scholarly journals “Actua” project: secondary prevention in patients at high-cardiovascular risk

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Prieto Lobato ◽  
M J Corbi Pascual ◽  
M Redondo Prieto ◽  
M Cubells Pastor ◽  
A Muros Ortega ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Phase 1 ◽  
Standards Of Care ◽  
Consensus Method ◽  
High Dispersion ◽  
Phase 2 ◽  
High Cardiovascular Risk ◽  
Private Company ◽  
Artery Disease

Abstract Introduction It is acknowledged that secondary prevention for patients at high cardiovascular risk is suboptimal. Data from EUROASPIRE V registry showed that less than 50% of cardiovascular risks factors were controlled in this population. Purpose “Actua” study was designed to identify potential gaps regarding secondary prevention for patients at very-high cardiovascular risk. The main objective was to assess differences between scientific evidence and clinical practice through an agreement/disagreement analysis of a questionnaire with statements based on clinical guidelines and expert recommendations. Methods A qualitative analysis based on Delphi methodology was conducted. The study was divided into 2 phases. In phase 1, doctors were asked to show agreement or disagreement with the statements presented by the scientific committee through a Likert 5-points-scale. Consensus was stablished according to consensus method of Tastle. Results were expressed as a percentage (%CNS) which shows power of agreement or disagreement consensus. CNS>70% were considered as consensus. In phase 2, same doctors were asked again about the statements with no consensus or high dispersion in previous phase, after disclosing results in phase 1. In addition, a third questionnaire was conducted to asses socio-demographic data of the sample. Results 246 and 265 questionnaires were conducted in phase 1 and 2 respectively. 90% of respondents in phase 1 and 94,3% in phase 2 answered all the questions. Statements which showed consensus among participants are represented in table 1. As reported, there was consensus in goals for blood pressure (<130/80mmHg), cLDL (<70mg/dl), chronic use of acetylsalicylic acid in secondary prevention for coronary artery disease, stroke and peripheral artery disease. Doctors also agreed with the fact that 40mg atorvastatin can achieve 50% cLDL reduction levels from baseline. Scarce resources in secondary prevention were reported as main reason for medical attendants not following the best standards of care. Besides, most respondents agreed with the statement that a simpler treatment regime could improve therapeutical adherence in most patients. In phase 2, consensus was achieved in the statements showed in table 2. Conclusion Doctors admitted that complex recommendations and lack of following-up were the main causes of low adherence to treatment among patients at high cardiovascular risk. Limitations The study was conducted following recommendations from 2016 ESC/EAS guidelines for the management of dyslipaemias. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Grupo Ferrer Internacional, S.A. Table 1. Questions phase 1 Table 2. Questions phase 2

scholarly journals Are pregnant women satisfied with perinatal standards of care during COVID-19 pandemic?

2020 ◽  
Author(s):  
Claudia Ravaldi ◽  
Laura Mosconi ◽  
Giada Crescioli ◽  
Valdo Ricca ◽  
Alfredo Vannacci
Keyword(s):  
Pregnant Women ◽  
Phase 1 ◽  
Perinatal Care ◽  
Standards Of Care ◽  
Phase 2 ◽  
Maternity Services ◽  
Use Of Technology ◽  
Perception Of Quality ◽  
Report Data ◽  
Restrictive Measures

AbstractCOVID-19 restrictive measures severely impacted maternity services worldwide, but little is known about the differences in women’s concerns, perception of the modifications of maternity services and childbirth programs at different times during the pandemic. Here we report data from the first COVID-19 wave in Italy, during the 2020 national lockdown (March-April) and soon after lockdown release (May).1307 pregnant women answered the survey during national lockdown (phase 1) or after restrictive measures were released (phase 2). Women reported a significantly higher COVID-19 concern during phase 1 than during phase 2 (2.34 SD 0.5 vs 2.12 SD 0.5 on a Likert scale 0-3; p<0.001). Several domains of perinatal care were affected during COVID-19 lockdown: while antenatal visits, the use of technology to keep in touch with healthcare professionals, and closeness of caregivers were generally more appreciated (especially during phase 2), women reported the greatest difficulties in receiving clear information on hospitalization, birth plan and partner’s presence at birth.Italian pregnant women’s worries about the effects of the pandemic on health and their perception of quality in the organization of maternity services improved during lockdown, but they continued to represent a challenge in May, especially regarding organizational aspects of hospitalization and childbirth.

scholarly journals Diabetes Management – Lowering Cardiovascular Risk

2014 ◽  
Vol 9 (1) ◽  
pp. 7
Author(s):  
Dan Gaiţă ◽  
Svetlana Moşteoru ◽  
Laurence Sperling ◽  
◽  
◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Glycaemic Control ◽  
Multidisciplinary Approach ◽  
Diabetes Management ◽  
Microvascular Complications ◽  
Diabetic Patients ◽  
High Cardiovascular Risk ◽  
Hypoglycaemic Agents ◽  
Artery Disease ◽  
Shed Light

Diabetes mellitus is one of the most common diseases to plague the present day. Sixty percent of mortality in diabetic patients is caused by coronary artery disease. Numerous studies have shown that improving glycaemic control helps manage microvascular complications. On the other hand, some studies have shed light on the fact that a too tight glycaemic control can have adverse effects, especially on patients with high cardiovascular risk. Thus ‘the lower the better’ attitude should be exchanged for ‘the earliest the best’ attitude. A multidisciplinary approach should therefore be undertaken in order to achieve a proper management of the cardiovascular risk for diabetic patients. This includes using hypoglycaemic agents, antihypertensive medication and statins to balance the myriad of cardiovascular risk factors.

scholarly journals Smartphone-guided secondary prevention for patients with coronary artery disease

2021 ◽  
Vol 8 ◽  
pp. 205566832199657
Author(s):  
Irina Eckardt ◽  
Clara Buschhaus ◽  
Georg Nickenig ◽  
Felix Jansen
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Lifestyle Changes ◽  
Secondary Outcome ◽  
Daily Routine ◽  
Artery Disease

Introduction Coronary artery disease (CAD) is the leading cause of death worldwide. Lifestyle change is a crucial part of secondary prevention. Only 30% of CAD patients follow the corresponding guideline recommendations. The widespread adoption of smartphones offers the opportunity to integrate secondary prevention into the daily routine of CAD patients. Methods We developed an app to integrate secondary prevention into CAD patients’ everyday life (smartphone-guided secondary prevention, SGSP). The app provided a daily 15-minute program that included video-guided exercises, video sessions with background information about CAD, and a tool to record blood pressure and heart rate once a day. The SGSP app was tested with the primary outcome of 28-day adherence. The secondary outcome was a composite of (1) self-reported behavioral changes, (2) gain of knowledge about cardiovascular risk factors, and (3) an increase in quality of life. Results Of the 66 patients screened, 43 (65%) were included into the study and, of those, 17 (40%) used the app continuously for 28 days. From this group, 14 (82%) were physically more active and ten (59%) improved their dietary habits. Usage of the SGSP app was also associated with a gain of knowledge about cardiovascular risk factors (70% physical activity, 59% healthy diet). Conclusion The regular use of a SGSP app appears to support lifestyle changes in patients with CAD.

scholarly journals One year after the dyslipidemia esc guidelines: which impact in a high cardiovascular risk population is shown?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
I Larrabide-Eguren ◽  
I Toribio-Garcia ◽  
C Santos-Garcia ◽  
JC Echarte-Morales ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Young Patients ◽  
Lipid Lowering ◽  
High Cardiovascular Risk ◽  
Esc Guidelines ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION After publication of the 2019 ESC Guidelines for dyslipidemia, the LDL cholesterol target in patients with very high cardiovascular risk was reduced from 70 mg/dl to 55 mg/dl. Currently, there is more and more evidence that getting these levels is very important in prognosis, to avoid new cardiovascular events. The paradigm of this situation could be represented by young patients after STEMI, in which secondary prevention is essential to achieve a long-life expectancy. OBJECTIVE The aim of the present study is to analyze the impact the new guidelines have had on the control of LDL cholesterol in a population of young patients after STEMI, one year after their publication. METHODS A total of 101 consecutive young patients (aged ≤ 40 years) presenting with STEMI admitted at our center between 2006 and 2017 were included. There were no exclusion criteria. We collect demographic, clinical and treatment information, and laboratory values in september/2019 and again one year later.  RESULTS Out of 101 patients, 89 were male (88.1%). Mean age was 35.87 ± 4.07 years. Among the classic cardiovascular risk factors, dyslipidemia (44.5%) was the second one most prevalent in our cohort, after smoking (93.1%). In September/2019, only 66.3% of our patients had a recent LDL-cholesterol control, and only 20.9% of them had a target LDL-cholesterol lower than 55 mg/dl ("LDL-c -goal"). During the following year, a new determination of LDL cholesterol was only carried out in 18 patients out of the total sample, with these results: 15 patients had an LDL&gt; 55 mg/dl; 2 patients maintained an "LDL-c-goal", and only a single patient achieved optimal control (from 81 mg/dl to 39 mg/dl) coinciding with the change from low to high intensity statin. Regarding lipid-lowering treatment, in September/2019 the 87.7% of our population were taking statins, 21.9% ezetimibe, and 0.0% PCSK9-inhibitors. In that moment, in 6 patients, the lipid-lowering treatment was reduced (all of them had LDL values were between 65-105 mg/dl). One year later, in September/2020, 82.2% were taking statins, 21.9% ezetimibe, and in 1 patient was started with the PCSK-9 inhibitor. Thirteen patients (12.9%) had suffered a reinfarction during follow-up, but none in the last year. CONCLUSIONS Despite of the new LDL-cholesterol target established by the ESC Guidelines, we have not improved our lipid control in a population with high cardiovascular risk -with a percentage of cardiovascular events during mean follow-up that is not negligible-, being only 1 of each 5 patients correctly treated. We must carry out a closer clinical and analytical follow-up, by increasing our efforts in secondary prevention, and perhaps the Cardiac Rehabilitation Units can play an essential role in this objective. It is possible that the Covid-19 pandemic could have influenced these results. Abstract Figure. Lipid-lowering treatment.

scholarly journals High cardiovascular risk of patients with type 2 diabetes is only partially attributed to angiographic burden of atherosclerosis

2020 ◽  
Vol 17 (5) ◽  
pp. 147916412095361
Author(s):  
Simone Battermann ◽  
Andrea Milzi ◽  
Rosalia Dettori ◽  
Kathrin Burgmaier ◽  
Nikolaus Marx ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Quantitative Coronary Angiography ◽  
High Cardiovascular Risk ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Angiographic Data ◽  
Artery Disease ◽  
Stable Cad

Background: Patients with type 2 diabetes (T2DM) are at high risk for cardiovascular events and present more severe coronary artery disease (CAD). The Gensini and COURAGE scores are established angiographic instruments to assess CAD severity, which may also predict future cardiovascular risk. However, it is unclear if these scores are able to depict the increased risk of patients with T2DM and stable CAD (T2DM-SAP). Methods: We performed quantitative coronary angiography and assessed the Gensini and COURAGE scores in 124 patients with T2DM-SAP. Angiographic data were compared to patients with stable angina without T2DM (Non-DM-SAP, n = 74), and to patients with acute coronary syndrome and T2DM (T2DM-ACS, n = 53). Results: T2DM-SAP patients had similar Gensini and COURAGE-scores compared to Non-DM-SAP-patients (Gensini: 14.44 ± 27.34 vs 11.49 ± 26.99, p = 0.465; COURAGE: 3.48 ± 4.49 vs 3.60 ± 4.72, p = 0.854). In contrast, T2DM-SAP patients had significantly lower Gensini (14.44 ± 27.34 vs 30.94 ± 48.74, p = 0.003) and lower COURAGE (3.48 ± 4.49 vs 5.30 ± 4.63, p = 0.016) scores compared to T2DM-ACS-patients. Conclusion: Both the Gensini and the COURAGE score fail to predict the high cardiovascular risk of patients with T2DM-SAP. Therefore, these scores should be used with caution in the assessment of future risk of patients with T2DM. However, among T2DM-ACS patients, both scores are increased, reflecting the high cardiovascular risk in this patient population.

scholarly journals The usefulness of dipyridamole stress echocardiography in high-risk patients before abdominal aneurism surgery

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Binno ◽  
L Moderato ◽  
P Capelli ◽  
MF Piepoli ◽  
M Scabini ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
High Risk ◽  
Stress Echocardiography ◽  
High Cardiovascular Risk ◽  
Stress Echo ◽  
Artery Disease ◽  
Dipyridamole Stress

Abstract Funding Acknowledgements Type of funding sources: None. Background  Coronary artery disease (CAD) and aortic aneurysm (AA) share commons risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, and smoking. Cardiac assessment before aortic abdominal aneurysm (AAA) surgery is indicated for patients with symptomatic coronary artery disease (CAD). The usefulness of assessment of moderate/high-risk patients is still debated.  Purpose the purpose of our study is to evaluate the safety and effectiveness of dipyridamole stress echocardiography (DSE) for the detection of CAD in patients undergoing AAA surgery with high cardiovascular risk.  Methods From 2017th to 2019th 120 patients underwent surgery for aortic aneurysm (71 endovascular technique and 49 with open laparotomy).  Of these, 74 asymptomatic patients with high cardiovascular risk underwent a pre-surgical contrast-enhanced dipyridamole stress echo (0,84 mg/kg over 6 minutes – protocol with LVO with sulfur hexafluoride), to exclude the presence of inducible myocardial ischemia, Mean follow-up was 6-24 months.  Results   Mean age was 77 years +/- 6.6, with male gender prevalent (83%).  No complication during DSE occurred; mean SCORE risk was 9.8% +/- 2.3%, with 63% patients with very high risk.  Only 1 patient showed inducible ischemia during stress echocardiography, with evidence of significant LAD stenosis; no myocardial infarction was reported at follow-up, while 1 ischemic stroke and 1 unplanned revascularization occurred.  11% of patients died, of which 50% for Sars-Cov-2 disease and 12% due to post-surgery dissection while no cardiac deaths were found. Conclusions dipyridamole stress echo is safe in patients with surgical-class abdominal aortic aneurism; in patients with high cardiovascular risk but no symptoms reversible ischemia is rare. DSE should not be routinely performed before high-risk surgery but only in patients with cardiac symptoms. Abstract Figure. Patients Diagram

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