Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Boriani, Giuseppe; Guerra, Federico; Ponti, Roberto De; D’Onofrio, Antonio; Accogli, Michele; Bisignani, Giovanni; Forleo, Giovanni B.; Landolina, Maurizio; Lavalle, Carlo; Ricci, Renato Pietro; Palmisano, Pietro; Luise, R.; Bonis, Silvana De; Pangallo, Antonio; Talarico, Antonello; Maglia, G.; Aspromonte, V.; Nigro, Gerardo; Bianchi, Valter; Rapacciuolo, Antonio; Ammendola, Ernesto; Solimene, F.; Stabile, Giuseppe; Biffi, Mauro; Ziacchi, Matteo; Malpighi, Policlinico S. Orsola; Saporito, Davide; Casali, Edoardo; Turco, Vincenzo; Malavasi, Vincenzo Livio; Vitolo, Marco; Imberti, Jacopo Francesco; Bertini, Matteo; Anna, Arcispedale S.; Zardini, Marco; Placci, Angelo; Quartieri, Fabio; Bottoni, Nicola; Carinci, Valeria; Barbato, G.; Maria, Elia De; Borghi, A.; Ramazzini, Ospedale B.; Bronzetti, G.; Tomasi, C.; Boggian, Giulio; Virzì, Santo; Sassone, Biagio; Corzani, Alessandro; Sabbatani, Paolo; Pastori, Paolo; Ciccaglioni, A.; Adamo, Francesco Maria; Scaccia, Alberto; Spampinato, A.; Patruno, Nicolino; Biscione, Francesco; Cinti, Claudio; Pignalberi, Carlo; Calò, Leonardo; Tancredi, M.; Belardino, Natale Di; Ricciardi, Danilo; Cauti, Filippo Maria; Rossi, P.; Cardinale, M.; Ansalone, G.; Narducci, Maria Lucia; Pelargonio, Gemma; Silvetti, M.; Drago, F.; Santini, Luca; Pentimalli, Francesco; Pepi, P.; Caravati, F.; Taravelli, E.; Belotti, Giuseppina; Rordorf, Roberto; Mazzone, Patrizio; Bella, P. Della; Rossi, S.; Canevese, L. F.; Cilloni, Silvia; Doni, Lorenzo A.; Vergara, P.; Baroni, M.; Perna, E.; Gardini, Andrea Casadei; Negro, Roberto W. Dal; Perego, Giovanni Battista; Antonio, Curnis; Arabia, Gianmarco; Russo, Alessandra; Marchese, P.; Dell’Era, Gabriele; Occhetta, E.; Pizzetti, F.; Amellone, Claudia; Giammaria, Massimo; Devecchi, Chiara; Coppolino, A.; Tommasi, S.; Anselmino, M.; Coluccia, G.; Guido, Alessandro; Rillo, Mariano; Palamà, Zefferino; Luzzi, G.; Pellegrino, Pier Luigi; Grimaldi, M.; Grandinetti, G.; Vilei, E.; Potenza, D.; Scicchitano, Pietro; Favale, Stefano; Santobuono, Vincenzo Ezio; Sai, R.; Melissano, Donato; Candida, T. R.; Bonfantino, V. M.; Canda, D. Di; Gianfrancesco, Domenico; Carretta, D; Pisanó, Ennio; Medico, A.; Giaccari, R.; Aste, R.; Murgia, C.; Nissardi, Vincenzo; Sanna, Giampaolo; Firetto, G.; Crea, P.; Ciotta, E.; Sgarito, Giuseppe; Caramanno, Giuseppe; Ciaramitaro, G.; Faraci, A.; Fasheri, A.; Gregorio, L. Di; Campsi, G.; Muscio, G.; Giannola, G.; Padeletti, Margherita; Rosso, Attilio Del; Notarstefano, Pasquale; Nesti, Martina; Miracapillo, G.; Giovannini, Tiziana; Pieragnoli, Paolo; Rauhe, W.; Marini, Marco; Guarracini, F.; Ridarelli, M.; Fedeli, Francesca; Mazza, Andrea; Zingarini, G.; Andreoli, Chiara; Carreras, G.; Zorzi, Alessandro; Zanotto, Gabriele; Rossillo, Antonio; Ignatuk, B.; Zerbo, F.; Molon, Giulio; Fantinel, M.; Zanon, Francesco; Marcantoni, L.; Zadro, M.; Bevilacqua, M.

doi:10.1007/s11739-022-03140-4

Cited by 32 publications

(18 citation statements)

References 57 publications

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“…In our study, the last period of patient enrolment was during the COVID-19 pandemic, which had an important impact on the activity of all centers involved in electrophysiology and device implants [ 45 , 46 , 47 , 48 ]. In particular, between March 2020 and February 2022, five waves of COVID-19 were observed in Italy.…”

Section: Discussionmentioning

confidence: 99%

“…A significant reduction in elective CIED implants was reported among several Italian arrhythmia centers during the first wave, with a progressive and gradual return to pre-pandemic volumes during the third–fourth waves. On the other hand, emergency procedures only dropped by 10%, and recovery was observed usually during the second wave [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

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Low Occurrence of Infections and Death in a Real-World Cohort of Patients with Cardiac Implantable Electronic Devices

Imberti

Mei

Fontanesi

et al. 2023

JCM

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Background. The incidence of infections and death in patients implanted with cardiac implantable electronic devices (CIEDs) is not fully known yet. Aim. To describe the incidence of CIED-related infection and death, and their potential predictors in a contemporary cohort of CIED patients. Methods. All consecutive patients implanted with a CIED at our institution were prospectively enrolled. Follow-up visits were performed 2 weeks after CIED implantation for all patients, and then every 6 months for implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) patients and every 12 months for pacemaker (PM) patients. The adjudication of CIED-related infections was performed by two independent investigators and potential disagreement was resolved by a senior investigator. Results. Between September 2016 and August 2020, a total of 838 patients were enrolled (34.6% female; median age 77 (69.6–83.6); median PADIT score 2 (2–4)). PMs were implanted in 569 (68%) patients and ICD/CRT in 269 (32%) patients. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2–56.4) months, five (0.6%) patients had a CIED-related infection and 212 (25.5%) patients died. Using multivariate Cox regression analysis, end-stage chronic kidney disease (CKD) requiring dialysis and therapy with corticosteroids was independently associated with a higher risk of infection (hazard ratio (HR): 14.20; 95% confidence interval (CI) 1.48–136.62 and HR: 14.71; 95% CI 1.53–141.53, respectively). Age (HR: 1.07; 95% CI 1.05–1.09), end-stage CKD requiring dialysis (HR: 6.13; 95% CI 3.38–11.13) and history of atrial fibrillation (HR: 1.47; 95% CI 1.12–1.94) were independently associated with all-cause death. Conclusions. In a contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED-related infections was low.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Low Occurrence of Infections and Death in a Real-World Cohort of Patients with Cardiac Implantable Electronic Devices

Imberti

Mei

Fontanesi

et al. 2023

JCM

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“…The meta-analysis showed that RM was associated with a reduction in all-cause mortality of 20% and HF hospitalization of 37% ( 12 ). Finally, the adoption of RM has been proven to be an efficient way of monitoring HF patients in situations during which there is an important need of reducing or interrupting face-to-face consultations, like the recent COVID-19 pandemic ( 13 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

Economic analysis of remote monitoring in patients with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators in the Trento area, Italy

Marini

Videsott

Fratte

et al. 2023

Front. Cardiovasc. Med.

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IntroductionRemote monitoring (RM) technologies have the potential to improve patient care by increasing compliance, providing early indications of heart failure (HF), and potentially allowing for therapy optimization to prevent HF admissions. The aim of this retrospective study was to assess the clinical and economic consequences of RM vs. standard monitoring (SM) through in-office cardiology visits, in patients carrying a cardiac implantable electronic device (CIED).MethodsClinical and resource consumption data were extracted from the Electrophysiology Registry of the Trento Cardiology Unit, which has been systemically collecting patient information from January 2011 to February 2022. From a clinical standpoint, survival analysis was conducted, and incidence of cardiovascular (CV) related hospitalizations was measured. From an economic standpoint, direct costs of RM and SM were collected to compare the cost per treated patient over a 2-year time horizon. Propensity score matching (PSM) was used to reduce the effect of confounding biases and the unbalance of patient characteristics at baseline.ResultsIn the enrollment period, N = 402 CIED patients met the inclusion criteria and were included in the analysis (N = 189 patients followed through SM; N = 213 patients followed through RM). After PSM, comparison was limited to N = 191 patients in each arm. After 2-years follow-up since CIED implantation, mortality rate for any cause was 1.6% in the RM group and 19.9% in the SM group (log-rank test, p < 0.0001). Also, a lower proportion of patients in the RM group (25.1%) were hospitalized for CV-related reasons, compared to the SM group (51.3%; p < 0.0001, two-sample test for proportions). Overall, the implementation of the RM program in the Trento territory was cost-saving in both payer and hospital perspectives. The investment required to fund RM (a fee for service in the payer perspective, and staffing costs for hospitals), was more than offset by the lower rate of hospitalizations for CV-related disease. RM adoption generated savings of −€4,771 and −€6,752 per patient in 2 years, in the payer and hospital perspective, respectively.ConclusionRM of patients carrying CIED improves short-term (2-years) morbidity and mortality risks, compared to SM and reduces direct management costs for both hospitals and healthcare services.

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“…Patients with cardiovascular (CV) conditions are typically followed up with a series of periodic examinations, but this has been severely restricted during the COVID-19 pandemic [ 1 , 2 , 3 , 4 , 5 , 6 ]. During the pandemic and in the immediate aftermath, healthcare providers tried to implement contact with patients through telemedicine to counterbalance the suspension of scheduled outpatient visits [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Among these cardiac disorders, atrial fibrillation (AF) is the most common sustained arrhythmia observed in clinical practice requiring a structured follow-up [ 11 , 12 , 13 ]. A recent survey reported a significant reduction in the activities and procedures related to arrhythmia management in Italy during the COVID-19 pandemic [ 1 , 4 ], highlighting the massive impact of COVID-19 on the entire organization of healthcare systems [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

DIGItal Health Literacy after COVID-19 Outbreak among Frail and Non-Frail Cardiology Patients: The DIGI-COVID Study

Vitolo

Ziveri

Gozzi

et al. 2022

JPM

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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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Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Cited by 32 publications

References 57 publications

Low Occurrence of Infections and Death in a Real-World Cohort of Patients with Cardiac Implantable Electronic Devices

Low Occurrence of Infections and Death in a Real-World Cohort of Patients with Cardiac Implantable Electronic Devices

Economic analysis of remote monitoring in patients with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators in the Trento area, Italy

DIGItal Health Literacy after COVID-19 Outbreak among Frail and Non-Frail Cardiology Patients: The DIGI-COVID Study

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