Effect of home-based telecardiology on chronic heart failure: costs and outcomes

Chronic heart failure (CHF) remains a common cause of disability. We have investigated the use of home-based telecardiology (HBT) in CHF patients. Four hundred and twenty-six patients were enrolled in the study: 230 in the HBT group and 196 in the usual-care group. HBT consisted of trans-telephonic follow-up and electrocardiogram (ECG) monitoring, followed by visits from the paramedical and medical team. A one-lead ECG recording was transmitted to a receiving station, where a nurse was available for reporting and interactive teleconsultation. The patient could call the centre when assistance was required (tele-assistance), while the team could call the patient for scheduled appointments (telemonitoring). The one-year clinical outcomes showed that there was a significant reduction in rehospitalizations in the HBT group compared with the usual-care group (24% versus 34%, respectively). There was an increase in quality of life in the HBT group (mean Minnesota Living Questionnaire scores 29 and 23.5, respectively). The total costs were lower in the HBT group (107,494 and 140,874, respectively). The results suggest that a telecardiology service can detect and prevent clinical instability, reduce rehospitalization and lower the cost of managing CHF patients.     

Clinical and laboratory predictors and prevalence of immune reconstitution inflammatory syndrome in patients with Whipple's disease

Objectives

Whipple's disease (WD) is a rare and potentially fatal infectious disease caused by Tropheryma whipplei. It is characterized by a long prodromal phase that mimics a rheumatological disease, often leading to immunosuppressant treatment. Immune reconstitution inflammatory syndrome (IRIS) is currently the most important complication of WD, requiring prompt recognition and treatment as it can be fatal. However, epidemiological data on IRIS are scarce. We aimed to identify the clinical and laboratory predictors of IRIS at WD diagnosis and to evaluate whether the prevalence of IRIS has changed over time.

Methods

Forty-five patients with WD (mean age 52 ± 11 years; 10 females) were followed up between January 2000 and December 2021. Clinical and laboratory data at WD diagnosis were retrospectively collected and compared among patients who developed IRIS and those who did not.

Results

Erythrocyte sedimentation rate (ESR; 33.4 ± 11.8 mm/h vs 67.1 ± 26.3 mm/h, P < 0.01), platelet (PLT; 234 × 10⁹/L vs 363 × 10⁹/L, P < 0.01), and body mass index (22.0 ± 2.0 kg/m² vs 19.8 ± 3.0 kg/m², P = 0.04) differed significantly between patients who subsequently developed IRIS and those who did not. ROC analysis identified ESR ≤46 mm/h (AUROC 0.88, 95% CI 0.72–1.00) and PLT ≤ 327 × 10⁹/L (AUROC 0.85, 95% CI 0.70–1.00) as optimal cut-off values to discriminate WD patients at a high risk of developing IRIS. Prevalence of IRIS remained stable (22.2%) over time.

Conclusions

Low ESR and PLT count at diagnosis help identify WD patients at high risk of developing IRIS. Instead, a greater inflammatory response suggests a lower risk of IRIS. Prevalence of IRIS did not change over two decades.     

Clinical outcome of neurological patients with COVID-19: the impact of healthcare organization improvement between waves

Neurological Sciences - The aim of this study is to evaluate the differences in clinical presentations and the impact of healthcare organization on outcomes of neurological COVID-19 patients...     

Tailoring the care in patients with chronic heart failure: a feasibility study on psychological support at distance

Continuity of care at home is essential for the management of patients with chronic heart failure (CHF) suffering also from anxiety/depressive symptoms. This study was aimed at evaluating the possibility of providing psychological support to CHF patients after hospital discharge. A psychodynamic model of counselling was approached by telephone by a psychotherapist and evaluated in terms of feasibility. 16 out 67 CHF patients who continue to suffer from mild to moderate anxiety/depressive disorders, which, because of location, transports or infirmity impediments, could not have access to any other care support, were enrolled in this feasibility study. At time of discharge, every 7–10 days for a pilot period of 6 months, patients were followed by a telephone call (lasting 45 min, as an in office visit) by the same psychotherapist who had previously performed in-hospital interview and tests. Evaluation of anxiety and depression and quality of life were performed by appropriate tests (Hospital Anxiety and Depression Scale and WHOQOL-Brief, respectively), questionnaires of satisfaction by patients and operator were also provided. There were 109 total contacts/6 months, with an average of 6.8 ± 3.6 calls per patient. 82 out of 109 calls (75%) were managed in the first 3-month period. Main areas of discussion were the insight and experience of disease and interaction with the health staff. At the end of the 6-month study, six patients needed further specific psychotherapist’s support and the programme was extended till 1 year (42 further calls). More than 90% patients were satisfied of the service. Operator encountered difficulties mainly due to schedule contacts during working time for worker patients. This preliminary study shows the assessment and feasibility of the psychodynamic counselling by telephone in CHF patients which needs further organizational improvement.     

Pediatric Migration and Hepatitis A Risk in Host Population

Hepatitis A virus (HAV) circulation in a given area is closely related to socioeconomic standards. Following the improvement of living conditions, HAV seroprevalence rates in the population have decreased steadily during the last decades in many Western European countries, including Italy, thereby leading to a shift of risk of disease towards older age groups. Since the severity of the disease closely parallels age, a higher incidence of symptomatic cases in adults is now reported in Europe and the United States, being travel-related to a large extent. Intrafamilial person-to-person spread is also an important source of infection and transmission from children to parents may occur due to the lack of immunity in the general population. In the last two decades, Italy has been the destination of an increasing number of migrants from developing countries, where HAV is highly endemic. Furthermore, international adoption programmes cause pediatric populations from HAV endemic countries to increase in low endemic areas, possibly leading to secondary cases in close contacts.7 The aim of this paper is to report the epidemic HAV outbreak which occurred among the voluntary nursing staff of a pediatric Rwandan refugee community hosted in a village of the Brescia Province, in northern Italy.     

Effects of oxygen on autonomic nervous system dysfunction in patients with chronic obstructive pulmonary disease.

Chronic hypoxaemia can play a pathological role in abnormalities of the autonomic nervous system (ANS). In patients with chronic obstructive pulmonary disease (COPD), chronic hypoxaemia is associated with increased mortality and only long-term oxygen therapy is able to improve their survival. Normoxaemic COPD patients have been shown to suffer from abnormalities in ANS function. The aims of this study were to evaluate ANS function in COPD patients with chronic hypercapnic respiratory insufficiency and to test whether oxygen supplementation could reverse any ANS dysfunction. Eleven stable COPD patients with chronic hypercapnic respiratory insufficiency underwent evaluation of ANS by analysis of variability in cardiac frequency at rest and during both vagal (controlled breathing) and sympathetic (tilting) stimuli breathing with and without oxygen supplementation. Thirteen male, healthy, nonsmoking volunteers served as controls. Evaluation of ANS in COPD patients during hypoxic conditions showed alterations both at rest and in response to vagal and sympathetic stimuli. Oxygen supply reversed hypoxaemia without significant changes in arterial carbon dioxide tension and, therefore, ANS alterations were corrected during sympathetic stimulus only. Breathing room air and oxygen, the resting low-frequency (LF) powers were 45+/-15 and 148+/-55 ms2 x Hz(-1), respectively, and controlled breathing LF were 107+/-41 and 141+/-113 ms2 x Hz(-1), respectively. In stable patients with chronic obstructive pulmonary disease with chronic respiratory insufficiency, hypoxaemia is associated with derangements in the autonomic nervous system which may be partially reversed by oxygen administration.