Increasingly effective primary and secondary prevention, to achieve an early diagnosis of pathologies and the identification of those at risk. Access to technological and pharmacological innovation. Ensuring that people correctly follow the prescribed treatments, especially in cases of chronicity, through greater attention to therapeutic adherence. Optimal exploitation of the opportunities offered by telemedicine and other digital health tools. Continuity of care and assistance between hospital and territory. Involvement of the patient, increasingly informed and “active” in person.
These are the six chapters of commitment to tackle cardiovascular pathologies that emerge from the conference “Cardiovascular Health for All – What prospects for Italy”, organized by Meridiano Cardio, the platform for discussion and dialogue on cardio, cerebro and vascular pathologies of The European House – Ambrosetti (TEHA), in collaboration with the Parliamentary Intergroup for cardio, cerebro and vascular diseases.
Early diagnosis and individual-targeted intervention for the tailor-made prevention of cardiovascular diseases
by Federico Mereta
The burden of heart attack, stroke and other diseases
Cardio, brain and vascular diseases, which still represent the leading cause of mortality in Italy with over 216,000 deaths in 2021, equal to 31% of the overall deaths in our country, are at the center, in the last few weeks, of a lively parliamentary debate with several resolutions that highlight the need for a National Plan dedicated to these pathologies, as is happening in other European countries.
Today these pathologies have important impacts in terms of high mortality, incidence, prevalence, which are influenced by risk factors and concomitant syndromes – the risk of contracting cardiovascular diseases, for example, manifests itself with a higher probability in the population with metabolic diseases (up to 4 times higher in the diabetic population) – and have a significant economic impact (42 billion euros per year between direct healthcare costs and indirect costs). The request for a Plan led to the identification of six priority areas.
Stroke cases and deaths will rise 30% by 2050
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The importance of measurement
Obviously, to understand where we are going, we need systems to evaluate what is happening. We therefore need indicators, also as a guidance and planning tool. “If we do not define monitoring indicators for each area of intervention, we will never know whether the actions implemented at local and regional level have allowed an improvement in the state of health of the population and to improve the effectiveness and efficiency of the system. – is the Senator’s comment Elena Murelli, Promoter of the Parliamentary Intergroup for cardio, cerebro and vascular diseases. The indicators, in fact, by measuring the changes that occur in the phenomena we observe, allow us to guide decision-making processes.” Over the years, numerous indicators referring to cardio, cerebro and vascular pathologies have been developed by Agenas with the National Outcomes Plan and the monitoring of the Cardiology Network, and of the Ministry of Health, through the New Guarantee System (NSG) for the monitoring of healthcare.
After the heart attack, the treatment is tailor-made
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What indicators are needed?
The Meridiano Cardio working group has surveyed a total of 75 indicators, of which almost 80% look at the hospital sector; of these, almost half are represented by volume indicators (28 out of 59) which do not provide a snapshot of the effectiveness of the interventions carried out.
“The technological and pharmacological innovations of recent years, which have modified the procedures and models for taking charge and management of cardio, cerebro and vascular patients, in addition to requiring an update of the DRGs, require a rationalization and revision of some indicators which in some cases appear partial and outdated and in other cases they do not respond to new procedures/technologies introduced into clinical practice” – is the opinion of Daniela BiancoPartner and Head of the Healthcare Area of The European House – Ambrosetti”.
Of the 75 indicators surveyed, 46 concern the cardiological field, 20 the vascular field and 9 the cerebrovascular field. Focusing attention on the cardiological field, which was the subject of the meeting, 32 indicators refer to the hospital field, i.e. to cardio-surgical procedures and the management of myocardial infarction in the acute phase, and 14 to the territory, to the management of the post-infarction phase and heart failure.
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Heart attack, heart failure and assistance, what the experts say
“The acute myocardial infarction network in Italy works by guaranteeing approximately 600 angioplasty operations per million inhabitants in a fairly homogeneous way throughout the national territory and this also thanks to the Agenas National Outcome Plan which has stimulated the implementation of the network and the procedures in urgency” – he says Giuseppe Musumeci, Scientific Coordinator of the Technical Group for the development of proposals for the implementation and evolution of the Agenas emergency cardiology network. However, the current indicators regarding interventions on heart valves do not take into account the recent introduction of minimally invasive techniques (TAVI and Mitral Clips) operated by interventional cardiologists as alternatives to traditional cardiac surgery techniques. It is therefore essential to implement indicators of volume and outcomes of these minimally invasive techniques in order to be able to distinguish the two types of interventions and monitor the outcomes of these interventions (which are currently around a third of the total procedures) to guarantee excellent volumes and outcomes. and homogeneous throughout the national territory”.
“Recently the Agenas technical group, starting from the positive results obtained by the cardiac emergency network, has identified 4 new indicators to improve the results which are currently less encouraging in the management of the patient after the acute event. In fact, they are relevant: the identification of patients at high residual ischemic risk, in particular those with reduced cardiac function, starting a cardiac rehabilitation program and achieving the lipid target – is the comment of Fabrizio Oliva, President of ANMCO. “In the context of heart failure, in addition to maintaining the process indicator regarding hospitalization, it would be important to monitor the use of recommended pharmacological treatments which have been shown to positively modify the prognosis of these patients.”
“From the mapping carried out by Meridiano Cardio, it is once again revealed that local assistance is undersized in terms of monitored indicators. After the recent introduction of secondary prevention indicators, indicators relating to early diagnosis, therapeutic adherence and telemedicine continue to be missing – let it be known Pasquale Perrone Filardi, President of SIC. The identification also for these areas of measurable indicators that look at cardiological screening, simplification of therapies – also through the use of fixed associations – and use of telemedicine, is essential to improve patient management and contribute to the sustainability of the NHS”.
Stroke prevention, valve repair: what can be done with interventional cardiology
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– 2024-04-16 17:50:32
