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

Russo, Veronica; Santarelli, Simona; Magrini, Laura; Moscatelli, Paolo; Altomonte, Fiorella; Cremonesi, Giulia; Battista, Stefania; Maggiorotto, Matteo; Pinto, Natalia; Maroccia, Alessio; Glorioso, Nicola; Sircana, Antonio; Moro, Marta; Pugliese, Francesco Rocco; Revello, Alessandra; Di Somma, Salvatore

Journal of Cardiovascular Medicine: March 2017 - Volume 18 - Issue 3 - p 136–143
doi: 10.2459/JCM.0000000000000221
Research articles

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.

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

Correspondence to Veronica Russo, Emergency Medicine Department, Sant’Andrea Hospital – ‘Sapienza’ Rome University – School of Medicine and Psychology, Via di Grottarossa, 1035–1039, 00189 Rome, ItalyTel: +39 06 33775364; fax: +39 06 33776315; e-mail:

Received 26 March, 2014

Revised 3 September, 2014

Accepted 4 September, 2014

© 2017 Italian Federation of Cardiology. All rights reserved.