Health, cardiologist Nardi: “Better care with ASCVD clinics and hospital-territory network”

Alongside clinics dedicated to “gender cardiology, pediatric cardiology and arrhythmias”, there is one, the first of this type, which “deals with secondary prevention, that is, patients who have had an ischemic event, the so-called patients with atherosclerotic cardiovascular disease” (Ascvd) from a multidisciplinary perspective. This is how Federico Nardi, director of the complex Cardiology Structure of the Santo Spirito Hospital in Casale Monferrato (Al) and national vice-president of the Anmco Foundation for your Heart, describes the reality of the Center of Excellence for Cardiovascular Pathologies which has stood out for its innovation , research and to provide maximum service thanks to the real connection between hospital and territory in a network that “avoids losing” patients during treatment. (Video)

LDL cholesterol is considered “the causal agent, the etiopathogenetic agent of heart attack and reinfarction”, recalls the cardiologist. Dyslipidemias are managed at the level of “primary prevention, as in the patient who is smoking and has irregular lifestyles, to whom we must explain that, if he continues with those risk factors, he will suffer a cardiovascular event. “But – adds Nardi – we also have a large database in the field of dyslipidemia and hypercholesterolemia” for “secondary” prevention, i.e. in those who have already had, for example, a heart attack.

It is therefore a question of managing “the targets” of risk factors such as LDL cholesterol, for example, “which become increasingly more stringent over the years – observes Nardi – We know very well that we started from values ​​of 100 mg/dl” , we passed through “ 70 and, now, we know that the very high risk and the extreme risk lead us towards increasingly lower targets below 55 and even below 40 mg/dl. Today we have a whole series of molecules that allow us to intervene “on the intensity of treatment, but one of the big problems that we have found ourselves managing in our dedicated clinics, such as the chronic coronary syndrome clinic, concerns non-adherence to treatments”.

Many “observational or registry” studies also carried out “by the National Association of hospital cardiologists (Anmco) of which I am a member – states Nardi – highlight that patients with ischemic heart disease, therefore fundamentally patients in secondary prevention, often, unfortunately, do not they are treated well. There are studies, Santorini for example, which show that just over 50% of these patients reach the target, i.e. they reach the recommended “LDL cholesterol” values, based on the risk level. This means that “almost 50% are not at target”. They are patients who “unfortunately are not treated adequately: they are on monotherapy with statins” which are “excellent” drugs, but which, in some cases, are not sufficient to obtain the expected results. To help achieve the values ​​indicated to reduce the risk of these events “we give our patients a real connection with their colleagues in general medicine, with their diabetologist colleagues, with local cardiologists who, clearly – highlights the cardiologist – refer directly to us.”

The problem is “having dedicated clinics to reduce what is called the residual risk – underlines Nardi – but also “the connection with the territory, with other colleagues, both in general medicine and in other specialties, which allows us to better identify and earlier, patients who are affected by hypercholesterolemia, therefore requiring management, and who, in the vast majority, are in secondary prevention, i.e. those patients who have already had an event of an atherosclerotic nature”.

These are the patients who, “in collaboration with the territory – clarifies the cardiologist – we are able to take through fast tracks, that is, with routes that are dedicated and which allow us to take care of them immediately and avoid losing them among the mesh” , thus containing the phenomenon of ‘lost in treatment’ patients, who are in limbo and who are not effectively followed. This organization “clearly allows us to optimize the therapy, but also to monitor how adherent the patient is to the given therapy – concludes Nardi – to control him and not abandon him to himself or to a colleague who perhaps is unable to evaluate and see all the facets of the pathology” .