Lavagna

Researchers are studying women who carry mutations in the BRCA1 or BRCA2 genes, which increase the risk of developing breast and ovarian cancers. Despite many studies over the past two decades, the best ways to manage these mutation carriers are still not fully established. In Italy, about 140,000 to 150,000 individuals carry these mutations, and it is estimated that 87% of women with these mutations will develop a genetically linked tumor during their lifetime. Approximately 20% of ovarian cancer cases in Italy each year have a genetic origin and could benefit from preventive approaches. Currently, there is no national prospective data collection specifically for women with BRCA mutations in Italy.

Researchers are conducting an observational, prospective, multicenter study in Italian cardiology centers to evaluate how well patients with Heart Failure with Reduced Ejection Fraction (HFrEF) follow guideline-recommended treatments. The study also aims to assess the safety of these treatments, monitor treatment patterns in patients with acute heart failure, and observe treatment approaches in all chronic heart failure patients regardless of their ejection fraction levels. The study involves two phases of educational interventions and data collection. Initially, healthcare providers will receive education on guideline recommendations and treatment patterns, followed by 3 months of patient data collection or up to 30 consecutive patients with chronic or acute heart failure. After 6 months, treatment modifications and outcomes will be evaluated. Then, a second educational session will highlight gaps between guidelines and practice, followed by another 3 months of data collection. Patients will be followed for 12 months total, with ongoing monitoring of treatment changes and outcomes. Participants will be assessed at enrollment and during the follow-up periods through clinical evaluations and data collection on treatment adherence and safety. The main outcome measured is adherence to guideline-directed medical therapies over 6 months. The study includes evaluations at 6 and 12 months after enrollment, with close monitoring of treatment patterns and patient health status throughout the study duration.

Researchers are evaluating a treatment approach aimed at increasing 24-hour systolic blood pressure (SBP) to reduce syncope recurrences in patients with hypotensive syncope over one year. This multicenter, prospective, observational study includes two parallel substudies: one focused on deprescribing blood pressure-lowering drugs in hypertensive patients with drug-related syncope, and the other on adding fludrocortisone therapy to raise blood pressure in patients with drug-unrelated hypotension. The study targets patients older than 18 years with severe, recurrent reflex syncope not responding to lifestyle measures and diagnosed with hypotensive syncope through specific blood pressure monitoring and autonomic tests. The study involves two treatment strategies depending on the patient group. In the deprescribing substudy, antihypertensive drugs are reduced or withdrawn to achieve a target 24-hour SBP increase, while in the drug-addition substudy, fludrocortisone is prescribed at initial doses of 0.2 mg/day (range 0.1 to 0.3 mg) to reach similar blood pressure goals. A 30-day optimization period allows adjustment of therapy to reach the intended SBP targets. Follow-up visits occur at 4, 8, and 12 months after treatment optimization. Participants undergo 24-hour ambulatory blood pressure monitoring and autonomic function assessments, including carotid sinus massage, active stand test, and head-up tilt test. Researchers track time to first syncope recurrence and syncope burden over one year to compare outcomes between those achieving target blood pressure and those who do not. Safety and efficacy are monitored throughout the study, with secondary analyses exploring changes in syncope and presyncope frequency before and after enrollment.