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Our review specifically focuses on virtual visit (televisit) in cardiology. Telemedicine comes as a response to the challenge caused by the COVID-19 pandemic. Among the many possibilities offered by telemedicine, one is the videoconference modality which consists of an online consultation, where a live interaction is created in real time through a video call system: recent studies confirm the rapid increase in video consultations during the pandemic. Despite the ongoing debate around the effectiveness of telemedicine in cardiology, the COVID-19 pandemic has made it necessary to move more or less immediately towards remote modalities to guarantee the continuation of care for cardiological patients. The transition generated many important questions about quality of care and patient and medical use. Most patients would benefit from virtual visit, as its implementation has shown similar results to face-to-face consultation, improving patient health and satisfaction, and improving access to health services. Virtual visit programming and regulation will be required, with a homogeneous system of platforms within which the services will operate, integrated with the "normal" diagnosis and therapy paths. Virtual visit must be an ordinary way of providing services and not an exception. Finally, the use of digital systems cannot be limited to the experienced citizen, but must be adapted to the skills of younger and less competent patients.

Lifestyle is a cornerstone of cardiovascular prevention and the process of risk communication constitutes an important step to obtain favorable changes in daily habits. Nevertheless, there is no definite consensus on how health operators should provide information on cardiovascular risk, and several models have been proposed in different settings. The current COVID-19 pandemic - with related communication strategies to reduce the spread of the disease and morbidity - may offer an interesting opportunity to reconsider communication in cardiovascular prevention: even though cardiovascular conditions are not communicable diseases, both COVID-19 and cardiac illnesses force a huge segment of the population to major lifestyle changes. This narrative commentary describes similarities between these conditions, mainly focusing on modalities of risk communication, strategies to counteract fake news, actions to enhance the expertise of health operators, and finally on new skills that could derive as a lesson from COVID-19.

Treatment adherence is a key element for (i) improving prognosis in cardiovascular and/or high-risk patients, (ii) reducing the burden of morbidity and mortality associated with cardiovascular disease at a population level, and (iii) decreasing costs due to rehospitalizations.Promotion of adherence should embrace all pharmacological and non-pharmacological interventions in cardiovascular prevention, including lifestyle and behavioral changes. In this perspective, cardiac prevention and rehabilitation programs are the most appropriate and cost-effective setting for delivering structured and multi-component interventions on patient's adherence. In this expert opinion document authored by the Italian Association for Cardiovascular Prevention and Rehabilitation, a modern reappraisal of the adherence issue is provided, together with simple, practical, and feasible suggestions to achieve this goal in the real life as well.

Cardiac rehabilitation (CR) represents a cardiology subspecialty that is devoted to the care of cardiac patients, early and long term after an acute event. CR aims at improving both quality of life and prognosis through risk and prognostic stratification, clinical stabilization and optimization of therapy, management of comorbidities, treatment of disability, and the provision of sustained long-term preventive and rehabilitative services.The mission of CR has changed over time. From being centred on the acute phase, health care of cardiac patients is increasingly involving the long-term chronic phase. The aim of the present position paper is to provide the state of the art of CR in Italy, discussing strengths and weaknesses as well as future perspectives.

Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to "gain health" through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation.

Effective implementation of change in patients' care is a substantive problem. Organizational learning is viewed as process of seeking, selecting, and adapting new "routines" to improve performance but learning from experience is not automatic, but rather may result from action and reflection within the organization.

An Acute Coronary Syndrome is a fine example of the communicative difficulties that precede and characterize hospital discharge. In recent years, due to the rapid changes in therapeutic approaches, hospitalizations have become extremely brief. This entails the risk of inadequate information at discharge, significantly affecting the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. There are a series of issues that the health practitioner should cover at discharge with the patient and family members: history of disease and prognosis, risk factors and strategies for their control, aims of treatment, instructions on drugs, diet and physical activity, need for medical check-up; and, last but not least, to verify that the information has been understood. Information on drug treatment is all too often left to patient's interpretation of hearsay or of the discharge letter, the new drug regime can easily be misunderstood or arbitrarily integrated into pre-existing drug regimes. Health practitioners must discuss issues, regardless of whether they are asked direct questions; and they should verify what imparted information has been correctly understood and assimilated. A rapid turn-over is crucial to the organization of acute units, therefore we need to identify a solution that ticks all the boxes of a good discharge in a reasonably brief time. Imparting information should be an integral component of care delivery, and the responsible practitioners (doctors and/or nurses) should be identified. We propose a standardized discharge form, containing the essential information, as a point of reference to be applied in different clinical settings.

Hospital discharge after an Acute Coronary Syndrome represents a potential pitfall for patients. Strict adherence to discharge instructions is sometimes essential for recovery and prevention of complications and patients' knowledge of diagnosis and treatment plan is an integral component of patient education. Discharge communication is an integral part of high-quality, patient-centered care but patients leaving hospital often fail to understand important elements of their discharge and home care plan. This paper describes the existing literature on patient understanding and implementation of discharge instructions, discusses previous interventions aimed at improving the discharge process, and recommends best practices.

Health behaviours, physician-patient communication and health outcomes are all influenced by the individual's perception of illness, which in turn is significantly influenced by one's cultural background. The nature of communication between people from different cultural groups is a complex phenomenon: communication even in a shared language can be hindered by the ambiguity of words that carry multiple meanings. Creating an environment of cultural awareness and sensitivity which respects the different values and beliefs of individuals is a first step in resolving this problem. Health education programs must take into account the subjective experience of illness, and on this basis promote collaboration with the patient, so improving not only the clinical outcome but also the patient's perceived satisfaction. Despite the current, general trend to promote the need for training of health professionals to give sensitive, empathetic patient care that guarantees full respect for the individual's autonomy, there are few empirical data available on the link between specific cultural skills and improved health care.

The development and the role of cardiac rehabilitation in healthcare programs related to cardiovascular diseases has led to the growth of knowledge, experience and specific technical, scientific, organizational and cultural skills on the part of the different health professionals engaged with the cardiologist in the management of rehabilitation programs. The need to define the characteristics of the psychological intervention in cardiac rehabilitation programs on the basis of scientific evidence encouraged the Board of the Italian Group of Cardiac Rehabilitation and Prevention [Gruppo Italiano di Cardiologia Riabilitativa e Preventiva (GICR)] to set up a working group (WG), composed of psychologists chosen on the basis of their proven specific experience in clinical research, with the task of defining the state-of-the-art of the psychological intervention in cardiac rehabilitation on the basis of documented efficacy, as a first step to formulating Guidelines on Psychological Intervention in Cardiac Rehabilitation. The methodology adopted by the WG was in line with the recommendations of the National Guidelines Program of the Italian Ministry of Health; the WG chose, in addition, to exploit a detailed critical review of clinical psychology practice in order to provide systematic evidence for recommendations and clinical approaches at present supported only by expert opinion. The document, which represents the basis upon which the Guidelines on the psychological activity in cardiac rehabilitation will be drawn up, is subdivided into three parts: an introduction, the main body of the text, and some appendices. In the introduction, the theme and context of the Guidelines are defined, preceded by a series of notes and user instructions; also defined in this section are the intended audience. The main body of the document is structured on the basis of the steps that characterize the interactions between the patient suffering from heart disease and the psychologist, through a qualitative analysis of the intervention offered by the psychologist. The phases of this process have been schematized as follows: selection, entry, evaluation, intervention, follow-up. For each of these phases, the evidence is given in support of the evaluative and therapeutic tools at the psychologist's disposition in the context of cardiac rehabilitation. The appendices to the document contain syntheses of the scientific information, some tables, a glossary and a section providing more in-depth information on specific topics. The recommendations contained in the document elaborated by the WG were formulated on the basis of a systematic review of the evidence available in the Italian and international literature, codified according to the National Guidelines Program. Also included is a series of recommendations or working instructions based on the shared clinical experience of the members of the WG. The state of progress of the work of formulating the Guidelines, the objectives, the methodological premises and the deadlines set for the phases of development, diffusion and implementation were presented at the VI National Congress of the GICR which was held in Cosenza, 3-5 October 2002. The base-draft of the document was submitted to the Scientific Committee of Reviewers. In October 2002 the Executive Committee of the GICR announced to the National Guidelines Program of the Ministry of Health, in the persons of the Presidents of the Advanced Institute of Health and of the Regional Health Services Agency, the planning and the timetable for the formulation of the Guidelines. In the course of the first 4 months of 2003 the document produced will be discussed and reviewed jointly by the WG, the Cardiologic Scientific Board instituted by the GICR enlarged to include a delegate of the patient and volunteer no-profit worker associations. The following phases will include the publication by mid 2003 of a position-paper. The final draft of the Guidelines on Psychological Intervention in Cardiac Rehabilitation will be submitted to the Commission of the National Guidelines Program.