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Copyright of Monaldi Archives for Chest Disease is the property of PAGEPress and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Preventive Cardiology and Cardiac Rehabilitation (CR) is the specialty of clinical cardiology dedicated to the care of post-acute and chronic heart disease patients. The goals are to improve quality of life and prognosis, clinical stability, optimization of pharmacological and non-pharmacologic therapy, management of comorbidities, treatment of disabilities, reinforcement of secondary prevention interventions and adherence to therapy. The global mandate of CR has changed over time. From the acute intervention, we moved on to the care in the medium and long-term period.Despite its clear benefits and guideline recommendations, CR is still not fully considered within the cardiovascular landscape. Furthermore, the importance of CR at the clinical level and of the "health" gain of CR is little known by the beneficiaries themselves, i.e. patients on one side and the health system on the other. The main criticism is the low referral rate of cardiac patients to CR programs. In Italy, in Europe and in the USA it appears to be <30%. The challenge for CR is to work on the changes induced by epidemiology and the healthcare system needs. CR inpatient wards must be increasingly available and organized to acquire complex patients, often elderly and frail, up to the development of sub-intensive rehabilitation therapy units; in Italy, it is also necessary to develop outpatient pathways for patients of moderate-low complexity, in order to increase the referral rate to CR. Finally, integrating CR programs with long-term follow-up pathways of cardiac patients is a very important task, fully entering in the areas of e-Health and m-Health.

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.

Objectives: The population of elderly adults is constantly increasing and age is a strong determinant of the development of chronic diseases, especially cardiovascular diseases; therefore old subjects represent a very high proportion of cardiac patients. Since cardiology is progressively more and more involved in the care of aged patients, a new area of Cardiology has been identified, the Geriatric Cardiology (GC)., Methods: On the other hand, Cardiac Rehabilitation (CR) and GC show a wide overlap, and GC seems to be the application in the aged cardiac patient of the core-components that CR has already tested in younger cardiac patients., Results: Now, CR is probably the cardiological area that seems better equipped, both from a cultural and organizational point of view, to care the aged cardiac patients who are often complex and frail, with multimorbidity, and "frequent users" of the health care services., Conclusions: The CR is therefore a concrete response, already ready and operative, to the demographic expansion of chronicity and aging. Beyond the definitions, CR and GC operate according to principles and methods which are in large part common; thus, CR and GC could merge themselves into a new area of cardiology, the Cardiogeriatric Rehabilitation (CGR)., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. In the present paper, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners equally contributed to the creation of the present document and defined three follow-up strategies and types and timing of clinical and instrumental evaluations in post-PCI patients.

Erectile dysfunction (ED) is a common clinical problem and its prevalence increases in frequency with age. ED is a risk marker for major cardiovascular events independently of other more common risk factors in men with and without known cardiovascular disease. On the basis of the "artery-size hypothesis" patients with cardiovascular disease often report ED before disease detection, in average 3 years. Thus, by an early identification of ED, the cardiol- ogist is given a unique opportunity to better assess the cardiovascular risk of each patient. Although there is a general impression that ED has an important predictive role, its diagnosis in clinical practice is widely suboptimal owing to misconceptions from the side of the patient and a suboptimal management of the personal relationship from the side of the physician. This paper explores the critical connection between ED and cardiovascular disease and evaluates how this association may influence clinical practice.

Unlabelled: The present Italian health planning demands the use of tools, care and treatments useful for the National Health Service, but with empirical effectiveness scientifically sustained. Aim of the present paper is to verify the validity, the reliability and the responsiveness of the factor "Perception of positive change" (named Schedule C) in cardiovascular rehabilitation., Method: The reliability of the Schedule C of the CBA VE has been examined comparing the mean scores obtained from each item at the entry and just before the discharge through the t-Student for paired sample. To assess the concurrent validity we used the AD Short Scale to measure anxiety and depression. 100 patients who underwent cardiac surgery were enrolled during hospitalization for a Cardiac Rehabilitation Programme. Cronbach's alpha was used to assess internal consistency of each item., Results: Each item of the Schedule C demonstrated good internal consistency (Cronbach Alpha > .88) and elevated correlations item-total for each item. The strong correlation of anxiety and depression scores with the Schedule C points out appropriate concurrent validation., Conclusions: We believe that the Schedule C of the CBA VE is endowed with suitable metric validity and then useful as outcome evaluation in cardiovascular rehabilitation settings.

The prevalence and incidence of heart failure are progressively increasing in both Europe and the United States. Despite many advances in diagnosis and therapy, morbidity and mortality remain high and long-term prognosis is still poor in most heart failure patients. The use of implantable devices, cardiac resynchronization therapy and implantable cardioverter-defibrillators plays a pivotal role in the treatment of heart failure. Cardiac resynchronization therapy improves survival and reduces cardiac mortality due to either sudden or non-sudden death. In clinical practice, patients with an indication for cardiac resynchronization therapy should be carefully evaluated in view of a potential concomitant indication for defibrillator implantation. The combination of the two therapies may have maximal beneficial effects on prognosis.

T-wave alternans is a change, in the microvolt range, of T-wave amplitude on an ABABAB sequence. At present, various groups of patients have been evaluated, including those with myocardial infarction, congestive heart failure, implantable cardioverter-defibrillators and a clinical indication for programmed ventricular stimulation. In all clinical conditions analyzed, T-wave alternans analysis demonstrated a good diagnostic accuracy, suggesting a possible clinical use of the test in these settings.

T wave alternans (TWA) is a change, in the microvolt range, of T wave amplitude on ABABAB sequence. TWA depends on heart rate, being optimally analyzed at a target frequency of 110 b/min. Initial studies used atrial pacing to reach the target frequency and reported a sensitivity and specificity of 89% for TWA in predicting tachyarrhythmic events. Subsequently, similar results were obtained using ergometric test to reach the target frequency, a less invasive and more "physiologic" approach to increase heart rate. This method became therefore the elective system to increase heart rate in order to evaluate the presence of TWA by means of spectral analysis. At present, various groups of high arrhythmic risk patients have been evaluated, including those with a recent myocardial infarction, congestive heart failure, implantable cardiac defibrillator and clinical indication to programmed ventricular stimulation. In all clinical conditions analyzed, TWA analysis demonstrated a good diagnostic accuracy, suggesting a possible clinical use of the test in these settings.