Vatri M, Angelino E, Ambrosetti M
… +3 more, Faggiano A, Faggiano P, Fattirolli F
G Ital Cardiol (Rome)
· 2026 May · PMID 42051182
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Therapeutic inertia is the result of a complex interaction between multiple factors. In the recent years, some authors suggested that the burden of responsibility for therapeutic inertia is shared, with 50% due to physic...Therapeutic inertia is the result of a complex interaction between multiple factors. In the recent years, some authors suggested that the burden of responsibility for therapeutic inertia is shared, with 50% due to physician-related factors, 30% to patient-related factors, and the remaining 20% to healthcare system barriers. This view is misleading because it fails to capture the deep interconnection between the various elements and how they feed into each other in a vicious circle that influences therapeutic action. The physician's decision-making is influenced by cognitive biases, mental shortcuts, and contextual pressures that can lead to systematic errors. Within the different care settings, the patient is never a passive actor; their fears, perceptions and behaviors play a crucial role in factors that influence clinical reasoning and give rise to interactions in which avoiding conflict leads to a loss of therapeutic opportunities. At least four recurring clinical profiles can be identified, which can be defined as "phenotypes of therapeutic inertia": uninformed, hesitant, rigid, overwhelmed. Each phenotype is characterized by a different level of self-awareness and is supported by cognitive biases as well as specific relational difficulties with different types of patients. Identifying the phenotypes of inertia is only the first step: the crucial question for clinical practice is whether and how they can be modified. There are no single solutions: it is therefore a matter of developing an interpretative grid to recognize recurring patterns of inertia in clinical practice and identify the most effective corrective strategies.
Lucà F, Gensini GF, Gabbrielli F
… +34 more, Aschieri D, Barisone M, Battistoni I, Benedetto FA, Bilato C, Bisignani G, Ceravolo R, Ciconte V, De Bonis S, De Luca L, Di Fusco SA, Di Lenarda A, Gelsomino S, Geraci G, Gil Ad V, Gori M, Iacovoni A, Mabritto BMT, Milli M, Parrini I, Pilleri A, Pozzi A, Rao CM, Riccio C, Rocca P, Scicchitano P, Vatrano M, Vigorito F, Gulizia MM, Colivicchi F, Gabrielli D, Oliva F, Nardi F, Grimaldi M
The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO posi...The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO position paper 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 position paper also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.
Iacoviello M, Citarelli G, Palmieri G
… +27 more, Scicchitano P, De Gennaro L, Massari F, Bonfantino MV, Accogli M, Bartolomucci F, Brunetti ND, Campanella C, Ciccone MM, Colonna G, Colonna P, Dalena G, Greco CA, Luzzi G, Paolillo C, Passantino A, Piccinni G, Pisanò E, Potenza D, Sollazzo V, Nardi F, Colivicchi F, Oliva F, Gabrielli D, Grimaldi M, Caldarola P, a nome degli Sperimentatori del Progetto PONTE-SC
BACKGROUND: Despite advances in therapy, heart failure (HF) remains a syndrome characterized by high morbidity and mortality. The PONTE-HF/ACS registry aims to assess the outcomes of a structured outpatient follow-up bet...BACKGROUND: Despite advances in therapy, heart failure (HF) remains a syndrome characterized by high morbidity and mortality. The PONTE-HF/ACS registry aims to assess the outcomes of a structured outpatient follow-up between hospital and community care for patients with HF or recently hospitalized for acute coronary syndrome. The purpose of this study is to evaluate one of the main process indicators of the registry for patients with HF, namely the prescribed pharmacological therapy, with particular reference to therapy with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNi), beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). METHODS: Between January 2024 and September 2025, 1203 patients were enrolled: 496 with HF and reduced ejection fraction (HFrEF), 189 with HF and mildly reduced ejection fraction (HFmrEF), 302 with HF and preserved ejection fraction (HFpEF), and 216 with HF and improved ejection fraction. RESULTS: In HFrEF patients, after enrollment, therapy was prescribed as follows: ACEi/ARB/ARNi in 89% of cases (64% ARNi), beta-blockers in 97%, MRA in 85%, and SGLT2i in 85%. Quadruple therapy with and without ARNi was prescribed in 69% and 51% of cases, respectively. The percentage of patients receiving at least 50% of the recommended dose was 63% for ARNi, 41% for ACEi/ARB, 70% for beta-blockers, and 98% for MRA. CONCLUSIONS: The PONTE-HF/ACS registry shows good optimization of therapy in enrolled patients with HFrEF. Achieving this important process indicator highlights the quality of care provided by the HF outpatient network in the Apulia region and confirms the relevance of the registry for the analysis and optimization of diagnostic-therapeutic pathways in patients with HF.
Manca P, Matassini MV, Gentile P
… +29 more, D'Elia E, Di Nora C, Fazzini L, Baldetti L, Inciardi RM, De Maria R, Carigi S, Nuzzi V, Cipriani M, De Gennaro L, Bianco M, Tinti MD, Palmieri V, Rizzello V, Doimo S, Cappannelli S, Marini M, Garascia A, Masciocco G, Senni M, Driussi M, Ajello S, Scandroglio AM, Metra M, Corda M, Colivicchi F, Grimaldi M, Oliva F, Gori M
Home-based inotropic therapy represents a therapeutic strategy in patients with advanced heart failure (AdvHF), both for a bridge to life-saving treatments such as heart transplant or ventricular assist devices and for p...Home-based inotropic therapy represents a therapeutic strategy in patients with advanced heart failure (AdvHF), both for a bridge to life-saving treatments such as heart transplant or ventricular assist devices and for palliative care in patients not eligible for these therapeutic options. In this review, we explore the role of home-administered inotropes, specifically dobutamine, milrinone, dopamine, and levosimendan, in the management of AdvHF patients through a summary of current literature and the presentation of management models adopted in selected Italian centers. Reported experiences suggest improved quality of life, reduced hospital admissions, and enhanced clinical stability in patients with AdvHF. These models may serve as practical examples for organizing care pathways in a clinical context that remains poorly defined by current guidelines.
Cignola S, Barisone M, Cruciani F
… +7 more, Calderaro C, Sacco A, Colivicchi F, Grimaldi M, Oliva F, Valente S, a nome del Gruppo Best Practice-Club delle UTIC ANMCO
Managing patients in intensive care units involves special attention for complex patients with multiple comorbidities and multi-organ dysfunction, for whom continuous and advanced staff training is required. Recent evide...Managing patients in intensive care units involves special attention for complex patients with multiple comorbidities and multi-organ dysfunction, for whom continuous and advanced staff training is required. Recent evidence shows malnutrition negatively impacts cardiovascular outcomes but can be improved with targeted strategies. However, gaps remain in standardizing nutritional assessment and management in clinical practice. The aim of the Best Practice working group is to draw up an operational flow chart to support assessments in nutrition for patients admitted to the cardiac intensive care unit (CICU) and to evaluate their impact on clinical practice. After a thorough literature review, including Cochrane guidelines and reviews, available evidence on nutrition in CICU has been synthesized and decision-making algorithms have been developed for the following clinical conditions: acute heart failure, acute coronary syndrome, after cardiac arrest, cardiogenic shock, which have been synthesized into a single algorithm to facilitate consultation and use in clinical practice. This project aims to disseminate and standardize best practice-based decision-making in the CICU, serving as a structured first step toward greater awareness and more consistent, effective management of nutrition assessment.
As in many other fields, artificial intelligence (AI) is transforming daily activities in cardiology. In pharmacological therapy, algorithms have been developed to prevent adverse reactions, improve therapeutic adherence...As in many other fields, artificial intelligence (AI) is transforming daily activities in cardiology. In pharmacological therapy, algorithms have been developed to prevent adverse reactions, improve therapeutic adherence, and optimize dosage. In the field of coronary intervention, AI has been studied primarily in the anatomical and functional assessment of coronary stenoses and in the characterization of atherosclerotic plaques, but also, for example, in predicting the efficacy of treatment for chronic total occlusions. In structural cardiac intervention, AI applications are currently focused on simplifying procedural planning and standardizing interventions, as well as post-interventional prognostic assessment. The purpose of this review is to explore the current or potential applications of AI in pharmacological and interventional cardiology, highlighting both its potential and its limitations and critical issues that must be addressed.
Ciliberti G, Cangemi S, Musella F
… +15 more, Fortuni F, Piroli F, Vitale E, Cornara S, Zabbia D, Spinelli A, Guasti S, Marazia S, Gentile P, Nardi F, Oliva F, Grimaldi M, Metra M, Imazio M, De Chiara B
Cardiac sarcoidosis is a rare but potentially life-threatening condition characterized by the formation of non-caseating granulomas in the myocardium. Clinical manifestations range from asymptomatic forms to atrioventric...Cardiac sarcoidosis is a rare but potentially life-threatening condition characterized by the formation of non-caseating granulomas in the myocardium. Clinical manifestations range from asymptomatic forms to atrioventricular blocks, ventricular arrhythmias, heart failure, and sudden cardiac death. Diagnostic work-up requires a multimodality approach combining advanced imaging, clinical criteria, and, when possible, histological confirmation. Immunosuppressive therapy remains the cornerstone of treatment, aimed at suppressing myocardial inflammation and preventing irreversible damage. Risk stratification for sudden cardiac death is crucial, and cardiac implantable electronic devices play a key role in selected patients. This review, structured in ten clinical questions, provides an overview of the epidemiology, clinical presentation, diagnostic criteria, differential diagnosis, therapeutic strategies, and risk stratification of cardiac sarcoidosis, in light of the most recent international guidelines and consensus documents.
Zorzi A, Ungaro S, Sciarra L
… +5 more, Scarà A, Compagnucci P, Palamà Z, Patrizi G, Dello Russo A
G Ital Cardiol (Rome)
· 2026 Mar · PMID 41738425
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The issue of sports participation in athletes with an implantable cardioverter-defibrillator (ICD) has gained increasing attention. Contrary to what is often reported by the media, in Italy there is no absolute ban on co...The issue of sports participation in athletes with an implantable cardioverter-defibrillator (ICD) has gained increasing attention. Contrary to what is often reported by the media, in Italy there is no absolute ban on competitive sports for individuals with an ICD: according to the 2023 COCIS guidelines, eligibility is determined not by the device itself, but by the underlying heart disease and the type of sport practiced. This document reviews the main international (AHA/ACC, ESC, HRS) and Italian guidelines, emphasizing that the indication for ICD implantation must follow the same criteria used for the general population, without considering the desire to practice sports as a determining factor. It then discusses the conditions under which, in Italy as well, athletes with an ICD may be allowed to return to competitive sports. Available evidence, including data from international registries, shows that sports participation in ICD carriers can be safe if performed under specialist supervision, although the risk of appropriate shocks is not negligible. This document also examines the advantages and limitations of different device types and proposes a flow-chart for ICD programming and follow-up, both at baseline and during exercise testing. Finally, it reaffirms that properly prescribed and monitored physical activity remains recommended for patients with ICDs due to its clinical and psychological benefits.
Di Spigno F, Gualandi F, Arata A
… +7 more, Foti MRS, Tedeschi A, Breviario F, Gerra L, Matrone BA, Novara P, Aschieri D
G Ital Cardiol (Rome)
· 2026 Mar · PMID 41738424
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BACKGROUND: Cardiogenetics aims to identify the genetic causes of inherited cardiac diseases, with significant implications for early diagnosis, clinical management, and prevention of sudden cardiac death in both patient...BACKGROUND: Cardiogenetics aims to identify the genetic causes of inherited cardiac diseases, with significant implications for early diagnosis, clinical management, and prevention of sudden cardiac death in both patients and their relatives. In Italy, however, access to structured cardiogenetic services remains uneven and is often limited to tertiary care centers, partly due to economic sustainability constraints. METHODS: We developed a second-level outpatient model that integrates telemedicine to facilitate access to genetic testing. The pathway includes pre-test genetic counseling performed by the cardiologist based on clinical and instrumental phenotype assessment, molecular analysis through blood sample collection and referral to the Medical Genetics Unit of Ferrara, and post-test counseling conducted as a teleconsultation, involving remote participation of a geneticist via a dedicated telemedicine platform (c4C Dedalus). In case of a positive result, the patient undergoes an in-person cardiology consultation in Piacenza, while negative or uncertain results are managed through further phenotypic or familial investigations as needed. RESULTS: In the first year of activity, 78 probands and 20 first-degree relatives underwent genetic testing. The positivity rates, including relevant variants of uncertain significance, were 44% for hypertrophic cardiomyopathy, 75% for non-dilated left ventricular cardiomyopathy, 20% for dilated cardiomyopathy, 100% for arrhythmogenic right ventricular cardiomyopathy, 100% for long QT syndrome, and 50% for Brugada syndrome. CONCLUSIONS: This model demonstrates that telemedicine can be an effective and sustainable tool to extend access to specialized genetic counseling in peripheral settings, improving equity of care and optimizing the use of resources for the management of inherited cardiomyopathies.
G Ital Cardiol (Rome)
· 2026 Mar · PMID 41738423
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Minimally invasive coronary revascularization has gained increasing interest as it represents a significant approach to reducing well-known complications of conventional sternotomy, such as bleeding, need for transfusion...Minimally invasive coronary revascularization has gained increasing interest as it represents a significant approach to reducing well-known complications of conventional sternotomy, such as bleeding, need for transfusions, postoperative atrial fibrillation, wound infections, and prolonged hospital stay. These potential benefits, described in numerous retrospective and observational studies, appear to be associated with faster functional recovery and improved quality of life, although prospective evidence remains limited at present. The harvesting of the internal mammary artery, initially performed under direct vision through a mini-thoracotomy, has been progressively refined through the introduction of thoracoscopy and, in highly specialized centers, with robotic assistance. The choice of the incision site and extent is now tailored to the patient's anatomy and the objectives of revascularization, resulting in an increasingly personalized approach. Among available techniques, the minimally invasive direct coronary artery bypass - in which the left internal mammary artery is anastomosed to the left anterior descending artery - represents a consolidated and effective option for isolated left anterior descending coronary artery lesions. Minimally invasive coronary surgery extends these possibilities to multivessel revascularization, performed with or without cardiopulmonary bypass, allowing accurate anastomoses even on lateral and inferior wall vessels. The totally endoscopic coronary artery bypass represents a further evolution, based on completely endoscopic access, whose clinical use remains limited to a few highly specialized centers, sometimes with robotic support, particularly during conduit harvesting. Overall, minimally invasive coronary surgery represents an evolving field, supported by a growing number of publications and clinical experiences in Europe, North America, and also in Italy, where centers such as the Santa Maria Hospital in Bari perform a significant proportion of minimally invasive revascularizations. According to the available literature, this approach is associated with reduced perioperative complications, shorter hospital stays, and faster return to daily activities, with greater patient acceptance. Thoracoscopy and robotics are promising innovations that may further enhance outcomes, while mini-invasiveness remains the cornerstone of an increasingly central evolution in coronary surgery.
G Ital Cardiol (Rome)
· 2026 Mar · PMID 41738422
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Factor XI (FXI) has emerged as a promising target in the prevention and treatment of venous and arterial thromboembolism in several clinical settings. Its pharmacological inhibition, through small molecules, monoclonal a...Factor XI (FXI) has emerged as a promising target in the prevention and treatment of venous and arterial thromboembolism in several clinical settings. Its pharmacological inhibition, through small molecules, monoclonal antibodies, antisense oligonucleotides and small-interfering RNA, has been developed with the aim of achieving effective anticoagulation while reducing bleeding risk compared to conventional anticoagulants. Phase II studies have explored the role of FXI inhibitors in surgical thromboprophylaxis, in non-valvular atrial fibrillation (AF), and as an adjunctive strategy in acute atherothrombotic settings such as acute coronary syndromes and ischemic stroke. Although preliminary data on these compounds suggest an encouraging safety profile, the available evidence regarding efficacy remains less than convincing. The phase II AZALEA-TIMI 71 trial was terminated early after showing a significant reduction in the incidence of major bleeding with abelacimab compared with rivaroxaban. In contrast, the phase III OCEANIC-AF trial of asundexian was halted due to inferiority versus apixaban. Ongoing trials, such as LILAC-TIMI 76 and LIBREXIA-AF, will be crucial to further clarify the true efficacy and safety profile of this therapeutic class. While FXI inhibitors represent a potential innovation in the treatment of AF, additional evidence is required to clearly and definitively define their role in clinical practice. This review aims to examine the pathophysiological rationale underlying the use of FXI inhibitors, to describe the different molecular subclasses currently under development, and to summarize the results of both completed and ongoing clinical trials of this novel therapeutic class, with the goal of outlining future perspectives for thromboembolic prevention in patients with AF.
Parisi V, Ditaranto R, Pasquale F
… +5 more, Graziosi M, Schiavo MA, Ruotolo I, Natali L, Biagini E
G Ital Cardiol (Rome)
· 2026 Mar · PMID 41738421
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The introduction of non-dilated left ventricular cardiomyopathy (NDLVC) represents one of the key highlights of the 2023 European Society of Cardiology guidelines on cardiomyopathies. NDLVC is defined by the presence of...The introduction of non-dilated left ventricular cardiomyopathy (NDLVC) represents one of the key highlights of the 2023 European Society of Cardiology guidelines on cardiomyopathies. NDLVC is defined by the presence of left ventricular systolic dysfunction in the absence of ventricular dilation and/or non-ischemic myocardial fibrosis detectable by cardiac magnetic resonance. The clinical manifestation may be arrhythmogenic, with a risk of life-threatening ventricular arrhythmias even in patients with preserved ejection fraction. The phenotypic heterogeneity and variability in clinical expression reflect the complex interplay between genetic predisposition (involving variants in genes such as FLNC, DSP, and LMNA) and environmental, epigenetic, or inflammatory factors. A synergistic approach combining comprehensive clinical and family assessment, electrocardiographic and echocardiographic findings, advanced imaging, and genetic testing enables more accurate phenotypic characterization, definitive diagnosis, and consequently, tailored therapeutic strategies.
Mannarini A, Manes MT, Ciliberti G
… +12 more, Pavan D, Khoury G, Aschieri D, Scardovi AB, Bruno N, Cocozza S, Francese M, Bilato C, Geraci G, Colivicchi F, Grimaldi M, Oliva F
G Ital Cardiol (Rome)
· 2026 Mar · PMID 41738420
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Cardiovascular risk estimation in transgender people is an emerging research area with significant clinical implications. Healthcare for transgender people is challenging, as it encompasses the impact of hormone therapie...Cardiovascular risk estimation in transgender people is an emerging research area with significant clinical implications. Healthcare for transgender people is challenging, as it encompasses the impact of hormone therapies, social inequalities, and chronic stress associated with potential discrimination. In fact, these factors may differently influence cardiovascular risk as compared to the cisgender population, although current evidence is still limited. The aim of this paper was to provide an overview of current knowledge about cardiovascular disease in transgender individuals in order to promote an evidence-based approach for this population and, finally, health equality in cardiovascular disease management.