COPD management as a model for all chronic respiratory conditions: report of the 4th Consensus Conference in Respiratory Medicine.

BACKGROUND: Non-communicable diseases (NCDs) kill 40 million people each year. The management of chronic respiratory NCDs such as chronic obstructive pulmonary disease (COPD) is particularly critical in Italy, where they are widespread and represent a heavy burden on healthcare resources. It is thus important to redefine the role and responsibility of respiratory specialists and their scientific societies, together with that of the whole healthcare system, in order to create a sustainable management of COPD, which could become a model for other chronic respiratory conditions. METHODS: These issues were divided into four main topics (Training, Organization, Responsibilities, and Sustainability) and discussed at a Consensus Conference promoted by the Research Center of the Italian Respiratory Society held in Rome, Italy, 3-4 November 2016. RESULTS AND CONCLUSIONS: Regarding training, important inadequacies emerged regarding specialist training - both the duration of practical training courses and teaching about chronic diseases like COPD. A better integration between university and teaching hospitals would improve the quality of specialization. A better organizational integration between hospital and specialists/general practitioners (GPs) in the local community is essential to improve the diagnostic and therapeutic pathways for chronic respiratory patients. Improving the care pathways is the joint responsibility of respiratory specialists, GPs, patients and their caregivers, and the healthcare system. The sustainability of the entire system depends on a better organization of the diagnostic-therapeutic pathways, in which also other stakeholders such as pharmacists and pharmaceutical companies can play an important role.

The care for chronic heart failure by general practitioners. Results from a clinical audit in Italy.

BACKGROUND: In Italian primary care, chronic heart failure (CHF) patients are mainly managed by general practitioners (GPs). However, there are few studies analysing CHF management challenges in primary care and identifying opportunities for improvement. OBJECTIVES: To describe CHF care as implemented by GPs in the Veneto Region and to identify opportunities for improvement. METHODS: In 2008, using an audit process, 114 Venetian GPs analysed their electronic health records, identified CHF patients and collected clinical and care related information: prevalence, co-morbidity, caring conditions, diagnostic and therapeutic management, and hospitalization. After two training sessions, data on pharmacotherapy were analysed again in 2009. RESULTS: The prevalence of CHF was 1.2% (95% CI: 1.1-1.3%). Diagnostic echocardiography was used in 57% of cases. At baseline, the proportions of patients that used specific medication were: diuretics 88%; angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) 77%, beta-blockers 46% and anti-aldosterone agents 32%. After two training sessions, the use of ACE inhibitors/ARB and beta-blockers increased to 80% and 56%, respectively. Renal failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus and dementia were the most prevalent concomitant diseases, posing specific management problems. Half of the patients were generally visited at home; they were dependent on some kind of care given. CONCLUSION: In Veneto a large number of CHF patients are mainly managed by GPs. Further improvements are necessary to meet standards of care with regard to diagnosis, medication, follow-up and home care. The care situation affected hospitalization and the quality of follow-up visits.

Prevalence of metabolic syndrome and its relationship with clinically prevalent cardiovascular disease in the Veneto region, northeastern Italy.

BACKGROUND: Cardiovascular disease (CVD) is more frequent in adults with metabolic syndrome than in those without. We wished to assess the prevalence of the metabolic syndrome and the role of its specific components on prevalent CVD in a large cohort of subjects from the general population. METHODS: Seventy-eight general practitioners among 3,542 were identified and participated in this study. Personal, anthropometric, and lifestyle data were obtained as was data relevant to CVD [coronary heart disease (CHD) or stroke or both]. A stratified random sample of 6,347 subjects taken from the population of the Veneto region in northeastern Italy was analyzed. RESULTS: The prevalence [and its 95% confidence limits (CL)] of metabolic syndrome by gender and age classes was higher in men than women (21.9% vs. 16.8) and it increased with age (29.8% in ages 60-69 vs. 8.0 in ages 30-39). The most frequent triad of metabolic syndrome was waist circumference (WC)-blood pressure (BP)-hyperglycemia (GLYC) (33%). Metabolic syndrome was significantly associated with CVD [odds ratio (OR)=1.53, 95% CL, 1.02-2.29] and gender (men have about six times the risk of women), and the risk of CVD increases with age (11% per additional year of age). High-density lipoprotein (HDL) is the only component of metabolic syndrome associated with CVD: The OR was 2.12 (95% CL, 1.32-3.43) and remains significant in sex-specific models only in men. CONCLUSIONS: The prevalence of metabolic syndrome in the Veneto region among subjects ages 30-69 is high. There is a significant association between prevalent CVD and metabolic syndrome, but the biological basis of association is strongly influenced by gender.