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J Cardiovasc Med (Hagerstown). 2017 Mar;18(3):136-143. doi: 10.2459/JCM.0000000000000221.

Multicentre Italian analysis on cardiovascular diseases: impact of immigrants' referral to emergency department.

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aEmergency Department, Sant'Andrea Hospital, School of Medicine and Psychology 'Sapienza' University, Rome bEmergency Medicine Department, San Martino Teaching Hospital, Genova University, Genoa cEmergency Medicine Department, Città della Scienza e della Salute Hospital, Turin dEmergency Medicine Department, Bari Teaching Hospital, Bari eEmergency Medicine Department, Sassari Teaching Hospital, Sassari fEmergency Medicine Department, Sandro Pertini Hospital, Rome, Italy.


During the recent years, immigration in Italy has increased. There are few data on the health status of immigrants and there is a need to improve their healthcare. Cardiovascular disorders account for 7.6% of immigrants' diseases and cause 3.6% of the total deaths. Lack of healthcare services to general medicine support and prescriptions leads immigrants to contact the Emergency Department (ED) to receive medical assistance. Primary endpoints of this study were to assess the use of national healthcare system by immigrants and to determine the incidence of cardiovascular diseases, and the frequency and type of risk factors for cardiovascular diseases in these patients. A no-profit, observational, multicentre study was conducted from April to September 2012. We studied 642 foreign patients referring to the ED for various symptoms/signs. One hundred and fourteen patients referred for suspected cardiovascular disease and 105 had a confirmed final diagnosis of cardiovascular disease. The more represented ethnic origin was Caucasian (59%), whereas the most represented country was Romania (24%). The main symptom recorded at ED arrival was chest pain (37.1%). Final cardiovascular diagnoses were represented by: hypertensive crisis (28.5%), acute coronary syndrome (20%), acute heart failure (12.3%), atrial fibrillation (10.4%) and chest pain (10.4%). Past medical history of cardiovascular disease, hypertension, obesity and male sex showed independent significant predictive value for cardiovascular disease diagnosis.Our study provides support for the development of specific primary prevention of cardiovascular risk factors in immigrants with the important role of culturally competent education of individuals and families. Better outpatient management seems to be needed in order to limit the need for emergency room referral.

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