bluuebunny/crossref_metadata_2025_split huggingface dataset:
P347 NURSING SENSITIVE OUTCOME (NSO) IN CARDIOVASCULAR CARE: NEW PERSPECTIVES TO IMPROVE QUALITY OF CARE AND PERSONALIZED ASSISTANCE
Authors: Boccini V , Giannini A , Martinelli C , Banti S , Baratta S 
Published: May 2022

Abstract

Over the years, attention of literature on the relation between the caring process and the patient’s outcomes has increased. In healthcare Organization, collection and recording of data about Nursing Sensitive Outcomes (NSO) allow a reflection on the impact of some nursing interventions in the clinical practice. The goals is to improve the quality and safety of nursing care and of continuing nursing training too. The cardiac and / or cardiac surgery patient is complex. For this reason, Nurse has a central role in the Healthcare Team to ensure prevention, assessment and treatment along the clinical pathway.

Objective
Mapping a set of NSOs, through shared clinical indicators. These specific indicators refer to several macro–areas: multidimensional assessment, pain management, wound care, vascular access management and assessment, drug therapies management. The indicators are measured in all of setting involved in cardiac patient care. METHODS Monocentric, observational, retrospective study. The data are extracted from the Computerized Nursing Record on the total hospitalizations in the 2020 and 2021 and will be analyzed. RESULTS Some data about the total accesses to the ward, in 2020: Barthel scale evaluated within 6 hours of admission in 90% of cases, Braden in 91% and Retos in 92%. Specifically, in patients &gt; = 65 years of age, Retos filled in 90% of cases. Mews score evaluated at least once in 24h in 95% of cases and if mews score &gt; = 3 vital signs are revalued in 93% of patients. STU correctly completed by physicians in 95.2% of patients.

Conclusions
The preliminary results of this study are strategic in order to initiate a monitoring phase about the nursing process, organizational models and skills over time. It allows a reflection on the quality and safety of care and to enhance nursing skills. However, in the future, we will hope to carry out a survey aimed at nurses, to explore, with an intra–professional perspective, which outcomes are the most perceived as sensitive to nursing care in the cardiovascular field and to better describe the competences related to NSOs. The association between the results of the questionnaire and the indicators monitoring, will strategic in order to build future specific nursing training.
P357 THE MANAGEMENT OF CHOLESTEROL LEVEL CONTROL WITH LIPID–LOWERING DRUGS IN ITALIAN CLINICAL PRACTICE: FINDINGS FROM THE STREAM (SUPPORTING WITH THE REAL–WORLD EVIDENCE THE ASSESSMENT OF MEDICINES AND HEALTH TECHNOLOGIES) STUDY
Authors: Degli Esposti L , Borghi C , Galvani M , Giacomini E , Manotti P , Marra A , Passaro A , Perrone V , Pieraccini F , Sangiorgi D , Navazio A 
Published: May 2022

Abstract
The study aimed to evaluate the proportion of patients not reaching their low–density lipoprotein (LDL)–cholesterol target according to their risk profile in real–world settings of Italian clinical practice.
This observational analysis was based on administrative and laboratory databases from a pool of Italian Entities covering around 10% of Italian population. All patients included had at least one laboratory LDL test between 2012 and 2019. Presence of lipid–lowering drugs was analyzed in the 6 months before index date (last LDL test detected), during which time adherence to these therapies was measured as proportion of days covered (PDC). Risk profile was assessed based on ESC guidelines.1 Among patients with LDL tests that received lipid–lowering drugs, 49.7% were deemed as very high–risk (VHR), 38.3% at high risk (HR), 12% with other risks (OR). Overall, 80% of patients did not reach their LDL–cholesterol target: 87.2% in the HR–cohort, 82.9% in the VHR–cohort (LDL level target 70 mg/dl and 55 mg/dl, respectively) and 49.6% in OR–cohort (LDL level target 116 mg/dl). Statin and ezetimibe combination was observed only in 6.5% of HR and OR and 10.3% of VHR patients, while patients were mainly in monotherapy with statins (87.5 VHR, 91.2% HR, 90.6% OR). Furthermore, patients adherent to treatment (PDC≥80%) accounted for the 52% of VHR–cohort, 47.2% of HR–cohort and 39.1% of OR–cohort. Our findings highlight the need to optimize the management of cholesterol control, especially among patients at risk. Despite the high proportion of patients not reaching LDL target, sub–optimal levels of adherence and a low use of combination regimens were observed, thus suggesting LDL–control could be supported by increasing adherence and/or the use of combination therapies and, if the target is not yet achieved, by the utilization of more recent therapies.
European Heart Journal (2020) 41, 111–188
P364 IMPORTANCE OF URIC ACID THRESHOLD IN ITS CORRELATION WITH METABOLIC SYNDROME
Authors: Maloberti A , Garofani I , Fumagalli S , Ciampi C , Ossola P , Carbonaro M , Monticelli M , Tavecchia G , Bombelli M , Giannattasio C 
Published: May 2022

Abstract

Background
The relationship between Hyperuricemia and Cardiovascular risk has been established but whether or not a correlation between Serum Uric Acid (SUA) and Metabolic Syndrome (MS) exists is still a matter of debate. Indeed whether SUA level is part of MS diagnosis or just a pure marker of an unfavourable metabolic profile has not been demonstrated. Besides it’s unknown whether SUA’s addition to MS definition makes a difference in terms of prognosis. In our study we focused on evaluating in a group of hypertensive patients, the correlation between MS diagnosis and SUA defined with two different cut–off: 1) ≥6 mg/dL for women and ≥7 for men (classic cut–off); 2) &gt;5.6 mg/dL for both sexes (recently proposed by the URRAH Project).

Methods
We enrolled 473 Hypertensive patients followed by the Hypertension Unit of San Gerardo Hospital (Monza, Italy), in which SUA was measured. Patients with Hyperuricemia were identified according to the two different thresholds. NCEP–ATP–III criteria were used for diagnosis of MS.

Results
MS was diagnosed in 33.6% while Hyperuricemia was found in 14.8% of subjects according to the traditional cut–off and 35.9% according to URRAH study’s cut–off. Hyperuricemia and MS coexist in 9.7% (traditional cut–off) and 17.3% (URRAH’s threshold) of the population. Hyperuricemia was more frequent in MS than in non–MS subjects (29 vs 7.6%, p–value&lt;0.0001 for cut–off 6/7 mg/dL and 51.6 vs 28.0%, p–value&lt;0.0001 for cut–off 5.6 mg/dL). Linear regression models showed that SUA is related to MS diagnosis (β = 1.597, p–value&lt;0.0001). At logistic analysis Hyperuricemia was strongly related to MS when defined by the HURRAH‘s cut–off (OR = 0.303, p–value&lt;0.0001). The same relation is weak, although significan, when Hyperuricemia was defined by the classic cut–off (OR = 0.182, p–value&lt;0.0001).

Conclusions
Hyperuricemia is related with MS diagnosis especially when defined by the recently defined cut–off of 5.6 mg/dL.
P380 THE REEL‘S SYNDROME : A RARE COMPLICATION AFTER PACEMAKER IMPLANTATION
Authors: Fais L , Floris R , Orrù F , Sirigu F , Marini R , Melis P , Mancosu M , Racis M , Delogu G 
Published: May 2022

Abstract
We report the case of a 83–year–old male who underwent single chamber pacemaker implantation in another center for bradyarrhythmia (atrial fibrillation) symptomatic for syncope. A ventricular lead was implanted in the apical septum, the post–procedural posterior–anterior chest radiograph showed correct placement of the leads and generator. Approximately 4 months after the implant, the patient came to our observation for repeated electric pulsations in his left shoulder. The patient was affected by mild dementia and was asymptomatic except for the presenting symptomatology, in particular he denied a history of syncope. The ECG showed arrhythmia due to atrial fibrillation, ventricular undersensing, and lack of ventricular capture (Figure 1). The chest X–ray showed the complete dislodgement of the ventricular lead tip apparently into the vein secondary to the rotation of the pulse generator on its transverse axis with consecutive coiling of the lead (Fig. 2). These findings were consistent with Reel syndrome The patient was admitted to undergo a lead repositioning attempt in consideration of the recent first implant. During the surgery, however, it was shown that the lead was completely displaced from the venous system, near the pectoral muscle. This extreme dislocation of the lead has been related to the electric pulsations felt by the patient. We proceeded with a new re–implantation of the lead and removal of the previous one. The lead was firmly tied to the pectoral muscle with 2 silk points with slight traction control of optimal fixation. Reel‘s syndrome is a variant of the better known Twiddler syndrome, characterized by the coiling of catheters along the transverse axis of the pacemaker. It is often a complication due to the manipulation of the generator by the patient, unlike Twiddler syndrome it occurs early and the leads remain intact. This syndrome is one of the most serious complications of pacemaker or defibrillator implants, it can be potentially fatal due to lack of therapy in the case of defibrillators, or asystole in pacemaker–dependent patients.
P385 SYNCOPAL VENTRICULAR TACHYCARDIA IN HEALTHY HEART: AN UNUSUAL ORIGIN!
Authors: Astegiano M , Pasquero M , Ruffini S , Franco E , Iancu D , Moretti C 
Published: May 2022

Abstract
Torsade de pointes is a particular type of ventricular tachycardia, characterized by QRS complexes that vary progressively in amplitude and morphology, giving the impression of oscillating around the isoelectric line. Causes include long QT syndrome (congenital or drug–induced) or severe hypomagnesemia. We report the case of a 57–year–old woman, a smoker, with a history of weight loss in the last 6 months, hospitalized in Medicine for marked asthenia and an episode of fleeting loss of consciousness, from sitting. She was asymptomatic for chest pain. The physical examination showed a pathological thinness, with BMI 15 kg/m2, rhythmic cardiac activity, no murmurs, no signs of decompensation, flat abdomen, not enlarged liver. Pale, dry skin was observed. On ECG: sinus rhythm, HR 70 bpm, QTc slightly increased 0.47 sec, flat T wave in lateral. Blood exams evidenced: hypokalemia, hypomagnesemia, rise of the amylase. On the MRI abdomen we found large inhomogeneous areas on the head and body of the pancreas, referable to the picture of focal pancreatitis. For syncopal episode during hospitalization in Medicine, she was transferred in Cardiology, where, during electrocardiographic monitoring, paroxysmal ventricular tachycardias torsade de pointes–like, symptomatic, self–resolved was registered. We diagnosed an acute pancreatitis with typical radiological characteristics of an autoimmune form, determining severe electrolyte imbalance and consequent symptomatic paroxysmal ventricular tachycardias. Oral magnesium supplement and corticosteroid therapy allowed the resolution of the arrhythmic problem, monitored over time through the implantation of a loop recorder.
P390 ADIPOSITY AND VASCULAR AGEING: WHICH PARAMETER BETTER CORRELATES?
Authors: Guareschi A , Vicenzi M , Calcagnino M , Carugo S , Scuteri A 
Published: May 2022

Abstract
The increase in stiffness of large arteries is one of the mechanisms that could play a role in the association between obesity and increased risk of cardiovascular (CV) events. Carotid–femoral pulse wave velocity (cfPWV), known as an independent CV risk factor, represents a validated measure of large arteries stiffness and a good proxy of arterial ageing. We aimed at evaluating which body composition parameters better correlated with cfPWV and whether this correlation differed between men and women. cfPWV was measured in all subjects with Sphigmocor by sequentially recording electrocardiogram–gated carotid and femoral artery waveforms; body composition was measured by bioimpedance analysis and waist circumference (W). Furthermore, each subject was characterized by sex, age, height, weight, body mass index (BMI), brachial blood pressure (BP) and heart rate. A linear correlation was used to define the relationship between cfPWV and parameters. Univariate and multivariate analysis were performed in male and female subgroups separately to select the main determinants of arterial stiffness, considering the following parameters: age, mean BP (mBP), BMI, W, fat mass (FM) and skeletal muscle mass (SMM). We enrolled 69 subjects (37 men, 32 women) with average age 34.5 years (min 19–max 76). cfPWV was significantly correlated with age (r = 0.65, p&lt;.0001), and mBP (r = 0.38, p&lt;.01). Among the body composition parameters, W, BMI and FM percentage were significantly correlated with cfPWV (respectively: r = 0.48, r = 0.42, r = 0.41; p&lt;.0001). Multivariable regression analysis in men revealed that age and mBP were significant determinants of cfPWV (respectively: b = 0.042, p = 0.002; b = 0.051, p = 0.004). Conversely, multivariate analysis in women showed that age, FM and SMM are retained as main determinants of increased cfPWV (respectively: b = 0.079; p &lt; 0.0001; b = 0.217, p = 0.012; b = 0.125, p = 0.011). Irrespectively of gender, age is the main determinant of arterial stiffness. Our results demonstrated that the relationship between adiposity and arterial stiffness is verified only in female subjects. This suggests that this relationship is influenced by complex and not fully known mechanisms. Moreover, technical factors (algorithm and indirect methods to assess body composition) contribute to uncertainty regarding which parameter exploring adiposity is more accurate in stratifying CV risk.
The present study recalls attention on possible gender–specific determinants of arterial ageing.
P417 ASSESSMENT OF RESIDUAL CARDIOVASCULAR RISK AFTER STENTING: THE ROLE OF IMAGING
Authors: Micillo M , Cocco M , Cossu A , De Raffele M , Boccadoro A , Campo G , Guardigli G , Tonet E 
Published: May 2022

Abstract

Background
Reduction of residual risk after myocardial infarction (MI) represents the main goal in secondary prevention. Imaging may provide additional evidence beyond the monitoring of risk factors.

Clinical Case
In June 2019 a 29–year old man, Pakistani ethnicity, former smoker with family history of cardiovascular disease experienced a myocardial infarction without ST–segment elevation. Coronary angiography revealed a severe disease of circumflex branch (LCx) and of second obtuse marginal branch (OM2) treated with drug eluting stent (DES) implantation. A strong medical therapy was planned including dual antiplatelet therapy, high–potency statin and ACE inhibitor. The year after, a new coronary angio was performed because of effort angina: intrastent restenosis of LCx–OM2 was highlighted and treated with balloon, associated with a critical disease of right coronary artery (RCA), treated with DES. In the following months, the patient experienced three hospitalization for unstable angina related to critical intra–stent restenosis of LCx and intermediate stenosis of left anterior descendent (LAD). In order to better understand the subtle mechanism of patient’s symptoms, an invasive assessment of microvascular disease was performed, showing microvascular dysfunction (IMR 30; CFR 2.2; RRR 2.7). Additionally, coronary angio images raised the suspicion of positive remodeling on mid tract of RCA and LCx, expression of a progressive and high risk atherosclerosis (Figure 1). A close follow up was planned: a coronary computed tomography angiography (CCTA) 4 months after the last angio was performed aiming the assessment of atherosclerosis progression. CT images showed patency of the previously placed stents. A severe amount of positive plaque remodeling of RCA and LCx was documented: it was characterized by hypodense eccentric plaque (&lt;30 HU) with some little calcific spot near to the lipid core. These features underlined the presence of high–risk coronary plaque (Figure 2, Figure 3). Taking into account clinical history, instrumental and laboratory data, the patient was a candidate for therapy with PCSK9 inhibitors, which previously demonstrated an effect on reduction of plaque’s lipid core.

Conclusions
CT coronary represents an excellent method for the assessment of residual risk in ischemic patients thanks to its ability to detect not only stenotic plaques, but also high–risk features of atherosclerosis, thus allowing therapeutic optimization.
P423 REACTION TIME IS CARE TIME: HOW TO ENSURE TO QUALITY AND SAFETY IN HEALTH CARE
Authors: Boccini V , Giannini A , Tongiani F , Ricci T , Banti S , Baratta S 
Published: May 2022

Abstract

Background
Caring cardiac and / or cardiac surgery patient requires specific and specialized skills. Interprofessional collaboration is needed along integrated care pathway. To improve innovation and quality of care services are important the multidisciplinary teamwork, customized patient interventions, continuing nursing training and the use of validated clinical tools shared between Healthcare Team. Nurses have a central role in terms of prevention: Patient monitoring system and multidimensional assessment allow to care and to identify ward patients who are in danger of clinical deterioration. That is important to ensure an appropriate management at an early stage.

Clinical Case
On admission the patient is bright and alert and does not appear to be in distress. His vital signs are normal (MEWS 0). The patient is on therapy with Tirofiban and Furosemide in drips The diagnosis at admission is sub–occlusion of the Common Trunk of the Coronary Artery. After a few hours, the patient report retrosternal heartburn and dyspnoea with spontaneous regression. There aren’t any significant alterations of clinical signs during the symptomatic phase (MEWS 0). However, the nurse decides to continue to monitor the person more frequently compared to the timing of MEWS Protocol. In a short time the nurse finds a progressive clinical instability of the patient, confirmed by an increase in MEWS score.

Treatment
The patient monitoring system and the nursing process of Problem Solving and Decision Making allow to identify patient clinical deterioration at an early stage. For this reason, physicians and the critical care Team discuss about the management plan to guarantee of an appropriate care is provided. They decide to transfer the patient to the Intensive Care Unite, already intubated and ventilated.

Conclusions
The reaction time is important to ensure quality and appropriateness of care, to minimize possible complications and to generate a positive impact on health outcomes, especially in the treatment of time–dependent disease. The experience is also important to promote the development of nurses’ critical–thinking skills, competence and the ability to associate the use of clinical tools to the overall assessment of the person (medical history, clinical pathway and manifestations of the disease).
P427 LATE TREATMENT OF A CASE OF PULMONARY ARTERY HYPOPLASIA
Authors: Parodi A , Trocchio G , Camerini A , De Caro E , Lupi G 
Published: May 2022

Abstract
Here we want to present the case of a woman who came to our observation for the onset of dyspnea due to exertion. It is a subject followed from a young age for a congenital malformation of the urinary tract. At that time the presence of stenosis of the branches of the pulmonary artery associated with an interventricular septal defect was accidentally diagnosed; however the blood pressure values in the pulmonary artery were within the limits, so no interventional therapy was undertaken. In the following years the patient developed systemic arterial hypertension associated with renal failure for which medical therapy was started and an annual follow–up was scheduled. Over the years various echocardiographic checks were repeated without ever finding high pressures in the pulmonary artery. At the last check, performed precisely for the onset of dyspnea from exertion, the estimated systolic pressure in the pulmonary artery was equal to 100 associated with a dilation of the right ventricle with hypertrophy, hepatomegaly was also present in the absence, however, of signs of peripheral congestion. The catheterization of the right heart confirmed the presence of severe precapillary pulmonary hypertension and the CT scan with three–dimensional reconstruction highlighted the almost total agenesis of the left lung branch thus revealing the presence of a pulmonary hypertension of the fourth group, also supported by the negativity of the other tests proposed in the diagnostic work of the ESC Guidelines. In agreement with a national reference center for the treatment of pulmonary hypertension, we started Bosentan therapy with increasing dosage up to the target dose and long–term oxygen therapy. After four months of follow–up, the patient shows an improvement in functional capacity and the haemodynamic data remain stable. To our knowledge there are only the experiences of single centers regarding the treatment of forms of pulmonary hypertension due to anatomical malformations of the pulmonary circulation and for this reason medical therapy is not standardized. This subset of patients represents a challenge for the clinician as hypertension can be secondary both to the lack of part of the vascular bed and to reactive hyperplasia of the endothelium of the remaining circulation due to parietal stress due to pressure overload.
Impact of myocardial revascularization on long-term outcomes in a nationwide cohort of first acute myocardial infarction survivors
Authors: De Luca Leonardo , D’Errigo Paola , Rosato Stefano , Mureddu Gian Francesco , Badoni Gabriella , Seccareccia Fulvia , Baglio Giovanni 
Published: May 2022

Abstract
The long-term clinical benefits of myocardial revascularization in a contemporary, nationwide cohort of acute myocardial infarction (AMI) survivors are unclear. We aimed to compare the mortality rates and clinical outcomes at 8 years of patients admitted in Italy for a first AMI managed with or without myocardial revascularization during the index event. This is a national retrospective cohort study that enrolled patients admitted for a first AMI in 2012 in all Italian hospitals who survived at 30 days. The outcomes of interest were all-cause mortality, major cardio-cerebrovascular events (MACCE), and re-hospitalization for heart failure (HF) at 8 years. Time to events was analysed using a Cox and Fine and Gray multivariate regression model. A total of 127 431 patients with AMI were admitted to Italian hospitals in 2012. The study cohort consisted of 62 336 AMI events, of whom 63.8% underwent percutaneous or surgical revascularization ≤30 days of the index hospital admission. At 8 years, the cumulative incidence of all-cause death was 36.5% (24.6% in revascularized and 57.6% in not revascularized patients). After multiple corrections, the hazard ratio (HR) for all-cause mortality in revascularized vs. not revascularized patients was 0.61 (P &lt; 0.0001). The rate of MACCE was 45.7% and 65.8% (adjusted HR 0.83; P &lt; 0.0001), while re-hospitalizations for HF occurred in 17.6% and 29.8% (adjusted HR 0.97; P = 0.16) in AMI survivors revascularized and not revascularized, respectively. In our contemporary nationwide cohort of patients at their first AMI episode, those who underwent myocardial revascularization within 1 month from the index event compared to those not revascularized presented an adjusted 39% risk reduction in all-cause mortality and 17% in MACCE at 8-year follow-up.