Valutazione dei processi assistenziali e del carico economico dei soggetti con ospedalizzazione incidente di infarto acuto del miocardio mediante il Data Warehouse DENALI (original) (raw)
Related papers
Giornale Italiano Di Cardiologia, 2014
Post-discharge management of patients with acute coronary syndrome (ACS) requires a comprehensive outpatient network and specific competence regarding risk factor control, optimal pharmacological therapy and adequate follow-up strategies. This combination should allow a significant outcome improvement with reduced rates of fatal and nonfatal events and hospital readmissions. On October 25-26, 2013, a consensus conference on clinical management after ACS was held in Naples, Italy, under the auspices of two Italian scientific societies, the Italian Association for Cardiac Prevention and Rehabilitation (GICR-IACPR) and the Italian Association of Hospital Cardiologists (ANMCO). The present document constitutes a joint proposal for the management and follow-up of patients discharged alive after ACS. The paper is divided into four sections: in Section 1 on "Epidemiology and prognostic stratification", the clinical and instrumental variables for the identification of patients at higher risk of adverse events (death, heart failure or reinfarction) in the months following an ACS are described on the basis of currently available data; in Section 2 on "Post-discharge care management", different pathways for follow-up and treatment are proposed, according to the baseline clinical presentation: a cardiac rehabilitation inpatient program is suggested for high-risk patients, an intensive secondary prevention outpatient program for those at high thrombotic risk, and a clinical follow-up for low-risk profile patients. Sections 3 and 4 on "Drug therapy targets" and "Strategies to improve adherence and promote lifestyle changes" emphasize the need for structured programs of pharmacological implementation and long-term maintenance of recommended therapy and healthy lifestyle.
Riassunto La definizione universale di infarto miocardico acuto si propone quale esigenza clinica e al contempo speculativa, essen-do l'infarto miocardico, una delle prime cause di mortalità e morbilità nei paesi occidentali nonché criterio di arruola-mento o end-point primario in molti studi clinici. Nel corso degli anni, sono state proposte differenti definizioni, ognuna delle quali nata dall'esigenza di superare i limiti delle precedenti e al contempo di integrare le informazioni dei progressi ottenuti nel campo della biochimica e delle tec-niche di imaging. La "definizione universale di infarto miocardico" proposta nel 2007 dalla Task Force dell'European Society of Cardiology/American College of Cardiology, si propone quale definizione integrata di criteri clinici, biochimici, di imaging e istopatologici e appare orientata non tanto alla definizione della patologia in sé, ma alla circoscrizione dei setting clinici in cui essa si manifesta, definendo 5 tipi ...