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BackgroundThe aim of this study was to assess by a census supported by the Italian Society of Cardiology (Società Italiana di Cardiologia, SIC) the present implementation of telemedicine in the field of cardiovascular disease in Italy.MethodsA dedicated questionnaire was sent by email to all the members of the SIC: data on telemedicine providers, service provided, reimbursement, funding and organisational solutions were collected and analysed.ResultsReported telemedicine activities were mostly stable and public hospital based, focused on acute cardiovascular disease and prehospital triage of suspected acute myocardial infarction (prehospital ECG, always interpreted by a cardiologist and not automatically reported by computerised algorithms). Private companies delivering telemedicine services in cardiology (ECGs, ambulatory ECG monitoring) were also present. In 16% of cases, ECGs were also delivered through pharmacies or general practitioners. ICD/CRT-D remote control was performed in 42% of cases, heart failure patient remote monitoring in 37% (21% vital parameters monitoring, 32% nurse telephone monitoring). Telemedicine service was public in 74% of cases, paid by the patient in 26%. About half of telemedicine service received no funding, 17% received State and/or European Union funding.ConclusionsSeveral telemedicine activities have been reported for the management of acute and chronic cardiovascular disease in Italy. The whole continuum of cardiovascular disease is covered by telemedicine solutions. A periodic census may be useful to assess the implementation of guidelines recommendations on telemedicine.

Endoscopic Submucosal Dissection (ESD) is a technique developed in Japan for "en bloc" resection of larger superficial neoplasms of the gastrointestinal tract as an alternative to the traditional Endoscopic Mucosal Resection (EMR), with removal of the lesion in multiple fragments ("piecemeal"). ESD offers a lower recurrence rate and allows a more accurate histopathological examination. This procedure is however considered technically difficult and therefore requires an adequate learning curve, it is time consuming with more discomfort for the patient, it has a higher complication rate, it is more expensive. To overcome these disadvantages, in the Western countries a hybrid technique called Circumferential Submucosal Incision - Endoscopic Mucosal Resection (CSI-EMR) has been developed and is especially employed for colonic lesions. This article analyzes retrospectively the results obtained in a single centre by a single operator in the treatment of 23 patients (12 men and 11 women, average age 65,6 years), all suffering from superficial, larger than ≥ 20 mm colorectal neoplasms: 9 were treated with ESD for rectal lesions and 14 were treated with CSI-EMR for colonic lesions. Findings show a technical success rate of 66,6% for ESD and 78,5% for CSI-EM, and a 0% recurrence rate during follow-up, 4,3% bleeding and 13% perforation complications. The histology of the removed lesions showed 13 (56,5%) low grade dysplasia adenomas, 8 (34,7%) high grade dysplasia adenomas, one grade 1 sigmoid colon adenocarcinoma infiltrating the submucosal layer without lymphovascular invasion, with free margins (R0), treated conservatively, and one grade 1 cecum adenocarcinoma, infiltrating the submucosal layer, with lymphovascular invasion and involved excision margin, treated surgically with no residual neoplastic disease in the surgical specimen. These data are in line with the most significant ones in literature, except for the higher complication rate, which the authors ascribe to the "learning curve" and the smaller number of treated patients.

Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease.

Patients with heart failure (HF) have reduced exercise capacity. The beneficial effect of beta-blocker on prognosis is not matched by an impact on exercise capacity and quality of life. We performed a randomised open blinded endpoint study to assess the effect of heart rate reduction with carvedilol, ivabradine, and their combination on exercise capacity in HF patients receiving maximal dose of ACE inhibitor.After a run-in phase patients were randomly allocated to 3 groups: carvedilol up to 25mg bid (n=38); ivabradine up to 7.5mg bid (n=41); and carvedilol/ivabradine up to 12.5/7.5mg bid (n=42). The maximal dose of study treatment was more frequently tolerated in patients receiving ivabradine (36/41) than in those receiving carvedilol (18/38) or combination therapy (32/42) (P0.01 ivabradine versus carvedilol). Heart rate was reduced in all three groups, but to a greater extent by the combination. The distance walked on the 6-min walking test and the exercise time on MVO(2) test significantly improved in the ivabradine and combination groups (both P0.01 versus baseline), as did peak VO(2) and VAT (P0.01 for ivabradine and P0.03 for combination versus carvedilol, respectively). No changes in these parameters were found with carvedilol. The patients receiving ivabradine or the combination had better quality of life (P0.01 versus baseline for ivabradine and P0.02 for combination), versus no change with carvedilol.Ivabradine alone or in combination with carvedilol is more effective than carvedilol alone at improving exercise tolerance and quality of life in HF patients.

Exercise Capacity is the expression of the cardiovascular and of metabolic organic efficiency and represents a important prognostic marker. The Six Minute Walking Test is adopted in the practice for exercise capacity evaluation in the normal subject as in pneumologic or cardiac rehabilitation programs, and in both pediatric and elderly ages. The aim of the work is to present a practical summary of the application of the six minutes walking test, according to the American Thoracic Society statement. We reviewed the various experiences of its application, and reported the indications, clinical interpretation parameters, relationship and correlation between functional and clinical parameters (hospitalization, quality of life, therapy and exercise control response and compliance), the basic and advanced protocol, the application modality, the reporting models, and the educational checklist.

OBJECTIVES Changing lifestyles and monitoring risk factors are two of the goals of secondary prevention programmes. To do this, it is necessary to investigate the level of patient's awareness regarding such factors. The purpose of this study was to investigate which factors the patients attribute as the cause of their ischemic disease and the level of their awareness. MATERIALS AND METHODS One hundred and fifty-one patients from the Cardiology Rehabilitation Ward, who had undergone coronary bypass surgery, were enlisted (average age: 63.25 +/- 9.01 years; 85.4% men). During the psychological clinical interview, they were asked about the cause of their own coronary disease; their answers were then compared to the risk factors really present, to evaluate the index of awareness. RESULTS The factors mainly indicated as linked to coronopathy are stress, smoking habits, dyslipidemia, and unbalanced eating habits ( 32, 30, 23, and 21%, respectively). The spontaneous indication of each of these factors was present only in individuals with the mentioned risk factors, and it varied on the basis of some sociological variables (chi, P < 0.05). CONCLUSION Interventions of cardiovascular education must consider the personal data of the recipient individuals to increase the efficacy through the selection of targeted strategies.