Acute Heart Failure in the Emergency Department: the SAFE-SIMEU Epidemiological Study.

BACKGROUND: Patients with acute heart failure (AHF) have high rates of attendance to emergency departments (EDs), with significant health care costs. OBJECTIVES: We aimed to describe the clinical characteristics of patients attending Italian EDs for AHF and their diagnostic and therapeutic work-up. METHODS: We carried out a retrospective analysis on 2683 cases observed in six Italian EDs for AHF (January 2011 to June 2012). RESULTS: The median age of patients was 84 years (interquartile range 12), with females accounting for 55.8% of cases (95% confidence interval [CI] 53.5-57.6%). A first episode of AHF was recorded in 55.3% (95% CI 55.4-57.2%). Respiratory disease was the main precipitating factor (approximately 30% of cases), and multiple comorbidities were recorded in > 50% of cases (history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease). The treatment was based on oxygen (69.7%; 67.9-71.5%), diuretics (69.2%; 67.9-71.5%), nitroglycerin (19.7%; 18.3-21.4%), and noninvasive ventilation (15.2%; 13.8-16.6%). Death occurred within 6 h in 2.5% of cases (2.0-3.1%), 6.4% (5.5-7.3%) were referred to the care of their general practitioners within a few hours from ED attendance or after short-term (< 24 h) observation 13.9% (12.6-15.2%); 60.4% (58.5-62.2%) were admitted to the hospital, and 16.8% (15.4-18.3%) were cared for in intensive care units according to disease severity. CONCLUSIONS: Our study reporting the "real-world" clinical activity indicates that subjects attending the Italian EDs for AHF are rather different from those reported in international registries. Subjects are older, with a higher proportion of females, and high prevalence of cardiac and noncardiac comorbidities.

Electroweak Sudakov corrections to new physics searches at the LHC.

We compute the one-loop electroweak Sudakov corrections to the production process Z(νν)+n jets, with n=1, 2, 3, in pp collisions at the LHC. It represents the main irreducible background to new physics searches at the energy frontier. The results are obtained at the leading and next-to-leading logarithmic accuracy by implementing the general algorithm of Denner and Pozzorini in the event generator for multiparton processes alpgen. For the standard selection cuts used by the ATLAS and CMS Collaborations, we show that the Sudakov corrections to the relevant observables can grow up to -40% at sqrt[s ]= 14 TeV. We also include the contribution due to undetected real radiation of massive gauge bosons, to show to what extent the partial cancellation with the large negative virtual corrections takes place in realistic event selections.

An event generator for same-sign W-boson scattering at the LHC including electroweak corrections.

In this article we present an event generator based on the Monte Carlo program Powheg in combination with the matrix-element generator Recola. We apply it to compute NLO electroweak corrections to same-sign W-boson scattering, which have been shown to be large at the LHC. The event generator allows for the generation of unweighted events including the effect of the NLO electroweak corrections matched to a QED parton shower and interfaced to a QCD parton shower. In view of the expected experimental precision of future measurements, the use of such a tool will be indispensable.

Acute heart failure in the emergency department: a follow-up study.

Acute heart failure (AHF) is a major public health issue due to high incidence and poor prognosis. Only a few studies are available on the long-term prognosis and on outcome predictors in the unselected population attending the emergency department (ED) for AHF. We carried out a 1-year follow-up analysis of 1234 consecutive patients from selected Italian EDs from January 2011 to June 2012 for an episode of AHF. Their prognosis and outcome-associated factors were tested by Cox proportional hazard model. Patients' mean age was 84, with 66.0% over 80 years and 56.2% females. Comorbidities were present in over 50% of cases, principally a history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease. Death occurred within 6 h in 24 cases (1.9%). At 30-day follow-up, death was registered in 123 cases (10.0%): 110 cases (89.4%) died of cardiovascular events and 13 (10.6%) of non-cardiovascular causes (cancer, gastrointestinal hemorrhages, sepsis, trauma). At 1-year follow-up, all-cause death was recorded in 50.1% (over 3 out of 4 cases for cardiovascular origin). Six variables (older age, diabetes, systolic arterial pressure <110 mm/Hg, high NT pro-BNP, high troponin levels and impaired cognitive status) were selected as outcome predictors, but with limited discriminant capacity (AUC = 0.649; SE 0.015). Recurrence of AHF was registered in 31.0%. The study identifies a cluster of variables associated with 1-year mortality in AHF, but their predictive capacity is low. Old age and the presence of comorbidities, in particular diabetes are likely to play a major role in dictating the prognosis.