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Filippi A, Vannuzzo D, Bignamini AA, Mazzaglia G, Brignoli O, Sabatini A, Cricelli C, Catapano AL. Secondary prevention
of myocardial infarction: a survey in primary care. J Cardiovasc Med (Hagerstown). Jun 2006;7(6):422-426
ABSTRACT. OBJECTIVE: To collect information on the major risk factors and secondary prevention among patients
with myocardial infarction in Italy. METHODS: Data were obtained from the database of the Italian College of General
Practitioners; 3588 patients (mean age 68.7 +/- 11.3 years; 2698 men, 888 women; two unrecorded gender), with
an average time from event of 6 +/- 5.7 years, were identified. RESULTS: Among the major risk factors, data entry
ranged from 50.3% for physical activity to 74.9% for blood pressure. Inadequate blood pressure control was present
in 49.2% and elevated plasma cholesterol levels (> 5.2 mmol/l) in 57.3%; among the latter group, 65% were on lipid-
lowering therapy. Only 47.2% of the treated patients achieved a total cholesterol level of < 5.2 mmol/l. Antiplatelet
or anticoagulant drugs, beta-blockers, and angiotensin-converting enzyme inhibitors were prescribed to 43%, 10.3%,
and 57.9% of patients, respectively. CONCLUSIONS: The preventive attitude of Italian general practitioners is similar to
that reported in other European countries with two noticeable exceptions: under-prescription of beta-blockers and of
antiplatelet drugs. Clearly, secondary prevention requires major improvement.
Galatti L, Sessa A, Mazzaglia G, Pecchioli S, Rossi A, Cricelli C, Schito GC, Nicoletti G. Antibiotic prescribing for acute
and recurrent cystitis in primary care: a 4 year descriptive study. J Antimicrob Chemother 2006; 57(3):551-6
ABSTRACT. OBJECTIVES: To explore the antibiotic prescribing pattern for cystitis and the patient-related variables
associated with prescription during a 4 year period among Italian general practitioners (GPs). METHODS: We obtained
information from the `Health Search Databasť (HSD), an Italian general practice research database. From a total sample
of 457 672 eligible patients aged >16 years registered up to December 2002, we included those whose diagnoses
could be classified as acute (uncomplicated and complicated) and recurrent cystitis. Patients' features and prevalence
of antibiotic users were assessed. RESULTS: Of 35 129 cases diagnosed during the period 1999-2002, 96.0% of
them were acute cystitis (39.2% recorded as uncomplicated). The prevalence of cases with acute complicated and
uncomplicated cystitis slightly increased during the 4 year period, whereas it remained stable for recurrent cystitis.
Most of the cystitis cases reported no diagnostic tests. More than 70% of patients were prescribed with at least
one antibiotic, with a 4-fold increased risk of antibiotic use for acute cystitis throughout the study period. The
prevalence of antibiotic users reached 86.2% for both acute uncomplicated and complicated cystitis in 2002, and
81.5% for recurrent cystitis. Fluoroquinolones represented the most common antibiotics being prescribed although
they markedly decreased during these years. Fosfomycin trometamol use increased dramatically, becoming the
first choice for any type of cystitis. CONCLUSIONS: Data indicate an evident rise in antibiotic use mostly related to
fosfomycin trometamol. They also indicate that such a prescriptive trend finds confirmation from the available
evidence for acute uncomplicated cystitis, although the management of recurrent cystitis could be further improved.
Mazzaglia G, Mantovani LG, Sturkenboom MC, Filippi A, Trifiro G, Cricelli C, Brignoli O, Caputi AP. Patterns of persistence
with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort
study in primary care.
J Hypertens 2005; 23(11):2093-100
ABSTRACT. OBJECTIVE: To describe patterns of persistence and related primary care costs associated with first
antihypertensive treatment. DESIGN AND SETTING: Retrospective cohort study during 2000-2001, using information
from 320 Italian general practitioners. PARTICIPANTS: We studied 13 303 patients with newly diagnosed hypertension,
who received a first single antihypertensive prescription within 3 months after diagnosis. MAIN OUTCOME MEASURES:
Persistence with first-line single treatment, categorized as follows: continuers: patients continuing the first-line
medication for at least 1 year; combiners: patients receiving an additional antihypertensive drug and continuing the initial
medication; switchers: patients changing from the first-line to another class of antihypertensive drug and discontinuing
the initial treatment; discontinuers: patients stopping the first-line treatment without having another prescription until
the end of the follow-up. Primary care costs were expressed as the cost of hypertension management per person-year
of follow-up. RESULTS: In the study cohort, 19.8% were continuers, 22.1% were combiners, 15.4% were switchers,
and 42.6% were discontinuers. Continuation was greatest with angiotensin II type 1 receptor blocking agents (25.2%),
calcium channel blockers (23.9%) and angiotensin-converting enzyme inhibitors (23.3%). Severe hypertension [hazards
ratio 1.30; 95% confidence interval (CI) 1.18 to 1.43] and severe health status (hazards ratio 1.22; 95% CI 1.15 to
1.30) increased the risk of discontinuation. The likelihood of needing an additional antihypertensive drug was associated
with mild-to-severe baseline blood pressure, diabetes (hazards ratio 1.20; 95% CI 1.06 to 1.36), and familial history
of cardiovascular disease (hazards ratio 1.24; 95% CI 1.10 to 1.39). Discontinuers accounted for 22.4% of the total
primary care cost. Initial treatment with angiotensin II type 1 receptor blocking agents and beta-blockers resulted in
incremental primary care costs of 145.2 and 144.2, respectively, compared with diuretics. Combiners and switchers
increased the primary care cost by 140.1 and 11.7, compared with continuers. CONCLUSION: Persistence with first-line