Vittorio Pascale

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.

Semaglutide, a glucagon-like peptide-1 receptor agonist, has emerged as a pivotal therapeutic agent in the management of the cardio-renal-metabolic continuum. Initially developed for glycaemic control in Type 2 diabetes mellitus, its benefits extend far beyond glucose regulation. Clinical trials have demonstrated semaglutide’s potential to reduce major adverse cardiovascular events, particularly in overweight/obese patients with high cardiovascular risk, as well as improving functional capacity in patients suffering from heart failure with preserved left ventricular function. Additionally, it has shown promise in improving renal outcomes, such as slowing the progression of albuminuria and reducing the risk of chronic kidney disease in diabetic populations. These effects are likely due to its multifaceted mechanisms, including anti-inflammatory properties, weight reduction, blood pressure lowering, and direct renal protection. This review synthesizes current evidence on semaglutide’s role in the interrelated domains of cardiovascular, renal, and metabolic health.

Hypertrophic cardiomyopathy (HCM) is a non-rare genetic cardiomyopathy, with an estimated prevalence of 1:500, characterized by an increase in the left ventricular wall thickness in the absence of increased loading conditions. The hypertrophy is mostly asymmetric and predominantly affects the basal septum and anterior wall. Left ventricular outflow tract obstruction, at rest or after provocative tests, is detected in many patients and represents the primary cause of reduced functional capacity, as well as an independent predictor of sudden cardiac death and advanced heart failure. Until ∼1 year ago, symptomatic patients despite maximal therapy with β-blockers or calcium channel blockers plus disopyramide had only basal septal reduction therapy through myectomy or septal alcoholization as additional therapeutic options. Today, a new class of drugs that inhibit cardiac myosin activity is available for patients with obstructive HCM. In light of the new treatment perspectives, the correct clinical-therapeutic classification of affected patients becomes of fundamental importance for the cardiologist. The aim of this position paper is to increase the knowledge of cardiologists in the field of HCM, defining its epidemiological, genetic, and pathological characteristics, identifying the diagnostic criteria and instrumental methods capable of stratifying the risk profile, with the aim of an optimal therapy tailored on the single patient.

Recently, intensive cardiac care units (ICCUs) have undergone a significant transformation related to the evolution in management of acute coronary syndrome and influenced by other factors such as the epidemiological transition, the increasing complexity of clinical cases, the technological advancement, and the growth of clinical and scientific expertise of cardiologists. In the context of this evolution, a functional reorganization of ICCUs in Italy has to be implemented in order to meet the changing needs of the population with cardiovascular disease requiring critical care. Therefore, the Italian Association of Hospital Cardiologists (ANMCO) proposes this position paper for the reorganization of CICUs into three levels with increasing functional complexity, based on the hospital characteristics, the available technology, and the clinical cases treated. The system would be functionally integrated into a regional ICCU organization modelled on a time-dependent care network. This proposed network aims to standardize diagnostic and therapeutic protocols and establish unified data collection registries to facilitate self-assessment and support clinical research. The document delineates specific requirements for each ICCU level, including the management of clinical cases, the expertise of intensive care cardiologists, the technological facilities, and the medical and nursing staff needed to ensure optimal care delivery.

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure. Therefore, diagnosing those patients early is crucial to provide the best treatment. Moreover, the diagnosis is influenced by the patient's comorbidities, and some HFpEF patients have symptoms common to other rare diseases that, if unrecognized, develop an unfavourable prognosis. This position paper aims to provide the clinician with a useful tool for diagnosing and treating patients with HFpEF, guiding the clinician towards the most appropriate diagnostic and therapeutic pathway.

Long COVID-19 (LC) is a poorly understood, multifactorial condition that persists for at least three months following SARS-CoV-2 infection. The underlying pathophysiological mechanisms responsible for the wide range of associated symptoms—including fatigue, brain fog, and respiratory issues—remain unclear. However, emerging evidence suggests that the reactivation of latent viral infections, such as Epstein-Barr virus, cytomegalovirus, and varicella-zoster virus, may significantly contribute to the complexity of LC. These latent viruses can be reactivated by SARS-CoV-2, contributing to a chronic inflammatory state that prolongs symptomatology. This review confirms the potential involvement of latent viral infections in LC and examines whether these infections play an independent role or act synergistically with other factors. In addition, recent studies have highlighted viral persistence and immune dysregulation as key elements in LC. Our findings suggest that preventative strategies, including vaccination and antiviral treatments during the acute phase of COVID-19, show potential in reducing LC risk by preventing viral reactivation. However, tailored diagnostic and therapeutic strategies targeting these latent infections are urgently needed. Identifying biomarkers of viral reactivation, particularly for high-risk populations, could be considered another effective strategy to mitigate LC severity. Further research is crucial to better understand the interactions between SARS-CoV-2 and latent infections, and to improve the prevention and treatment of LC.

Vitamin D deficiency has a pathogenetic and prognostic role in coronary artery disease and a key role in pain transmission. Diabetic patients have a higher risk of silent myocardial ischemia (SMI) due to diabetic neuropathy. We evaluated the correlation between SMI and Vitamin D serum levels in type 2 diabetic patients and assessed whether SMI patients had a worse survival rate than their symptomatic counterpart. We enrolled 253 patients admitted in our Cardiology Unit and compared them with 50 healthy volunteers. We created three sub-groups: symptomatic MI group (125, 32.4%); SMI group (78, 25.7%), and no-MI group (50, 41.9%). 25(OH)D levels (nmol/L) were lower in the SMI group (34.9 ± 5.8) compared to those in the symptomatic MI (49.6 ± 6.1; p = 0.01), no MI (53.1 ± 6.2; p = 0.001), and control groups (62.1 ± 6.7; p = 0.0001). 25(OH)D levels predicted SMI in diabetic patients, with an inverted odds ratio of 1.11 (p = 0.01). Symptomatic MI group survival was higher than the SMI one (6-year survival rate: 83 vs. 69%; p = 0.01). Diabetic patients with SMI had a higher mortality risk and showed lower 25(OH)D levels than the symptomatic group. This suggests the crucial role that vitamin D has in the pathogenesis of SMI.