[Epidemiologic evaluation of cardiac decompensation and its impact on health costs]. / Valutazione epidemiologica dello scompenso cardiaco e sue implicazioni sulla spesa sanitaria.

BACKGROUND: Heart failure is a frequent pathology that requires a high degree of hospitalization. These characteristics have a high assistance cost. The purpose of this study was to evaluate the prevalence, acuteness, predisposing factors and therapy carried out in patients of a northeastern Italian town, and to evaluate their impact on health costs. METHODS: We have examined patient under observation of the Department of Emergency at the Padua Hospital for 12 months. They had been hospitalized for heart failure symptoms. They all underwent individual and pharmacological anamnesis, objective exam, ECG, thorax X-rays and echocardiogram. The health expenses were calculated in relation to hospital stay, the cost of daily assistance, exams and medical treatments used. RESULTS: 630 patients of both sexes (422 males and 208 females) aged 74.6 +/- 6.1 were studied. Among significantly interrelated factors were: hypertension in 51.4% of the patients; diabetes mellitus in 9% of the patients; hypercholesterolemia in 31.3% of the patients; hypertriglyceridemia in 7.2% of the patients; cigarettes smoking in 19.3% of the patients, whereas obesity was present in 19.7% of all the subjects. Heart diseases directly correlated with heart failure were respectively: myocardial ischemia (65.6%); hypertensive cardiopathy (14.7%); idiopathic dilatative (15%); and valvular cardiopathy (4.7%). In 9.5% of cases, patients presented episodes of TIA, ictus, or they were carriers of neurologic focal deficiencies. As far as NYHA functional class was concerned, the third was most prevalent with a different distribution (p < 0.05) between males and females. ACE inhibitors, digitalis and calcium antagonists are to be indicated among the most widely used drugs. The health cost for patients in this survey was deduced on the basis of: average; hospitalization stay (9.8 days); estimated daily expenses for patient and for further controls (L. 282,000); the area of users (85% of residents). Therefore the full hospital assistance of patients with heart failure is approximately L. 2.1 thousand millions. CONCLUSIONS: Given the high preponderance of heart failure, the frequent relation with vascular risk factors and with ischemic cardiopathy, further investigation is necessary to curb these high rates. On the other hand, the NYHA advanced state of patients is not likely to allow lower costs in relation to hospital admission or the reduction of hospital stay. Nevertheless, the individualization of standardized therapeutic protocols and an adequate home care surveillance follow-up may reduce the number of hospitalizations and consequently the connected health expenses.

[Short term changes in risk factors of cerebrovascular diseases. A failure of preventive measures?]. / Modificazioni nel breve termine dei fattori di rischio delle malattie cerebrovascolari. Un insuccesso degli interventi di prevenzione?

BACKGROUND AND PURPOSE: Stroke is the third main cause of death in western countries. To evaluate its ever-changing characteristics and the impact of recent public campaigns on cardiovascular risk factors (CRFs) in stroke morbidity and mortality, we carried out a retrospective investigation on subjects with cerebrovascular disease in different periods. METHODS: All clinical data of patients with acute cerebrovascular disease (TIA or stroke) admitted to a regional hospital (Padua, Italy) during two distinct years (1985 and 1992) were examined (381 in 1985 and 440 in 1992). In every case the characteristics of the episode, clinical course, concomitant CRFs and relevant biochemical and instrumental examinations were recorded. RESULTS: Altogether Transient Ischemic Attack (TIA) represented almost half the records; remaining cases could be classified as ischemic stroke (66% vs 55%), Intracerebral Haemorrhage (17% vs 26%) and subarachnoideal haemorrhage (17% vs 19%) (1985 vs 1992, respectively). The mean hospitalization period was longer in the most recent year, particularly in haemorrhagic patients (H-P, subarachnoid + intracerebral haemorrhage); the in-hospital case fatality rate was reduced in HP while it was significantly increased in those with Cerebral Ischemia (CI-P, TIA + ischemic stroke). The prevalence of blood hypertension, atrial fibrillation and dyslipidaemias rose significantly in 1992 compared to 1985. High plasma lipids were more frequently present in CI-P than in H-P; their 7-year increase was particularly related to combined forms, rather then isolated hypercholesterolemia or hypertriglyceridemia. CONCLUSIONS: These results do not agree with an hypothetical improvement in the prognosis of stroke in the period we considered. Besides the efforts aiming at reducing CRFs in the short term have not shown to be successful.

[Comparative characteristics of electrocardiographic tracing in young subjects of various ethnic groups]. / Caratteristiche comparative del tracciato elettrocardiografico in soggetti giovani appartenenti a razze diverse.

In this study we evaluated the potential differences in normal electrocardiographic parameters between two groups of young patients belonging to different races (Caucasians and Blacks). For this purpose 100 electrocardiograms had been taken, coded and compared in 50 Italian males and 50 north-Africans who came to an Emergency Department because of minor condition. On the whole we could not find significant differences between the two groups, except for a small increase in P-wave duration in black people. We conclude that the same parameters used to evaluate normal electrocardiograms in white people, may be satisfactory applied also for black individuals. This fact is worthy of attention since more and more extracomunitarian patients are addressing the Italian Health Service.

[Herpes zoster and post-herpetic neuralgia. Comparison between elderly patients and young adults treated with acyclovir]. / Herpes zoster e nevralgia post-erpetica. Confronto tra anziani e giovani adulti trattati con acyclovir.

Herpes zoster (HZ) is a common skin disease due to a virus identical to that responsible for chickenpox. In a variable number of cases neuritic pain persist after cutaneous healing. Aim of this investigation was to analyze zoster clinical evolution in 102 immunocompetent patients, subdivided by age (< 60 years and > or = 60 years) and sex, after treatment with acyclovir (4 g/die x 10 days). Signs and symptoms of the disease were evaluated, with particular attention to pain and the duration of post-herpetic neuralgia. Vescicular eruption was most frequently found in the thoraco-abdominal region and in the trigeminal one, with no significant differences among the subgroups. Two thirds of the subjects complained of pain and it was prevalent in female sex (84% of cases vs 53%, p < 0.01) but not in any age-class. After 1 months from the episode (and its pharmacological treatment), post-herpetic neuralgia was still present in about 20% of the patients, above all in those > or = 60 years; this last difference reached statistical significance after 6 months (9.7% vs 1.4% for subjects > or = 60 years and < 60 years respectively, p < 0.05). No patient showed any adverse pharmacological effect after treatment. We conclude that acyclovir is well accepted both in young and elderly immune-competent subjects suffering from HZ, but it necessitates further efficacy investigations in sight of its broader utilization.