[Hypercholesterolemia and laboratory reports: joint document from the Italian Society of Cardiology (SIC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Lab Medicine (SIBioC)]. / Ipercolesterolemia e referti di laboratorio: documento congiunto della Società Italiana di Cardiologia (SIC) e Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica - Medicina di Laboratorio (SIBioC).

Dyslipidemia is one of the most important risk factors for the development of atherosclerotic disease and its control, through well-proven therapies, allows an optimal risk management over time. LDL-cholesterol targets are well defined by international guidelines and based on individual cardiovascular risk. As guidelines evolve, also laboratory reports need to do the same, including lipid reference values by cardiovascular risk classes, to avoid misunderstandings and inappropriate lipid-lowering therapy withdrawal. The aim of the present joint document from the Italian Society of Cardiology (SIC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Lab Medicine (SIBioC) is to analyze the importance of cardiovascular risk estimation, therapeutical targets, and crucial elements about dyslipidemia in laboratory tests, as well as to suggest a shared proposal for the report of lipid profile parameters to be applied to all clinical scenarios of our daily practice.

[Appropriateness of requests for urgent outpatient cardiological services and impact on waiting lists: the experience of the Azienda Socio-Sanitaria Territoriale of the Province of Lodi]. / Appropriatezza delle richieste di prestazioni cardiologiche ambulatoriali urgenti e impatto sulle liste di attesa: l'esperienza dell'Azienda Socio-Sanitaria Territoriale della Provincia di Lodi.

BACKGROUND: The Cardiology Complex Structure of the Azienda Socio Sanitaria Territoriale (ASST) of Lodi, Italy, assists patients with clinical conditions ranging from emergency to chronicity. The model of Homogeneous Waiting Groups should guide the appropriateness of prescriptions categorized as U (urgent), B (brief), D (deferrable), and P (programmable). This study aims to describe and analyze the characteristics of prescription and delivery of clinical and instrumental cardiology outpatient services with U and B priority during the November 2023-January 2024 quarter, paying particular attention to the clinical appropriateness of prescribing. METHODS: A prospective observational study was conducted. Computerized data were anonymously extracted from the company's Management Control and provided with the authorization of the Data Protection Officer. RESULTS: During the observed quarter, the Cardiology Complex Structure provided 7379 services for outpatients. Out of 123 U services, 94 (76.4%) were managed through SBC (Single Booking Center) and 29 (23.6%) were managed outside the SBC. From 529 services with B priority, 504 (95%) were managed through SBC and 25 (5%) outside the SBC. Requests with U priority mainly referred to ECG (n = 50; 40.6%) and first cardiological visit (n = 46; 37.4%). Fifty percent of U and B requests were prescribed by 4% and 8% of general practitioners, respectively. The prescribed priority was correct for 13% of requests (n = 64). CONCLUSIONS: This study shows a vastly inappropriate use of resources allocated to urgent outpatient cardiological services. Actions aimed at promoting the adherence to the Homogeneous Waiting Groups Manual and enhancing telemedicine services, currently limited to heart failure, are necessary for resource optimization in cardiology within the ASST of Lodi.

Scientific statement from the French neurovascular and cardiac societies for improved detection of atrial fibrillation after ischaemic stroke and transient ischaemic attack.

Atrial fibrillation (AF) is the primary cause of ischaemic stroke and transient ischaemic attack (TIA). AF is associated with a high risk of recurrence, which can be reduced using optimal prevention strategies, mainly anticoagulant therapy. The availability of effective prophylaxis justifies the need for a significant, coordinated and thorough transdisciplinary effort to screen for AF associated with stroke. A recent French national survey, initiated and supported by the Société française neurovasculaire (SFNV) and the Société française de cardiologie (SFC), revealed many shortcomings, such as the absence or inadequacy of telemetry equipment in more than half of stroke units, insufficient and highly variable access to monitoring tools, delays in performing screening tests, heterogeneous access to advanced or connected ambulatory monitoring techniques, and a lack of dedicated human resources. The present scientific document has been prepared on the initiative of the SFNV and the SFC with the aim of helping to address the current shortcomings and gaps, to promote efficient and cost-effective AF detection, and to improve and, where possible, homogenize the quality of practice in AF screening among stroke units and outpatient post-stroke care networks. The working group, composed of cardiologists and vascular neurologists who are experts in the field and are nominated by their peers, reviewed the literature to propose statements, which were discussed in successive cycles, and maintained, either by consensus or by vote, as appropriate. The text was then submitted to the SFNV and SFC board members for review. This scientific statement document argues for the widespread development of patient pathways to enable the most efficient AF screening after stroke. This assessment should be carried out by a multidisciplinary team, including expert cardiologists and vascular neurologists.

Conflicts of interest in clinical practice: lessons learned from cardiovascular medicine.

Cardiovascular diseases represent a major burden worldwide, and clinical trials are critical to define treatment improvements. Since various conflicts of interest (COIs) may influence trials at multiple levels, cardiovascular research represents a paradigmatic example to analyze their effects and manage them effectively to re-establish the centrality of evidence-based medicine.Despite the manifest role of industry, COIs may differently affect both sponsored and non-sponsored studies in many ways. COIs influence may start from the research question, data collection and adjudication, up to result reporting, including the spin phenomenon. Outcomes and endpoints (especially composite) choice and definitions also represent potential sources for COIs interference. Since large randomized controlled trials significantly influence international guidelines, thus impacting also clinical practice, their critical assessment for COIs is mandatory. Despite specific protocols aimed to mitigate COI influence, even scientific societies and guideline panels may not be totally free from COIs, negatively affecting their accountability and trustworthiness.Shared rules, awareness of COI mechanisms and transparency with external data access may help promoting evidence-based research and mitigate COIs impact. Managing COIs effectively should preserve public trust in the cardiovascular profession without compromising the positive relationships between investigators and industry.

[Legal aspects in digital cardiology]. / Rechtliche Aspekte in der digitalen Kardiologie.

Digital assistants have become an indispensable tool in modern cardiology. The associated technological progress offers a significant potential to increase the efficiency of medical processes, enable more precise diagnoses in a shorter time, and thus improve patient care. However, the integration of digital assistants into clinical cardiology also raises new challenges and questions, particularly regarding the handling of legal issues. This review article aims to raise awareness of individual legal issues resulting from the use of digital technologies in cardiology. The focus is on how to deal with various legal challenges that cardiologists face, including issues related to treatment freedom, professional confidentiality and data protection. The integration of digital assistants in cardiology leads to a noticeable improvement in efficiency and quality of patient care, but at the same time, it involves a variety of legal challenges that need to be carefully addressed.

Work Environment, Burnout, and Intent to Leave Current Job Among Cardiologists and Cardiology Health Care Workers: Results From the National Coping With COVID Survey.

BACKGROUND: Little is known about factors contributing to burnout and intent to leave in cardiologists and other cardiology health care workers. METHODS AND RESULTS: The Coping With COVID survey assessed work conditions, burnout, and intent to leave among physicians, nurses, advanced practice providers, and other clinical staff (OCS) from April 2020 to December 2020. Single-item measures assessed work conditions, burnout (emotional exhaustion), and intent to leave. Multilevel logistic regression examined work life variables' relationships to burnout among role types and feeling valued as a mediator. Open-ended comments analyzed via grounded theory contributed to a conceptual model. Coping With COVID was completed by 1199 US cardiology health care workers (354 physician/520 nurses/198 advanced practice providers/127 OCS). Nurses were most likely to report burnout (59% nurses, 57% OCS, 46% advanced practice providers, 40% physicians, P<0.0001). Workload correlated with burnout in all groups (adjusted odds ratios [aORs], 4.1-17.4; Ps<0.005), whereas anxiety/depression related to burnout in all except OCS (aORs, 3.9-8.3; Ps≤0.001). Feeling valued was related to lower burnout in most groups. Intent to leave was common (23%-45%) and was lower in physicians and advanced practice providers who felt valued (aORs, 0.26 and 0.22, respectively; Ps<0.05). Burnout was highest for nurses in practice 16 to 20 years, and intent to leave was highest for OCS in practice 16 to 20 years. Themes contributing to burnout included personal and patient safety, leadership, and financial issues. CONCLUSIONS: Burnout was prevalent among cardiology health care workers and highest in nurses and OCS. Addressing factors associated with burnout in different role types may improve work life sustainability for all cardiology health care workers.