Simone Savastano

Background/Objectives: Sustained ventricular tachycardia (VT) is a potentially life-threatening arrhythmia requiring prompt Emergency Department (ED) assessment and management. However, data on its frequency, real-world treatment, and prognosis in the ED remain limited. We aimed to describe the clinical characteristics, acute management, and short- and long-term outcomes of patients presenting with VT. Methods: We retrospectively included consecutive patients presenting to the ED between January 2018 and December 2024 with a primary diagnosis of sustained VT with a pulse. We collected baseline characteristics, hemodynamic status, underlying cardiac disease, and acute treatment. In-hospital events and 30-day and 1-year outcomes were assessed. Results: A total of 103 patients were identified, accounting for approximately 0.025% of all ED visits during the study period; 84.5% were male. Chest pain (31.1%) and palpitations (25.2%) were the most common presenting symptoms. Structural heart disease was present in 90% of the cases, predominantly of ischemic origin (61%). Nearly half of the patients (49.5%) had a prior history of VT. Electrical cardioversion was performed in 28.2% of the cases. The majority of the patients (95/103; 92%) required hospitalization. Mortality was 4.9% at 30 days and 17% at 1 year. After adjustment for age, a left ventricular ejection fraction ≤ 30% and in-hospital arrhythmic recurrence were independently associated with 1-year mortality. Conclusions: Sustained VT is an uncommon but high-risk ED presentation, mainly affecting patients with ischemic structural heart disease. A discrepancy was observed between real-world clinical practice and guideline recommendations. The substantial mortality observed, particularly among patients with impaired left ventricular function or in-hospital arrhythmic recurrence, highlights the need for prompt risk stratification and optimized, guideline-concordant acute management.

Introduction Cardiac arrest is the loss of mechanical cardiac function and the absence of systemic circulation. When it occurs out-of-hospital it is defined out-of-hospital cardiac arrest (OHCA). Survival after OHCA does not fully capture recovery, as survivors often experience persistent cognitive, psychological, and functional consequences. Patient-reported outcome measures (PROMs) are essential to assess these domains, but their longitudinal collection in routine survivorship care depends on patient engagement and retention over time. REVIVE is a regional hub-and-spoke survivorship pathway implemented within the Cardiac Arrest Registry of the Lombardy Region (LombardiaCARe) network to coordinate post-discharge follow-up after OHCA and standardize the assessment of patient-reported outcomes. Objectives To describe the structure of PROM collection within REVIVE and to evaluate patient retention, evaluability, and follow-up completeness over the 2025 calendar year. Methods We conducted a descriptive analysis of the REVIVE study between January and December 2025. During this period, 1,663 OHCA events were admitted to participating hospitals, 127 patients were eligible for the REVIVE pathway, 99 were contacted by the hub psychologist after signing informed consent, and 67 completed at least one assessment. REVIVE is structured as a hub-and-spoke pathway, with a specialist hub coordinating post-discharge follow-up and outcome assessment across participating hospitals. PROMs and related outcomes were collected at predefined timepoints and included discharge, 1 month, 3 months, and 6 months after the OHCA event. The PROMs assessed were anxiety and depression (HADS), post-traumatic stress symptoms (IES-R), cognitive performance (MoCA), and health-related quality of life (EQ-5D-5L), together with a clinical semi-structured interview. The analysis focused on the number of patients contributing at each timepoint and on the availability of at least one evaluable PROM per patient. Results Among the 99 consenting patients, 67 (67.7%) were evaluable and formed the analytic denominator. At the visit level, 46 patients had at least one PROM recorded at discharge, 49 at 1 month, 52 at 3 months, and 49 at 6 months. Domain-level completeness was high: HADS was available in 66 of 67 evaluable patients (98.5%), while MoCA and EQ-5D VAS were available in all evaluable patients (67/67, 100%). These results suggest that the main methodological challenge was not baseline collection, but maintaining patient engagement across repeated assessments, which in PROM-based survivorship care is inherently patient-driven rather than passive. Conclusions PROMs add value beyond survival by capturing outcomes that matter to OHCA survivors, but their validity depends on sustained patient engagement throughout follow-up. In REVIVE, the main challenge was not baseline collection, but maintaining retention in a patient-driven and psychologically sensitive assessment process, where readiness to participate may vary over time. These findings support clear definition of the evaluable cohort, transparent reporting of timepoint-specific completeness, and retention-oriented strategies to improve the quality and interpretability of longitudinal PROM data.

Introduction Cardiac arrest is the loss of mechanical cardiac function and systemic circulation; when it occurs outside hospital settings, it is defined as out-of-hospital cardiac arrest (OHCA). OHCA is influenced by both individual and contextual factors, including population structure, socioeconomic disadvantage, and access to emergency care. Geographic approaches offer a framework to investigate spatial inequalities and support place‑based decision making. Objectives This study assesses spatial inequalities in OHCA incidence in relation to demographic (ageing index, population density) and socioeconomic (low income) determinants in Lombardy between 2021 and 2024. Methods A municipal‑level retrospective ecological study was conducted in Lombardy (2021–2024). The outcome was an OHCA event. Data were obtained from the Lombardia Cardiac Arrest Registry (CARe), covering 924 municipalities across seven provinces. The eligible population included residents of municipalities in the CARe registry (cumulative at‑risk population: 17,612,296 inhabitants). Due to incomplete registry coverage in 296 municipalities, analyses focused on 628 municipalities forming the South‑East (SE) macro‑area (Pavia, Lodi, Cremona, Mantua, Brescia). Determinants included: proportion of taxpayers with annual income <€10,000 (proxy for socioeconomic vulnerability), ageing index (proxy for demographic imbalance), and population density (proxy for rurality/urbanization). Contextual covariates were: bystander cardiopulmonary (CPR) rate (proxy for community response) and EMS response time (minutes from emergency call to first vehicle arrival, proxy for geographic isolation).The analytical strategy combined global and local spatial autocorrelation (Global Moran’s I; Local Indicators of Spatial Association, LISA), hotspot analysis (Getis‑Ord Gi*), and geographically weighted regression (GWR) to identify clustering patterns and spatially varying associations between OHCA and determinants, adjusting for covariates. Results The cumulative OHCA incidence was 126 per 100,000 inhabitants. OHCA incidence was not randomly distributed, but showed significant spatial heterogeneity. Global Moran’s I confirmed clustering (I = 0.27; p < 0.001). Municipalities characterized by high- and low-incidence aggregation patterns were identified (Getis-Ord Gi* z-scores > |1.96|): a hot-spot cluster located in the south-western hilly area of the region and a cold-spot cluster in the south-eastern flat area. GWR showed that the strength and direction of associations varied across the region, highlighting spatial non-stationarity in the relationship between OHCA incidence and the area-level determinants, independently of community response, response time, and geographic isolation. Specifically, increasing the ageing index and the proportion of low-income individuals significantly increased OHCA incidence, whereas population density was inversely correlated with OHCA incidence. Conclusions OHCA incidence hot spots were concentrated in mountainous and hilly areas, especially in remote areas distant from hospitals. Indicators of social inequality showed spatially heterogeneous associations with OHCA, confirming that territorial disparities extend beyond demographic composition alone. Considering both structural determinants and contextual covariates improved interpretation of spatial patterns and highlighted the contribution of place‑based factors to OHCA burden. The integration of geographic data with health information represents a robust methodological approach for studying spatial inequalities in healthcare. Cardiac arrest findings may be translated into public health impact and guide equity-oriented planning by identifying priority areas and informing geographically targeted interventions.

Aims: Out-of-hospital cardiac arrest (OHCA) remains a major public health concern, characterized by high mortality and substantial variability in survival rates. As patient and event characteristics are largely unmodifiable, system efficiency is essential to improve survival. Methods and results: We conducted a retrospective cohort study using data from the Lombardia Cardiac Arrest Registry, including 12 532 OHCA cases (2015–2023). Multivariate logistic regression models were applied to assess the relationship between emergency medical service (EMS) arrival time and prehospital mortality, as well as long-term outcomes according to system efficiency. Furthermore, a sub-cohort of 515 hospitalized patients was analysed to evaluate hospital stay and healthcare costs. Prehospital event mortality increased from 74.7 to 93.2% with longer EMS response time, with survival decreasing by 0.6% for each additional minute of EMS delay (OR 1.03; 95% CI 1.02–1.05). Higher system efficiency, characterized by bystander cardiopulmonary resuscitation and EMS arrival within 10 min, was associated with markedly higher survival at hospital admission (25.4% vs. 7.6%) and at 12 months (13.0% vs. 1.6%), as well as improved neurological outcomes and discharge survival among hospitalized patients. Higher hospital costs were observed among patients in the high-efficiency system group, while less efficient systems showed higher costs per survivor at 12 months follow-up (€61 781 vs. €48 985). Conclusion: System responsiveness is a key modifiable factor influencing outcomes after OHCA, with each minute of EMS delay substantially reducing survival odds. Enhancing the entire chain of survival is essential to improve patient outcomes and reduce the indirect societal costs associated with OHCA.

Background/Objectives: A structured follow-up after out-of-hospital cardiac arrest (OHCA) is recommended, but implementation across regional networks remains challenging. REVIVE introduced a hub-and-spoke survivorship pathway in Lombardy. This 12-month formative implementation evaluation aimed to describe staged pathway progression, operational reach, attrition points, centre-level variation, and documented barriers to assessment completion. Methods: Adult OHCA survivors with Cerebral Performance Category (CPC) 1–2 or Modified Rankin Scale (mRS) ≤ 3 were considered eligible. The evaluation was structured using Proctor et al.’s implementation outcomes framework. Implementation outcomes were operationalised using prospectively collected pathway indicators: eligibility ascertainment, successful contact, T0 assessment completion, completion of planned assessment components, timeliness where available, and documented reasons for non-progression. Analyses were descriptive and used chi-square or Fisher’s exact tests for unadjusted centre-level comparisons. Results: Of the 1663 patients hospitalised, 1458 (87.7%) were recorded as deceased or having an unfavourable neurological outcome and were therefore outside the intended REVIVE target population. Among the remaining 205 patients, eligibility could not be determined for 78 (4.7% of the total cohort), and 127 (7.6%) met eligibility criteria. Of eligible survivors, 96 (75.6%) were contacted and 64 completed the T0 assessment (66.7% of contacted; 50.4% of eligible). Pavia showed higher observed rates of eligibility ascertainment, contact, and assessment completion than spoke centres, but these differences were unadjusted and should be interpreted as centre-level implementation variation rather than evidence of causal superiority. Conclusions: REVIVE initiated a structured regional pathway for post-OHCA follow-up, but first-year implementation was partial rather than definitive. The 50.4% T0 completion rate among eligible survivors should be interpreted as an initial internal implementation indicator, not as evidence of established feasibility, effectiveness, or regional benchmarking. Priorities for further optimisation include eligibility ascertainment, transfer of contact information, patient engagement, and spoke-site support for assessment delivery.