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European Journal of Heart Failure 2004 6(6):769-779; doi:10.1016/j.ejheart.2003.11.021
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© 2004 European Society of Cardiology

The ‘real’ woman with heart failure. Impact of sex on current in-hospital management of heart failure by cardiologists and internists

C. Opasicha, S. De Feoa, G.A. Ambrosiob, P. Bellisc, A. Di Lenardad, G. Di Tanoe,1, D. Ficof, L. Gonzinig, R. Lavecchiag, C. Tomasih and Aldo P. Maggionig,*

a Department of Cardiology, Salvatore Maugeri Foundation Pavia, Italy
b Department of Internal Medicine, SS. Giovanni e Paolo Hospital Venice, Italy
c Department of Internal Medicine, Loreto Mare Hospital Naples, Italy
d Department of Cardiology, Maggiore Hospital Trieste, Italy
e Department of Cardiology, Piemonte Hospital Messina, Italy
f Department of Internal Medicine, Leonardi-Riboli Hospital Lavagna, Genoa, Italy
g Italian Association of Hospital Cardiologists (ANMCO) Research Center, Via La Marmora 34-50121, Firenze, Italy
h Department of Internal Medicine, Ospedale Generale Provinciale Bolzano, Italy

* Corresponding author. Tel.: +39-055-5001703; fax: +39-055-583400.. E-mail address: centro_studi{at}anmco.it


   Abstract
Top
 Notes
 Abstract
1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
Aim: To identify differences between sexes in the clinical profile, use of resources, management and outcome in a large population of ‘real world’ patients with heart failure (HF).

Methods: A prospective cross-sectional survey was conducted on 2127 consecutive patients (47% women) admitted with HF to 167 cardiology and 250 internal medicine departments between February 14 and 25, 2000.

Results: Women were older, had a higher prevalence of atrial fibrillation, and more frequently a hypertensive or valvular aetiology. Females were admitted more frequently in Medical than in Cardiology Departments. The rate of invasive and non-invasive procedures was lower in women than in men, slightly higher if managed by cardiologists. Women were less frequently prescribed ACE-inhibitors, amiodarone, and spironolactone, and more frequently prescribed digoxin. In-hospital mortality was similar, without difference between health-care providers. A 6-month follow-up was performed in 56.4% of the cases in both setting, but less frequently in women. Event rates were similar with nearly half of patients re-hospitalised at least once.

Conclusion: The ‘real’ HF woman has generally a more severe disease; she is an old lady who is more frequently hospitalised in a medical unit, receives few diagnostic, and cardiovascular procedures and pharmacological therapy, has a relatively low probability of dying in hospital, but a high likelihood of requiring readmission.

Key Words: Heart failure • Women • Management • Prognosis

Received November 20, 2002; Revised June 23, 2003; Accepted November 13, 2003


   1. Introduction
Top
 Notes
 Abstract
 1. Introduction
2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
In recent years, epidemiological and clinical evidence have shown some differences between men and women in several aspects of cardiovascular disease, including risk factors, presentation, response to therapy, management, quality of care and outcome [1]. However, most work has been concentrated on the sex differences of patients with ischaemic heart disease; scarce information is available on this topic in the care and outcome of patients with heart failure (HF) [2,3].

Looking at HF clinical trials, women are not adequately represented (0–34% of study population, Table 1). Many women are not entered because they do not have the ejection fraction level required by the trials [4,5]. Under-representation is exacerbated by the exclusion of older patients, as HF predominates in older women. Women, being older, often have multiple health problems that may create additional risks and confuse the results of a trial.


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  		Table 1 Number of women enrolled

 
Community-based studies suggest a sex bias in medical treatment and management, associated with the speciality of the caregiver physician [6–10]. With respect to Italy, in the Italian Network on Congestive Heart Failure (IN-CHF), a database that prospectively collects long-term data concerning outpatients referred to a large number of cardiology centres, women account for only 26% of the total population [11]. This low rate of women is explained by the characteristics of the registry itself, in which patients are followed only by cardiologists. Patients followed by internal medicine specialists are generally older and, consequently, women are more represented.

Recently, some of the results from the TEMISTOCLE (Heart Failure Epidemiological Study in Italian people) study have been presented [12]. This study was aimed to identify the differences in the clinical profile, use of resources, management and outcome in a large population of real world patients with heart failure.

The aim of the present study was to highlight sex-related differences of in-hospital HF management as recorded by the TEMISTOCLE survey. We, therefore, compared clinical profile, use of resources, treatment and 6-month outcome among women and men, consecutively admitted for worsening HF to cardiology or internal medicine departments.


   2. Patients and methods
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
Details of the TEMISTOCLE study have already been presented [12]. In brief, the TEMISTOCLE survey was conducted in a network of 167 Cardiology Departments and 250 Internal Medicine Units. Participating centres were co-ordinated by the Association of Italian Hospital Cardiologists (ANMCO) and the Italian Federation of Hospital Internists (FADOI). The TEMISTOCLE survey prospectively evaluated all patients with a primary discharge diagnosis of HF, admitted to the 417 participating centres between February 14 and 25, 2000.

On discharge, the data from history, physical examination, diagnostic procedures and in-hospital course were recorded on a standardised form to allow the assessment of provider-related differences in the clinical profile of the study population. Potential differences in patients’ management were assessed by comparing the frequency of use of diagnostic tests during the hospital admission, pharmacological treatment during the hospital stay and at discharge and patients’ referral for follow-up. Co-morbidity was defined as the presence of at least one of the following: diabetes, chronic obstructive pulmonary disease, renal dysfunction, anaemia and thyroid disease.

Evaluation of in-hospital outcome included duration of hospital stay, New York Heart Association (NYHA) functional class at discharge and total in-hospital mortality. Follow-up was not mandatory as part of the study plan and was performed according to the clinical practice of the participating centre. When performed, it included assessment of outcome and hospital re-admissions in the first 6 months after discharge.

2.1. Statistical analysis
The ANMCO Research centre in Florence (Italy) collected the data, controlled their quality and analysed them. The study cohort was stratified according to sex and admission, to either a cardiology (CARD) or an internal medicine (MED) department.

Continuous variables were expressed as mean±S.D. Differences between continuous variables were evaluated by the Student's t test. Discrete variables were summarised by frequency percent and compared by the Chi-square test or the Fischer exact test. Two multivariate logistic regression analyses were performed in order to evaluate the independent predictors of in-hospital mortality in women and in men. Results are expressed as odds ratios with 95% confidence intervals. A P value <0.05 was considered as statistically significant.


   3. Results
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
3.1. Population of patients
From February 14 to 25, 2000, the 417 participating centres enrolled 2127 consecutive patients with HF. Cardiology departments (n=167, 40.1% of total centres) enrolled 789 patients (37.1% of total), while 1338 patients (62.9%) were enlisted in 250 Medicine departments (59.9% of centres). Of these patients, 1000 (47.0%) were women and a significantly higher percentage of them were enrolled through the MED units (69.7 vs. 30.3%; P<0.0001). Most admissions were non-planned, more so in females (92.4 vs. 89.0%, P=0.0088). The baseline demographic and clinical features of the patients are summarised in Table 2. Women were significantly older than men; they had a less frequent ischemic etiology and a more frequent hypertensive or valvular aetiology for their disease. Atrial flutter–fibrillation was very frequent in both groups but more prevalent in women (about half of the patients), in whom, however, left ventricular dysfunction was less severe. Seventy percent of males and females had co-morbidity; diabetes, anaemia and thyroid disease were more frequent in women.


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  		Table 2 Clinical characteristics at enrolment of women vs. men

 
Women admitted to CARD were significantly younger (73±12 vs. 79±9; P<0.0001), had a more dramatic presentation (i.e. NYHA IV: 36 vs. 28%; pulmonary edema: 26 vs. 23%), and a lower frequency of preserved LV function than those admitted to MED (LVEF >40%: 40 vs. 47%). Valvular aetiology and dilated cardiomyopathy were more frequent in women admitted to CARD units.

3.2. Precipitating factors
The factors considered to have potentially caused the heart failure destabilisation are shown in Table 3. In women, these were less frequently myocardial ischaemia and other non-cardiovascular factors such as pulmonary disease, poor drug adherence and inappropriate drug prescription. Uncontrolled hypertension, as well as anaemia and endocrine dysfunction, which were, however, more represented in women, more often precipitated the index worsening episode.


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  		Table 3 Precipitating factors

 
3.3. In-hospital course
Length of stay, and diagnostic and therapeutic procedures performed during hospital stay are detailed in Table 4. Sex per se did not affect the duration of hospital stay although women admitted to medical wards tended to stay in hospital longer than those admitted to cardiology units. Female sex negatively influenced the use of diagnostic tests (non-invasive or invasive procedures) whose absolute numbers were rather low even in men and even in patients admitted into CARD units. Left ventricular function was measured in 48.5% of females (in 61.5% of males; P<0.0001), nearly entirely (98%) by echocardiography and, as in males, more frequently in CARD units. Even after adjustment for all covariates, including age, female sex was associated with a significant lower use of echocardiography (OR 0.72; 95%CI 0.52–0.99).


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  		Table 4 Diagnostic and therapeutic procedures during hospital stay

 
Sex did not influence the use of cardiovascular procedures, in a context of a general low rate of utilisation.

Table 5 shows prescribed drug treatment in hospital and at discharge, in women and men. During the in-hospital stay, all drugs, with the exception of digoxin, were less frequently prescribed to women. To better focus the attention on the rate of use of ACE-inhibitors, we stratified the population of patients in two groups: those with an EF ≤40% and those with EF >40%. In patients with preserved ventricular function, ACE-inhibitors were prescribed in 77.7% and 73.9%, respectively, of males and females, while in the patients with depressed LV function ACE-inhibitors were prescribed in 78.0% of males and 73.0% of females. Of note, at discharge ACE-inhibitors were less frequently prescribed in CARD women (67 vs. 74%; P=0.0218); spironolactone and amiodarone were less frequently prescribed in MED women (respectively, 31 vs. 45% and 6 vs. 16%; P<0.0001). CARD women received less nitrates and antiplatelets (respectively, 34 vs. 48%, P=0.0001 and 33 vs. 41%, P=0.0282), while they received more statins (8 vs. 3%; P=0.0026), β-blockers (16 vs. 9%; P=0.0007) and anticoagulants (36 vs. 18%; P<0.0001).


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  		Table 5 Medical treatment during hospital stay and at discharge in women and men

 
The most frequent reasons for non-prescription of ACE-inhibitors in women were cough (32.0%), hypotension (14.4%), renal impairment (11.7%) and aortic valve stenosis (7.2%); no difference was found between health-care provider. Women had aortic stenosis more frequently than men (men: 1.2%; P=0.0003) while renal failure was less common in women (men: 21.4%; P=0.003).

The most frequent reasons why β-blockers were not prescribed in women were older age (46.1%), COPD (31.1%) and NYHA class IV disease (14.2%), with diabetes and older age being more frequent in women treated in MED units and hypotension more frequent in those in CARD units.

3.4. Clinical outcome
Even if all cause in-hospital mortality was higher in women than in men, the difference was not statistically significant (6.5 vs. 4.9%, P=ns). The most frequent cause of death was worsening heart failure, which did not differ according to health-care provider (Table 4). Table 6 lists the variables resulting, from multivariate analysis, as being independently associated with in-hospital mortality, respectively, in women and men.


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  		Table 6 Predictors of in hospital mortality by multivariate analysis*

 
Nearly all patients were discharged, in NYHA class I–II; post-discharge instrumental evaluation was infrequently scheduled, while outpatient follow-up visits were frequently planned, with a higher percentage for CARD women (Table 7). A 6-month follow-up visit was actually performed in 53.2% of women and in 59.2% of men, P=0.0061, more frequently in CARD patients than in MED ones. During the 6-month period, nearly half of the patients had at least one new hospital admission, without differences between females and males, or between CARD and MED departments. Six-month total mortality of women was similar to that of men, and in MED women was nearly double that in CARD women.


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  		Table 7 Discharge, planning and six-month follow-up data

 

   4. Discussion
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
The rate of women in this large population of unselected patients with HF admitted for worsening heart failure into CARD or MED settings was 47%, much higher than that reported in controlled trials (Table 1) or in the IN-CHF registry [11]. This is the main difference between patients recruited mainly by cardiology institutions or in controlled trials vs. the ‘real world’, in which more than two thirds of women with HF were admitted into MED units.

In our survey, women differ from men in being older (approx. 65% of women were aged 75 years or more), less frequently having a history of coronary artery disease (which was, in any case, the most frequent HF aetiology), and more often having hypertension and valvular disease. The higher prevalence of hypertension is also supported by other observation, such as those of the Framingham study, the SOLVD, CIBIS II trials and, recently, the MERIT-HF trial [13–16]. This difference between men and women may reflect a sex difference in the cardiac response to an increased afterload, a situation in which women are more likely to develop concentric hypertrophy with no change in cavity dimensions and diastolic dysfunction [17]. The SOLVD [18], Framingham [19], and other hospital-based studies [20] reported a predominance of women with valvular heart disease, although a declining frequency of rheumatic heart disease was noted in both sexes, suggesting that HF is secondary to a degenerative valvular disease [19]. Sex differences in left ventricular responses to aortic stenosis have also been found [21].

In women, comorbidity did not influence referrals to MED units, even if diabetes was highly prevalent (as it was in the SOLVD and MERIT-HF registries [16,22]), together with anaemia and endocrine disease, and even though non-cardiovascular factors, such as anaemia and endocrine dysfunction, were more frequently identified as precipitating factors. Interestingly, dietary and iatrogenic factors (including poor compliance) precipitated worsening HF more rarely in women than in men, suggesting that women adhere better to their prescribed treatment. Presentation in hospital did not differ between sexes being always severe; most admissions were urgent with a high rate of patients in NYHA class IV, pulmonary edema or shock (56.9% of women and 54.9% of men). Females admitted to CARD units were younger with an even more severe pattern of presentation than those referred to MED units.

Women admitted into CARD units stayed in hospital a shorter time, probably because of the generally faster turnover of patients in CARD departments than in MED ones. Hospital stay in TEMISTOCLE appeared to be mainly devoted to clinical stabilisation, in keeping with the very high rate of urgent admissions. Consistent with previous studies [20,23–25], the proportion of patients who underwent diagnostic or therapeutic procedures during admission was very low in both sexes (with the notable exception of echocardiography), but always lower in women than men, both in MED and CARD units. This result was in accordance with other population-based studies regarding lower use of cardiovascular procedures in women with HF and in elderly patients, even when adjusted for severity of illness [6,7,20,24,26]. It is possible that in a scenario in which few procedures are used, physicians specifically neglect elderly women.

With respect to the pharmacological treatments prescribed during hospital stay, females were less frequently treated with inotropes, spironolactone, amiodarone, nitrates, statins and antiplatelet agents. However, digoxin was more often used in women both in hospital and at discharge, perhaps as a consequence of the atrial fibrillation and of the common opinion that this drug is a first-line therapy in all aged patients with HF. At discharge, ACE-inhibitors, amiodarone and spironolactone were less frequently prescribed in females. Thus, also in Italy women receive ACE-inhibitors/Angiotensin II receptor antagonists less often than men (79 vs. 84%), even if the prescription rate found in TEMISTOCLE is satisfactory, both in CARD and in MED units [27–31]. Different aetiologies and a higher rate of preserved left ventricular function could explain this difference. It should be remembered that women are more likely to experience cough with ACE-inhibitors and also other side effects such as a rise in creatinine, taste disturbances, skin rash and gastrointestinal upset [3].

Reasons why amiodarone and spironolactone are less prescribed in women are less clear. Atrial fibrillation was more frequent at entry and at discharge in women, but the severity of symptoms was comparable between the sexes at entry and at discharge. It should be noted, however, that spironolactone is not indicated in patients with preserved left ventricular function, which includes many of the women in this survey.

Beta-blockers were not routinely prescribed, either in men or women, even at discharge, when majority of the patients were in NYHA class I–II. The low use of β-blockers probably reflects the scarce evidence at the time of this study. Systematic analyses on the efficacy of β-blockers in the elderly are still lacking and β-blockade may be objectively difficult to implement in frail elderly patients. Being elderly and the presence of preserved left ventricular systolic function were the main reasons for β-blocker non-prescription, more often in women than in men, confirming the more frequent diastolic heart failure pattern in older women. When provider-differences are highlighted, diabetes and older age more often deterred the internists from prescribing frail women with a β-blocker. It was, however, hypotension that prevented the cardiologists, who treated females with more severe HF, from giving such a prescription.

Of note, the rate of prescribing of oral anticoagulants did not differ between the sexes, even though atrial fibrillation was more frequent in females and a greater risk of thrombotic events in women in sinus rhythm has been reported (2.4 vs. 1.8%, from SOLVD trials), proportional with left ventricular dysfunction decline [32]. It should be considered, once more, that physicians may refrain from prescribing anticoagulants to elderly women who frequently live alone and without social support.

In the TEMISTOCLE population, sex per se did not influence in-hospital mortality. A comparison with previous published studies conducted in hospital is hard, because of different end-points, timing and different management. In any case, among the hospital studies [23,24,33], Philbin compared in-hospital mortality rate between women and men, showing a difference (lower mortality rate for women), even after adjustment for age and comorbidities [20]. In the women of the TEMISTOCLE survey, age, clinical severity, renal failure and atrial fibrillation negatively affected the in-hospital prognosis. While the first three predictors are easily explained, the negative prognostic power of atrial fibrillation is still controversial, being for instance in contrast with its positive prognostic power shown in the Scottish hospital registry [33]. In that study, atrial fibrillation reduced the short-term (30-days) case-fatality rate by 24% in women. It was likely that in the Scottish study, a proportion of patients with atrial fibrillation may have had heart failure but preserved left ventricular function, and this may have accounted for their better prognosis.

Despite the fact that the large majority of patients were discharged home in low NYHA class more than 40% of such chronic severely ill patients were re-admitted during the 6 months after the index admission, confirming the high recurrence of the disease and not suggesting any sex-related difference in the short-term prognosis.


   5. Conclusion
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
From our survey a profile of the ‘real HF woman’ can be drawn: she is an old frail lady who, in case of a severe worsening of her HF, is more likely to be referred to a MED unit, less likely than a man to undergo diagnostic and cardiovascular procedures and receive pharmacological therapy. Women have a relatively low risk of dying in hospital, but a high probability of being readmitted within a short period of time.

5.1. Study limitations
The TEMISTOCLE survey might have had a bias caused by the centres choosing to participate: some cardiology centres might have been specialised or interested in heart failure, while participating medicine departments were probably cardiology-oriented.

Follow-up was not a mandatory procedure; its relatively low rate is, therefore, not surprising and mirrors everyday clinical practice.

However, another national survey of HF, like TEMISTOCLE, which was conducted in France [34] and which analysed the spectrum of patients hospitalised for HF in different departments, confirmed the gap between the populations in clinical trials and those in routine clinical practice.


   A.1. Steering Committee
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
M. Cafiero (chairman), M. Scherillo (co-chairman), N. Acquarone, G.B. Ambrosio, M. Annicchiarico, P. Bellis, P. Bellotti, A. Di Lenarda, G. Mathieu, C. Opasich, M. Porcu, L. Tavazzi


   A.2. Executive Committee
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
A.3. Scientific and organising...
 A.4. Participating centres
 References
 
M. Cafiero, A.P. Maggioni, M. Scherillo


   A.3. Scientific and organising secretariat and data management
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
A.4. Participating centres
 References
 
R. Lavecchia, M. Marini, S. Barlera, D. Lucci, G. Orsini, P. Priami


   A.4. Participating centres
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
References
 
Piemonte Alba Medicina (G. Loparco); Arona Medicina (V. Petrella, M. Gialdini); Asti Medicina (G. Pinna), Medicina A (E. Scassa, G. Fornaca, G. Ciravegna); Avigliana Medicina (F. Melo’); Biella Cardiologia (F. Bobba, R. Ursi), Medicina Interna (S. Fontana, G. Lanza), Medicina Generale A (V. Zampaglione); Borgomanero Medicina (V. Infelise, P. Colombo); Borgosesia Cardiologia (G. Rognoni); Bra Medicina (A. Vanni, G. Dallorto); Cuneo Medicina (L. Perotti); Domodossola Cardiologia (G. Tirella, G. Folini), Medicina (P. Cassani); Fossano Medicina (R. Conte, P. Ferraro); Galliate Medicina (S. Cardano, M. Zeno); Moncalieri Cardiologia (G. Lavezzaro, P. Pedenovi), Medicina (C. Marengo, R. Frediani, F. Molino); Nizza Monferrato Medicina (M. Favro, E. Borgno); Novara Cardiologia Univ. (C. Vassanelli, M.E. Caccia), II Cardiologia (C. Cernigliaro, G. Fornaro); Novi Ligure Medicina (G. Fiore; A. Daffonchio); Omegna Medicina (C. Gasparini, A. Gioria); Pinerolo Cardiologia (E. Bellone, P. Carvalho), Medicina (G. Mathieu, Carosio); Pomaretto Medicina (F. Maina, L. Rissone); Rivoli Cardiologia (M.R. Conte, L. Mainardi); Saluzzo Medicina (M. Frascisco, L. Solavagione, S. Reynaud); Savigliano Medicina (A. Diana, M. Tatì); Susa Medicina (M. Dore, M. Dore); Torino S.G. Battista Cardiologia Univ. (G. Trevi, M. Bobbio, S. Bergerone), Medicina Urg. (V. Gai, P. Schinco), Medicina Int. (R. Godio, R. Bonardi), Dea (C. Valenzano, R. Mingozzi); Torino M. Vittoria Medicina 1 (U. Marchisio, Stralla), Medicina 2 (V. Indemburgo); Torino Mauriziano Cardiologia (G. Baduini, A. Bonzano), Medicina (A. Chiesa, R. De Paoli, D. Bertola), Medicina (R. Cavaliere, C. Norbiato); Torino Gradenigo Medicina (S. Gabasio, A. Corino); Venaria Medicina (P. Moiraghi, M.C. Orlando); Verbania Medicina (M. Bersi, G. Ferrara, M. Rinaldi); Veruno Cardiologia (P. Giannuzzi, E. Bosimini); Valle D'Aosta Aosta Medicina (M. Pesenti Compagno, M.S. Modesti, Milloz); Lombardia Brescia Cardiologia (C. Rusconi, P. Faggiano, A. Gualeni); Castellanza Cardiologia (J. Salerno Uriarte, R. Marazzi); Chiari Cardiologia (C. Bellet, F. Bortolini), Medicina (G. Cremonesi, L. Botrugno); Clusone Medicina (B. Minetti, E. Agostoni, B. Minetti); Como Cardiologia (G. Ferrari, R. Jemoli), Medicina (E. D'Ingianna, A. Sciascera); Cremona Cardiologia (S. Pirelli, S. Coppetti); Desenzano Garda Cardiologia (V. Ziacchi, Comini); Desio Cardiologia (M. De Martini, G. Iacuitti); Erba Cardiologia (W. Bonini, D. Agnelli); Esine Cardiologia (E. Ferrara), Medicina (G. Garatti, R. Strazzeri); Garbagnate Milanese Medicina (D. Sommariva, A. Torri, M. Colombo); Gazzaniga Cardiologia (C. Malinverni, V. Chimenti); Gussago Cardiologia (A. Giordano, S. Scalvini, E. Zanelli); Lodi Cardiologia (M. Orlandi, M. Ponzetta); Manerbio Cardiologia (G. Moretti, S. Perotti); Milano Sacco Medicina (A. Malliani, S. Guzzetti); Milano San Carlo Borromeo Medicina (A. Bargiggia, L. Flocco); Milano Pio Albergo Trivulzio Cardiologia (S. Corallo, D. Valenti); Montescano Cardiologia (F. Cobelli, O. Febo); Orzinuovi Medicina (G. Lombardi, G. Pasini); Pavia Fondazione S. Maugeri Cardiologia (R. Tramarin, G. Forni); Pavia San Matteo Cardiologia (L. Tavazzi, A. Fontana); Rho Cardiologia (G. Rovelli, V. Cospite); Rivolta D'adda Medicina (G. Gamba); Sarnico Medicina (C. Spadaro, M. Lorenzi); Sondalo Cardiologia (G. Occhi, P. Bandini); Tradate Cardiologia (R. Pedretti, C. Anza’); Varese Cardiologia (G. Binaghi, F. Morandi, S. Provasoli); Varzi Medicina (G. Carpinella, C. Varasi); Vigevano Cardiologia (A.C. Mazzini, G. Graziano); Vizzolo Predabissi Cardiologia (G. Colombo, F. Fea); P.A. Bolzano Bolzano Cardiologia (W. Pitscheider, A. Erlicher, E. Apuzzo), Medicina (M. Marchesi, C. Tomasi); Cavalese Medicina (V. Moser, P. Bernardi); P.A. Trento Trento Medicina (G. Devenuto, A. Marzano); Veneto Arzignano Cardiologia (E. De Dominicis, P. Dovigo); Asiago Medicina (G. Gheno, L. Cinetto); Belluno Cardiologia (G. Catania, L. Tarantini); Bovolone Medicina (M. Poli, M. Pizzardini), Cardiologia (G. Rigatelli, A. Pasini); Camposampiero Cardiologia (A. Pantaleoni, A. Munaro); Cittadella Medicina (G.M. Patrassi, B. Blasina); Conegliano Veneto Medicina (A. Sacchetta, R. Sciascia); Dolo Medicina (G. Marin, G. Laurini); Este Medicina (S. Bergamo, D. Munaro); Feltre Medicina (G. Cappellari, A. Cavallaro), Cardiologia (P. Delise, F. De Cian); Isola Della Scala Medicina (F. Bonfanti, D. Bonato); Legnago Cardiologia (G. Rigatelli, M. Barbiero); Mestre Cardiologia (A. Raviele, C. Zanella), Medicina (P. Zanchi, G. Griffo); Montagnana Medicina (C. Zappala’, M. Scarmagnan); Montebelluna Cardiologia (R. Buchberger, P. Biondi); Negrar Cardiologia (G. Salazzari, H. Guilarte); Padova Cardiologia (S. Dalla Volta, G.M. Boffa, E. Tiso); Pieve Di Cadore Medicina (D. Mongillo, F. Vascellari, M. Zagolin); Rovigo Cardiologia (P. Zonzin, M. Carraro), Medicina (S. Zamboni); San Bonifacio Medicina (P. Pancera, L. Turr), Cardiologia (R. Rossi, E. Carbonieri); San Dona’ Di Piave Cardiologia (L. Milani, R. Valle); Treviso Medicina (G. Foscolo, P. De Bastiani, C. Doroldi); Venezia Cardiologia (G. Risica, S. Baracchi), Medicina (G.B. Ambrosio), Medicina Interna (G. Bittolo Bon, F. Sinisi); Vittorio Veneto Medicina (F. Sanzuol, D. Dannhauser, A. Rizzo); Friuli Gorizia Cardiologia (A. Fontanelli, G. Giuliano); Monfalcone Medicina (F. Loru); Palmanova Medicina (F. Montanar, P. Dalla Montà); Spilimbergo Medicina (F. Brovedani, F. Bertuzzi); Tolmezzo Medicina (V. Di Piazza); Trieste Di Cattinara I Medica (L. Triolo, M.N. De Savorgnani); Trieste Maggiore Cardiologia (G. Sinagra, A. Di Lenarda); Udine Cardiologia (P. Fioretti, M.C. Albanese), Medicina (P. Rossi, P. Goss), Medicina 2 (A. Bulfoni); Liguria Arenzano Medicina (M. Comaschi, M. Fallabrini); Bordighera Medicina (G. Oddone, R. Ariano); Genova Dimi Cardiologia (A. Barsotti, G. Gnecco), Medica 2 (F. Dallegri, P. Dapino); Genova Gallino Medicina (Parodi, Pittaluga); Genova Civili Cardiologia (S. Mazzantini, F. Torre), Medicina (G. Grillo, B. Ligas), Medicina Interna (G. Murialdo, F. Gavaudan); Genova Galliera Cardiologia (P. Spirito, P. Bellotti), Medicina II (R. Poggio, P. Beltrami), I Medicina (N. Acquarone, G. Antonucci); Genova-Sestri Ponente Cardiologia (M.V. Iannetti, L.A. Moroni); Imperia Medicina (G. Rizzi, G.F. Fiscella, G. Ronco); La Spezia Medicina (L. De Giorgio, E. Romano, E. Bondi), Cardiologia (A.S. Faraguti, M. Rizzo); Lavagna Medicina (E. Haupt, D. Fico); Pietra Ligure Medicina (A. Artom, D. Mela, A. Giudici Cipriani); Rapallo Cardiologia (G. Gigli, S. Orlandi); San Remo Medicina (E. Rondelli, F. Martini); Santa Margherita Ligure Medicina (G. Lo Pinto, A. Cerruti); Sestri Levante Medicina (M. Scudeletti, S. Bertelli); Emilia Romagna Bentivoglio Cardiologia (G. Di Pasquale, N. De Simone); Bologna Bellaria Cardiologia (G. Pinelli, S. Urbinati, F. Pergolini); Bologna S.Orsola-M.Malpighi (A. Branzi, N. Gallè); Budrio Medicina (G. Kindt, Battilana); Carpi Cardiologia (Dott. S. Ricci, V. Neri); Copparo Medicina (M. Faggioli, Pelizzola, Cazzuffi); Faenza Cardiologia (M. Sanguinetti, L. Caravita, T. Tognoli); Ferrara Medicina (P. Malacarne, P. Ruffoni, G. Battaglia); Fidenza Medicina (M. Pini, G. Rastelli); Forli’ Cardiologia (F. Rusticali, G.L. Morgagni, Balestra); Forlimpopoli Medicina (P.L. Costa, C. Conti, L. Todero); Imola Medicina (G.B. Evangelisti, E. Cerioli); Loiano Medicina (D. Panuccio, G. Canè); Modena Sant'Agostino Medicina (E. De Micheli, P. Neri), Medicina D'urgenza (S. Zucchelli, M. Pradelli), Cardiologia (G.R. Zennaro, C. Trovato); Modena Policlinico Medicina (L. Di Maria, A. Zanni); Parma Medica E Malattie Cardiov. (A. Giannini, P. Bernardi); Pavullo Nel Frignano Medicina (R. Salati, M. Giuliani); Piacenza Cardiologia (A. Capucci, M. Piepoli); Reggio Emilia Medicina (I. Iori, D. Galimberti), II Medicina (E. Rossi, F. Perazzoli); Rimini Cardiologia (G. Piovaccari, F. Bologna); Sassuolo Medicina (M. Grandi, C. Sacchetti), Cardiologia (F. Melandri, E. Bagni); Vignola Medicina (G. Curci, M. Bozzoli, P. Orlandi); Toscana Abbadia S. Salvatore Cardiologia (E. Gullino, E. Bianconi), Medicina Interna (P. Biagi, A. Gobbini); Arezzo Cardiologia (M. Forzoni, L. Tellini), Medicina II (C. Pedace, M. Bernardini); Bagno a Ripoli Medicina (A. Ghetti, G. Regoli); Bibbiena Medicina (Cuccuini, Boncompagni); Casteldelpiano Medicina (P.Pescatori, Bonaventura Caprio); Castelnuovo Garfagnana Medicina (A. Bianchini), Cardiologia (D. Bernardi, P.R. Mariani); Cecina Medicina (A. Carnicelli, N. Giomi), Cardiologia (F. Chiesa, F. Mazzinghi); Chianciano Medicina (E. Iommi, L. Abate); Empoli Medicina (D. Neri, A. Frittelli), Cardiologia (A. Bini, F. Venturi); Figline Valdarno Medicina (G. Fabrizi De Biani); Firenze Careggi Medicina IV (V. Lampronti, B. Alterini), Medicina I (Morettini, S. Andorlini), Medicina III (G. Berni, A. Conti), Medicina II (C. Mozzoli, V. Verdiani); Firenze Torregalli Medicina II (M. Ricca, L. Gallerini), Medicina I-Centro Ipertensione (C. Cappelletti, G. Nenci, R. Laureano); Firenze S. Maria Nuova Medicina (A. Lagi, M. Granelli), Cardiologia (F. Marchi, G. Zambaldi); Fucecchio Cardiologia (A. Ieri, F. Bonechi); Grosseto Medicina (M. Cipriani, M. Alessandri), Cardiologia (S. Severi, G. Miracapillo); Livorno Medicina (G. Giannelli, P. Pasquinelli, M. Seppia); Lucca Medicina (M. Marchioro, A. Nieri); Massa Pasquinucci Cardiologia Adulti-Cnr (A. Biagini, A. Rizza, U. Paradossi); Massa SS. Giacomo e Cristoforo Medicina (A. Leone, L. Di Palma); Massa Marittima Medicina (A. Brancato); Pescia Cardiologia (W. Vergoni, G. Italiani, S. Di Marco); Pisa S. Chiara Cardiologia (M. De Tommasi, A.M. Paci, E. Cabani); Pistoia Cardiologia (F. Del Citerna, M. Parigi); Pontedera Cardiologia (G. Tartarini, F. Lattanzi); Portoferraio Medicina (G. Giacomelli, D. Caniggia, F. Querci); Prato Medicina 3 (D. Degl'Innocenti), Medicina Interna (F. Corradi, C. Ignesti), Cardiologia (R.P. Dabizzi, F. Bellandi, F. Frascarelli); San Giovanni Valdarno Medicina (L. Bronzi, N. Corti), Cardiologia (M. Grazini, S. Amidei); San Marcello Pistoiese Medicina (E. Silvestrini, R. Lammel, M. Chiarlone); San Miniato Medicina (D. Neri, F. Prattichizzo); Siena Cardiologia 1 (F.M. De Luca, R. Favilli); Viareggio Medicina (C. Passaglia, Fascetti, A. Pizzi); Volterra Auxilium Vitae Cardiologia (C. Giustarini, M.M. Matarazzo); Umbria Citta’ di Castello Cardiologia (M. Guarnerio, G. Arcuri); Foligno Cardiologia (L. Meniconi, U. Gasperini); Gualdo Tadino Cardiologia (S. Galiotto, G. Saba); Gubbio Cardiologia (E.A. Capponi, R. Gattobigio, Ercolani); Perugia Cardiologia (M. Cocchieri, G. Alunni, A. Murrone); Todi Medicina (B. Biscottini, I. Bartolini, L. Marinacci); Marche Amandola Medicina (F. Cipollini, F. Silenzi); Ascoli Piceno Cardiologia (L. Capponi, S. Amabile); Cagli Medicina (M. Belogi, A. Giacomucci); Fermo Medicina (S. Sturbini, Carassai); Jesi Medicina (P. Agostinelli, R. Reginelli); Loreto Medicina (R. Lo Presti, P. Lanzafame, D. Gelibter); Pesaro Cardiologia (E. Sgarbi, M.C. Borghi); San Benedetto del Tronto Cardiologia (B. Floris, M. Persico); Sassocorvaro Medicina (M. Balducci, M. Tatali); Senigallia Medicina (A. Marcosignori); Lazio Acquapendente Medicina (F. Rollo, A.R. Felici); Albano Laziale Cardiologia (G. Ruggeri, P. Midi, M. Carrano); Ceccano Medicina (M. Iorio, G. Manfrè); Civitavecchia Cardiologia (M. Di Gennaro, M. Testa); Frosinone Medicina (G. Merolli, M. Mastrandrea); Monterotondo Medicina (F. Russo, M. Rolloni); Pontecorvo Medicina (M. Fanelli); Rieti Cardiologia (A. De Sanctis, M. Palmieri, R. Bock); Roma I.N.R.C.A. Cardiologia (F. Leggio, D. Del Sindaco); Roma Forlanini Medicina (C. Patrizi, L. Perrone, P. Battistoni); Roma Fatebenefratelli Medicina (E. Bologna, A.M. Sidoti, Enrico Breda); Roma San Camillo Medicina (L. Rascio, S. De Simone), Medicina Int. (G. Di Lascio, S. Miglionico), Medicina Int. I ( G. Gasparro, G. Pennelli), Cardiologia (E. Giovannini, G. Pulignano); Roma San Filippo Neri Cardiologia (M. Santini, G. Ansalone, Giannantoni); Roma San Giovanni Medicina (A. Ciammaichella, N. Aracri, Scotti); Roma San Pietro FBF Medicina (P. Alimonti, A. Migliore), Cardiologia (F. Ferri, P. Delle Grotti); Roma Sant'Eugenio Cardiologia (F. Colace, G. Barbato); Sezze Medicina (A. Del Duca, M.G. Talani, P. Tiberi); Sora Medicina (G. Gasbarrini, Fortuna, E. Zaccardelli); Tivoli Medicina (Gallotti, P. Belli); Viterbo Cardiologia (E.V. Scabbia, D. Pontillo, S. Ficili); Abruzzo Chieti Cardiologia (F. Gaeta, A. De Lucia); Giulianova Cardiologia (P. Di Sabatino, G. Lombardi, C. Fiorenza); Guardiagrele Medicina (F. Salvati, G. Galassi); Lanciano Cardiologia (D. Di Gregorio, Q. Lannutti, L. Mantini); Ortona Cardiologia (C. De Luca, M. Manetta); Penne Cardiologia (A. Vacri, A. De Finis); Pescara Medicina (G. Traisci, L. De Feudis); Popoli Cardiologia (A. Mobilij, C. Frattaroli, A. Mariani); Teramo Cardiologia (F. Iacovoni, S. Delle Monache); Vasto Cardiologia (G. Di Marco, G. Levantesi); Molise Campobasso Cardiologia (G. De Curtis, G. Fiore); Campania Ariano Irpino Cardiologia (D.F. Martino, C. Lo Conte); Avellino Cardiologia (D. Rotiroti, M.R. Pagliuca), Medicina (A. D'Avanzo, A. Sorrentino, G. Vietri); Aversa Medicina (P. Cristiano, E. Mesolella); Benevento Sacro Cuore Di Gesu’ Fbf Medicina (F. Sgambato, S. Prozzo, D. Tresca); Benevento G. Rummo Medicina (N. Lanni, N. Tozzi); Caserta Cardiologia (G. Corsini, A. Brienza), Medicina (G. Paolisso, Vinciguerra), Card. Riab. (C. Chieffo, A. Palermo); Castellammare Di Stabia Cardiologia (G. Somma, R. Longobardi); Frattamaggiore Cardiologia (R. Di Nola, F. Piemonte); Mercato San Severino Medicina Gen. (G. Alfano, A. Pisaturo), Medicina Int. (C. Guariglia, C. Guariglia); Napoli Monaldi Cardiologia (N. Mininni, S. Pirone, D. Miceli), Medicina-Centro Diagnosi e Cura S.C.C. (P. Sensale, O. Maiolica); II Medicina (G. Buono, R. D'Oriano); Napoli Buon Consiglio FBF Cardiologia (V. Sepe, G. Visciola); Napoli Cardarelli XII Medicina (D. Caruso, E. Anastasio), XX Medicina (L. D'Aniello, G. Cinquegrana); Napoli Incurabili Medicina (M. Visconti, N. Armogida); Napoli Loreto Mare Medicina (A. Russo, C. Cristiano); Napoli Nuovo Dei Pellegrini Cardiologia (M. Giasi, A.M. De Fortuna), Medicina (F. Caputo, E. Russolillo); Napoli San Gennaro Medicina (A. Zuccoli); Napoli San Paolo Medicina (P. Bellis, V. Mazza); Napoli Pol. Univ. I Cardiologia (A. Iacono, A. Scialdone); Nola Cardiologia (G. Vergara, F. Scafuro); Oliveto Citra Cardiologia (G. D'angelo, M.R. Di Muro); Pagani Medicina (E. Cesareo, A. Ambrosio); Polla Cardiologia (T. Di Napoli, M. D'alto), Medicina (A. Rescinito, A.C. Pessolano); Pozzuoli Cardiologia (G. Sibilio, S. Sarracino); Salerno Cardiologia (L. Di Leo, C. Baldi); Sant'Agata De’ Goti Medicina (U. Grimaldi, G.M. Bellorno); Santa Maria Capua Vetere Medicina (A. Niosi, G. Lasorella); Sapri Medicina (G. Giugliano); Scafati Cardiologia (A. Pesce, Sarno); Torre Del Greco Medicina (A. Agozzino, C. Fiengo), Cardiologia (M. Gaio, C. Arrotino); Puglia Bari Medicina (R. Marano, S. Caccavo); Bari-Carbonara Medicina (S. Arbore, E. Saracino); Brindisi Cardiologia (G. Ignone, E. Angelini); Canosa Cardiologia (G. Barone, V. Manuppelli); Casarano Cardiologia (G. Pettinati, F. Portone); Cassano Delle Murge Cardiologia (D. Scrutinio, R. Lagioia); Ceglie Messapica Medicina (G. Politi, D. Santoro); Cerignola Cardiologia (M. Cannone, W. Giordano); Foggia Colonnello D'avanzo Cardiologia (G. Mastrangelo, D. D'alessandro); Foggia Riuniti Medicina (A. Di Taranto, R. Pagliana, G. Iadarola), II Medicina (A. Parente, P. Dercole); Francavilla Fontana Cardiologia (V. Cito, F. Cocco); Galatina Medicina (F. Daniele, A. Zecca); Grumo Appula Medicina (V. Loragno, A. Ansel); Lecce Cardiologia (F. Bacca, F. Magliari); Lucera Medicina (G. Antonucci, Lepore); Manfredonia Medicina (D. Prencipe, M. Tomaiuolo); Minervino Murge Medicina (U. Carozza, C. Paolillo); Molfetta Medicina (G. Cappello, C.D. Ciannamea); Monopoli Medicina (G. Fera); San Giovanni Rotondo Cardiologia (R. Fanelli, M. Villella); Terlizzi Medicina (D. Ruggiero, A. Gattulli); Tricase Cardiologia (A. Galati, R. Mangia, P. Palma); Triggiano Medicina (S. Mongelli); Basilicata Matera Medicina (A. Sacco, A. Fragasso); Pisticci Medicina (A. Vitelli); Calabria Acri Medicina (F. Florio, M.C. Minisci); Cariati Cardiologia (N. Cosentino); Castrovillari Medicina (O. Salerni, A. Ferrara); Catanzaro Medicina (G. Zimatore, V. Nestico’), Catanzaro Medicina II (D. Galasso, R. Cimino); Cetraro Medicina (A. Nicoletti, S. Brusco); Cosenza Inrca Cardiologia (E. Feraco, M.P. Porto); Cosenza Dell'Annunziata Cardiologia (F. Plastina, G. Misuraca, O. Serafini), Medicina (A. Noto, R. Pellegrini), Medicina Int. (L. Vigna, V. Spagnuolo); Crotone Medicina (V. Tucci, G. Frontera); Lungro Medicina (A. Lupi, G.C. Falbo); Melito Porto Salvo Medicina (F. Ferraro, A. Scordo); Mormanno Medicina (G. Musca, N. Peccerillo); Oppido Mamertina Medicina (B. Madaffari, A. Mercuri); Palmi Cardiologia (R. Ortuso, M. De Vecchis); Reggio Calabria Cardiologia (E. Adornato, P. Monea, G. Majolo); Rossano Medicina (F. Naccarato, G. Bova); San Giovanni In Fiore Medicina (G.F. Mauro, C. Ruffolo); San Marco Argentano Medicina (G. Cersosimo, A. Carlomagno); Soriano Calabro Medicina (L. Anastasio, A. Arone); Soverato Medicina (A. Raffaele, G. Caridi); Tropea Medicina (V. Luciano, G. Barbuto); Sicilia Acireale Medicina (G. Calcara, R. Brischetto); Agrigento Medicina (S. Morreale, G. Alongi); Alcamo Cardiologia (F. Ippolito, E. Borruso); Augusta Cardiologia (E. Mossuti, G. Muscio); Caltagirone Cardiologia (D. Malfitano, C. Fossi); Caltanissetta Cardiologia (S. Giglia), Medicina (F. Vancheri, M. Alletto); Canicattì Medicina (A. Corbo); Castelvetrano Medicina (S. Mantia, G. Gioia), Cardiologia (F. Pompeo, F. Taormina); Catania Garibaldi Medicina (V. Inserra, A. Arena); Catania Vittorio Emanuele II Cardiologia (A. Circo, S. Gusmano, F. Platania), Medicina (B. Condorelli, A. Fisichella); Cefalu’ Medicina (S. D'anna, S. Curcio); Comiso Medicina (S. Molino); Enna Medicina (M. Trimarchi); Giarre Medicina (R. Siciliano, R. Trovato); Licata Medicina (R. Terrazzino, N. La Manna); Mazara Del Vallo Cardiologia (N. Di Giovanni, I. Fiore); Messina Cardiologia (G. Consolo, G. Di Tano); Milazzo Medicina (F. Di Blasi, P. Venuto); Modica Medicina (V. Manenti, G. Carbone); Mussomeli Medicina (D. Picone, C. Messina); Palermo Buccheri La Ferla FBF Cardiologia (A. Castello, L. Americo, D'alfonso), Medicina (A. D'angelo, M. Fazio); Palermo Civico E Benfratelli Cardiologia (E. D'antonio, A. Salmeri), Medicina II (P. Hamel, B.Curiale), Medicina I (A. Maringhini, F. Colombo); Palermo Ingrassia Cardiologia (P. Di Pasquale, F. Clemenza), Medicina (A. Bajardi, V. Mandalà); Palermo Cervello Cardiologia (A. Canonico, M.C. Matassa); Palermo Giaccone Cardiologia (A. Raineri, A. Rotolo); Palermo Villa Sofia Cardiologia (A. Battaglia, V. Cirrincione, F. Ingrillì), Medicina (S. Di Rosa, G. Nicolosi); Paterno’ Medicina (A. Musco); Petralia Sottana Medicina (M. Augugliaro, A. Stracci); Piazza Armerina Cardiologia (B. Aloisi, M. Cipriano); Ragusa Civile Cardiologia (V. Spadola, M.L. Guarrella), Medicina (L. Costilletti, C. Scrofani, Ignazio Pinelli); Ragusa M.P. Arezzo Medicina (S. Burrafato), Cardiologia (R. Ferrante, V. Scollo); Ribera Medicina (P. Indelicato, L. Lo Cascio); Salemi Medicina (F. Ampola); San Cataldo Medicina (R. Maira); Sciacca Cardiologia (V. Indelicato, G. Marrone); Scicli Medicina (E. Portelli, S. Modica); Termini Imerese Medicina (G. Amato); Trapani Cardiologia (G.B. Braschi, G. Ledda); Vittoria Medicina (F. Foresti, M. Borrometi); Sardegna Bosa Medicina (E. Pisano, M.G. Murtas); Cagliari San Michele Brotzu 2 Medicina (G. Pilleri, V. Atzeni), 3 Medicina (F. Pintus, S. Murgiu), Cardiologia (A. Sanna, L. Pistis, M. Dadea), Medicina 1 (G. Guiso, G. Fadda); Cagliari SS. Trinita’ Medicina (V. Palomba); Carbonia Medicina (C. Saragat, M.T. Anolfo), Cardiologia (R. Aste, S. Cherchi); Ittiri Medicina (F. Masala, S. Dore); Nuoro Cardiologia (G. Congiu, G. Motta); Oristano Cardiologia (S.M. Marchi); Sassari Cardiologia (P. Terrosu, L. Sannia, F. Uras), Medicina (Paolini, F. Bandiera)


   Acknowledgements
 
The TEMISTOCLE survey was endorsed by the Italian Association of Hospital Cardiologists (ANMCO) and by the Italian Federation of Hospital Internists (FADOI) and partially supported by AstraZeneca, Italy.


   Notes
Top
 Notes
Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 
{star} On behalf of the TEMISTOCLE investigators. The complete list of TEMISTOCLE Investigators and participating centres is reported in Appendix A. Back

1 Present address: Papardo Hospital, Department of Cardiology, Messina, Italy. Back


   References
Top
 Notes
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 5. Conclusion
 A.1. Steering Committee
 A.2. Executive Committee
 A.3. Scientific and organising...
 A.4. Participating centres
 References
 

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