Heart failure in community-dwelling older persons: aims, design and adherence rate of the ICARe Dicomano project: an epidemiologic study. Insufficienza Cardiaca negli Anziani Residenti a Dicomano.

BACKGROUND: The prevalence of heart failure (HF) increases with age, and HF is a major cause of disability and mortality in older persons. Detection of HF in epidemiological studies has relied on criteria validated only in young and middle-age adults, and, therefore, may prove inadequate in older subjects, because they do not take into account the pathophysiologic and clinical peculiarities of HF in old age. Thus, the true prevalence of HF in the older general population remains uncertain and has probably been underestimated in previous studies. Moreover, the mechanism and the extent by which HF hinders physical functioning in older people has not been fully elucidated. OBJECTIVES: This paper describes the design of the ICARe study, carried out in an older home-dwelling population to collect data about: (1) the sensitivity and specificity of diagnostic criteria used previously in epidemiological studies of HF; (2) the prevalence of the different pathophysiologic forms of HF; and (3) the impact of HF on overall health status, and on physical functioning, in the absence or presence of chronic comorbidity. DESIGN AND SETTING: This was a cross-sectional survey. Eligible were all community-dwelling persons aged 65 years or older recorded in the Registry Office of Dicomano, a small town nearby Florence (Italy). All the domains of multidimensional geriatric assessment were explored through different phases of the study (home interview, laboratory testing, geriatric visit) that comprised an extensive cardiopulmonary instrumental assessment including: color Doppler echocardiography, echotomography of the carotid arteries used in an original method to determine arterial compliance, and bell spirometry. Presence of major chronic conditions was ascertained by predefined, standard algorithms that were based largely on clinical examination. RESULTS: There were 864 older persons eligible for the ICARe study. Even with a substantial decline from home interview (91.2%) to the cardiopulmonary study (71.1%), the adherence rate remained high throughout the study, and the population examined was fairly representative of the original eligible population. Thus, we believe that the data collected in this study offer a unique opportunity to assess the validity of the diagnostic clinical criteria for HF in the general older population, to identify the pathophysiology underlying the syndrome, and to investigate the relationship between HF, comorbidity, and disability.

[Hemorrheological changes induced by submaximal exertion in subjects with insulin-dependent diabetes mellitus]. / Modificazioni emoreologiche indotte da uno sforzo submassimale in soggetti con diabete mellito insulinodipendente.

The influence of an acute physical exercise on hemorheological parameters in insulin-dependent diabetes mellitus in not actually known. We have examined the behavior of hemorheological parameters and other laboratory findings such as blood glucose, blood lactic acid, O2 and CO2 venous pressure and venous pH before and after a submaximal physical exercise standardized by ECG monitoring and by means of an 'oxygen consumption computer'. The work load was significantly lower in diabetic patients than in normal control subjects. On the other hand, changes in hemorheological parameters were more evident in diabetic patients. The significance of these findings is also discussed.

[Use of pentoxifylline in diabetes with intermittent claudication]. / L'uso della pentossifillina nei diabetici con claudicatio intermittens.

The authors have investigated the effect of pentoxifylline administration (400 mg in three doses) in diabetic subjects with lower limb vasculopathy. The results have shown a marked improvement in clinical symptoms and VRBC and a slight improvement in fibrinogen and blood lipid levels.

Digoxin clearance and glomerular filtration rate.

The authors have studied the correlation between digoxin clearance and glomerular filtration rate. This correlation was better than between digoxin clearance and creatinine clearance without reducing the error of a programed therapy.

Digoxin and congestive heart failure.

The purpose of our study was to evaluate the absorption of digoxin in alcoholic solution in normal subjects and in patients on congestive heart failure whose water and electrolyte balances were determined. While the parameters of the distribution kinetics were not significantly different between the two groups, the areas under the serum concentration curve resulted increased in the patients on congestive heart failure indicating a more efficient absorption respect to the normal subjects.