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single antihypertensive drugs is extremely low during the first year of treatment. Potential cost saving should be possible
by reducing the high frequency of discontinuation. Diuretics represent the least expensive therapeutic option, although
further investigations in the long-term are needed to analyse the effects of persistence on therapeutic effectiveness and
related costs.
Filippi A, Sessa E, Pecchioli S, Trifirņ G, Samani F, Mazzaglia G. Homecare for patients with heart failure in Italy. Ital
Heart J 2005; 6(7):573-7
ABSTRACT. BACKGROUND; Heart failure (HF) represents an important health issue in western countries, especially
for the elderly, frail population. A number of HF patients must usually be assisted at home. No information is available
about the usual care of HF patients in Italy. The aim of this study was to describe the characteristics of HF patients
receiving homecare in the Italian general practice. METHODS: A questionnaire was sent to 320 general practitioners
(GPs) involved in the Health Search project. Among these, 148 (46.2%) answered and 376 home-ridden HF patients
(60.3% women, median age 85 years) were identified. RESULTS: 257 (57%) patients were in NYHA class III or IV.
Multiple relevant concomitant diseases occurred in 326 (86.7%) subjects. Only 140 (37.2%) patients were able to take
their pills without any help; caregivers, mainly family members, were required 24 hours a day in 78.7% of cases. The
length of homecare was > 1 year in 84.5% of cases. CONCLUSIONS: According to our data, thousands of HF patients
are usually assisted at home for long periods in Italy. This is a very old group of subjects with heavy co-morbidity and a
high need for continuous, prolonged assistance. Studies specifically aimed at the care of HF patients are needed.
Filippi A, Vanuzzo D, Bignamini AA, Mazzaglia G, Cricelli C, Catapano AL. The database of Italian general practitioners
allows a reliable determination of the prevalence of myocardial infarction. Ital Heart J. 2005; 6(4):311-4
ABSTRACT. BACKGROUND: To plan preventive intervention after myocardial infarction (MI) the disease prevalence
and the age and time from acute event of the index population should be known. METHODS: We identified all the
living patients with MI coded diagnosis in the database of the Italian College of General Practitioners (Health Search
Database-HSD). The years from the first acute MI were also determined. RESULTS: 3588 subjects with MI diagnosis were
identified (2698 males and 888 females, for 2 gender not recorded). Based on the distribution of our population and
on that reported by the Italian Institute of Statistics, stratified by gender and age (segments of 10 years), the estimated
number of subjects with MI in Italy (age-standardized rates x 10000) was 309284 for men and 102343 for women.
CONCLUSIONS: The prevalence of MI diagnosis in the HSD is very close to that obtained by other epidemiological
methods. Querying the database can provide a simple and inexpensive way to estimate and monitor the prevalence of
MI in Italy.
Balestrieri M, Marcon G, Samani F, Marini M, Sessa E, Gelatti U, Donato F. Mental disorders associated with
benzodiazepine use among older primary care attenders. A regional survey.
Soc Psychiatry Psychiatr Epidemiol
2005; 40(4):308-15
ABSTRACT. BACKGROUND: Benzodiazepines (BDZs) are among the most commonly prescribed drugs in the elderly and
their use is often too prolonged according to current international guidelines. METHODS: We investigated the pattern
of use of BDZs among 65- to 84-year-old attenders at 40 Italian primary care practices who answered positively in a
questionnaire on the use of anxiolytic/hypnotic drugs and successfully completed the PRIME-MD questionnaire. The
survey lasted 6 months, from February to July 2001. RESULTS: Of the 1,156 subjects who completed the PRIME-MD, 748
subjects were positive for at least one psychiatric diagnosis. A depressive disorder was present in 36.5% of all PRIME-MD
completers and in about one-third of cases represented by major depression, whereas anxiety disorders, somatoform
disorders and alcohol abuse accounted for 18.2%, 8.1% and 1.7% of all PRIME-MD completers, respectively. Most
patients were first prescribed BDZs by their General Practitioners (GPs) for each diagnostic group. However, patients with
pure anxiety started BDZ treatment during hospitalisation more often (19.7%) than patients with depressive disorders
(13.7 %). Moreover, patients with comorbid anxiety and depressive disorders (CADD) were most likely to receive their
first BDZ prescription from a psychiatrist (15.7 %). Sleep disturbances were present in at least 50% of cases (and up
to 86 %) in each diagnostic group. About 75% of prescriptions concerned anxiolytic BDZ or medium/long-acting BDZ.
Most patients with anxiety, CADD and depression used night-time BDZ (65.2%, 56.9 % and 60.5%, respectively).
The prevalence of chronic use of BDZs was equally high in all categories of psychiatric disorder (about 90 % for each),
showing that the vast majority of patients, irrespective of the diagnosis, had been using BDZs for years. CONCLUSIONS:
BDZs are widely prescribed for elderly people by their GPs, often for a considerable length of time. The evidence that
many BDZ consumers suffer from a depressive or an anxiety disorder, or both, could be a starting point for encouraging
a rational prescription in accordance with international guidelines.