bluuebunny/crossref_metadata_2025_split huggingface dataset:
APPLICATION OF AN ORGANIZATIONAL MODEL FOR PATIENT CARE: PRIMARY NURSING IN A REHABILITATION CARDIOLOGY CENTER
Authors: Zanuzzi B , Longobardo E , Ferrante G , Vecchi S , Vaccaro M 
Published: May 2024

Abstract
The issue of chronicity and frailty is shaped in the current health care environment as an increase in the complexity of pz–users referred to Rehabilitation Cardiology. Advances in medical care and improvements in general living conditions have led to an explosion of chronic diseases and the spread of a new figure of the caregiver, in which several diseases coexist. For this reason, over the past 20 years, the need for care, in the R.C. has increased significantly precisely bc of the increase in multiple comorbidities of pz hospitalized for cardiologic events. This need translates into increased care complexity, which therefore requires the need to experiment with new organizational models capable of ensuring a systemic approach to taking care of the person. In this scenario, the PN of care is developed, an innovative method capable of going beyond the therapeutic project, centering the process from operator–centered to pz–centered. The essential aspect of this organizational model is the practitioner‘s full acceptance of his or her responsibilities from admission to discharge of the pz. From August 2023 to November 2023, 228 consecutive pz were admitted to the RC. The PN organizational model was applied to all in pz admitted during the period under observation. During admission to the ward, the charge nurse, in full sharing with the pz, carried out data collection and planned care activities; in order to create guidance for colleagues who collaborated with the charge nurse in the care plan, the nurse implemented the drafting of the care process. Finally, in order to provide assurance of continuity of care and to ensure a safer and smoother return home or transfer to another facility for the pz and family members, the nurse, thanks to the PN, also planned the discharge, having personally followed the patient throughout the entire hospitalization. In order to assess the quality of care provided, a satisfaction questionnaire was administered to all in pz admitted during the period under observation. The mean age of the observed pz is 68.7 aa, 79% of pz observed had previous hospitalizations in other hospitals,no pz had any experience with PN, 98% of observed pz noted improved care with referral nurse intake,2% of pz did not complete the questionnaire.In our brief experience, the PN organizational proved to be an effective and comprehensive method, contributed to improving the quality of care provided in our OU and improved the satisfaction of staff.
CONNECT HF/CKD A MULTI–DISCIPLINARY TELEMONITORING PROJECT FOR HOSPITAL RE–ADMISSIONS REDUCTION AND THERAPEUTIC OPTIMIZATION IN HEART FAILURE IN THE ERA OF DIGITAL DEVICES
Authors: Grossi F , Fatucchi S , Innocenti L , Bertini A , Bartolini S , Taborchi G , Minneci C , Zoppi P , Alti E , Rosati A , Milli M 
Published: May 2024

Abstract

Introduction
Management of patients affected both from heart failure (HF) and Chronic Kidney Disease (CKD) is a well–known issue. The latest ESC 2023 Heart Failure Guidelines recommend the use of four classes of drugs to reduce mortality and hospital admissions due to HF. CKD represents one of the most frequently reported factors underlying the failure to prescribe or to titrate recommended treatments. New telemonitoring techniques can be useful in the detection of signs of decompensation and achievement of therapeutic targets.

Methods
Our project aims at optimizing the management, treatment and follow–up of patients with HF, thanks to multidisciplinary management and an accurate and easy–to–use home telemonitoring equipment provided to patients. Patients will be divided into two groups based on a high (group A) or medium/low risk (group B) profile. Remote monitoring will last 3 weeks, before the first clinical control in out–patient HF clinic. Once the inclusion and exclusion criteria have been assessed, the patient will be enrolled in one of the two groups. The home telemonitoring equipment allows the detection of different clinical parameters (oximetry, blood pressure, heart rate, 6–lead EKG, body weight) and the visualization of blood test reports. Data are recorded on a tablet connected to a cloud server. A questionnaire is provided to the patient aimed at understanding his/her symptoms and quality of life. Data are sent daily to all the healthcare professionals involved in the project. Group A: High risk patients. The patient will be trained on the operation of the remote monitoring equipment. Daily self–measurement of parameters for 3 weeks after discharge. GROUP B: Low–medium risk patients. Weekly measurement of the parameters by the community nurse for 3 weeks after discharge. In case of signs of congestion and clinical HF decompensation patients from both groups could be treated with diuretic infusion at home or in community out–patient clinics (Case di Comunità).

Expected Results
Reducing mortality and re–hospitalization for decompensated HF, achievement of the pharmacological treatment targets recommended by the ESC guidelines, reducing renal disease progression, building a multi–professional HF support–team, testing a community telemonitoring programme based on the cloud. Preliminary data: preliminary data will be available on May 2024.
PULMONARY EMBOLISM: FROM MANAGEMENT IN THE EMERGENCY ROOM TO THE APPROPRIATENESS OF HOSPITALIZATION. INTRO-HOSPITAL SHARED MANAGEMENT ORGANIZATIONAL MODEL
Authors: Girasoli C , Picciolo A , Colonna G 
Published: May 2024

Abstract

Introduction
Pulmonary Embolism (PE) represents the final effect of the sudden obstruction of the pulmonary artery or one of its branches by an embolus and is burdened by high mortality when not promptly and adequately treated. The clinical presentation is often non-specific, which explains the diagnostic difficulty and the frequent autopsy finding of PE: 90% of fatal cases occur in patients who have not undergone treatment due to the failure to formulate the diagnostic suspicion, while less than 10% of all deaths occur in treated patients.

Materials and Methods
The established intra-hospital management path arises from the integration between clinical suspicion, first level diagnostic tests (ECG, EGA, chest x-ray, blood chemistry tests) and pre-test clinical probability (Wells, modified Geneva). In patients with Wells 0 to 4 and negative D-dimer, the diagnosis of PE can be excluded; in other cases a pulmonary CT angiography is performed. The sPESI Score with troponin measurement and echocardiogram are used in patients with diagnosis of high-risk PE for prognostic stratification and to identify the destination of hospitalization.

Results
The comparison of the epidemiological data regarding PE between 2021 and 2023 allowed us to verify how, thanks to the intra-hospital shared management process, a different distribution of hospitalizations was obtained in the Operating Units involved: hospitalizations in Cardiology are reduced by 50%; on the contrary, admissions to Internal Medicine increased by 60% in 2022, remaining stable in 2023; hospitalizations in the Pneumology Operating Unit are stable. Admissions to other departments of the hospital for patients suffering from other important prevalent co-morbidities went from 3% to 7%.

Conclusions
The clinical presentation of PE is often non-specific, which explains the diagnostic difficulty and the frequent autopsy finding of PE not diagnosed during life. We have established an internal management process ensuring the correct diagnostic classification and timely treatment, through stratification according to risk class and identifying the most appropriate hospitalization setting.
MANAGEMENT OF REMOTE MONITORING FOR IMPLANTABLE DEVICES CONTROLS: SINGLE CENTER EXPERIENCE
Authors: Bolognesi M , Rossi L , Biagi A , Bricoli S , Sticozzi C , Comastri G , Puccio F , Montedoro A , Aschieri D 
Published: May 2024

Abstract

Background
Nowadays the benefits of remote monitoring (RM)of cardiac implantable electronic devices (CIEDs) are Known: an improved both device surveillance and patient clinical management and a decrease in office follow up. So RM is used as supplement in clinic follow up for patients with CIED.However despite decades to RM utilization there are challenges in managing patients with RM including large number of trasmissions and lack of trained staff. There are many different model of care to RM management.

Methods
We describe our model of care to management CIED recipients with RM considering data collected from January 2021 to November 2023.

Results
Our model of care consists of 4 electrophysiologists Physicians and 4 Tecnicians. RM enrollment is performed at scheduled in office visit after ten days from hospital discharge after device implantation. implantable cardiac device(ICD)recipients with RM are annualy followed in office and biennal for pacemaker (PM) recipients and they send every three months transmissions. Trained tecnicians gives home monitor, take care of patients education and collected and screen transmissions. Tecnicians inform immediately physicians in case of urgent alert (shock or antitachicardia pacing therapy (ATP), sustained ventricular tachycardia(TV), ventricular fibrillation (Fv) indicator of elective replacement (ERI), lead releted alert or noise). Physician contact patients the same day (exept Saturday and Sunday). In addiction Physicians twice a week review less urgent and scheduled transmissions and call the patients by phone for visit in office for patients with low rate of biventricular pacing, detection of atrial fibrillation. We have 1000 patients with RM: 746 ICD recipients (103 Biotronik, 150 Abbott, 200 Boston scientific, 293 medtronic), 50 implantable cardiac monitor (ICM) recipients and 204 PM recipients. We analyze 12721 transmissions.Considering ICD recipient we detect 96 episode of ATP and 31 of shock. Shock of ICD was registered in 52 patients (6,9%)We received 1982 atrial fibrillation (AF) detection, with 35 for new detectable AF.The most of transmisisone were for low bIV pacing. We contacted these patients by phone about clinical status and in some case we called them in office.

Conclusions
Our model of care allows to control a large number of trasmissions with fast management of urgent alert trasmissions.
TIMES, ARE THEY A–CHANGING? IMPLANTATION AND FOLLOW–UP EXPERIENCE WITH LEADLESS PACEMAKERS (MICRA) AT PISA UNIVERSITY HOSPITAL
Authors: Barletta V , Parlato A , Tamborrino P , Parollo M , Sbragi S , Canu A , Di Cori A , Grifoni G , Segreti L , De Lucia R , Viani S , Paperini L , Soldati E , Bongiorni M , Zucchelli G 
Published: May 2024

Abstract

Background
Leadless pacing represents a pivotal advancement in cardiac stimulation. Eliminating traditional pacing leads, leadless devices offer reduced complications, a bailout strategy for many previously challenging cases and streamlined procedures.

Purpose
This retrospective study aimed to compare, starting from December 1st 2023, newer implants (within the 3 years preceding Dec 1st 2023) and older implants (&gt;3 years before) in a single–center experience with M–TPS (Micra Transcatheter Pacing System) in terms of safety and efficacy, at baseline and in a short–term follow–up (6 months).

Methods
A comprehensive analysis was conducted on 195 patients who underwent leadless pacemaker implantation at our Center, and that were followed–up for a minimum of 6 months. The cohort was stratified into two groups: recent (n=73) and less recent implants (n=122). Procedural variables, patient demographics, and clinical outcomes were documented. Post–implantation follow–up data include pacing threshold, fluoroscopy time, and other relevant variables.

Results
Comparison between the two groups revealed significant differences fluoroscopy time. Newer implants demonstrated a reduced fluoroscopy time [8 (IQR 5–12) vs 10 minutes (IQR 7–14)], suggesting potential advancements in technique. No significant differences were observed in other procedural or electrical parameters. Discussion: The comparison between older and newer leadless pacemaker implants reveals reassuring constancy in most parameters, suggesting the reliability of the M–TPS. The reduced fluoroscopy time aligns with the evolving proficiency of implanters and improved procedural efficiency. The dependable consistency observed across various parameters strengthens the confidence in the M–TPS, reinforcing its status as a reliable and effective solution for pacing.

Conclusion
The implantation and follow–up experience at our center elucidates very few differences between newer and older implants. This nuanced analysis contributes to the ongoing evolution of leadless pacemaker technology, which heralds a transformative era in cardiac care. With several years of implementation, accumulated follow–up data unveils valuable insights into its sustained effectiveness, guiding clinicians in optimizing patient outcomes and solidifying leadless pacing as a breakthrough in the realm of cardiac rhythm management.
SAFETY AND EFFICACY OF A SINGLE PROCEDURE OF EXTRACTION AND REIMPLANTATION OF INFECTED CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE (CIED) IN COMPARISON WITH DEFERRAL TIMING: AN OBSERVATIONAL RETROSPECTIVE MULTICENTRIC STUDY
Authors: Sordelli C , Tascini C , Fele N , Weisz S , Guarino A , Verde R , De Vivo S , Corrado S , Severino S 
Published: May 2024

Abstract

Background
Infections are among the most frequent and life–threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single–procedure device extraction and contralateral implantation versus the standard–of–care (SoC) two–stage replacement for infected CIEDs.

Methods
We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure.

Results
Considering those lost to follow–up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single–procedure group and 84.6% in the SoC group (p = 0.075).

Conclusions
Single–procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED–dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single–procedure reimplantation.
HYBRID TRANSVENOUS AND SURGICAL APPROACH FOR THE EXTRACTION OF CORONARY SINUS LEADS: A CASE SERIES
Authors: Arabia G , Cerini M , Calvi E , Bellicini M , Falco R , Curnis A 
Published: May 2024

Abstract
Transvenous lead extraction (TLE) is the standard therapy for cardiac device–related infection, however sometimes the procedure cannot be completed through the transvenous route alone and it is necessary to rely on other techniques. Hybrid surgical and transvenous approach can be useful in these cases. We present 3 cases of hybrid surgical and transvenous approach. A 64–year–old male patient with a cardiac resynchronization therapy defibrillator (CRT–D) implanted in 2011, with an active–fixation coronary sinus (CS) lead. In order to perform the extraction, a locking stylet was inserted in the CS lead, then a mechanical sheath was advanced over the lead itself, however failing in detaching the lead from the surrounding adhesions. The lead was then extracted by left mini–thoracotomy. A 60–year–old male was implanted with a CRT–D in 2012. After the transvenous extraction of atrial and ventricular leads, we attempted to extract the coronary sinus lead, positioned in the anterolateral vein, using a locking stylet, telescoping mechanical sheaths, a 9 Fr hand–powered rotational sheath, and a 16–Fr excimer laser sheath. The lead was extensively fibrosed and could only be retrieved to the proximal part of the vein, approximately 2 cm from the body of the coronary sinus. Considering the high operative risk, a sternotomy was performed with complete extraction of the CS lead. A 74–year–old male was implanted with a CRT–D in 2012, with a bipolar CS lead positioned in the posterolateral vein. During CS lead extraction we firstly used a locking stylet, followed by the introduction of telescopic mechanical sheaths which ceased to advance at 3 cm from the tip of the lead due to strong fibrosis. The procedure was interrupted due to the risk of coronary sinus tear and a left minithoracotomy was performed, effective in the removal of the lead. Sometimes the TLE procedure cannot be completed through the transvenous route alone and there is a need for an hybrid approach with the aid of a cardiothoracic surgeon. Hybrid surgical and transvenous approach can be useful in these cases.
LDL TARGET IN PATIENTS WITH HIV AT HIGH CARDIOVASCULAR RISK: THE ROLE OF BEMPEDOIC ACID
Authors: Gatto M , Moschella Orsini F , Passarelli I , Antinori A 
Published: May 2024

Abstract

Background
Previous observational studies have shown that 70% of HIV–infected patients have clinical conditions that classify them at high or very high cardiovascular risk. Among these patients, only 12% succeed in achieving a target LDL &lt; 55 mg/dl in accordance with the latest ESC guidelines.

Aim
To evaluate the impact of bempedoic acid therapy in achieving the LDL target for HIV–infected patients.

Methods
From April 2023 to September 2023, all HIV–infected patients referred to our dedicated cardiology outpatient clinic were consecutively screened. Inclusion criteria were: acquisition of informed consent, high cardiovascular risk (defined in accordance with the latest ESC guidelines), need to optimize anti–dyslipidemic therapy to achieve LDL target &lt; 55mg/dl. Planned follow–ups were at 3 and 6 months. Clinical and laboratory data were collected in spreadsheets and analyzed with GraphPad Prism 8.

Results
Thirty–two patients were enrolled, 94% male with a mean age 61±4 years. At baseline the laboratory’s data (mean ± SD) were: total cholesterol 202±50 mg/dl, LDL 130±40 mg/dl, HDL 56±15 mg/dl, triglyceride 105±24 mg/dl. The 75% of patients was on statin+ezetimibe, but only 37% of them were taking high–intensity statins. No patients reached the target of LDL &lt; 55 mg/dl and, therefore, all patients were prescribed bempedoic acid 180 mg/day. At three months of follow–up, all patients were compliant with bempedoic acid therapy, and none reported any side effects; the laboratory monitoring of the lipid profile showed a mean LDL 80±35 mg/dl, –39% from baseline and a mean total cholesterol of 156±44 mg/dl, –26% from baseline. The 12% of patients reached LDL target &lt; 55 mg/dl with a reduction &gt;50% from baseline.

Conclusion
The use of bempedoic acid, in addition to statin+ezetimibe therapy, or ezetimibe alone in statin–intolerant patients, reduces baseline LDL by 39% and achieves the guideline–recommended LDL target in 12% of cases with an excellent safety and tolerability profile in HIV–infected patients.
EARLY MOBILIZATION POST ACS: IMPACT OF QUALITY IMPROVMENT NURSING PROJECT
Authors: Barp L , Pacucci N , Melillo F , Gallizioli E , Lanno V , Massi S , Berardinelli E , Patrignani S , Contino V , Ottaviani V , Pagnini N , Tarsi G , Cantarini L , Battistini A , Frassini S , Rasori S 
Published: May 2024

Abstract

Background
Acute Coronary Syndrome (ACS) accounts for about seven million deaths every year. Early mobilization is needed to optimize health status in ACS patients as recommended by current European Society of Cardiology (ESC) Guidelines and American Heart Association (AHA) guidelines.

Aims
Evaluate the impact of a quality improvement nursing project on early mobilization after ACS, analyzing data before and after the implementation of an evidence–based company protocol.

Materials and Methods
From 04/01/2023 to 30 /07/2023 the first data collection phase (baseline) took place detecting mobilization times and complications in patients according to the habits of the care setting in the ICCU. A protocol was then created and implemented. The second data collection phase (post implementation) began on 01/09/2023 and will end on 31/12/2023 with the same data collection method. Data were collected consecutively in patients admitted to the ICCU of the AST Pesaro/Urbino (S.Salvatore Pesaro establishment) because of uncomplicated ACS, patients were self–sufficient at home, without cognitive disorders and comorbidities limiting mobilization, absence of femoral introducer. Data collection form was created containing: personal data, medical diagnosis, patient characteristics, complications during mobilization, Troponin I value.

Results
50 patients were enrolled at baseline and post–implementation data collection is still underway. From an initial analysis of the data, an average reduction in the length of stay of 6.19%, equal to 0.43 days, was recorded. Patients in the experimental group developed a lower complication rate than the control group (9% vs 4.52%) with a reduction in the complication rate of 4.48%.

Conclusions
The implementation of the protocol allows a standardization of assistance in the mobilization of patients, also guaranteeing psycho–physical benefits. The first results highlight a reduction in hospitalization times and complications related to mobilization. Further data will be analyzed at the end of data collection on 12/31/2023. Limitations: low sample size and unfavorable environment (absence of telemetry and nearby toilets).
THE TALK TEST AS A VALUABLE REHABILITATION TOOL IN PATIENTS WITH HEART FAILURE
Authors: Scalabrino N , Crespi L , Lazzarini E , Colombo F , Guzon S , Saporiti L , Picozzi A 
Published: May 2024

Abstract

Aim
To determine whether a rehabilitation program for heart failure patients in interval training, established by Talk Test, is more effective than the protocol in endurance training set by 6MWT.

Materials and Methods
For this retrospective study, 32 subjects with reduced left ventricular ejection fraction (LVF) &lt;40%, enrolled at the outpatient decompensation clinic of Multimedica Castellanza, age 40–75 years, without neurological, oncological and orthopedic comorbidities were evaluated. Half of the patients worked in endurance training on the basis of the 6MWT. Observed patients who performed endurance training were placed in the control group (GC) while half of the patients who worked in interval training were placed in the study group (GS). All patients were evaluated before the start of ambulatory training (T0) and were assessed by: 6MWT, SPPB, Gait Speed and Sit to Stand. GS subjects underwent Talk Test and worked in interval training. After 3 weeks (T1), at the end of the physical training program, all patients were reassessed with the same tests performed at T0. After 3 months after the end of the outpatient rehabilitation cycle (T2), all patients were evaluated by cycle ergometer stress test.

Results
A nonparametric statistical analysis was used; the two groups were homogeneous with each other at T0. The data obtained showed a statistically significant improvement in functional ability for both groups. The GS obtained better functional results than the GC, especially in 6MWT, Gait Speed and Sit to Stand. At T2, by exercise test, the GS subjects obtained better results than the GC, moreover, there was a statistically significant difference in maximum load in watts at stress test (p&lt;0.04). All patients on echocardiography performed at follow–up (T2) showed a significant increase in ejection fraction. Recovery of left ventricular contractile function in the GS appears to be more significant.

Conclusions
Both workouts can be considered valuable in the treatment of patients with heart failure but interval training was found to be the better choice and the one that could maintain the results obtained longer over time. The Talk Test proved to be a valuable tool to set higher loads in the absence of cardiopulmonary testing.