Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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G Ital Cardiol (Rome) · Sep 2019
[SICI-GISE Position paper: Enhancing radiation safety in the catheterization laboratory].
The radiation dose received by interventional cardiologists during their activity in the catheterization laboratory is a matter of concern in terms of possible deterministic and stochastic risk. At the same time, very often, the knowledge of the effect and consequences of radiation exposure in the interventional cardiology community is limited. This document endorsed by the Italian Society of Interventional Cardiology (SICI-GISE) provides recommendations for cardiologists' radiation protection. Radiation safety considerations dedicated to women and other staff personnel working in the catheterization laboratory are also discussed.
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Stroke Unit admission together with reperfusion strategies (intravenous thrombolysis and mechanical thrombectomy) are the main treatment options for acute ischemic stroke. The last 15 years have seen a revolution in the treatment of ischemic stroke: intravenous thrombolysis with recombinant tissue-type plasminogen activator is indicated within 4.5 h of symptom onset regardless of age or severity, whereas mechanical thrombectomy is indicated within 6 h of anterior circulation intracranial occlusion. In case of favorable mismatch, advanced neuroimaging allows wake-up or non-datable strokes or with late onset time windows to be treated with thrombolysis and/or thrombectomy (within 9 h for thrombolysis and 24 h for thrombectomy).
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G Ital Cardiol (Rome) · May 2019
[ANMCO/FADOI/SIAARTI/SIC/SIMG/SIMI/SIMEU consensus document: The clinical care pathway of acute heart failure patients from symptom onset to discharge from the emergency department].
Acute heart failure (AHF) represents a relevant burden for emergency departments worldwide. AHF patients have markedly worse long-term outcomes than patients with other acute cardiac diseases (e.g. acute coronary syndromes); mortality or readmissions rates at 3 months approximate 33%, whereas 1-year mortality from index discharge ranges from 25% to 50%. The multiplicity of healthcare professionals acting across the care pathway of AHF patients represents a critical factor, which generates the need for integrating the different expertise and competence of general practitioners, emergency physicians, cardiologists, internists, and intensive care physicians to focus on care goals able to improve clinical outcomes. ⋯ The increasing care burden and complex problems generated by AHF are unlikely to be solved without an integrated multidisciplinary approach. Efficient networking among emergency departments, intensive care units, ordinary wards and primary care settings is crucial to achieve better outcomes. Thanks to the joint effort of qualified scientific societies, this document aims to achieve this goal through an integrated, shared and applicable pathway that will contribute to a homogeneous care management of AHF patients across the country.
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G Ital Cardiol (Rome) · Jan 2019
Comparative Study[Subcutaneous defibrillator implantation with ultrasound-guided serratus block using the two-incision technique: our experience].
The aim of this study was to report our experience with subcutaneous defibrillator (S-ICD) implantation. ⋯ In our experience, S-ICD implantation with the technique of the serratus anterior plane block is safe and effective, and significantly facilitated pain control during the procedure and postoperatively.
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G Ital Cardiol (Rome) · Jan 2019
Practice Guideline[Palliative care in the cardiac setting: a consensus document of the Italian Society of Cardiology/Italian Society of Palliative Care (SIC/SICP)].
Palliative care is recognized as an approach that improves quality of life of patients and families facing life-threatening illnesses. This is achieved through prevention, early identification, assessment and treatment of symptoms and other psycho-social, spiritual and economic issues. Palliative care is not dependent on prognosis and can be delivered as "simultaneous care", together with disease-modifying treatments and adequate symptom relief. ⋯ The process of advanced care planning should be clearly documented and regularly reviewed. Barriers to the provision of palliative care in heart failure include clinical issues (disease trajectory), prognostic uncertainty, failure in identification of patients who need palliative care and timing of referral to specialist services, but also misconceptions of patients, families and sanitary staff regarding the role of palliative care, organization problems, and finally educational and time issues. This document focuses on the need of further, coordinated research and work-out on: (i) identification of heart failure patients eligible for palliative care, in terms of clinical and social-psychological issues, (ii) identification of trigger events and timing of referral; (iii) identification of adequate performance indicators/scales for measurement, assessment and follow-up of symptoms and quality of life in end-stage heart failure, including patient-reported outcome measures; (iv) treatment, care and organization strategies and models for advanced/end-stage heart failure ("care management"); and (v) implementation of knowledge and education of healthcare professionals in the fields of communication, ethics, and advanced care planning in heart failure.