecutive days in a fasting subject, was < or =2.8% for all segments and frequencies. CONCLUSION: Eight-polar BIA is a precise method that offers accurate estimates of TBW in healthy subjects. This promising method should undergo further studies of precision and its accuracy in assessing extracellular water and appendicular body composition should be determined. SPONSORSHIP: Modena and Reggio Emilia University.


2002 - Genetic polymorphisms of Fas (CD95) and FasL (CD178) in human longevity: studies on centenarians [Articolo su rivista]
Pinti, Marcello; Troiano, Leonarda; Nasi, Milena; L., Moretti; E., Monterastelli; A., Mazzacani; Mussi, Chiara; Ventura, Paolo; F., Olivieri; C., Franceschi; Salvioli, Gianfranco; Cossarizza, Andrea
abstract

Apoptosis plays a crucial role in immunosenescence, as also evidenced by the increased expression of Fas in lymphocytes from aged people. However, little is known about the genetic regulation of Fas and its ligand, FasL. We have studied their polymorphisms in 50 centenarians and 86 young donors living in Northern Italy. The first Fas polymorphism; at position -670, has in Caucasian a heterozigosity of 51%; the second, at -1377 position, has the wild type allele (G) with a very high frequency (83%) respect to the mutant allele. Genotype and allele distribution for both polymorphisms were similar in controls and centenarians. Similar results were found as far as two FasL polymorphisms (IVS2nt-124 and IVS3nt169) are concerned. On the whole, our data suggest that Fas and FasL polymorphisms, as well as their haplotypes, are unlikely to be associated with successful human longevity.


2002 - Impact factor of medical journals: Problems in geriatrics [Articolo su rivista]
Mussi, Chiara; Palazzi, Carmela; Pasqualini, Rita; Salvioli, Gianfranco
abstract

The Impact Factor (IF) is one of the most reliable methods for evaluating the quality of scientific journals. To date, no one has studied the IF of geriatric journals over time. Our aims were 1) to evaluate the IF trend of geriatric journals in general, and with respect to internal medicine, which is the nearest discipline, and 2) to assess the proportion of papers on common geriatric topics published in geriatric journals, with respect to other general periodicals. The current literature was studied to define what IF is and describe its good points and deficiencies. We then analyzed the situation regarding geriatric journals. A bibliometric analysis addressed the kind of journal interested in important geriatric themes (syncope, falls, hip fractures, delirium). Geriatric journals have a low IF, but their importance has been growing over the years. Despite this, papers regarding geriatric themes are published mainly in non-specific journals, and the number of publications regarding syncope, falls, hip fractures, and delirium has not increased during the period in question. In conclusion, it is difficult to use the IF for comparisons between different disciplines, in particular when the one under consideration (geriatrics and gerontology) is spread over a wide range of medical fields. The increase in IF of geriatric journals over time is the most important result of our analysis; this finding will encourage geriatric scientists to submit their papers to geriatric periodicals and will increase the specificity of the gerontological discipline.


2002 - Relationship between body composition and bone mineral content in young and elderly women. [Articolo su rivista]
Bedogni, G.; Mussi, Chiara; Malavolti, Marcella; Borghi, Athos; Poli, M.; Battistini, Nino Carlo; Salvioli, Gianfranco
abstract

PRIMARY OBJECTIVE: To study the relationship between bone mineral content (BMC), lean tissue mass (LTM) and fat mass (FM) in a large sample of young and elderly women. RESEARCH DESIGN: Cross-sectional. METHODS AND PROCEDURES: BMC, LTM and FM were measured by dual-energy X-ray absorptiometry in 2009 free-dwelling Caucasian women aged 63 +/- 7 years (mean +/- SD; range: 37-88 years). The majority of women were postmenopausal (96%). RESULTS: LTM explained 13% more variance of BMC than FM (R(2)(adj) = 0.39 vs 0.26, p < 0.0001) but weight (Wt) explained 5% more variance of BMC than LTM (R(2)(adj) = 0.44, p < 0.0001). The prediction of BMC obtained from LTM and FM (R(2)(adj)= 0.46, p < 0.0001) was only slightly better than that obtained from Wt. After the effects of age, Wt and height (Ht) on BMC were taken into account by multiple regression, the contribution of LTM and FM to BMC was just one-fifth of that of Wt (R(2)(adj) for full models < or =0.56, p < 0.0001). After a further correction for bone area (BA), the contribution of LTM and FM to BMC was just one-tenth of that of BA and not different from that of Wt and Ht on practical grounds (R(2)(adj) for full models = 0.84, p < 0.0001). Thus, after inter-individual differences in age, Wt, Ht (and bone size) are taken into account, the relationship between body composition and BMC is substantially weakened. CONCLUSIONS: In Caucasian women, (1) LTM is a stronger predictor of BMC than FM, but (2) Wt is a better predictor of BMC than body composition for practical purposes, and (3) Wt and body composition are not able to explain more than 46% of BMC variance.


2002 - The "Time and Change" test: An appropriate method to detect cognitive decline in the elderly [Articolo su rivista]
Mussi, Chiara; Foroni, Micaela; A., Valli; S., Ascari; I., Tolve; Salvioli, Gianfranco
abstract

The Time and Change (T&C) test is an easy and time-saving test validated for the detection of dementia. Our aim was to determine how geriatric features like depression, disability, and comorbidity are able to influence the result of the T&C and, consequently, to decide whether it could be a reliable screening test for cognitive impairment in the elderly. A total of 220 participants (mean age = 75.8 +/- 9.6 years, 63.7% females) underwent the T&C, Mini-Mental State Examination, and the Clock Drawing Test; Activities of Daily Living, Instrumental Activities of Daily Living, comorbidity, and depression were also evaluated. Time and Change-positive participants were older, had poorer cognitive tests, and had higher levels of disability and comorbidity than participants testing negative. Multivariate analysis showed that cognitive impairment and comorbidity were the only features that influenced the T&C, regardless of age, education, disability, and depression. We conclude that the T&C should be implemented in primary care because it quickly identifies elderly patients with cognitive impairment who need a more accurate evaluation.


2002 - Usefulness and safety of shortened head-up tilt testing potentiated with sublingual glyceryl trinitrate in older patients with recurrent unexplained syncope. [Articolo su rivista]
A., Del Rosso; A., Ungar; P., Bartoli; T., Cellai; Mussi, Chiara; N., Marchionni; G., Masotti
abstract

OBJECTIVES: To evaluate the sensitivity and tolerability of shortened, glyceryl trinitrate (GTN)-potentiated, head-up tilt test (HUT) in patients older and younger than 65 with unexplained syncope and to compare the specificity of GTN-potentiated HUT (GTN-HUT) in older and younger controls.DESIGN: Methodological study.SETTING: Syncope units in secondary and tertiary hospitals.PARTICIPANTS: Three hundred twenty-four consecutive patients with unexplained syncope (100 aged greater than or equal to65 (mean age +/- standard deviation 73 +/- 6; 35 men) and 224 aged <65 (41 +/- 15; 111 men)) and 64 controls (29 aged &GE;65 (73 +/- 6; 13 men) and 35 aged <65 (42 +/- 13; 16 men).INTERVENTION: Patients and controls were tilted upright to 60degrees for 20 minutes. If syncope did not occur, sublingual GTN (400 mug) was administered and 60degrees HUT was continued for 15 minutes. Responses were classified as positive, negative, or exaggerated (slow decrease in blood pressure with a slight decrease in heart rate after GTN).MEASUREMENTS: Electrocardiogram and arterial pressure were monitored continuously.RESULTS: GTN-HUT was positive in 60% and 66% (NS), negative in 29% and 33% (NS), and exaggerated in 11% and 1% (P < .001) of older and younger patients, respectively. In older and younger controls, the GTN-HUT was negative in 70% and 86% and exaggerated in 28% and 9% of cases, respectively, (P < .05). The overall specificity (considering as negative also the exaggerated responses) was 97% in older and 94% in younger subjects. No patient or control experienced serious side effects.CONCLUSION: The shortened GTN-HUT provides satisfactory positivity rate and specificity in older patients. This test may be considered as a diagnostic tool in assessing recurrent unexplained syncope in older patients.


2001 - Specificity and total positive rate of head-up, tilt testing potentiated with sublingual nitroglycerin in older patients with unexplained syncope. [Articolo su rivista]
Mussi, Chiara; I., Tolve; Foroni, Micaela; A., Valli; S., Ascari; Salvioli, Gianfranco
abstract

The aim of this study was to assess the specificity and total positive rate of head-up tilt testing (HUTT) potentiated with sublingual nitroglycerin in detecting the vasovagal origin of unexplained syncope in the elderly, since the diagnostic value of this non-invasive test has not yet been proven in this age group. In a period of 3 years, 128 elderly patients (mean age 71.6 +/-5.1 years, 50% males) with syncope of unknown origin, and 101 control subjects matched for age and gender were tilted upright to 60 degrees for 45 minutes. If syncope did not occur, sublingual nitroglycerin (0.4 mg) was administered, and observation Was continued for 20 minutes. The positive response was defined as the reproduction of syncope or pre-syncope according to VASIS definition. During the unmedicated phase, syncope occurred in 26 patients (20.3%) and in no members of the control group. After nitroglycerin, 53 patients (41.4%) and 2 control subjects (2%) displayed syncope. The total positive rate of the test Was 61.8% With a specificity of 98.0%. In conclusion, HUTT potentiated with sublingual nitroglycerin provides an adequate specificity and total positive rate in old patients with unexplained syncope; therefore it can be proposed as a useful diagnostic tool to detect the vasovagal origin of syncope not only in middle but also in advanced age.


2000 - Fattori associati alla presenza di calcificazioni dell’aorta addominale in una popolazione anziana ospedalizzata. [Articolo su rivista]
S., Ascari; Mussi, Chiara; Salvioli, Gianfranco
abstract

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2000 - La valutazione della forza muscolare nell’anziano fragile. [Articolo su rivista]
S., Ascari; Mussi, Chiara; R., Pasqualini; F., Sabbatini; Salvioli, Gianfranco
abstract

Il lavoro si propone di studiare la forza muscolare nell'anziano, come valutarla nei vari setting assistenziali e come prevenire la sarcopenia nell'anziano fragile.


2000 - Linee Guida per la diagnosi e la terapia del delirium nell’anziano. [Articolo su rivista]
Mussi, Chiara; Salvioli, Gianfranco
abstract

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2000 - Problemi di case-mix. Appropriatezza dei criteri di misura e loro applicazioni nella riabilitazione geriatrica. [Articolo su rivista]
A., Valli; Mussi, Chiara; Salvioli, Gianfranco
abstract

Il lavoro si propone come obiettivo la definizione di case-mix per il paziente anziano e la possibilità dell'applicazione dei criteri di misura in ambiente riabilitativo.


1999 - Importance of serum anticholinergic activity in the assessment of elderly patients with delirium [Articolo su rivista]
Mussi, Chiara; Ferrari, Rosaria; S., Ascari; Salvioli, Gianfranco
abstract

To evaluate the importance of serum anticholinergic activity (SAA) in elderly patients who developed delirium following hospital admission, we performed a cross-sectional study with consecutively referred inpatients in a university geriatric medical ward. Sixty-one patients aged 66 to 95 years (mean age: 79.2 +/- 11.6; 54% females) were recruited. Delirium was assessed by means of the Confusion Assessment Method, SAA determination, questionnaire for current drug treatment, past medical history and clinical examination, and blood chemistries. Patients were divided into two groups according to the absence (N = 49) or the presence (N = 12) of delirium. Delirious patients showed a significantly higher SAA(23.0 vs 3.9 pmol/mL atropine equivalents, P < .004); they were using antibiotics (P < .05), neuroleptics (P < .002), barbiturates (P < .004), and benzodiazepines (P < .005) more frequently. Subjects with delirium were more likely to have infections and a lower Body Mass Index; they had higher plasma glucose and creatinine. The multivariate analysis identified SAA and use of neuroleptics, and benzodiazepines as the most important features independently associated with delirium. SAA may be a suitable marker for identifying people at risk of developing delirium. Moreover, neuroleptics and benzodiazepines must be carefully used in the elderly because of their relationship with the onset of delirium.


1998 - Il delirium nell’anziano [Articolo su rivista]
Salvioli, Gianfranco; Mussi, Chiara; S., Ascari
abstract

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1996 - Omocisteina: modificazioni in rapporto alla dieta e all’invecchiamento [Articolo su rivista]
Salvioli, Gianfranco; Ventura, Paolo; Mussi, Chiara
abstract

L'articolo affronta le cause di iperomocisteinemia nell'anziano con particolare riferimento alle forme conseguenti a malnutrizione


1996 - Treatment of postprandial hypotension in the elderly [Articolo su rivista]
Salvioli, Gianfranco; G., Rioli; Mussi, Chiara; Jm, Pradelli
abstract

Food intake induces splanchnic vasodilation lasting for at least one hour, which can precipitate in postprandial hypotension, if systolic arterial blood pressure falls by more than 20 mmHg. Postprandial hypotension has a high prevalence in the elderly, above all in subjects receiving hypotensive drugs or in those with disorders of the autonomic nervous system. In our total case series of 567 subjects, the prevalence of postprandial hypotension evaluated by 24-hr blood pressure recording, was 14.5 %, increasing to 28 % in the oldest group. Since relevant cerebral ischemic symptoms may become manifest, a correct diagnosis of the disorder and both pharmacological and non-pharmacological therapeutical approaches are of great importance for the wellbeing of old patients.