Fabrizio Oliva

Background: Heart failure (HF) remains a major cause of morbidity, mortality, and healthcare resource utilisation, requiring integrated multidisciplinary care across hospital and community settings. This study aimed to describe the organisation of HF care and post-discharge management in Italy through two complementary national surveys promoted by the Italian Association of Hospital Cardiologists (ANMCO). Methods: Two complementary cross-sectional organisational surveys were conducted to describe the organisation of HF care in Italy. The Regioni 3.0 survey, performed between November 2023 and September 2024, collected 196 responses from directors of cardiology departments and HF Centers regarding organisational resources, post-discharge follow-up pathways, and integration with community healthcare services. A second survey, administered during the ANMCO Heart Failure Centers Convention in October 2024, collected 135 responses on discharge planning and outpatient follow-up practices. Results: HF outpatient clinics were available in 85.7% of Centers, whereas only 42.6% reported non-physician staff specifically assigned to HF care. Structured post-discharge follow-up pathways were reported by 91.3% of Centers, but functional links with primary care or community healthcare services were present in only 47.7%. Medication reconciliation and patient education were routinely performed in most Centers, whereas telemonitoring systems were available in approximately one-third of respondents. Conclusions: HF care in Italy is supported by a widespread network of outpatient clinics and structured post-discharge follow-up pathways. However, important organizational gaps remain in multidisciplinary staffing, hospital–community integration, and telemonitoring, highlighting the need to strengthen multidisciplinary resources, improve hospital–community integration, and expand telemonitoring to support more coordinated HF care nationwide.

Elderly patients with heart failure (HF) represent a rapidly growing and highly heterogeneous population marked by multimorbidity, frailty, and polypharmacy. These age-related features profoundly influence the course of HF and modify therapeutic response. Vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, targets the impaired nitric oxide (NO)-sGC-cyclic guanosine monophosphate (cGMP) pathway, a central mechanism in vascular dysfunction and maladaptive remodelling. Clinical evidence, primarily from the VICTORIA trial and subsequent studies, supports vericiguat in selected patients with heart failure with reduced ejection fraction (HFrEF), particularly following recent worsening HF despite guideline-directed medical therapy (GDMT). Most of the available evidence derives from HFrEF populations, whereas studies in heart failure with preserved ejection fraction (HFpEF) have not demonstrated significant clinical benefit. In addition, dedicated evidence in frail older adults and in patients with geriatric syndromes remains limited. This review summarises current knowledge on the pharmacological rationale, pharmacokinetics, and pivotal clinical studies of vericiguat, highlighting quantitative results and their implications for clinical implementation in elderly patients with HFrEF and complex clinical profiles.

Nutritional status is a pivotal determinant of health and longevity in ageing populations. Malnutrition, overnutrition, and sarcopenic obesity are increasingly recognised as key modifiers of CV risk in older adults. Beyond caloric imbalance, age-related metabolic, hormonal, and inflammatory changes profoundly influence CV structure and function. Both nutrient deficiency and excess contribute to endothelial dysfunction, oxidative stress, and chronic inflammation, core mechanisms underlying atherosclerosis, heart failure, and frailty. This review analyses the complex interplay between nutrition and cardiovascular diseases in older adults, outlining physiological mechanisms, diagnostic tools for nutritional assessment, and evidence-based dietary strategies aimed at prevention and management. Particular attention is given to the challenges of multimorbidity, polypharmacy, and altered body composition that shape nutritional care in geriatric cardiology.

The prevalence of diabetes and heart failure rises sharply with age, and their coexistence amplifies cardiovascular and renal risk. Elderly patients display unique clinical and biological profiles characterised by frailty, multimorbidity, and pharmacodynamic variability that challenge conventional treatment strategies. Sodium–glucose co-transporter-2 inhibitors (SGLT2i) have emerged as a cornerstone of cardio–renal–metabolic protection, with the most consistent cardiovascular benefit being the reduction in heart failure hospitalisation, whereas effects on cardiovascular death and major adverse cardiovascular events vary according to baseline cardiovascular risk, heart failure phenotype, diabetic status, and trial design. However, real-world use among the elderly remains limited due to concerns about tolerability, polypharmacy, and cost. This review analyses the pharmacological rationale and evidence base for SGLT2i therapy in older adults, highlighting mechanisms beyond glucose control, quantitative data from pivotal trials, and practical issues for geriatric implementation.

Background/Objectives: Ultrasound-assisted catheter-directed thrombolysis (USAT) and mechanical thrombectomy (MT) are increasingly used for intermediate-high-risk pulmonary embolism (PE), but real-world comparisons are scarce. We compare 30-day all-cause, cardiovascular, non-cardiovascular, PE-related, and major bleeding events between intermediate-high-risk patients with acute PE treated with USAT or MT. Methods: We analyzed 286 patients with acute intermediate-high-risk PE enrolled in the multicenter USAT IH-PE registry (March 2019–October 2025). Patients underwent USAT (EKOS™, Boston Scientific, Marlborough, MA, USA) or MT (FlowTriever, Inari Medical, Irvine, CA, USA or Indigo, Penumbra, Inc., Alameda, CA, USA) during index hospitalization. Primary endpoints were 30-day all-cause, cardiovascular, and PE-related mortality. Propensity score matching (1:1) balanced baseline characteristics. Kaplan–Meier analyses with log-rank testing assessed time-to-event outcomes. Results: After matching (69 patients per group), baseline clinical and hemodynamic variables were well balanced. Both USAT and MT significantly improved RV/LV ratio, tricuspid annular plane systolic excursion (TAPSE), and PASP (all p < 0.001). Thirty-day all-cause mortality was similar between USAT and MT (13.0% vs. 11.5%; p = 0.78), with no differences in cardiovascular or PE-related mortality (8.6% vs. 1.4%, p = 0.58 and 5.7% vs. 1.4%, p = 0.17, respectively). Major bleeding was infrequent and observed only in the USAT group (4.3%). Conclusions: In this real-world multicenter cohort, USAT and MT showed comparable short-term mortality, safety, and echocardiographic recovery, supporting individualized catheter-based reperfusion strategies for intermediate-high-risk PE.

The ongoing digital transformation is reshaping organisational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This manuscript presents a comprehensive and critical overview of telemedicine applications in cardiovascular care, with a focus on its role in strengthening hospital-community integration, its deployment within hospital-based healthcare systems, and the associated regulatory and operational frameworks. The analysis encompasses the management of chronic cardiovascular conditions, such as heart failure and atrial fibrillation, through telemonitoring, telecontrol, televisit, and teleconsultation. Additionally, it explores the use of digital technologies in post-myocardial infarction follow-up, oral anticoagulation management, preoperative assessment, and care for elderly patients. The review also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.

Cardiovascular diseases remain the leading cause of mortality globally and in Italy, with a growing burden exacerbated by ageing populations and underdeveloped strategies for managing chronic cardiovascular conditions. This position paper, resulting from the 2024 ANMCO General Assembly, addresses the current state of cardiovascular chronicity management in Italy, highlighting critical gaps and proposing sustainable, integrative solutions. Despite improvements in acute cardiovascular care, the lack of structured post-acute management, insufficient adoption of secondary prevention protocols, limited access to innovative therapies, and a slow digital transition continue to hinder effective chronic care. The document stresses the pivotal role of cardiologists, not only in acute intervention but also in long-term care and secondary prevention, emphasising the need for a multidisciplinary, multichannel healthcare model. The paper explores the potential of e-Health and artificial intelligence to revolutionize chronic disease management. It advocates for the widespread implementation of integrated care pathways, digital tools like electronic health records and telemedicine platforms, which together could enhance early detection, patient monitoring, and therapeutic adherence while reducing unnecessary hospitalisations. It also underscores the necessity of updating national and regional pharmaceutical policies to improve equitable access to disease-modifying therapies. Furthermore, the integration of palliative care in end-stage cardiovascular disease and the enhancement of post-acute care networks are deemed essential. Ultimately, the document advocates for a comprehensive systemic and cultural transformation spearheaded by scientific societies such as ANMCO, where technological innovation, organisational reform, and patient-centred care align to ensure a sustainable and universally accessible healthcare system. This vision is consistent with the objectives of the PNRR, the 2030 Agenda, and, most importantly, the foundational principles of the Italian Constitution.

Hospital discharge is a pivotal stage in the continuum of care, marking the transition from the acute clinical episode to subsequent therapeutic management. Rather than being a purely administrative procedure, discharge is a multifaceted process that requires structured planning, clear communication, and the coordinated participation of all healthcare stakeholders, with the patient playing a central role. Inadequate discharge processes may adversely affect clinical outcomes and increase hospital readmission rates, resulting in sub-optimal utilization of healthcare resources. This issue is particularly relevant in the context of an ageing and increasingly frail population, characterized by a high burden of comorbidities and complex clinical needs. In this setting, discharge planning should be treated as an integral component of the care pathway, embedded within a comprehensive, coordinated model of care. This document proposes an updated, practical framework for hospital discharge management, grounded in current scientific evidence and multidisciplinary expertise. Its primary objective is to enhance continuity of care, support individualized treatment strategies, and ultimately improve patient outcomes. Specifically, this paper aims to provide clinical cardiologists with a structured reference tool for discharge management, including actionable recommendations to strengthen physician–patient communication, optimize therapeutic regimens, and promote better health outcomes.

Interventional cardiology has profoundly transformed the management of cardiovascular disease; however, working within the cardiac catheterization laboratory exposes healthcare professionals to substantial occupational hazards. Four principal risks can be identified: (i) malignancy and non-malignant sequelae related to chronic exposure to ionizing radiation; (ii) musculoskeletal injury associated with prolonged use of heavy radioprotective equipment; (iii) exposure to blood-borne pathogens and other infectious agents; and (iv) work-related psychological strain. Among these, cumulative radiation exposure remains the most consequential and historically under-recognized threat. Although the radiation dose which operators receive during a single procedure is markedly lower than that delivered to patients, healthcare professionals are subjected to repeated, lifelong exposure. For a high-volume interventional cardiologist, the annual effective dose may substantially exceed that of other radiation-exposed professionals, including nuclear industry workers and diagnostic radiologists. Importantly, unlike radiologists, many cardiologists receive limited formal training in radiation physics and radiobiology, which may lead to limited awareness of dose-optimization strategies and stochastic risk. Contemporary epidemiological evidence has refined our understanding of the biological effects of chronic low-dose and low-dose-rate radiation. Risk estimates for malignancy have progressively increased as follow-up durations have lengthened and methodological approaches have improved. Moreover, emerging data suggest that sustained low-dose exposure may confer an elevated risk of cardiovascular disease, thereby extending concern beyond oncological endpoints. Occupational exposure varies greatly depending on the location: doses to the head can be several times higher than doses to the chest, with a predominance on the left side attributable to the position of the operator in relation to the X-ray source. In addition to the well-established association with posterior subcapsular cataracts, observational studies have reported potential links between long-term occupational exposure and neurodegenerative disorders, including Alzheimer’s and Parkinson’s diseases, although causality remains to be definitively established. Mitigation of these risks necessitates a paradigm shift towards a rigorous culture of radiation safety. Institutional commitment is essential, encompassing advanced shielding systems, ceiling-suspended protection, real-time dosimetry with immediate feedback, and systematic optimization of imaging protocols. Ultimately, the future of the field may depend on the progressive adoption of radiation-sparing and radiation-free technologies, including intracardiac and intracoronary ultrasound, electro anatomical mapping systems, and non-fluoroscopic navigation platforms. In parallel, robot-assisted procedures enable remote manipulation of the catheter promise to reduce the operator's direct exposure. The pursuit of a zero-radiation environment in the workplace should not be considered an ambitious ideal but a strategic priority to safeguard the next generation of interventional cardiologists.

Aims: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has been shown to reduce cardiovascular (CV) events in patients with Type 2 diabetes mellitus and chronic kidney disease. We aimed to quantify the robustness of its CV benefits in randomized controlled trials using fragility metrics coupled with conventional clinical effect measures. Methods: We systematically searched MEDLINE and Scopus (from inception to June 2025) for Phase 3/4 placebo-controlled randomized trials of finerenone in Type 2 diabetes mellitus and chronic kidney disease reporting dichotomous CV outcomes. Three studies were included: FIDELIO-DKD, FIGARO-DKD, and the pooled FIDELITY analysis. We extracted hazard ratios (HRs), absolute risk reduction, relative risk reduction, number needed to treat (NNT), fragility index (FI), reverse FI, fragility quotient (FQ), and reverse FQ for the primary composite CV outcome (CV death, non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalization) and individual components. Results: The primary composite outcome was significantly reduced in FIDELIO-DKD (HR .86, NNT 56; FI 4, FQ .0007) and FIDELITY (HR .86, NNT 59; FI 38, FQ .002), but not FIGARO-DKD (HR .87; reverse FI 7, reverse FQ .0009). Among individual outcomes, heart failure hospitalization showed the most consistent and robust benefit (FIDELITY: HR .78, NNT 91; FI 23, FQ .001). Effects on CV death, myocardial infarction, and stroke were numerically favourable but statistically non-significant, with low reverse fragility indices. Conclusions: Finerenone significantly reduces heart failure hospitalization and modestly improves CV outcomes in Type 2 diabetes mellitus with chronic kidney disease, but effects on CV death, myocardial infarction, and stroke are fragile. Combining fragility metrics with standard efficacy measures offers a clearer view of the reliability of trial results.