bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE REBUS OF POCKET INFECTIONS
Authors: Ferrieri A , Dentico A , Pastore I , Benedetto L , Carretta D , D‘Agostino C 
Published: May 2024

Abstract

Introduction
The guidelines define pocket infection as an infection limited exclusively to the generator pocket. This is clinically associated with local signs of inflammation. However, the infection often also involves the electrocatheters which constitute a gateway to the infection at a cardiac and systemic level. Does the pocket infection constitute a big rebus for the type of approach to adopt, conservative or aggressive? Our study aims to identify significant predictive criteria to develop a score that identifies the patients most at risk of endocarditis and sepsis.

Methodology
66 patients who underwent extraction for pocket infection were enrolled. Before extraction, all patients underwent instrumental and laboratory investigations to look for vegetations or culture positivity.

Results
Of the 66 patients, 61 presented vegetations and/or positivity on culture examination of the catheters. The statistical analysis made it possible to assign a score to each sign and/or symptom with the creation of a score with a maximum cut-off of 5. The 61 positive patients had a score greater than/equal to 5. The score structured in this way demonstrated a predictability of 92.4%, resulting positive in 61 out of 66 patients.

Conclusions
In patients with pocket infection, the identification of a highly predictive score of endocarditis or sepsis on leads allows the clinician to easily identify the patients at highest risk to be quickly sent to third level centers for the most suitable treatment of the clinical situation without having to carry out particular tests, often difficult to perform (PET/CT), and allows the electrophysiologist, who will have to carry out the extraction procedure, to have a precise indication in class I. The study we have initiated is a preliminary study which has the limit on the number of patients enrolled. We intend to increase the number of patients thanks to collaboration with other centers that carry out extractions. However, this study, based on the data obtained so far, could be a guide to the management of patients with pocket infection who often create awkward decisions about the therapy to be adopted also due to the lack of clarity of the guidelines.
DILATED CARDIOMYOPATHY AND THERAPEUTIC FOLLOW–UP: EXPERIENCE OF A DEDICATED HEART FAILURE CLINIC
Authors: Dominici T , Percoco F , Schiavoni M , Dato I , Tung M , Pontiroli C , Verbena S , Evangelista F , Ciccaglioni L , Barbato A , Kol A 
Published: May 2024

Abstract
Dilated Cardiomyopathy (DCM)is associated with an increased risk of developing ventricular arrhythmias and sudden cardiac death (SCD), although to a lesser extent than ischemic heart disease (IHD).It is now well established that defibrillator implantation (ICD) reduces mortality in patients with reduced systolic function after a myocardial infarction, conversely, this effect is less evident in patients with DCM. The aim of this work is to report the experience of a dedicated outpatient clinic for heart failure patients and to underline the importance of a multiparametric assessment for a patient who is a candidate for ICD implantation. From December 2019 to December 2023, 38 patients (34 males and 4 females) (mean age 62.6 years) were referred to our hospital with a diagnosis of hypokinetic dilated heart disease of first detection, in 4 cases due to declared alcohol and/or substance abuse.Three patients had already undergone defibrillator implantation in primary prevention but did not have on board the 4 classes of drugs recommended by the latest guidelines, so they were subjected to the maximum tolerated dose and re–evaluated remotely with clinical improvement and echocardiographic values. The other 35 patients, whose disease began with de novo reduced ejection fraction heart failure (HFrEF), admitted to our ICU, all underwent coronary angiography with finding of a coronary tree free of critical alterations; 28 had performed a magnetic resonance imaging (MRI) that showed no edema, necrosis and/or fibrosis; only in two patients have been documented fibrosis with a low percentage of distribution, which does not account for low EF values. Of the other 7 patients, 4 did not undergo MRI 2 for claustrophobia and 3 for atrial fibrillation. Maximal drug therapy with the 4 pillars recommended by the guidelines was set up for all patients;the introduction of glyphozines in diabetic patients has been shared with diabetologist. All patients underwent echocardiographic check–ups at 3–6 months and one year, which over time documented a recovery associated with improvement in symptoms and quality of life. All patients also underwent ECG according to Holter for arrhythmic risk stratification: none of them required ICD implantation procedures. This preliminary analysis shows that a correct application of the guidelines allows to improve the prognosis of patients with dilated cardiomyopathy; of course, further larger studies are needed to substantiate these findings.
INCIDENCE AND DETERMINANTS OF SUB–OPTIMAL DRUG TREATMENT IN CHRONIC HEART FAILURE: A SINGLE CENTER PILOT SURVEY
Authors: Arcari L , Belmonte E , Manzo D , Camastra G , Cacciotti L 
Published: May 2024

Abstract

Background
The latest European Society of Cardiology guidelines on heart failure (HF) recommend a pharmacological treatment including 4 drugs (ARNI or ACE–inhibitor, beta–blocker, SGLT–2 inhibitor and MRA), with a class I indication in patients with HFrEF. However, the implementation of the 4 pillars approach is still largely insufficient in clinical practice. The aim of the present study was to investigate incidence and determinants of sub–optimal HF drug–treatment.

Methods
We conducted a 2–months survey in the heart failure outpatient clinic at our first–level community hospital. Physicians were asked to record the drug treatment patients were actually taking, and in the absence of one of the four pillars drug, to specify the underlying reason.

Results
100 patients were enrolled, mean age 72±10 years old, 32 females. There were 36 HFpEF and 64 HFrEF patients. Quadruple therapy was present in 67 (HFpEF 58%, HFrEF 72%). Prescription rates of the four pillars drugs were: ARNI/ACE–inhibitor 96% (HFpEF 92%, HFrEF 98%; p=0.097), beta–blockers 98% (HFpEF 97%, HFrEF 98%; p&gt;0.99), SGLT–2 inhibitor 81% (HFpEF 72%, HFrEF 86%; p=0.093), MRA 82% (HFpEF 78%, HFrEF 84%; p=0.410). No significant associations between age and sex with pharmacological treatments were noted (all p&gt;0.05). Considering left ventricular ejection fraction (LVEF) as a continuous variable, patients under ARNI and SGLT–2 inhibitor treatments had lower values (43±10% vs 36±9%, p=0.001 and 43±9% vs 38±10%, p=0.034 respectively). Main reasons absent treatment were presence of chronic kidney disease with or without hyperkalemia (ARNI: 7%; ACE–inhibitor: 1%; BB: 0%; SGLT–2 inhibitor: 3%; MRA: 8%) and LVEF value (ARNI: 7%; Ace–inhibitor: 0%; BB: 0%; SGLT–2 inhibitor: 3%; MRA: 2%). Beta–blocker was not prescribed in 2% of the patients due to bradycardia. Hypotension leading to treatment discontinuation was more common in the ARNI group (ARNI: 8%; ACE–inhibitor: 1%; others: 0%).

Conclusions
In our sample, more than two thirds of HF patients were prescribed the quadruple heart failure pharmacological treatment. Save for hypotension in the ARNI treated patients, a high drug tolerability was observed. Physician–guided lack of prescription was influenced by the presence of chronic kidney disease and absent drug reimbursement due to LVEF cut–off as per AIFA criteria at the time of prescription. Results of this survey highlights potential areas to improve adherence to guidelines–directed medical treatments.
EARLY USE OF SGLT–2 INHIBITORS FOLLOWING ACUTE DECOMPENSATED HEART FAILURE PATIENTS WITHOUT REDUCED EJECTION FRACTION: PRELIMINARY DATA FROM A SINGLE CENTRE
Authors: Alonzo A , Matteucci A , Castello L , Marino G , Spinelli A , Di Fusco S A , Colivicchi F 
Published: May 2024

Abstract

Introduction
Following the 2023 ESC Guidelines update for heart failure, SGLT2 inhibitors (dapagliflozin, empagliflozin) are strongly recommended for cardiovascular outcomes both in patients with heart failure with preserved ejection fraction (HFpEF) and with mildly reduced ejection fraction (HFmrEF). The EMPULSE study supports empagliflozin initiation in acute heart failure, regardless of ejection fraction, demonstrating tolerance and significant clinical benefits. Our study aims to establish the feasibility of early use of SGLT-2 inhibitors in acute decompensated heart failure (ADHF) without HFrEF, exploring prescription rates and reasons for underutilization.

Methods
We retrospectively collected data from 33 consecutive patients admitted from the Emergency Room to our Department with a diagnosis of HFpEF and HFmrEF from August to October 2023. We compared data of systolic arterial pressure, creatinine, glomerular filtration rate (GFR), kaliemia, and hemoglobin values at admission with those at discharge.

Results
Patients had a mean age of 80.7±6, and 55% were male. The mean ejection fraction was 50.8% ± 7.5. The mean BMI was 28.4±5 and 39% of the patients had diabetes. The mean hospital stay was 4.3 ± 2.6 days. The utilization of SGLT2 inhibitors at admission was 18% up to 64% at discharge (p &lt;0.001). Both hemoglobin values and systolic arterial pressure significantly decreased during hospitalization, from 13.1±1.6 g/dl to 12.7±1.8 g/dl (p=0.030) and from 129±15 mmHg to 118±14 mmHg (p=0.003), respectively. Creatinine levels moved from 1.32±0.44 to 1.39±0.44 (p=0.006), while GFR reduced from 51±19 ml/min to 46±15 ml/min (p = 0.012), significantly. Kaliemia remained stable from 4.04±0.47 mEq/l to 4±0.42 mEq/l (p = 0.73). Among patients who didn’t receive SGLT2 inhibitors, only two patients (9%) had an absolute contraindication represented by a GFR &lt; 25 ml/min.

Discussion
Our data confirm that the prescription rate of SGLT2 inhibitors in patients with HFpEF and HFmrEF is still low. Approximately 26% of patients lacked clear clinical reasons for not receiving the treatment. Despite mild reductions in hemoglobin, systolic arterial pressure, and GFR, consistent with the class profile, SGLT2 inhibitors demonstrate safety and tolerability without significant impact on key clinical and laboratory parameters. This underutilization is likely linked to therapeutic inertia, necessitating concerted efforts to bridge this gap.
DIFFERENT FATES AND ROUTES OF CHRONIC HEART FAILURE, AN ARTIFICIAL INTELLIGENT BASED ANALYSIS OF THE MECKI SCORE DATASET
Authors: Chiesa M , Salvioni E , Emdin M , Piepoli M , Sinagra G , Sanni M , Mapelli M , Limongelli G , Parati G , Agostoni P 
Published: May 2024

Abstract

Background
Individual prognostic assessment and disease evolution pathways in chronic heart failure (HF) are unmet needs. The application of unsupervised learning methodologies could help at: a) identification of HF patient phenotypes; b) identification of the evolution states and progression in each phenotype and c) assessment of risk of adverse event.

Methods
We retrospectively analyzed the MECKI registry including 7948 HF patients. After preliminary preprocessing, we selected 4876 patients with a minimum 2–year follow–up. We implemented a Topological Data Analysis (TDA), based on 43 variables derived from clinical, biochemical, cardiac ultrasound and exercise evaluations, to identify several patients’ clusters. Thereafter, we used the trajectory analysis to describe the evolution of HF states, which is able to identify bifurcation points, characterized by different follow–up paths, as well as stopping points, i.e. specific end–stages conditions of the disease. Finally, we conducted a survival analysis to generate 5–year time–to–event curves using as study endpoint the composite of cardiovascular death, LVAD or urgent heart transplant. Findings were validated on internal (n=527) and external (n=777) populations.

Results
Nineteen patient clusters were identified by TDA. Trajectory analysis revealed a path characterized by 3 bifurcation points with 2 different follow–up path each and 4 stopping points. Clusters survival rate varied from 44% to 100% at 2 years and from 20% to 100% at 5 years, respectively. Finally, we compared the event frequency at a 5–year follow–up for each study cohort cluster with those in the validation cohorts (R = 0.94 and R = 0.84, p &lt; 0.001, for internal and external cohort, respectively).

Conclusions
Each HF phenotype has a specific disease progression and prognosis. The bifurcation points need attention since are followed by different disease routes as the 4 different disease end–stages which are characterized by different prognosis. These findings allow to individualize HF patient evolutions and to tailor assessment.
QUALITY OF CARE FOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: RESULTS OF THE FIRST 3 MONTHS OF THE QUALITY IN CARDIOLOGY (QIC) PROJECT
Authors: Chiappa L , Avanzini F , Conti A , Anguilano M , Bova C , Centola M , Colombo G , Di Giulio P , Iacuitti G , Mollichelli N , Moro C , Paone M , Rigamonti A , Rogacka R , Saltafossi D , Santambrogio M , Spina M , Vinci F , Achilli F 
Published: May 2024

Abstract

Background
Assessing the quality of care is the first step for improve the management of patients with acute myocardial infarction (AMI). The European Society of Cardiology (ESC) and the Acute Cardiovascular Care Association (ACCA) recently defined a set of quality indicators (QI) of care for AMI.

Aim
To evaluate the quality of care of patients admitted to the Cardiology ward of our first level hospital for an AMI using the ESC ACCA QI.

Methods
QiC project is a prospective quality improvement study in real–world practice on all patients admitted to our ward for an AMI from 1.5.2023 to 30.4.25 with six–monthly audit activities. Case record forms were filled in by doctors during admission and were attached to the patient’s discharge letter. Thirty–day mortality was assessed by telephone interviews. The ESC ACCA QI include 18 main and 8 secondary QI on centre organization, reperfusion and invasive strategy, risk assessment, antithrombotic treatment, secondary prevention discharge treatments, and patient experience. For each IQ was evaluated the percentage of QI assessable and attained.

Results
A total of 78 patients were admitted for AMI in our Cardiology Department in the first 3 months. No one patient denied consent, one died during hospitalization, 7 patients had to be transferred to another hospital, and 3 patients did not have their record form filled in. The median age of the 67 patients discharged alive was 66 (IQR 58–75) years, 45 (67.2%) were males, 35 (52.2%) had a ST–segment elevation myocardial infarction (STEMI) and 32 (47.8%) a non–ST–segment myocardial infarction (NSTEMI). The percentages of non–assessment, non–attainment and attainment for each QI are reported in the Figure: the degree of non–assessment of the 26 QI ranged from 0 to 22% and the degree of QI attainment from 25 to 100%.

Conclusions
Quality of care for acute myocardial infarction can be measured in the majority of patients admitted to our Cardiology Department using the ESC ACCA quality indicators. Although most quality indicators are met in our patients, a large room for improvement is present in the reperfusion and invasive strategy (mainly in timely reperfusion of STEMI patients) and in the patient’s satisfaction (discharge letter sent to patient).
IMPLEMENTATION OF TELEMEDICINE IN ASST BERGAMO EST: RESULTS ACHIEVED
Authors: Rocca P , Bighi M 
Published: May 2024

Abstract
The Healthcare Trust Bergamo Est (ASST–bergamo Est) started a telemedicine project in 2020, setting up a Telemedicine Team and a managment model called “TEELEMEBII strategy” (see dedicated abstract). Three years after their establishment, the four minimum Telemedicine services required by the legislation, are active: Televisit, Teleconsultation, Home monitoring, Teleassistance (Figure 1). Televisit has been active in the company in six Units: Rehabilitative Cardiology, Diabetology, Home Artificial Nutrition, Gynaecology, Addiction Service and Pain Therapy. Teleconsultation was developed in two healthcare contexts: Teleconsultation among General Practitioners and Specialists: the GPs can ask for a teleconsultation with the hospital physicians of ten specialties. Multidisciplinary teleconsultation for the discussion of complex clinical cases. The diagnostic–therapeutic process of patients with head–neck cancer is discussed in teleconsultation with the synchronous participation of Otolaryngologist, Oncologist and Radiation Oncologist and, if necessary, Radiologist, Anatomopathologist, Speech therapist, Nutritionist. Other multidisciplinary teams are activating this service. Telemonitoring allows transmission of clinical parameters through wearable sensors. The service, primarily provided by nursing staff, is active in Rehabilitative Cardiology for patient with chronic heart failure and in Electrophysiology Clinic for patients with implantable devices (PM, ICD, wearable defibrillator). A feasibility project is being activated in Gazzaniga Community House where nursing staff can remotely monitor vital parameters of fragile patients. Teleassistance provided by a nurse is based on the remote interaction between the professional and the patient. Nursing teleassistance is active, associated with telemonitoring, for patients with chronic heart failure, diabetes mellitus and fragile patients. Data express the positive impact of the implementation of the management model (Figure 2): Medical specialties involved in company telemedicine processes went from 7 in 2022 to 18 in the first half of 2023, with an increase of 157%; The number of operators with access to the company‘s telemedicine platform increased from 33 in 2022 to 107 in the first half of 2023, an increase of 224%; Televisits provided since the beginning of 2022 are approximately 800; in the first half of 2023 there were 293, 38.2% more than in the same period of the previous year.
ACUTE MYOCARDIAL INFARCTION WITH “ST” SEGMENT ELEVATION IN SOUTHERN MARCHE: INTRA AND POST–HOSPITAL PROCESS INDICATORS IN THE APPLICATION OF THE UNIFIED PDTA “RETE STEMI” AST OF ASCOLI PICENO AND FERMO. LONGITUDINAL OBSERVATIONAL CLINICAL STUDY
Authors: Parato V , Fratini T , Traini T , Lattanzio F , Principi T , Viviani G , Grossi P , Marcelli S 
Published: May 2024

Abstract

Background
SCAs (Acute Coronary Syndromes) are one of the most frequent cardiovascular diseases, among which STEMI is certainly the most relevant in terms of short and long–term prognosis. The latest ESC Guidelines about ACS–STEMI indicate some key elements in terms of diagnosis and treatment, from first contact to cardiological rehabilitation.

Objective
Detect the number of SCA–STEMIs managed in the AST of Ascoli Piceno, along with intra and post–hospital process indicators provided in the PDTA of the “RETE STEMI” issued by the Marche Region specifically in AST of Ascoli Piceno. MATERIALS & METHODS An observational, longitudinal, monocentric, not–for–profit clinical study without diagnostic–therapeutic interventions was designed. The data collection started on 01/11/2022 and ended on 30/06/2023, at “Madonna del Soccorso” Hospital of San Benedetto del Tronto and “Mazzoni” Hospital of Ascoli Piceno in Cardiological Intensive Care Units (UTIC). Useful data for this study were acquired every month, consulting the folders of each patient diagnosed with “SCA–STEMI”, and then, reported in an Excel sheet, they were processed with different mathematical and statistical functions, including frequency, percentage, arithmetic average and standard deviation, and later used to design tables and graphs. All the data have been aggregated in full compliance with current legislation on the protection of patient privacy.

Results
The most significant results are related to the time between the first medical contact and the’ starting of the PPCI procedure, with an average time detected of 110 minutes. Another very important result is the number of patients sent to a post–acute cardiological rehabilitation program (PCRP): from the present study it appears that only the 1% of the entire sample was sent to a PCRP. Finally, other indicators considered in relation to the PDTA appear to be in line with the current Guidelines.

Conclusions
The present study highlights the aspects of the STEMI PDTA of the Marche Region which could be improved, namely reducing FCM–Wire crossing time and sending patients to a cardiological rehabilitation program, also by implementing the figure of the nurse specialized in the critical and cardiological area.
ENDOCARDITIS TEAM? DESIGNING AN ORIGINAL AND TAILORED CLINICAL PATHWAY
Authors: Pavone N , Cammertoni F , Bruno P , Calabrese M , Lombardo A , D‘Acierno E , Conserva A , De Belvis A , Scoppettuolo G , Massetti M 
Published: May 2024

Abstract
Infective endocarditis (IE) remains a poorly understood disease that primarily affects either native or prosthetic heart valves. Its incidence has increased over the past two decades, now affecting 3 to 10 individuals per 100.000/year in the general population. Despite advances in early diagnosis and surgical intervention, IE continues to pose a significant challenge, often leading to severe complications and carrying a substantial burden of morbidity and mortality. Data from the EURO–Endo registry show a drastic change in IE and provide an accurate picture of IE disease today. In European countries, it tends to affect older patients with a remarkable 12% of cases occurring in those aged ≥ 80 years. The traditional care pathway is often fragmented into multiple and potentially dangerous steps, resulting in delayed diagnosis and treatment. Such a “patchy” approach may cause suboptimal patient management, especially in the subset of frail patients with important concomitant diseases and high surgical risk. Clinical pathways (CPs) are an evidence–based multidisciplinary care plans involving diagnosis, treatment and rehabilitation phases, through which to follow patients from hospital admission to discharge, in order to manage a specific health condition, aiming to optimize patient and hospital/team outcomes, while contributing to a better organized care processes. In 2018, a working group composed by healthcare managers, infectious disease specialists, cardiac surgeons, cardiologists, anesthesiologists, geriatricians and other professionals involved in the care of IE patients have engineered a dedicated CP for IE at our institution. The CP introduced significant changes in the management of patients with IE. As a result, the quality of care and services offered increased, a faster and more appropriate diagnosis and treatment were achieved, patient outcomes and safety improved and a better coordination and continuity of care between different settings was guaranteed. The growing burden of IE in western countries demands an evidence–based multidisciplinary care plan. The creation of a territorial network ensures continuity and appropriateness of care in conjunction with the referring physicians/hospital and rationalization of resources. Although some controversies still exist, we believe that CP will have a positive impact on quality in health care.