BACKGROUND:Although the acute phase of the COVID-19 pandemic has subsided, long COVID remains a significant and ongoing public health concern. Persistent symptoms continue to affect a substantial proportion of COVID-19 survivors, increasing healthcare burden. OBJECTIVE:This study aims to identify the determinants of long-term symptom trajectories following COVID-19 infection. METHODS:We conducted a prospective cohort study of 1666 adults discharged after hospitalisation for COVID-19 in Tuscany, Italy. The presence of mental confusion, exertional dyspnoea, fatigue, and insomnia was assessed at 1, 3, 6, 9, and 12 months post-discharge. The mean hospital stay was 13.6 (±12) days and 131 patients required intensive care unit admissions. Latent growth curve models were used to examine the baseline prevalence and longitudinal trajectories of each symptom, and to identify demographic and clinical factors associated with symptom persistence. RESULTS:Fatigue was the most common persistent symptom at baseline, followed by exertional dyspnoea, insomnia, and mental confusion. Female sex was consistently associated with both baseline presence and persistence of all symptoms. Older age was linked to baseline mental confusion and to persistent dyspnoea and fatigue. Markers of greater acute severity (ICU admission, longer hospital stay, higher WHO score) were associated with symptom improvement over time. Pre-existing coronary heart disease and cancer independently predicted persistent dyspnoea and fatigue, whereas hypertension appeared protective. CONCLUSIONS:Persistent symptoms are common after COVID-19 and vary by sex, age, comorbidities, and acute disease features. Symptoms may persist up to 12 months post-hospitalisation, underscoring the need for long-term follow-up and targeted interventions.

Introduction. Cardiovascular diseases are the leading cause of morbidity and mortality in older adults, highlighting the need for effective preventive strategies. Structured screening programs may enhance the early detection and management of cardiovascular risk factors in this population. To describe the impact of the PREVASC multidisciplinary model in promoting collaboration in cardiovascular prevention, collecting evidence on cardiovascular risk, and assessing gender differences in cardiovascular risk prevention among the older population. Methods. In this descriptive correlational cross-sectional study data were collected from 1,836 participants aged 65–94 years enrolled in the PREVASC screening program. All professionals involved in the PREVASC screening campaign entered data into a standardized data collection system. Participants underwent structured cardiovascular assessments, and adherence to pharmacological therapy, sociodemographic characteristics, and time spent at the screening center were recorded. Descriptive statistics were used to analyze frequencies, percentages, and measures of central tendency and dispersion. Results. Among the scheduled participants, 1,640 (89.37%) attended the screening, while 196 (10.63%) did not. Adherence to pharmacological therapy was high, with 1,453 participants (90%) reporting ongoing treatment; adherence was higher among women (91.4%) than men (88.3%). The mean age of participants was 72.52 years, with a predominance of women (55.9%). The average time spent at the screening center was 1 hour and 3 minutes (range: 22 minutes–3 hours and 47 minutes), indicating an efficient organizational structure. Discussion. The PREVASC program demonstrated high participation rates and sustainable operational performance, supporting the feasibility of structured cardiovascular screening in older adults. The integration of multiprofessional expertise and community-based preventive activities represents a replicable model for effective cardiovascular prevention and early risk identification, with potential relevance for public health planning.

Background: Coronary computed tomography angiography (cCTA) is now indicated as a non-invasive tool for ruling out obstructive coronary artery disease (O-CAD) in patients who are candidates for transcatheter aortic valve implantation (TAVI) showing low-intermediate pre-test probability of O-CAD. In elderly and comorbid TAVI candidates, the safety and accuracy of cCTA as an alternative to invasive coronary angiography (ICA) for ruling out O-CAD remain to be established. Aim: To assess the feasibility, diagnostic accuracy, and clinical safety of cCTA for ruling out proximal O-CAD in elderly, comorbid, high-risk patients undergoing TAVI. Methods: We conducted a retrospective, single-center study including all consecutive patients with severe symptomatic aortic stenosis who underwent TAVI between January 2019 and December 2020. All patients underwent pre-TAVI cCTA. Patients with positive or non-diagnostic cCTA underwent ICA selectively (ICA group). In patients with no-O-CAD, ICA was omitted and proceeded directly to TAVI (no-ICA group). Accordingly, patients were divided into two groups: no-ICA and ICA group. Clinical follow-up was extended up to 5 years, with assessment of major adverse cardiovascular events (MACEs), mortality, heart failure hospitalizations, and unplanned revascularization. Results: Among 355 patients enrolled, 210 were included in the study. Among them, 140 (66.7%) had negative cCTA for O-CAD, and ICA was safely omitted in 132 patients (62.8%). cCTA was inconclusive in 43 patients (20.5%) and positive in 27 (12.9%). ICA confirmed O-CAD in 53 of 78 patients (67.9%) and PCI was performed in 35 of 53 (66.0%). The accuracy of cCTA for ruling in O-CAD was low (66.28%). During the follow-up period (1513 ± 508 days), the no-ICA group showed comparable outcomes to the ICA group in terms of periprocedural complications and long-term results—at both 1 and 5 years—for MACEs, heart failure hospitalizations, mortality and unplanned revascularization. Outcomes remain comparable between the two groups after performing matched-pair analyses. Conclusions: Our data show that cCTA may provide a reliable, safe, and effective alternative to ICA for ruling out obstructive CAD in elderly patients undergoing TAVI when image quality is diagnostic. A cCTA-based strategy allows deferral of ICA in most cases without compromising procedural safety or long-term clinical outcomes, enabling a personalized and tailored clinical pathway. Whether advanced CT techniques, such as CT-FFR and photon-counting CT, may help refine patient selection for invasive coronary assessment remains to be demonstrated.

Background In older COPD patients with cognitive impairment, inhaler technique errors are common, but may be reduced by simplified designs and structured training. Methods We conducted a prospective, crossover study with follow-up at 5±1 weeks in device-naïve COPD patients aged ≥70 years with moderate cognitive impairment (Mini Mental State Examination score 10–24). Physical function was assessed (Fried's Frailty Phenotype and Barthel Index). Participants demonstrated technique with a multidose dry powder inhaler (mDPI), a capsule-based DPI (cDPI), and a pressurised metered-dose inhaler (pMDI) after reading the patient information leaflet, then received a standardised stepwise training programme. Co-primary end-points were mastery after reading the patient information leaflet and after expert tuition. Secondary end-points included time to mastery, 1-month technique retention, and satisfaction (10-item Feeling of Satisfaction with Inhaler questionnaire). Results 96 patients completed the study (mean age 79 years; 42% women; 66% pre-frail, 14% frail). After reading the patient information leaflet, correct technique was achieved by 29% with mDPI, 13% with cDPI, and 7% with pMDI. Errors were more frequent (p<0.001) with the pMDI (n=137) and cDPI (n=98) than with the mDPI (n=65). Training enabled all patients to achieve mastery, with shorter (p<0.001) times for the mDPI (3.1±1.1 min) than the cDPI (8.5±2.1 min) or pMDI (9.1±3.3 min). After 1 month, 85% maintained correct technique, higher (p<0.05) for the mDPI (97%) than pMDI (77%). Satisfaction scores favoured (p<0.01) the mDPI. Conclusions Structured training allows older cognitively impaired COPD patients to master and retain inhaler technique. The mDPI was simpler, faster to learn, and better retained, supporting its use in geriatric COPD care.

Background Thrombocytopenia (TP) is a common laboratory finding following transcatheter aortic valve implantation (TAVI), but its prognostic impact remains uncertain. This study aimed to evaluate the incidence, predictors, and clinical outcomes of TP in a real-world TAVI population. Methods A retrospective analysis of 299 patients who underwent TAVI at Careggi University Hospital (Florence, Italy) between January 2021 and December 2022 was conducted. TP was defined as a platelet count <150,000/mm³. Platelet trends, procedural details, and clinical outcomes were assessed. Multivariate Cox regression and Kaplan-Meier analyses were used to evaluate associations with all-cause mortality and ischemic stroke. Results A reduction in platelet count post-procedure occurred in 98% of patients; TP developed in 60.5% and persisting at discharge in 45.5%. Pre-procedural TP was independently associated with increased all-cause mortality (HR 1.7, p=0.027), whereas post-procedural TP was not. A >50% drop in platelet count was significantly associated with ischemic stroke (HR 7.9, p=0.017). Predictors of >50% platelet reduction included elevated CRP, infection, Sapien valve use, general anesthesia, and continuous veno-venous hemodiafiltration (CVVHDF). Conclusions TP frequently follows TAVI, but only preprocedural TP and a >50% platelet reduction are associated with adverse outcomes. These findings emphasize the prognostic importance of baseline hematologic evaluation and the need to monitor for substantial platelet declines post-procedure, which may reflect underlying thrombo-inflammatory processes.

BACKGROUND:A significant proportion of older adults undergoing transcatheter aortic valve replacement (TAVR) fail to achieve meaningful clinical benefit at 1 year, highlighting the need for improved risk stratification. OBJECTIVES:The aim of this study was to develop and validate a geriatric score to determine 1-year mortality or functional decline. METHODS:A multicenter cohort study was conducted across 3 high-volume academic centers in Italy from January 2020 to December 2022. Consecutive patients ≥75 years of age with severe symptomatic aortic stenosis evaluated for TAVR were enrolled. Participants underwent a comprehensive geriatric assessment, including basic activities of daily living (BADL) and the Mini Nutritional Assessment-Short Form. The Society of Thoracic Surgeons score was also collected. The primary outcome was a composite of all-cause mortality or significant functional decline (loss of ≥2 BADL or failure to improve if already impaired) at 1 year. A logistic regression model identified predictive factors, and a new risk score was derived in a 66% derivation cohort and tested in a 34% validation cohort. RESULTS:Among 562 patients (median age 83 years, 58.5% women), 78 (13.9%) met the primary outcome over 11 months (Q1-Q3: 10-12 months). Mini Nutritional Assessment-Short Form score, BADL, lower estimated glomerular filtration rate, and elevated pulmonary artery systolic pressure were independently associated with the composite outcome. The derived score showed high discrimination (area under the curve, 0.92; 95% CI: 0.88-0.96). In validation, performance remained robust (area under the curve, 0.87; 95% CI: 0.79-0.95), outperforming the Society of Thoracic Surgeons score. CONCLUSIONS:A geriatric assessment-based model significantly improved the prediction of 1-year mortality or functional decline in older TAVR candidates, offering a valuable tool to refine patient selection and avoid procedural futility.

The Italian Association for Cardiovascular Rehabilitation and Prevention (ITACARE-P) together with the Società Italiana di Gerontologia e Geriatria (SIGG); Società Italiana di Geriatria Ospedale e Territorio (SIGOT); SICGE, Società Italiana di Cardiologia Geriatrica (SICGE) released a joint position paper to guide referrals of elderly cardiovascular patients discharged from Geriatric wards to Cardiac Rehabilitation (CR) facilities. The document provides rationale and operative recommendations for appropriateness (i.e. qualifying diagnosis) and priority criteria to overcome mismatch between potential demand and effective supply of CR programmes. In case of no-referral due to logistic restraints, the document recommends the adoption of best alternatives to CR for disability reduction, better prognosis, and improvement of quality of life. The joint position paper is also aimed at promoting the consideration of Geriatric Medicine as a potential stakeholder of CR.

AIMS:Ranolazine (Ran) is an anti-anginal drug inhibiting late sodium current, an action possibly hindering arrhythmias onset. Indeed, some evidence supports the anti-arrhythmic effects of Ran. The aim of this study, which evaluated Italian patients with chronic coronary syndrome (CCS), was to investigate whether Ran, as an add-on therapy, was associated with a lower incidence of atrial fibrillation (AF) compared with no-Ran prescription (No-Ran). METHODS AND RESULTS:The original population (N = 6.1 million) derived from the databases of the Italian National Health System; information concerned hospitalizations with the related diagnoses, drug therapy, follow-up clinical events and visits. Patients hospitalized between 2011 and 2020 for any cause and discharged with an ICD-9-CM CCS code were studied if AF had not been diagnosed before. The follow-up duration was 4.4 and 5.0 years for the Ran and the No-Ran cohorts, respectively. Study subjects were 171 015 (mean age: 72 years; men: 66%; Ran: N = 22 207; No-Ran: N = 148 808). After propensity score matching, Ran (N = 6384) and No-Ran (N = 25 536) cohorts were similar for age, sex, comorbidities and drug therapy. AF incidence during follow-up was 5.3% and 9.6% in the Ran and in the No-Ran cohorts, respectively, with a 41% drug-related lower risk of arrhythmia development in the Cox model (HR = 0.59, 95% CI: 0.53-0.67, P < 0.001). Also, Ran correlated with reduced incidence of brady-arrhythmias (P = 0.001) and ventricular tachy-arrhythmias (P = 0.049), and with lower mortality (P < 0.001). CONCLUSION:Our study, performed in a subset of the Italian CCS population, showed that Ran therapy was safe and associated with a long-term reduced AF incidence.

The prevalence of transthyretin cardiac amyloidosis (ATTR-CA) among older adults is increasing. Whether age and geriatric syndromes bear any impact on the management and outcomes in ATTR-CA is poorly understood. In a prospective, multicenter cohort study, 256 patients diagnosed with ATTR-CA from 03/2021 to 03/2024 underwent comprehensive geriatric assessment (CGA). The study evaluated the prevalence and clinical associations of CGAs across different disease stages (National Amyloidosis Centre (NAC) stage). Key CGA domains included disability, malnutrition, depression, frailty, short physical performance battery (SPPB) and cumulative deficits (sum of the single CGA items). Associations of these measures with disease modifying therapy and overall mortality were analyzed. Median age was 82 years (men: 87%, variant: 19,7.4%); 129 (50.3%) patients received disease-modifiers. Those >85 years had significantly lower odds of receiving disease modifying therapy even after adjusting for disability, frailty, and cumulative deficits. Over 1.7 [interquartile range 1.0-2.1] years, 44 (17.2%) patients died. After adjustment for NAC stage, diuretics and diseasemodifiers, CGA domains of disability, malnutrition, SPPB, frailty and number of deficits, but not age, were significantly associated with mortality. Assessment of CGA domains improved NAC prognostic accuracy. In a national prospective cohort of ATTR-CA patients, older age was associated with lower prescription of disease-modifiers, even among individuals with a low burden of geriatric syndromes. However, when adjusted for geriatric domains, age was not associated with survival, indicating potential ageism. Since some geriatric syndromes may be modifiable, a CGA could enhance risk stratification, reduce age-related bias, and improve outcomes.

Background:Fever following transcatheter aortic valve implantation (TAVI) poses a clinical challenge, necessitating a comprehensive diagnostic approach to discern between infectious and non-infectious origins. Despite its minimally invasive nature, TAVI disrupts protective anatomical barriers, leading to an increased risk of infection, as well as to aseptic inflammatory responses. Standardized strategies for the management of these patients are lacking. Methods:We retrospectively analyzed 1074 consecutive patients. Data retrieved from electronic hospital charts included demographics, comorbidities, NYHA functional class, Multidimensional Prognostic Index (MPI), EUROSCORE II and STS risk score, pre- and post-procedural echocardiographic data, and procedural details. Fever was defined as temperature >37.5°C. Results:Overall, 391 patients (36.4%) experienced at least one episode of fever, in all cases ensuing within the first 2 days after the procedure. Fever lasted only one day (ODF) in most patients (86%). Antibiotic prophylaxis varied, with cefazolin showing the highest efficacy. Management of post-TAVI fever was heterogeneous. Twenty-five percent of febrile patients received an empiric antibiotic therapy, although a presumed site of infection was identified in only 17% of them and just 19 patients (4.9%) had positive blood cultures. Of the 19 patients with positive cultures, 11 had a Gram+ and 8 a Gram-infection. Fever duration, invasive accesses, and clinical suspicion of infection influenced antibiotic initiation. Fever lasting more than one day (MODF) was associated with new-onset atrial fibrillation and prolonged in-hospital stay. Positive blood cultures were linked to higher mortality, especially with Gram-bacteremia. However, patients with short-term fever had a similar mortality to those without fever, highlighting the benign nature of self-limited fever. Conclusions:Fever is a common complication after TAVI. A watchful waiting strategy is advisable in stable patients without evidence of infection and self-limited episodes of fever, while selected patients may benefit from an aggressive approach.

Postoperative atrial fibrillation (PoAF) complicates 10–15% of pulmonary lobectomy and 20–30% of pneumonectomy, contributing to increased morbidity, extended hospital stays, and healthcare costs. Identifying predictors of PoAF may aid in risk stratification and preventive care. We prospectively studied 100 consecutive patients who underwent lung surgery for a malignant tumour, including video-assisted thoracic surgery (VATS) and open thoracotomy. Patients with prior atrial fibrillation, cardiac surgery, or thyroid abnormalities were excluded. All patients received pre-operative echocardiography, including speckle-tracking for left atrial (LA) and ventricular function. PoAF incidence was monitored through continuous electrocardiographic follow-up. Univariable and multivariable analyses identified clinical and echocardiographic predictors of PoAF. At univariable analysis, PoAF patients (8%) were more likely to have hypertension (100% vs. 58%, p = 0.018), higher fibrinogen (432 ± 118 mg/dl vs. 346 ± 87 mg/dl, p = 0.03), and lower magnesium levels (1.8 ± 0.2 mEq/l vs. 2.1 ± 0.2 mEq/l, p = 0.003). Echocardiographic differences included larger LA diameter (42 ± 5 mm vs. 35 ± 5 mm, p = 0.002), area (23.8 ± 3.3 cm 2 vs. 17.7 ± 4.5 cm 2 , p < 0.001), and volume (36.9 ± 7.2 ml vs. 28.6 ± 9.4 ml, p = 0.003). Multivariable analysis identified fibrinogen (HR 1.01, p = 0.036), interventricular septal thickness (HR 3.05, p = 0.029), LA area (HR 1.33, p = 0.016) and LA peak contraction strain (PACS, HR 2.3, p = 0.023) as independent PoAF predictors. Hypertension, inflammation, electrolyte imbalance, and LA remodelling were associated with PoAF. Pre-operative identification of these factors may help target high-risk patients for preventive interventions.

Valvular heart disease (VHD) is the third leading cause of cardiovascular morbidity, with its incidence and public health impact projected to increase significantly. This study adopts a novel perspective, focusing on elderly individuals residing in rural areas, highlighting the unique dynamics of small-town settings. This multicenter, observational study was conducted from May 2022 to September 2023, under the coordination of the AOU Careggi Echo Core-Lab, which managed the entire screening program. In 10 small Italian villages, each municipality facilitated the enrollment of asymptomatic individuals aged ≥ 65 years, with no prior VHD history, through voluntary participation. Participants were grouped into three age categories (65–69, 70–74, and ≥ 75 years) and underwent a thorough evaluation, including a Quality of Life (QoL) questionnaire and comprehensive echocardiographic assessment focusing on VHD detection and grading. Among 1,113 participants, the prevalence and severity of VHD showed a significant increase with age (p < 0.0001). Remarkably, 94

Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis (AS), especially in high-risk surgical patients. However, the impact of right ventricular (RV) dysfunction on TAVI outcomes remains unclear. This study aimed to evaluate RV function, measured by tricuspid annular plane systolic excursion (TAPSE), as a predictor of mortality post-TAVI. In a multicenter retrospective cohort study, 637 patients with severe AS who underwent TAVI were assessed for RV function using TAPSE measurements. Data were analyzed to explore the relationship between TAPSE and mortality at 30 days and 1 year, adjusting for demographic factors, comorbidities, and echocardiographic parameters. The prognostic value of the RV–pulmonary artery coupling parameter (TAPSE/PASP) was also investigated. A reduced TAPSE was identified as an independent predictor of 30-day mortality, with each 1-mm increase in TAPSE linked to a 14

BACKGROUND:The prevalence of transthyretin cardiac amyloidosis among older adults (often octogenarians) is increasing. We aimed to determine whether age and geriatric syndromes bear any impact on the management and outcomes in transthyretin cardiac amyloidosis and assess the risk of ageism. METHODS:In a prospective, multicenter cohort study, 256 patients diagnosed with transthyretin cardiac amyloidosis from March 2021 to March 2024 underwent comprehensive geriatric assessment (CGA). The study evaluated the prevalence and clinical associations of CGAs across different disease stages (National Amyloidosis Centre stage). Key CGA domains included disability, malnutrition, depression, frailty, Short Physical Performance Battery, and cumulative deficits (sum of the single CGA items). Associations of these measures with disease-modifying therapy and overall mortality were analyzed. RESULTS:Median age was 82 years (men: n=223 [87%]; variant: n=19 [7.4%]); 129 (50.3%) patients received disease modifiers. Those ≥85 years had significantly lower odds of receiving disease-modifying therapy even after adjusting for disability, frailty, and cumulative deficits. Over 1.9 (interquartile range, 1.0-2.3) years, 45 (17.6%) patients died. After adjustment for National Amyloidosis Centre stage, diuretics and disease modifiers, CGA domains of disability, malnutrition, Short Physical Performance Battery, frailty, and number of deficits, but not age, were significantly associated with mortality. Assessment of CGA domains improved National Amyloidosis Centre prognostic accuracy. CONCLUSIONS:In a national prospective cohort of patients with transthyretin cardiac amyloidosis, older age was associated with lower prescription of disease modifiers, even among individuals with a low burden of geriatric syndromes. However, when adjusted for geriatric domains, age was not associated with survival, indicating potential ageism. Because some geriatric syndromes may be modifiable, a CGA could enhance risk stratification, reduce age-related bias, and improve outcomes.

Thrombotic microangiopathy (TMA) represents a pathological response to endothelial damage, caused by genetic or acquired factors. It includes conditions like thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome (aHUS), and secondary TMAs. Malignant hypertension can both result from and trigger TMA. This study aims to identify risk factors for severe cardiac involvement, defined as a left ventricular ejection fraction ≤ 50

BACKGROUND:The prevalence and clinical impact of frailty in transthyretin cardiac amyloidosis (ATTR-CA) remains poorly characterized. OBJECTIVES:This study aimed to evaluate the prevalence, clinical determinants, and prognostic significance of frailty in a large cohort of patients with ATTR-CA. METHODS:Frailty was assessed in 880 patients with ATTR-CA (median age 80 years [Q1-Q3: 75-84 years], 719 [81.7%] male) using the Clinical Frailty Scale (CFS). Frailty was analyzed as a continuous variable and categorized as CFS 1 to 3, CFS 4 or 5, CFS 6 or 7, and CFS 8 or 9. RESULTS:Frailty was observed in 502 (57.1%) patients (CFS 4 or 5: 364 [41.4%]; CFS 6 or 7: 129 [14.7%]; CFS 8 or 9: 9 [1.0%]). Independent predictors of worsening frailty included older age, female sex, non-p.(V142I) hereditary ATTR-CA variants, and National Amyloidosis Centre stage 3 disease. Mortality rates increased incrementally with frailty severity (deaths per 100 person-years: 2.9 vs 11.0 vs 21.1 vs 40.9; log-rank P < 0.001). Frailty was independently associated with higher mortality risk across all age groups, genotypes, and disease stages. CONCLUSIONS:Frailty is common in ATTR-CA and is independently linked to increased mortality risk. Incorporating frailty assessment alongside traditional markers enhances prognostication across genotypes and disease severities, particularly for short-term risk estimation.

Intracoronary in-stent restenosis (ISR) is a phenomenon that generally occurs between 3 and 6 months after stent placement. With the introduction of drug-eluting stents (DES), the incidence of ISR has decreased but not disappeared. We report a case of reiterant in-stent restenosis of an 81-year-old female patient who underwent multiple percutaneous coronary intervention and two coronary artery bypass surgeries. ISR is possibly associated with extra-stent, stent-related and intra-stent factors. Here, we excluded the first two and focused on the intra-stent factors that seem more likely in our case. A challenging diagnostic workup led us to the hypothesis of a coronary vasculitis potentially triggered by some component of the stent in a predisposed patient carrier of non-disease-specific ANA, with an exaggerated immune response. No recurrence of ISR occurred after the introduction of steroids. Biological and intra-stent causes of ISR should be taken into careful consideration to aim for the early detection of the underlying mechanism of restenosis and to embrace the best therapeutic strategy.