Heart failure, if not treated adequately, worsens over time. New scenarios – WWN

The heart failurea chronic disease on the rise, affecting 15 million people in Europe, over a million of Italians, of which approximately 20 percent are over 80 years old. In our country it is the main cause of hospitalization for the people of age over 65 years.

If not properly treatedheart failure it gets worse over time, with
fatal outcome in 50 percent of patients within five years of diagnosis. To take stock of prevention and new therapies, the cardiologists of ANMCO – National Association of hospital cardiologists organized a national convention «ANMCO 2023 Heart Failure Centers» in Milan on 27 and 28 October.

The illness

Heart failure is caused byinability of the heart to perform its normal contractile pump function and to ensure the correct blood supply for all organs which, therefore, they receive insufficient amounts of oxygen for their metabolic needs leading to a accumulation of fluids in the lungs and tissues.

In the early stage the illness may be asymptomatic and not always easily diagnosable but. as time passes, the symptoms tend to worsen.
It is a particularly complex clinical syndrome that may expose you to an increased risk of arrhythmias
life-threatening and sudden death.

New therapeutic scenarios

The president of ANMCO Fabrizio Oliva, director of Cardiology 1 of the Niguarda Hospital in Milan, explains: «Fortunately, innovation in the medical field is changing the scenario; in recent years the pharmacological therapies and the possibilities of non-pharmacological intervention in these patients with improved prognosis. If you start one therapeutic schemewhich includes i new drugs, after 55 yearsthe patient could be guaranteed, compared to the previous therapy, eight more years of life. After 65 yearsyou could guarantee a difference of 6 more years of life – reports the cardiologist – . In heart failure the concept of “stability” is different from that of “severity”. The patient may be clinically stable, but simultaneously present a high degree of risk of both death and hospitalization; practically there is no such thing as a low-risk patient: we could say that heart failure is a chronically acute pathology.”

Care paths

How to improve the quality of life of people with heart failure? «It is necessary to implement innovative care models that provide the territory is in closer contact with the hospital because, even if the patient requires more hospitalizations over the course of the year, the time he or she will spend at home or in any case in a local care setting will always increase – says Dr. Oliva -. This is why, in addition tooptimization of therapywe have to think aboutorganizational optimization for the inclusion of patients in care pathways in order to improve management and prognosis of these patients, both in terms of hospital admissions and survival.

Imaging techniques

«Another relevant aspect – continues Dr. Oliva – is the definition of the risk of sudden cardiac death in the context of heart failure; in this, the advanced imaging techniquesfirst and foremost in the context ofechocardiography. Furthermore, in recent years other methods have been added to echocardiography which are used more and more frequently in cardiology, such as magnetic resonance imaging. Over the last few years, as part of the therapy for heart failure a number of have become available new pharmacological and non-pharmacological treatments. In the context of trials, some of these therapies have been shown to be able to significantly improve the prognosis of patients but in the real world they remain difficulty in their implementation”.

Telemedicine

«One of the aspects to be implemented in the near future, which will allow bring hospital and territory closer together and the various actors who will be able to guarantee multidisciplinary assistance, is the telemedicine – intervenes the vice-president of ANMCO Alessandro Navazio, director of complex cardiology at the Santa Maria Nuova-IRCCS hospital in Reggio Emilia – . Technology offers us many possibilities for patient care and assistance at home, but we must build organizational models so that the information collected is managed in the best possible way.”

Proximity of care and community homes

Another important aspect is the proximity to care, which should be possible with the birth, in the territory, of Community houses. «We need innovative care models that deliver in closer contact on the territory The family doctor, cardiologist and all other professional figures, including the nurse, to create a “link” and an effective and immediate response for the patient who turns to the National Health Service – underlines Dr. Navazio -. Today there are conditions to guarantee patients with heart failure – and generally with chronic pathologies, often present in the same patient – an aassistance in terms of pharmacological and non-pharmacological therapy which can change the trajectory of the disease, ensuring better survival, reduction in hospitalizations and better quality of life. All this must be supported by innovative care models in which the patient can be taken charge
in a multidisciplinary and personalized way. Mission 6 of the PNRR offers us this opportunity.”