Reorganize Italian cardiology after the perfect Covid-19 storm, also overcoming the problems that existed before the pandemic. This is the proposal, which aims to ensure high standards of care for all patients through the establishment and funding of a National Cardiovascular Plan, which comes from the experts present in Milan on the occasion of the Congress of the Italian Society of Interventional Cardiology (Gise). . It must be said that the pandemic alone should not be called into question, as some limits to the availability of these “no-scalpel” approaches were present before. This was revealed by Giuseppe Tarantini, National President of Gise: “in 2019, so before the outbreak of the pandemic, only one in seven patients had access to the standards of care in interventional cardiology”.
The guidelines
The requests of the specialists, who focus on the appropriateness of the treatments also on the basis of the indications coming from the international scientific societies, are clear. An example for all: the Tavi, or the possibility of replacing the aortic valve through a probe that goes up to the left ventricle, instead of with the traditional surgery. The choice of treatment is now justified by the recently promulgated guidelines of the European Society of Cardiology (ESC). “Tavi is used for the management of aortic valve stenosis, the most common valve disease in Italy and Europe – reports Giovanni Esposito, President Elected Gise. Thanks to this transcatheter implant, inserted from the groin, we can replace the aortic valve in about 45 minutes without having to open the patient’s sternum and thus avoiding scars and total anesthesia. Recently, new guidelines from the European Society of Cardiology have broadened the spectrum of people who can be treated. The over 75s were also included and this is excellent news since it is this category of elderly people who are most exposed to the dangers of the disease “.
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Seniors
This approach, however, would also allow for economic savings in the elderly. The use of Tavi in 90% of Italian patients over 75 would allow a saving of 52 thousand days of hospitalization and rehabilitation in hospital for a total of 13 million euros a year. “We would also have a reduction of 14 thousand days of acute hospitalization and therefore we could treat 1,000 more patients per year in our wards – continues Tarantini”.
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Minimally invasive interventions
The situation appears to be greatly improved also for minimally invasive mitral valve repair: less than 1,000 patients have had access in Italy to minimally invasive mitral valve repair therapy and Italy, considering epidemiological data, is far behind compared to other countries. It is necessary to optimize the identification of patients’ unmet needs with the local area thanks to multidisciplinary teams, the so-called Heart Teams, which guarantee the appropriateness of treatments for the treatment of diseases of the aortic, mitral and tricuspid valves. According to specialists, it is also the need to recover the interventions that we were unable to carry out due to Covid-19 to force attention to be asked for attention to the issue “.
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“In 2020 we had a + 30% deaths from heart problems outside hospitals compared to previous years – adds Esposito. We also recorded a 20% reduction in the activities of the hemodynamics laboratories. For Tavi and other cardiovascular interventional procedures, such as the minimally invasive repair of the mitral valve and the percutaneous closure of the left auricle of the heart in patients with atrial fibrillation not pharmacologically treatable, there remain numerous clinical, organizational and financial obstacles that risk severely penalizing patients. As a Scientific Society we are ready to collaborate for the drafting and application of the National Cardiovascular Plan. We want to share data, monitor the outcomes and make operational proposals to evaluate investments in health care that guarantee better diagnostic-therapeutic assistance and the optimization of human and technological resources “.
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