Giornale italiano di cardiologia最新文献

The epidemiological transition has led to an increase in life expectancy and to a growing population of chronic patients, often with heart failure. These patients are frequently affected by comorbidities and frailty, which in turn increase the risk of disability and worsening quality of life, requiring an accurate multidimensional assessment (MDA). In this context, MDA is crucial for integrated and holistic management of elderly patients, considering not only the pathology but the patient in his complexity. MDA requires a multidisciplinary team to ensure a comprehensive and integrated assessment of the elderly patient. MDA tools assess various domains of health, using scales and validated tools to explore physical, functional, mental and socio-economic status. MDA is applied in two phases: an initial screening procedure and an in-depth analysis of individual problems for targeted interventions. MDA can be performed in various care settings, including outpatient clinics, hospitals, nursing homes, home care, and rehabilitation centers. Several studies show that MDA improves survival as well as functional and mental status, reducing hospitalization times and the frequency of institutionalization. This ANMCO position paper discusses MDA tools of older adults with chronic heart disease, highlighting the need for a holistic approach to address comorbidities and frailty in a growing population.

Cardiovascular diseases remain the leading cause of mortality globally and in Italy, with a growing burden exacerbated by aging populations and underdeveloped strategies for managing chronic cardiovascular conditions. This position paper, resulting from the 2024 ANMCO General Assembly, addresses the current state of cardiovascular chronicity management in Italy, highlighting critical gaps and proposing sustainable, integrative solutions. Despite improvements in acute cardiovascular care, the lack of structured post-acute management, insufficient adoption of secondary prevention protocols, limited access to innovative therapies, and a slow digital transition continue to hinder effective chronic care. The document stresses the pivotal role of cardiologists, not only in acute intervention but also in long-term care and secondary prevention, emphasizing the need for a multidisciplinary, multichannel healthcare model. The paper explores the potential of e-Health and artificial intelligence to revolutionize chronic disease management. It advocates for the widespread implementation of integrated care pathways, digital tools like electronic health records and telemedicine platforms, which together could enhance early detection, patient monitoring, and therapeutic adherence while reducing unnecessary hospitalizations. It also underscores the necessity of updating national and regional pharmaceutical policies to improve equitable access to disease-modifying therapies. Furthermore, the integration of palliative care in end-stage cardiovascular disease and the enhancement of post-acute care networks are deemed essential. Ultimately, the document advocates for a comprehensive systemic and cultural transformation - spearheaded by scientific societies such as ANMCO - where technological innovation, organizational reform, and patient-centered care align to ensure a sustainable and universally accessible healthcare system. This vision is consistent with the objectives of the PNRR, the 2030 Agenda, and, most importantly, the foundational principles of the Italian Constitution.

Background: Pulmonary arterial hypertension (PAH) is a rare syndrome characterized by remodeling of the small pulmonary arterial vessels and increased pulmonary vascular resistance, which in the later stages can lead to right-sided heart failure and death. The therapeutic approach is evolving, but differences remain between countries.

Methods: An Italian survey was designed to evaluate differences in the diagnosis, management and treatment of PAH patients across Italian centers. The survey was administered to 32 PAH Centers in Italy via an online questionnaire. A panel of 9 PAH experts analyzed and discussed the results.

Results: Thirty Centers from 15 regions responded, thus representing the entire Italian reality. The results showed that all participating Centers perform right heart catheterization at PAH diagnosis (100%), while genetic testing is available in 73% of cases. Centers with a high patient volume have 10.4% of patients on oral monotherapy, while Centers with a low patient volume have a low percentage of patients on triple oral therapy (15%) or parenteral prostanoids (11.3%). Many Centers (70%) use parenteral prostanoids in up-front approach in incident high-risk PAH patients. Nine Centers (30%) achieve the low risk profile in more than 60% of the population followed. In line with the literature, an upfront strategy including parenteral prostanoids was associated with a high likelihood of achieving a low-risk profile. Overall, 70% of Centers have patients on the list for lung transplant.

Conclusions: Italian PAH Centers have excellent adherence to the diagnostic standards recommended by European guidelines and good uniformity in therapeutic management, with some divergences related to differences in the phenotype of PAH patients. The survey also revealed a good awareness of the efficacy of parenteral prostanoids, especially if started early. Collaboration and referral of selected PAH patients to Centers with greater experience in the management of complex infusion therapies is the key to success.

The surgical treatment of atrial fibrillation (AF) has evolved significantly over years and even more so in the last 10 years. Eliminating AF and AF-related stroke are the current objectives, more than just heart rate control, and there are now many successful surgical procedures focused on and with excellent results. We reviewed the current types of surgical AF procedures, discussing minimally invasive and hybrid ones, and this may be helpful to clinicians in understanding the different surgical AF options available and to help them in the management of this patient population.

The enormous progress made in recent decades in the diagnosis and treatment of oncological and hematological diseases has resulted in a significant increase in patient survival and a substantial growth in the population of cancer survivors. These include both living patients with active disease and those who are free of cancer after treatment. There is strong evidence that cancer survivors are at an increased risk of developing cardiovascular diseases and that this risk may outweigh the prognostic impact that is imposed by the disease itself for certain types of cancer. The pathophysiological bases of the interaction between cardiovascular disease and cancer are complex and involve the sharing of both modifiable and non-modifiable risk factors, the effects on the cardiovascular system of certain treatments, as well as the pathogenic changes imposed by cancer, in which inflammation appears to play a key role. In this context, it is therefore essential to increase the attention of the cardiology community to this issue and to enhance cardiological follow-up programs for this high cardiovascular risk population.

Waiting lists in cardiology are one of the most significant problems of the Italian Health Service (SSN). This phenomenon is perceived with significant delays in accessing specialist visits, diagnostic tests and surgical interventions, negatively affecting the health of patients and the overall quality of the SSN. Structural, organizational and demographic factors can be identified among the main causes of waiting lists in cardiology. On the one hand, the number of cardiologists and specialized healthcare workers is often insufficient compared to the growing demand for care. In fact, the distribution of medical personnel is uneven across the country and there are also real problems regarding the number of doctors and nurses within the SSN, workloads and salary aspects. Furthermore, the Italian population is rapidly aging, with a significant increase in age-related cardiovascular diseases, such as heart failure, arrhythmias and coronary heart disease. These factors lead to an ever-increasing demand for cardiology services, putting pressure on the SSN. The aim of this document is to provide an updated overview of the problem of waiting lists in cardiology, to analyze the causes and to provide possible solutions.