Panminerva medica
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Multicenter Study
A novel algorithm for the computation of the diastolic pressure ratio in the invasive assessment of the functional significance of coronary artery disease.
Invasive functional assessment is a mainstay in the management of patients with coronary artery disease (CAD), but there is uncertainty on the comparative accuracy of diagnostic indices of functional significance. We aimed to validate the diagnostic performance of a novel non-hyperemic diastolic pressure ratio (dPR). ⋯ This multicenter registry suggests this novel dPR algorithm provides results that are numerically equivalent to iFR. Pending further studies, physicians may consider using this novel dPR algorithm to gauge the functional significance of a coronary lesion.
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The third phase of the Cardiac Rehabilitation Program (CRP) is a lifelong, maintenance phase beginning 3 to 6 months after the cardiac event. Individualized surveillance and monitoring schedules are established. ⋯ Currently, with the emergence of the COVID-19 pandemic, telerehabilitation and telemonitoring are of great value in this phase. The benefits of phase 3 have been demonstrated with prolonged survival by 1.82 years, at a cost of $ 1773 per year of life saved.
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The increased efficacy of cancer therapy has resulted in greater cancer survival and increasing number of people with cancer and cardiovascular diseases. The sharing of risk factors, the bidirectional relationship between cancer and cardiovascular diseases and the cardiotoxic effect of chemotherapy and radiotherapy, are the cause of the rapid expansion of cardio-oncology. All strategies to preserve cardiovascular health and mitigate the negative effect of cancer therapy, by reducing the cardiovascular risk, must be pursued to enable the timely and complete delivery of anticancer therapy and to achieve the longest remission of the disease. ⋯ Furthermore, particular attention will be paid to how CORE can counterbalance the negative effect of therapies in those at heightened cardiovascular risk after a cancer diagnosis. Barriers for implementation, including personal, family, social and of the health care system barriers for a widespread diffusion of the CORE will also be discussed. Finally, there will be a call-to-action, for randomized clinical trials that can test the impact of CORE, on morbidity and mortality.
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Cardiac rehabilitation (CR) has pioneered using multidisciplinary teams to attend all aspects of a patient's illness with high levels of professionalism and quality, providing individualized treatment, and negotiating any changes in lifestyle and treatment course. Clinical management transfers the management capacity to professionals, thus avoiding any increase in costs and healthcare spending, which can result in quality losses and less social legitimacy. Modern CR has been configured as the most effective comprehensive cardiovascular prevention strategy and given its preventive nature it must be a part of all cardiovascular health-related processes as a sub-process. ⋯ Its improvement allows for better rationalization of resources, reduces costs, and offers safer care focused on the needs of the patient. The definition of the technical competencies of the different professionals (functions of the members of the CR unit) is a necessity both from the point of view of its teaching utility, and from planning and management of health services. For a CR team able to carry out clinical management by the quality and safety processes, it needs members who possess professionalism, leadership, adequate communication, adequate training and knowledge management.