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Zoppo F.,Laboratorio Of Elettrofisiologia | Facchin D.,Az. Ospedaliera S. Maria della Misericordia | Molon G.,Azienda Ospedaliera Sacro Cuore Don Calabria | Zanotto G.,Ospedale Materials Salutis di Legnago | And 9 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2014

Background: Atrial fibrillation (AF) is common in patients with cardiac implantable electronic devices (CIED) and has been associated with an increased stroke risk. The aim of our project was to assess the clinical value of a web-based application, Discovery Link AFinder, in improving AF detection in CIED patients.Methods and Results: Seven Italian hospitals performed an observational study consisting of four phases. During phase 1, expert nurses and cardiologists prospectively followed-up CIED patients via in-hospital examinations and remote monitoring, and classified clinically relevant events, particularly AF occurrence. During phase 2, Discovery Link AFinder was exploited to identify patients who had suffered AF in the previous 12 months through the systematic scanning of device data remote transmissions. Phases 3 and 4 were repetitions of phases 1 and 2, respectively, and were implemented 6 months after the previous phases. A total of 472 consecutive patients were included in phase 1; AF occurred in 170 patients, 61 of whom were identified as new AF patients. Evidence of AF during this phase prompted prescription of oral anticoagulation (OAC) therapy in 30 patients. In phase 2, AFinder uncovered new AF, unidentified in phase 1, in 54 patients and prompted implementation of OAC therapy in 11 patients. During phase 3, 30 new AF patients were identified by means of remote monitoring, while during phase 4, a further three AF patients were identified by AFinder only.Conclusions: The AFinder web-based software, applied on top of standard in-hospital and remote monitoring, improved AF detection and enabled OAC treatment to be undertaken. ©2014 Wiley Periodicals, Inc. Source

Armelao F.,Ospedale Santa Chiara | Orlandi P.G.,Ospedale San Camillo | Tasini E.,Ospedale Santa Maria Del Carmine | Franceschini G.,Ospedale di Arco | And 3 more authors.
Endoscopy | Year: 2010

Background and study aims: A screening program in first-degree relatives (FDRs) of colorectal cancer (CRC) patients (index patients) was started in Trentino, Italy, to analyze factors that influence uptake of CRC screening among invited FDRs (first objective) and to describe colorectal findings among those undergoing colonoscopy (secondary objective). Patients and methods: FDRs aged between 45 and 75 years were invited; exclusion criteria were: colonoscopy or barium enema in the preceding 5 years, a history of familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, inflammatory bowel diseases, and severe comorbidities. FDRs who were eligible but were not invited for screening because consent was not obtained from the index patients were considered as the control group. FDRs were invited by the education campaign targeted at the population at risk (both study and control groups); in the study group, interventions targeting individuals at risk (letters, phone calls, face-to-face counseling) were implemented. Results: Starting from 626 new index cases of diagnosed CRC, 725 FDRs were invited to counseling; 77.6% of these attended for colonoscopy in the study group vs. 8% in the control group (P<0.0001). Predictors of colonoscopy uptake were FDR age above 60 years [odds ratio (OR) 2.50, 95%CI 1.723.62], complex family history (simple family history: one CRC at age above 60 years; complex family history: one CRC at age below 60 or two or more CRC; OR 1.54; 95%CI 1.042.33) and living in a rural area (OR 1.64, 95%CI 1.122.44). Of the 560 FDRs in the study group, 186 (33.8%) had adenomas, and 48 (8.8%) had advanced adenomas or cancer. Conclusions: Interventions that target FDRs of patients with CRC, especially those younger than 60 years, with a complex family history of CRC and who live in a rural area, may improve uptake of CRC screening via colonoscopy. © Georg Thieme Verlag KG Stuttgart - New York. Source

Armelao F.,Ospedale S. Chiara | Paternolli C.,University of Trento | Franceschini G.,Ospedale di Arco | Franch R.,Ospedale di Cles | And 16 more authors.
Gastrointestinal Endoscopy | Year: 2011

Background: A screening colonoscopy is recommended in first-degree relatives (FDRs) of colorectal cancer patients; few prospective, controlled studies have evaluated colorectal findings in a population-based screening program. Objective: To evaluate the prevalence of colorectal neoplasia (adenomas and adenocarcinomas) in this increased-risk population, to compare it with that of average-risk individuals, and to identify features that might allow risk stratification for neoplasia among FDRs. Design: Cross-sectional study. Setting: Population-based screening program in Trentino, Italy. Patients: FDRs of colorectal cancer patients between 45 and 75 years of age with no history of hereditary colorectal cancer syndromes or inflammatory bowel disease. Controls: Average-risk individuals undergoing screening colonoscopy. Intervention: Screening colonoscopy. Results: Neoplasia was found in 33.4% of 1252 FDRs and in 30.3% of 765 controls; advanced neoplasia was found in 11.3% of FDRs and in 6.3% of controls. Odds ratios (ORs) from the multivariate logistic regression analysis adjusted for age, sex, cecal intubation rates, and colon cleansing showed an increased risk of advanced neoplasia (OR 2.41; 95% CI, 1.69-3.43; P < .0001) in FDRs. Age older than 56 years (OR 1.83; 95% CI, 1.15-2.99; P = .013) and male sex (OR 2.17; 95% CI, 1.39-3.10; P < .001) are independent predictors of advanced neoplasia. Limitations: Italian subjects living in the same geographic area; of 4301 FDRs, 2521 were excluded. Conclusions: The increased risk of advanced neoplasia supports the current recommendation for colonoscopic screening in this group; age and sex may assist in risk stratification of these individuals. © 2011 American Society for Gastrointestinal Endoscopy. Source

Verlato R.,General Hospital Cosma | Facchin D.,Azienda Ospedaliero Universitaria di Udine | Catanzariti D.,Ospedale Santa Maria Del Carmine | Molon G.,Ospedale Sacro Cuore | And 6 more authors.
Heart | Year: 2013

Objective: The performances of implantable cardioverter defibrillators and leads are important issues for healthcare providers and patients. In 2007 Sprint Fidelis leads were found to be associated with an increased failure rate and so the purpose of the study was to evaluate long-term mortality and clinical outcomes in patients implanted with Sprint Fidelis leads compared with Sprint Quattro leads. Design, setting, patients 508 patients with Sprint Fidelis leads and 468 with Sprint Quattro leads were prospectively followed in 12 Italian cardiology centres. Main outcome measures Information on hospitalisations and other clinical events were collected during scheduled and unscheduled hospital visits. Deaths were identified from medical records or via phone contacts with patients' family members or through the National Office of Vital Statistics. Results: Over a mean follow-up of 27±18 months 141 deaths occurred in the overall population. No death was observed in patients with diagnosed failing lead. Kaplan-Meier patient survival differed between the two lead groups (80±2% in Fidelis leads vs 70±4% in the Sprint Quattro leads at 4 years, p=0.002). Multivariate analyses showed that mortality was neither associated with lead type nor with diagnosed failed lead. The annual rate of lead failure was 1.8% patient-year for Fidelis leads and 0.2% for the Sprint Quattro leads. Conclusions: In our multicentre research, the clinical outcomes of patients with Fidelis leads differed from those of patients with Sprint Quattro leads. Nevertheless, neither mortality nor the combined endpoint of mortality and heart failure hospitalisations was associated with the lead type. Source

Tomasi L.,Azienda Ospedaliera Istituti Ospitalieri di Verona | Zanotto G.,Azienda Ospedaliera Istituti Ospitalieri di Verona | Zanolla L.,Azienda Ospedaliera Istituti Ospitalieri di Verona | Golia G.,Azienda Ospedaliera Istituti Ospitalieri di Verona | And 11 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2011

Background: Increased plasma levels of amino-terminal fraction of brain natriuretic peptide (NT-proBNP) and alterations of diastolic filling as described by Doppler transmitral flow pattern are well-known markers of decompensated heart failure (HF). Recently, some implantable defibrillators have allowed monitoring of intrathoracic impedance, which is related to lung water content, potentially indicating HF deterioration. The aim of this study was to assess the correlation between intrathoracic impedance and NT-proBNP and echo-Doppler transmitral flow indexes. Methods: Data were collected from 111 HF patients, in six Italian centers. All patients were on optimal medical therapy. Device diagnostics, echographic data, NT-proBNP determination, and clinical status as assessed by the Heart Failure Score (HFS) were registered at baseline, at bimonthly visits, and at unscheduled examinations due to HF decompensation or device alerts. Results: Over a median follow-up of 413 days, 955 examinations were performed. Intrathoracic impedance was significantly correlated with NT-proBNP (P = 0.013) and with mitral E-wave deceleration time (DtE) (P=0.017), but not with HFS. At the time of confirmed alert events, NT-proBNP was significantly higher than during confirmed nonalert event examinations; DtE did not differ, whereas impedance was significantly lower. Conclusion: A decrease in intrathoracic impedance is inversely correlated with NT-proBNP and directly correlated with DtE. Intrathoracic impedance monitoring therefore has the physiologic basis for being a useful tool to identify early HF decompensation. ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc. Source

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