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Boriani G, Mantovani M, Cherubini B, Tartaglia E, Bonini N. [Management and treatment of atrial fibrillation in cancer patients: an important decision-making hub in cardio-oncology]. G Ital Cardiol (Rome) 2024; 25:346-349. [PMID: 38639125 DOI: 10.1714/4252.42298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Giuseppe Boriani
- Cardiologia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena
| | - Marta Mantovani
- Cardiologia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena
| | - Benedetta Cherubini
- Cardiologia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena
| | - Enrico Tartaglia
- Cardiologia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena
| | - Niccolò Bonini
- Cardiologia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena
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Imberti JF, Maisano A, Rampini F, Minnocci M, Bertuglia F, Mantovani M, Cherubini B, Mei DA, Ferrara L, Bonini N, Valenti AC, Vitolo M, Longo G, Boriani G. Cardiovascular Reasons for Access to a Tertiary Oncological Emergency Service: The CARILLON Study. J Clin Med 2023; 12:jcm12030962. [PMID: 36769610 PMCID: PMC9917995 DOI: 10.3390/jcm12030962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The prevalence of acute cardiovascular diseases (CVDs) in cancer patients is steadily increasing and represents a significant reason for admission to the emergency department (ED). METHODS We conducted a prospective observational study, enrolling consecutive patients with cancer presenting to a tertiary oncological ED and consequently admitted to the oncology ward. Two groups of patients were identified based on main symptoms that lead to ED presentation: symptoms potentially related to CVD vs. symptoms potentially not related to CVD. The aims of the study were to describe the prevalence of symptoms potentially related to CVD in this specific setting and to evaluate the prevalence of definite CV diagnoses at discharge. Secondary endpoints were new intercurrent in-hospital CV events occurrence, length of stay in the oncology ward, and mid-term mortality for all-cause. RESULTS A total of 469 patients (51.8% female, median age 68.0 [59.1-76.3]) were enrolled. One hundred and eighty-six out of 469 (39.7%) presented to the ED with symptoms potentially related to CVD. Baseline characteristics were substantially similar between the two study groups. A discharge diagnosis of CVD was confirmed in 24/186 (12.9%) patients presenting with symptoms potentially related to CVD and in no patients presenting without symptoms potentially related to CVD (p < 0.01). During a median follow-up of 3.4 (1.2-6.5) months, 204 (43.5%) patients died (incidence rate of 10.1 per 100 person/months). No differences were found between study groups in terms of all-cause mortality (hazard ratio [HR]: 0.85, 95% confidence interval [CI] 0.64-1.12), new in-hospital CV events (HR: 1.03, 95% CI 0.77-1.37), and length of stay (p = 0.57). CONCLUSIONS In a contemporary cohort of cancer patients presenting to a tertiary oncological ED and admitted to an oncology ward, symptoms potentially related to CVD were present in around 40% of patients, but only a minority were actually diagnosed with an acute CVD.
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Affiliation(s)
- Jacopo F. Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Anna Maisano
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Francesca Rampini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Melania Minnocci
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Filippo Bertuglia
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Marta Mantovani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Benedetta Cherubini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Davide A. Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Leonardo Ferrara
- Medical Oncology, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence:
| | - Giuseppe Longo
- Medical Oncology, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125 Modena, Italy
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Vitolo M, Ziveri V, Gozzi G, Busi C, Imberti JF, Bonini N, Muto F, Mei DA, Menozzi M, Mantovani M, Cherubini B, Malavasi VL, Boriani G. DIGItal Health Literacy after COVID-19 Outbreak among Frail and Non-Frail Cardiology Patients: The DIGI-COVID Study. J Pers Med 2022; 13:jpm13010099. [PMID: 36675760 PMCID: PMC9863916 DOI: 10.3390/jpm13010099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Telemedicine requires either the use of digital tools or a minimum technological knowledge of the patients. Digital health literacy may influence the use of telemedicine in most patients, particularly those with frailty. We aimed to explore the association between frailty, the use of digital tools, and patients' digital health literacy. METHODS We prospectively enrolled patients referred to arrhythmia outpatient clinics of our cardiology department from March to September 2022. Patients were divided according to frailty status as defined by the Edmonton Frail Scale (EFS) into robust, pre-frail, and frail. The degree of digital health literacy was assessed through the Digital Health Literacy Instrument (DHLI), which explores seven digital skill categories measured by 21 self-report questions. RESULTS A total of 300 patients were enrolled (36.3% females, median age 75 (66-84)) and stratified according to frailty status as robust (EFS ≤ 5; 70.7%), pre-frail (EFS 6-7; 15.7%), and frail (EFS ≥ 8; 13.7%). Frail and pre-frail patients used digital tools less frequently and accessed the Internet less frequently compared to robust patients. In the logistic regression analysis, frail patients were significantly associated with the non-use of the Internet (adjusted odds ratio 2.58, 95% CI 1.92-5.61) compared to robust and pre-frail patients. Digital health literacy decreased as the level of frailty increased in all the digital domains examined. CONCLUSIONS Frail patients are characterized by lower use of digital tools compared to robust patients, even though these patients would benefit the most from telemedicine. Digital skills were strongly influenced by frailty.
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Affiliation(s)
- Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Valentina Ziveri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Giacomo Gozzi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Chiara Busi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Federico Muto
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Davide Antonio Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Matteo Menozzi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Marta Mantovani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Benedetta Cherubini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Correspondence:
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Maisano A, Valenti A, Alessandro A, Cherubini B, Mantovani M, Leo G, Trapanese P, Rampini F, Bertuglia FF, Minnocci M, Boriani G. 711 CROSS-SECTIONAL ANALYSIS OF CARDIOVASCULAR CAUSES OF COMMON PRESENTING SYMPTOMS IN PATIENTS WITH ACTIVE CANCER: THE EXPERIENCE FROM A TERTIARY ONCOLOGICAL CENTRE IN MODENA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background and aim of the study
There is a rising interest in cardio-oncology as an holistic approach to oncological patients with established cardiovascular comorbidities or at increased cardiovascular risk. Symptoms of potential cardiovascular significance are a common cause of cardiologic consultation in patients with active cancer. Moving from this perspective, we analyzed the proportion of cardiovascular conditions underpinning potentially cardiologic presenting symptoms in a cohort of patients with active malignancy referred to the Emergency Department (ER) of a tertiary oncological centre.
Methods and Results
The study included 250 consecutive patients (median age 69 years [IQR 59.7-77.4], 50% female) presenting to the oncologic ER from September 1st 2021 to May 31st 2022. The most common presenting symptoms were fever (26.9%), gastrointestinal symptoms (24.9%), dyspnea (10.4%), hypotension and hypertension (1.6%), syncope (1.2%) and other (11.2%). We considered as symptoms of potential cardiologic significance the following: dyspnea, lipothymia and syncope, palpitations, fever, chest pain, hypotension and hypertension. We found that 101 of 250 patients (40%) presented with symptoms of potential cardiologic significance. Out of them, 14 patients (13.9%) had confirmed cardiologic diseases: pulmonary embolism (21.4%), heart failure (21.4%), pericardial effusion (21.4%), reflex syncope (14.2%), pericarditis (14.2%) and new onset atrial fibrillation (7.1%). As reported in the table, no significant difference was reported in terms of risk profile or history of cardiac diseases when comparing patients with and without cardiovascular cause of presenting symptoms (CV cause vs non-CV cause).
Conclusions
Cardiovascular conditions are not common causes of ER presentation among oncologic patients with active cancer. Nevertheless, when a cardiologic condition is diagnosed, it could be potentially life-threatening. The cardiovascular risk profile and the history of cardiac disease is not a good discriminator to identify a cardiac cause of presenting symptoms in this specific setting.
Table. Characteristics of patients with potentially cardiologic presenting symptoms.
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Affiliation(s)
- Anna Maisano
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Annachiara Valenti
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Albini Alessandro
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Benedetta Cherubini
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Marta Mantovani
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Giulio Leo
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Paola Trapanese
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Francesca Rampini
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Filippo Federico Bertuglia
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Melania Minnocci
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
| | - Giuseppe Boriani
- Cardiology Division, Department Of Biomedical, Metabolic And Neural Sciences, University Of Modena And Reggio Emilia, Policlinico Di Modena , Modena , Italy
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