Search

Evidence supports the association of some non-conventional or yet to be established risk factors (RFs), such as serum uric acid (UA) or high-sensitivity C-reactive protein (hs-CRP), with the risk of arterial hypertension (HTN), metabolic syndrome, and chronic kidney disease and a worse prognosis in patients with known coronary vascular disease (CVD). However, there is no evidence from randomized controlled trials to support their use in guiding therapy. In the secondary prevention setting, detection of peripheral vascular damage and kidney dysfunction may provide significant additional prognostic implications.

According to the latest WHO guidelines, the ICD-ICF joint use currently represents the most agreed method to portray a patient's Care Pathway during a hospitalization. On this note, ICS Maugeri carried out an internal project aiming to identify the ICF codes that better describe the rehabilitation pathways in its Italian Institutes. 2 main goals so far have been achieved: 1. To re-conceptualize the Care Pathways thought the lenses of the ICD-ICF frameworks; 2. To link, whenever possible and by means of the WHO-ICF linking rules, each pertinent ICF code to the most appropriate assessment method, harmonizing its outputs to the 0-4 ICF Likert scale. The current project represents a first attempt towards the creation of a standard functioning assessment methodology to be implemented in rehabilitation settings. Despite being referred to the Maugeri group only, the ICD-ICF procedure described could hopefully be extended to other settings, representing a support for health information technologies.In accordo ai recenti mandati OMS, l’uso congiunto di ICD e ICF rappresenta il metodo più completo e concordato per la descrizione dei percorsi diagnostici terapeutici riabilitativi del paziente. A tal proposito, è stato avviato un percorso interno a ICS Maugeri finalizzato a identificare i codici ICF descrittivi dei principali percorsi riabilitativi condotti negli istituti. Sono stati delineati due macro-obiettivi: 1. Riconcettualizzazione dei PDTA e del Progetto Riabilitativo Individuale (PRI) attraverso la chiave di lettura del modello ICD-ICF; 2. Abbinamento, tramite le regole di linking e laddove possibile, di ciascun codice ICF identificato ad una scala o ad un metodo di valutazione pertinente, armonizzando il livello di compromissione alla scala Likert 0-4 prevista dall’ICF. Il percorso rappresenta un primo passo verso la creazione di un sistema standard di ricodifica del funzionamento in un’ottica riabilitativa. Sebbene autodeterminata, l’implementazione sistematica della valutazione della disabilità e del funzionamento secondo il modello ICF dell’OMS, associata alla valutazione ICD, potrebbe diventare uno strumento di dialogo e di sostegno ai percorsi clinici digitalizzati del futuro.

The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more".The present document is aimed at providing the general practitioner with practical information about a prompt diagnosis of signs/symptoms (angina, dyspnea, palpitations, syncope) of the major cardiovascular diseases. It will also provide an overview about appropriate use of diagnostic exams (echocardiogram, stress test), about the appropriate timing of their execution, in order to ensure effectiveness, efficiency, and equity of the health system.

The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. Of note, clinical evaluations and non-invasive exams are often performed to low risk patients. In the present consensus document, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Three strategies follow-up have been defined and types and timing of clinical and instrumental evaluations are reported. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners, who are in charge to manage post-PCI patients, equally contributed to the creation of the present document.

To describe the results of the 6-min walking test performed on admission to an intensive rehabilitation program after cardiac surgery and to develop, through an algorithm based on a few clinical indicators, reference tables in order to apply distance walked values more efficiently in the individual patient at his/her entry into a cardiac rehabilitation program.Intensive cardiac rehabilitation units.A total of 2,555 consecutive patients admitted between January 2001 and December 2002 to the Cardiac Rehabilitation Department of the S. Maugeri Foundation early after cardiac surgery performed a 6-min walking test within the fourth day of hospital admission.The mean walked distance was 296 +/- 111 m (+/- SD). At multiple regression analysis, age, sex, and comorbidity were independent predictors of walking test performance. The left ventricular ejection fraction only influenced the walked distance in men. Starting from these variables, we propose an algorithm and specific reference tables.Reference values for gender-, age-, comorbidity-, and systolic function-related test performance in patients after cardiac surgery at the beginning of the rehabilitative phase are provided. Once a new patient has been categorized through simple parameters, the actual distance walked could be compared with the matched reference value, thus making the interpretation of the result more efficient. The walked distance might be used to define different levels of disability and to personalize therapeutic exercise prescriptions.

Sudden death and pump failure are the main causes of death in patients with heart failure. Patients with ischemic and non-ischemic cardiomyopathy are at similar risk of arrhythmic mortality; however, standard non-invasive and invasive tests are not routinely available for non-ischemic patients. T-wave alternans (TWA) has been proposed as a potential marker of susceptibility to ventricular tachycardia-fibrillation in several groups of patients.The ALPHA study was designed to evaluate the independent predictive value of the measurement of microvolt TWA on the combined occurrence, after 18 months of follow-up, of cardiac death and life-threatening arrhythmias in a population of patients with non-ischemic dilated cardiomyopathy and NYHA class II and III. This is a multicenter prospective observational study. A total of 370 patients, with measurable TWA, will be enrolled during routine follow-up for heart failure treatment; a logbook will be used to collect basic information on the whole screened population. Patients will be enrolled during a 2-year period and will be followed up for 18 months. The primary endpoint of the study will be the combined incidence of cardiac death and life-threatening ventricular arrhythmias. The study will complete recruitment by mid 2004 and report in 2006.

The Beta-blocker Strategy plus Implantable Cardioverter Defibrillator (BEST-ICD) Trial is a multicenter prospective randomized trial that started in June 1998, in 95 centers in Italy and Germany. The trial will test the hypothesis whether, in high-risk post myocardial infarction (MI) patients already treated with beta blockers, electrophysiologic study (EPS)-guided therapy (including the prophylactic implantation of implantable cardioverter defibrillator [ICD] in inducible patients) will improve survival compared with conventional therapy. Patients eligible for the study are survivors of recent MI (or = 5 andor = 21 days), agedor = 80 years, with left ventricular ejection fractionor = 35% andor = 1 of the following additional risk factors: (1) ventricular premature beatsor = 10/hour; (2) decreased heart rate variability (standard deviation of unusual RR intervals70 msec); and (3) presence of ventricular late potentials. Furthermore, all enrolled patients must be able to tolerate at least 25 mg of metoprolol per day. These patients constitute about 9% of all patients with recent MI and are expected to have a 2-year all-cause mortality25% of which 50% is anticipated to be from sudden death. The main criteria of exclusion from the study are (1) a history of sustained ventricular arrhythmia; (2) documentation of nonsustained ventricular tachycardia during the screening phase; and (3) the need for myocardial revascularization and contraindications or intolerance to beta-blocker therapy. Eligible patients will be randomized to 2 different therapeutic strategies: conventional strategy or EPS/ICD strategy. Patients allocated to the EPS/ICD strategy will undergo further risk stratification, and electrophysiologically inducible patients (approximately 35%) will receive prophylactic ICDs, in addition to the conventional therapy, whereas noninducible patients will be only conventionally treated. The primary endpoint of the study will be death from all causes. By hypothesizing a 30% reduction in the 2-year mortality (from 20% to 14%) in the EPS/ICD group compared with conventionally treated patients, 1,200 patients will have to be included. A triangular, 2-sided sequential design with preset boundaries, for a 5% significance level and 90% power to detect a reduction in 2-year mortality from 20% to 14%, will be used to permit early termination of the trial if the strategy is found to be efficacious, no difference, or inefficacious.

Il saggio analizza i rapporti politici tra il Sudafrica post-apartheid e i paesi africani, con un'attenzione particolare alla gestione della sicurezza, alla NEPAD e alla risoluzione della crisi politica in Zimbabwe.