title: Heart surgery for immigrants in Italy: burden of cardiovascular disease, adherence to treatment and outcomes.
abstract: OBJECTIVE
  Italy is a country with high rates of immigration and the knowledge of immigrant health is very fragmentary. We provide a current picture of cardiovascular disease causes and clinical outcomes following heart surgery.
  
  
  METHODS
  A clinical and echocardiographic survey was conducted on 154 consecutive immigrants referred for heart surgery to San Raffaele Hospital in Milan between 2003 and 2011.
  
  
  RESULTS
  Major causes of heart disease were rheumatic heart disease (RHD) (n = 64, 41%), nonrheumatic valvulopathies (n = 41, 27%), ischemic heart disease (IHD) (n = 25, 16%), congenital heart disease (n = 13, 9%) and miscellaneous (n = 11, 7%). Median age was 49 years [interquartile range (IQR) 7-81]; 55% of patients were male. Among valvulopathies, rheumatic mitral disease was predominant (n = 56, 53%) as both single and multivalvular disease (n = 46, 73%); myxomatous prolapse emerged as the second main pattern of mitral disease (n = 30, 33%). Among patients with IHD, 72% had a high cardiovascular risk. Surgery was scheduled in 138 patients (90%). Clinical follow-up was available in 96 patients (62%) [median time 62 months (IQR 15-123)], among whom 92 (96%) were alive, four patients (4%) had died and 58 (38%) were lost.
  
  
  CONCLUSIONS
  Cardiovascular diseases represent a major health topic among immigrants in developed countries. RHD still is the predominant cause of hospitalization for heart surgery, nonrheumatic valvulopathies and IHD emerging as second and third causes, respectively. Data underline the need of reinforcement of prevention and care strategies in the matter of immigrant health and warrant the urgent attention of the international public health and research communities.
authors.affiliation: Cardiovascular and Thoracic Department, San Raffaele Scientific Institute and Università Vita-Salute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Vermi
authors.forename: Valeria
authors.initials: V
authors.lastname: Cammalleri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castiglioni
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.forename: Francesca
authors.initials: F
authors.lastname: Baratto
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002648:Child; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult