“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 overall deaths occurred in our country, are at the center, in the last few weeks, of a lively parliamentary debate with various resolutions that highlight the need for a national plan dedicated to these pathologies, as is happening in other European countries”. This is what the experts who spoke highlighted at the event 'Cardiovascular Health for All – What prospects for Italy', created 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.
“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, occurs with a higher probability in the population with metabolic diseases (up to 4 times higher in the diabetic population) – and have a significant economic burden (42 billion euros per year between direct healthcare costs and indirect costs)”, the experts recalled.
The request for a Plan, “which ensures a unified and shared vision among the various stakeholders”, goes in the direction of “improving the management of these patients and consequently their health outcomes, through a series of interventions in some priority areas of intervention “. Meridiano Cardio has identified 6 priority areas, including: primary and secondary prevention and early diagnosis activities, access to technological and pharmacological innovation, therapeutic adherence, telemedicine and other digital health tools, continuity of care between the different care settings and the involvement and empowerment of the patient.
“The indicators are not only a monitoring tool but also 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. – stated Senator 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 have been developed relating to cardio, cerebro and vascular pathologies by Agenas with the National Outcomes Plan and the monitoring of the Cardiology Network, and by the Ministry of Health, through the New Guarantee System (NSG) for the monitoring of healthcare. The Meridiano Cardio working group has surveyed a total of 75 indicators, 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 AMI in the acute phase, and 14 to the territory, to management of the post-infarction phase and heart failure.
“The acute myocardial infarction network in Italy works by guaranteeing approximately 600 angioplasty interventions 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 – added Giuseppe Musumeci, Scientific coordinator of the Technical Group for the development of proposals for the implementation and evolution of the cardiological network for the Agenas emergency – However, the current indicators regarding interventions on heart valves do not take into account of 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 currently account for around a third of the total procedures) to guarantee excellent and homogeneous volumes and outcomes across 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 – stated Fabrizio Oliva, president of Anmco – In the context of heart failure, in addition to maintaining the “Process indicator regarding hospitalization 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 can be seen once again 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 – underlined Pasquale Perrone Filardi, president of the Italian Society of Cardiology – 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”.
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