Demographic and comorbidity profile of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a real-life clinical setting: Are 5-alpha-reductase inhibitor consumers different?

PURPOSE: We aimed to describe, in a daily clinical practice setting, the demographic and comorbidity profile of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH-LUTS), to compare the characteristics of patients receiving 5-alpha-reductase inhibitors (5-ARIs) with those not receiving them and to investigate predictors of 5-ARI prescription. METHODS: We performed a retrospective observational study using data retrieved from a general practitioners database. Male patients with diagnosis of BPH-LUTS were included. The following demographic and clinical data were available and extracted: age, comorbidities, BPH-LUTS medical therapy, drugs for comorbidities. A subgroup analysis was performed according to the use of 5-ARIs. Factors associated with 5-ARI prescription were assessed with uni- and multivariate analyses. RESULTS: A total of 7,103 patients were identified. Most patients (71.7%) were aged ≥65 years. Hypertension was present in 64.9% of patients; it was the most prevalent comorbidity followed by diabetes mellitus, hypercholesterolemia, coronary artery disease and other dyslipidemias. Overall, 38.22% of patients were treated with 5-ARIs. Mean age of patients taking 5-ARIs was significantly higher. The prevalence of hypertension and the use of antihypertensive drugs were significantly higher among patients receiving 5-ARIs. Older age was an independent predictor of 5-ARI prescription. CONCLUSIONS: In a daily clinical practice setting, patients with BPH-LUTS receiving 5-ARIs are significantly older and have significantly higher prevalence of hypertension if compared with patients with BPH-LUTS not receiving 5-ARIs. Older age is an independent predictor of 5-ARI prescription.

Diagnosis and management of atrial fibrillation by primary care physicians in Italy : a retrospective, observational analysis.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a heavy burden of morbidity and mortality, mainly due to an increased risk of cerebrovascular events and cardiac failure. Oral anticoagulant (OAC) treatment prevents stroke and systemic thromboembolism in patients with AF and its use is strongly recommended in guidelines. However, its use in this patient group remains limited. Primary care physicians (PCPs) have an important role to play in this context. OBJECTIVE: The primary objective was to estimate prevalence and epidemiological features of AF in the primary care setting, focusing on ischaemic and bleeding risk assessment. A secondary objective was to examine the PCPs' level of adherence to the guidelines for the prevention of thromboembolic risk in these patients. METHODS: This retrospective, observational study was based on data entered by 128 PCPs into the Health Search (HS) Thales database, identifying patients with a diagnosis of AF at the time of the analysis. RESULTS: Out of 167,056 patients analysed, 2,173 (1.3 %) were diagnosed with AF, with 86 % at high risk for ischaemic stroke, according to CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) stratification. After the diagnosis of AF, 84 % of patients were prescribed OAC treatment. However, at 2 years' follow-up, only 29.6 % were still being treated with OACs. CONCLUSION: The prevalence of AF in this analysis was consistent with previously reported Italian national epidemiological data. Adherence to the European Society of Cardiology AF guidelines by PCPs was low, despite the high levels of stroke risk. At the end of the observation period less than one-third of patients were still on OAC therapy. Awareness of the benefits of OACs in stroke prevention in AF patients needs to be improved.

Management of chronic liver disease by general practitioners in southern Italy: unmet educational needs.

BACKGROUND: Despite chronic liver diseases represent an important cause of illness in Italy, data from family practice are poor. AIM: To assess the management of chronic liver diseases by general practitioners in a large area of Southern Italy. METHODS: This was a 5-year retrospective analysis from 104 physicians in charge of a population of 143,159 adult subjects. RESULTS: Amongst 6550 patients with chronic liver disease (4.7%, 3400 M, median age 57 years), 1330 (20.3%) had HCV infection, 226 (3.4%) HBV infection, and 293 (4.5%) liver cirrhosis (25 alcohol-related). The prevalence of alcohol consumption, recorded by 90% of physicians, was 20.4%. Hypertransaminasemia and liver steatosis had a prevalence of 6.7% and 2.4%, respectively. Although transaminases were checked 3 times over 5 years in 80% of cases, few patients were investigated for viral infection, and less than 50% underwent ultrasonography and consultation, leaving undefined a consistent number of cases. Alcohol consumption, body mass index and ultrasonography were poorly checked even in hypertransaminasemic patients. CONCLUSIONS: This study shows that data recording by general practitioners in chronic liver disease patients lacks homogeneity and can miss important information. One unmet need is therefore the integration between theoretical knowledge and practice to share similar behaviours and improve the management of these patients.