Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Background: No data are available regarding long-term survival of out-of-hospital cardiac arrest (OHCA) patients based on different Utstein subgroups, which are expected to significantly differ in terms of survival. We aimed to provide the first long-term survival analysis of OHCA patients divided according to Utstein categories.

Methods: We analyzed all the 4,924 OHCA cases prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 2015 to 2019. Pre-hospital data, survival, and cerebral performance category score (CPC) at 1, 6, and 12 months and then every year up to 5 years after the event were analyzed for each patient.

Results: A decrease in survival was observed during the follow-up in all the Utstein categories. The risk of death of the “all-EMS treated” group exceeded the general population for all the years of follow-up with standardized mortality ratios (SMRs) of 23 (95%CI, 16.8–30.2), 6.8 (95%CI, 3.8–10.7), 3.8 (95%CI, 1.7–6.7), 4.05 (95%CI, 1.9–6.9), and 2.6 (95%CI, 1.03–4.8) from the first to the fifth year of follow-up. The risk of death was higher also for the Utstein categories “shockable bystander witnessed” and “shockable bystander CPR”: SMRs of 19.4 (95%CI, 11.3–29.8) and 19.4 (95%CI, 10.8–30.6) for the first year and of 6.8 (95%CI, 6.6–13) and 8.1 (95%CI, 3.1–15.3) for the second one, respectively. Similar results were observed considering the patients discharged with a CPC of 1–2.

Conclusions: The mortality of OHCA patients discharged alive from the hospital is higher than the Italian standard population, also considering those with the most favorable OHCA characteristics and those discharged with good neurological outcome. Long-term follow-up should be included in the next Utstein-style revision.

First COVID-19 sub-intensive respiratory unit in Europe: the Italian experience

European SARS-CoV-2 pandemic epicenter was detected in Northern Italy, in a little Italian town of Lodi province, the Lodi Hospital was therefore rapidly saturated, and in particularly the departments of respiratory diseases and Intensive Care Unit had been largely involved. In this paper, we describe how the first Sub-intensive Respiratory Unit in Europe completely dedicated to COVID-19 patients was organized and managed in our hospital. From February 25^th to April 30^th 2020, 156 patients were admitted to our Respiratory Sub-intensive Unit. Among them, 100 were discharged, 28 dead and 28 transferred to ICU for intubation.

[Heart failure: epidemiology, costs and healthcare programs in Italy]

Epidemiological data show an even greater prevalence of heart failure in the general population, in particular in elderly people, both in Italy and the other European countries. Patients admitted to hospital because of heart failure are commonly complex patients with relevant comorbidities and frequent readmissions. Hospital care accounts largely for the costs due to heart failure, whereas expenditure for therapies (drugs, devices and surgery) is less significant; non-medical and social costs represent also a relevant part of total costs. By far, the real challenge in the care of heart failure patients consists in the efforts to reduce hospital readmissions. A broad spectrum of interventions has been proposed for improving care of heart failure patients: multidisciplinary interventions involving physicians and nurses consisting of different modalities of transtelephonic monitoring have been demonstrated to be effective in reducing readmission rates and improving patient outcome. New technologies for remote monitoring with implantable devices (defibrillators and pacemakers) are becoming the standard of clinical practice in a great number of cardiology departments in our country. In addition, implantable devices for automatic and continuous hemodynamic monitoring are in an advanced phase of clinical evaluation. In conclusion, new modalities of care, centered on out-of-hospital assistance by means of interactive as well as automatic remote monitoring, are now available and seem to impact positively on the growing need for resources to be allocated to the care of heart failure patients.