Optimizing urine albumin-to-creatinine ratio testing and referral pathways for chronic kidney disease: a nominal group technique consensus study among Italian experts.

Background: Chronic kidney disease (CKD) represents a major global health burden, often diagnosed at advanced stages when treatment is less effective. Albuminuria, assessed by the urine albumin-to-creatinine ratio (uACR), is a key biomarker for CKD detection and risk stratification. Despite guideline recommendations, adherence to uACR testing remains low, limiting early diagnosis and timely referral.

Improving the Management of Patients with Heart Failure with Reduced Ejection Fraction in Clinical Practice: The Case for Angiotensin Receptor-Neprilysin Inhibitor.

The high risk of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF) demands urgent efforts in the initiation of guideline-directed medical therapy to reduce morbidity and mortality. Angiotensin receptor-neprilysin inhibitor showed substantial benefits in reducing the risks of heart failure hospitalisation and cardiovascular mortality in HFrEF patients. Therefore, the European Society of Cardiology 2021 guidelines recommend angiotensin receptor-neprilysin inhibitor as a first-line therapy for HFrEF patients.

[ANMCO Position paper in collaboration with ITACARE-P: Management of hospital discharge].

Hospital discharge is a crucial moment in the continuity of care, acting as a bridge between the acute phase and the treatment pathway that follows. Far from being a simple administrative act, it is a complex process requiring careful planning, effective communication, and the active involvement of all the stakeholders of the healthcare system, including the patient. Poor discharge management can have a negative impact on clinical outcomes, resulting in a higher risk of hospital readmission and inefficient use of healthcare resources.

ANMCO position paper: diagnosis and treatment of heart failure with preserved systolic function.

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure.

[Management of cardiac amyloidosis in Italy: a national survey of the Italian Cardiac Amyloidosis Network (RIAC)].

Background: The national survey of the SIC-ANMCO Amyloidosis Centers was designed to create a geographical mapping of the centers that identify and follow patients with cardiac amyloidosis in Italy and to describe their diagnostic capabilities and multidisciplinary organization.

Methods: The survey was administered to 212 centers in Italy. Among them, 153 centers responded (72%), 31/35 (89%) of which were academic medical centers and 122/177 (69%) hospitals.

[Artificial intelligence in cardiology: definition, types, glossary, algorithms used - opportunities, limitations, development barriers, and challenges].

Artificial intelligence (AI) is revolutionizing cardiology, offering new opportunities to improve diagnosis, therapy, and prevention of cardiovascular diseases. By analyzing large amounts of data and supporting clinical decisions, AI can simplify modern medical complexities. However, its development is limited by methodological, ethical, and organizational obstacles.

LDL-cholesterol levels and lipid lowering therapy in secondary prevention. Baseline data from the BRING-UP prospective registry.

Aims: To narrow the gap between guidelines recommendation for secondary cardiovascular prevention and clinical practice, we designed a national project based on educational programs and patient data collection.

Methods: BRING-UP Prevention is an observational, prospective, multicentre study on patients with an atherothrombotic event enrolled in 2 phases: an educational intervention followed by two 3-months data collection, followed by 6 and 12-month follow-up, when the primary, secondary and exploratory endpoints will be evaluated. Clinical characteristics, treatments and target achievement for LDL cholesterol and other modifiable risk factors at baseline are reported in this manuscript.

[ANMCO Position paper: Management of heart failure with preserved ejection fraction].

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure.

Wavelet-Mixed Landmark Survival Models for the Effect of Short-Term Changes of Potassium in Heart Failure Patients.

Statistical methods to study the association between a longitudinal biomarker and the risk of death are very relevant for the long-term care of subjects affected by chronic illnesses, such as potassium in heart failure patients. Particularly in the presence of comorbidities or pharmacological treatments, sudden crises can cause potassium to undergo very abrupt yet transient changes. In the context of the monitoring of potassium, there is a need for a dynamic model that can be used in clinical practice to assess the risk of death related to an observed patient's potassium trajectory.

[Multidisciplinary and multiprofessional care to multimorbid chronic patients with cardiovascular disease: the experience of the Azienda Sanitaria Universitaria Giuliano Isontina].

The world of chronic non-communicable diseases is progressively growing epidemiologically, requiring a significant commitment of resources, continuity of care, and strong integration between healthcare professionals and care settings. The National Recovery and Resilience Plan, in the Ministerial Decree 77 of 23/5/2022, identifies Community Homes as the privileged location for providing integrated, multidisciplinary and multiprofessional interventions, involving specialists and nursing clinics, general practitioners and district structures, utilizing all the necessary technological equipment, including digital platforms for telemedicine. In this context, cardiology is facing a complicated challenge: cardiologists must take care of patients with cardiovascular diseases who have also complex comorbidities and are required to extend their knowledge beyond the specific, sometimes super-specialistic, cardiovascular field, to avoid fragmentation, redundancy, and potential conflicts in the diagnostic-therapeutic care pathways.

Differences between MINOCA and type 2 myocardial infarction: An ITALIAN observational study.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) and type 2 myocardial infarction (MI), both presenting as non-ST-elevation MI (NSTEMI), are often grouped together due to overlapping symptoms. The aim of our study is to compare their characteristics and prognosis to distinguish between them.

Methods: Among 7815 patients with NSTEMI who underwent coronary angiography between 2005 and 2022 we identified 538 patients with diagnosis of MINOCA (n = 301; 3,9 %) and type 2 MI (n = 237; 3 %).

Effects of sacubitril/valsartan on the functional capacity of real-world patients in Italy: the REAL.IT study on heart failure with reduced ejection fraction.

Background: Heart failure (HF) significantly affects the morbidity, mortality, and quality of life of patients. New therapeutic strategies aim to improve the functional capacity and quality of life of patients while controlling HF-related risks. Real-world data on both the functional and cardiopulmonary exercise capacities of patients with HF with reduced ejection fraction upon sacubitril/valsartan use are lacking.

Cost-effectiveness of outpatient adherence to recommendations for monitoring of patients hospitalized for heart failure.

Aims: A set of indicators to assess the quality of care for patients hospitalized for heart failure was developed by an expert working group of the Italian Health Ministry. Because a better performance profile measured using these indicators does not necessarily translate to better outcomes, a study to validate these indicators through their relationship with measurable clinical outcomes and healthcare costs supported by the Italian National Health System was carried out.

Methods And Results: Residents of four Italian regions (Lombardy, Marche, Lazio, and Sicily) who were newly hospitalized for heart failure (irrespective of stage and New York Heart Association class) during 2014-2015 entered in the cohort and followed up until 2019.

Flexible Approaches Based on Multistate Models and Microsimulation to Perform Real-World Cost-Effectiveness Analyses: An Application to Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors.

Objectives: This study aims to show the application of flexible statistical methods in real-world cost-effectiveness analyses applied in the cardiovascular field, focusing specifically on the use of proprotein convertase subtilisin-kexin type 9 inhibitors for hyperlipidemia.

Methods: The proposed method allowed us to use an electronic health database to emulate a target trial for cost-effectiveness analysis using multistate modeling and microsimulation. We formally established the study design and provided precise definitions of the causal measures of interest while also outlining the assumptions necessary for accurately estimating these measures using the available data.

Simple scores to predict 1-year mortality in atrial fibrillation.

Background: Traditional scores as CHADS2 and CHA2DS2-Vasc are suitable for predicting stroke and systemic embolism in patients with atrial fibrillation (AF) and have shown to be also associated with mortality. Other more complex scores have been recommended for survival prediction. The purpose of our analysis was to test the performance of different clinical scores in predicting 1-year mortality in AF patients.

[ANMCO Position paper: States General 2023 - Digital medicine in cardiology: evidence and state of progress in Italy].

Technological innovation provides easily accessible tools capable of simplifying healthcare processes. Notably, digital technology application in the cardiology field can improve prognosis, reduce costs, and lead to an overall improvement in healthcare. The digitization of health data, with the use of electronic health records and of electronic health files in Italy, represents one of the fields of application of digital technologies in medicine.

Impact of left ventricular hemodynamic forces in adult patients with treated aortic coarctation and preserved left ventricular systolic function.

Background: The LV myocardial strain and hemodynamic forces (HDFs) are innovative markers of LV function. Aortic coarctation is safely repaired in infancy; however, mortality and morbidity remain increased in later life. The study investigated the role of left ventricular myocardial deformation and HDFs in asymptomatic patients who underwent successful aortic coarctation repair.