The superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) has not been fully demonstrated in a real-world setting. This prospective study included 5706 AS patients who underwent SAVR from 2010 to 2012 and 2989 AS patients who underwent TAVR from 2017 to 2018 from the prospective multicenter observational studies OBSERVANT I and II. Early adverse events as well as all-cause mortality, major adverse cardiac and cerebrovascular events (MACCEs), and hospital readmission due to heart failure at 1-year were investigated. Among 1008 propensity score matched pairs, TAVR was associated with significantly lower 30-day mortality (1.8 vs. 3.5%, p = 0.020), stroke (0.8 vs. 2.3%, p = 0.005), and acute kidney injury (0.6 vs. 8.2%, p < 0.001) compared to SAVR. Moderate-to-severe paravalvular regurgitation (5.9 vs. 2.0%, p < 0.001) and permanent pacemaker implantation (13.8 vs. 3.3%, p < 0.001) were more frequent after TAVR. At 1-year, TAVR was associated with lower risk of all-cause mortality (7.9 vs. 11.5%, p = 0.006), MACCE (12.0 vs. 15.8%, p = 0.011), readmission due to heart failure (10.8 vs. 15.9%, p < 0.001), and stroke (3.2 vs. 5.1%, p = 0.033) compared to SAVR. TAVR reduced 1-year mortality in the subgroups of patients aged 80 years or older (HR 0.49, 95% CI 0.33–0.71), in females (HR 0.57, 0.38–0.85), and among patients with EuroSCORE II ≥ 4.0% (HR 0.48, 95% CI 0.32–0.71). In a real-world setting, TAVR using new-generation devices was associated with lower rates of adverse events up to 1-year follow-up compared to SAVR.

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April–October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services.

Aim: To estimate national incidence, temporal trends, and regional variability of hospital-acquired pressure ulcers in Italy from 2018 to 2024 using age-adjusted models and regional estimates. Design: Retrospective nationwide observational study using hospital administrative data. Methods: All Italian Hospital Discharge Records (SDOs) for adults aged ≥ 18 years with hospital stays ≥ 5 days between 2018 and 2024 were analysed. Records with pre-existing or principal diagnoses of pressure ulcer and excluded MDC/DRG categories were omitted according to adapted AHRQ PSI 03 specifications. The final dataset represented eligible hospitalizations considered at risk for hospital-acquired pressure ulcers. Crude and age-adjusted rates per 10,000 eligible discharges were estimated using logistic regression models. Results: Eligible discharges declined from approximately 1.7 million in 2018 to 1.4 million in 2020, increasing to 1.5 million in 2024. Within this population, coded hospital-acquired pressure ulcer events decreased from 3657 to 1888, then increased to 2728. Age-adjusted national rates ranged from 13.5 to 21.3 per 10,000 eligible discharges, showing temporal fluctuations during the study period, including a reduction during 2020–2021 followed by a gradual return toward pre-pandemic levels. Substantial regional variability was observed, with lower median annual adjusted rates in regions such as Friuli Venezia Giulia and Toscana and higher values in Lazio and Abruzzo. Conclusions: This nationwide analysis provides an initial descriptive overview of temporal and regional variability in coded hospital-acquired pressure ulcer events identified through an adapted PSI 03-based administrative indicator in Italy. The findings may contribute to future methodological discussion and exploratory development of nursing-sensitive indicators using national administrative healthcare databases. Implications for the profession and/or patient care: The integration of nursing-sensitive administrative indicators into national quality monitoring systems may represent an initial methodological area for future benchmarking activities, indicator validation processes, and descriptive evaluation of preventive care practices using national healthcare administrative databases. Impact (addressing): Problem: limited national evidence on hospital-acquired pressure ulcers and interregional variability in Italy. Main findings: temporal fluctuations in age-adjusted rates and persistent regional heterogeneity in coded pressure ulcer events. Impact: administrative data may represent a preliminary and exploratory source for the study of nursing-sensitive outcomes and patient safety indicators at national level.