L'Istat, grazie alle sinergie attivate con il Ministero dell'Interno per l'acquisizione tempestiva dei dati ANPR è in grado di contribuire alla diffusione di informazioni utili alla comprensione della situazione legata all'emergenza sanitaria da COVID-19.L'utilizzo a fini statistici, e il relativo trattamento, delle informazioni che l'Istituto nazionale di statistica acquisisce dall'Anagrafe Nazionale della Popolazione Residente (ANPR), come previsto dal DPCM n.194/2014, permette di diffondere i dati relativi alla mortalità generale di una parte dei comuni subentrati nell'ANPR, che a oggi ammontano a 5.866, circa tre quarti del totale dei comuni italiani.

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The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.

publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Correspondence Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ www.thelancet.com Published online March 23, 2020 https://doi.org/10.1016/S0140-6736(20)30690-5 1appears to be higher than previously estimated, with a crude case-fatality rate of almost 4%. 6 We declare no competing interests.

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Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).

Objective To clarify whether any particular β blocker is superior in patients with heart failure and reduced ejection fraction or whether the benefits of these agents are mainly due to a class effect.Design Systematic review and network meta-analysis of efficacy of different β blockers in heart failure. CINAHL(1982CINAHL( -2011, Cochrane Collaboration Central Register of Controlled Trials (-2011(- ), Embase (1980(- -2011, Medline/PubMed (1966-2011, and Web of Science (1965Science ( -2011. Data sourcesStudy selection Randomized trials comparing β blockers with other β blockers or other treatments. Data extractionThe primary endpoint was all cause death at the longest available follow-up, assessed with odds ratios and Bayesian random effect 95% credible intervals, with independent extraction by observers.Results 21 trials were included, focusing on atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, and nebivolol. As expected, in the overall analysis, β blockers provided credible mortality benefits in comparison with placebo or standard treatment after a median of 12 months (odds ratio 0.69, 0.56 to 0.80). However, no obvious differences were found when comparing the different β blockers head to head for the risk of death, sudden cardiac death, death due to pump failure, or drug discontinuation. Accordingly, improvements in left ventricular ejection fraction were also similar irrespective of the individual study drug. ConclusionThe benefits of β blockers in patients with heart failure with reduced ejection fraction seem to be mainly due to a class effect, as no statistical evidence from current trials supports the superiority of any single agent over the others. IntroductionAccording to the American Heart Association, heart failure affects nearly 8.26 million Americans and accounts for 32.8% of cardiovascular related deaths. 1 β blockers have been one of the mainstays of treatment because of their ability to reverse the neurohumoral effects of the sympathetic nervous system, with ensuing prognostic and symptomatic benefits, and different societies have thus included them in guidelines for management of heart failure. [2][3][4] Specifically, β adrenergic blockers have been shown in randomized trials to prolong survival, prevent arrhythmia, improve symptoms of heart failure and left ventricular ejection fraction, and control ventricular rate, especially in patients with chronic heart failure. 5 However, controversy exists as to the optimal selection of a particular β blocker for management of heart failure, as the available β blockers differ in their selectivity for adrenergic receptors and their effects on the peripheral circulation. 6 In addition, several of the available studies had a small sample size with a short duration of follow-up, thereby limiting their inferential capacity, and published meta-analyses have evaluated the role of β blockers in heart failure with reduced ejection fraction in terms of clinical and echocardiographic endpoints. [7][8][9] Moreover, few studies have attempted to ans...