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1. Practice Recommendations for the Management of MASLD in Primary Care: Consensus Results

Author

Christos Lionis, Sophia Papadakis, Marilena Anastasaki, Eftihis Aligizakis, Foteini Anastasiou, Sven Francque, Irini Gergianaki, Juan Manuel Mendive, Maria Marketou, Jean Muris, Spilios Manolakopoulos, Georgios Papatheodoridis, Dimitrios Samonakis, Emmanouil Symvoulakis, and Ioanna Tsiligianni

Subjects
non-alcoholic fatty liver disease, metabolic dysfunction-associated steatotic liver disease, primary care, consensus, Europe, recommendations, Medicine
Abstract

Background: Despite its high prevalence and impact on health, metabolic dysfunction-associated steatotic liver disease (MASLD) is inadequately addressed in European primary care (PC), with a large proportion of cases going undiagnosed or diagnosed too late. A multi-country European research consortium led a project to design and evaluate a patient-centered, integrated model for MASLD screening, diagnosis, and linkage to specialty care for European PC settings. Based on the lessons from this project, the latest research evidence, and existing guidelines for the management of MASLD, we sought to develop a set of practice recommendations for screening, referral, and management of MASLD in PC. Methods: The Rand/UCLA modified Delphi panel method, with two rounds, was used to reach consensus on practice recommendations. The international panel consisted of experts from six countries, representing family medicine, gastroenterology, hepatology, cardiology, and public health. Initially, fifteen statements were drafted based on a synthesis of evidence from the literature and earlier findings from our consortium. Prior to the consensus meeting, the statements were rated by the experts in the first round. Then, in a hybrid meeting, the experts discussed findings from round one, adjusted the statements, and reassessed the updated recommendations in a second round. Results: In round one, there was already a high level of consensus on 10 out of 15 statements. After round 2, there were fourteen statements with a high degree of agreement (>90%). One statement was not endorsed. The approved recommendations addressed the following practice areas: risk screening and diagnosis, management of MASLD–lifestyle interventions, pharmacological treatment of MASLD/MASH, pharmacological treatment for co-morbidity, integrated care, surgical management, and other referrals to specialists. Conclusions: The final set of 14 recommendations focuses on increasing comprehensive care for MASLD in PC. The recommendations provide practical evidence-based guidance tailored to PC practitioners. We expect that these recommendations will contribute to the ongoing discussion on systematic approaches to tackling MASLD and supporting European PC providers by integrating the latest evidence into practice.

Published
2024
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2. The early effect of dapagliflozin on strain and tissue Doppler parameters of diastolic function in diabetic patients with heart failure with reduced ejection fraction

Author

Labrini Tsigkriki, Fragkiskos Parthenakis, Vasiliki Katsi, Alexandros P. Patrianakos, Maria Mamaloukaki, Spyridon Maragkoudakis, George E. Kochiadakis, Kostas Tsioufis, and Maria Marketou

Subjects
medicine.medical_specialty, Ejection fraction, strain and tissue Doppler parameters, business.industry, diastolic function, Diastole, General Medicine, dapagliflozin, medicine.disease, Sacubitril, chemistry.chemical_compound, chemistry, Valsartan, Clinical Research, Internal medicine, Heart failure, Cardiology, Medicine, Enalapril, Dapagliflozin, business, Prospective cohort study, medicine.drug
Abstract

IntroductionHeart failure (HF) with reduced ejection fraction (HFrEF) remains a challenging problem due to its high mortality rate. The PARADIGM HF trial and a new class of drugs – angiotensin receptor–neprilysin inhibitors (ARNIs) – managed to change the current perception of HF treatment by reducing cardiovascular mortality and morbidity as well as HF hospitalizations compared with enalapril and have emerged as an evidence-based therapy for HFrEF. Another novelty in HF therapy is dapagliflozin, a sodium-glucose transporter-2 inhibitor (SGLT2i) which decreased the rates of cardiac death and worsening of HF in the DAPA-HF trial, when added in other guideline recommended therapy. A recent study evaluated the potency of dapagliflozin in terms of mortality and deterioration of HF, in patients taking sacubitril/valsartan and in patients who were naive.Material and methodsA prospective cohort study of 30 symptomatic HF patients with EF < 35% (aged 65 ±10 years) was conducted. Diabetic (2TDM) patients of NYHA status II–III, previously treated with ARNI, -blocker, and mineralocorticoid receptor antagonists (MRA) were included. Dapagliflozin was added to their therapy.ResultsEchocardiographic evaluation revealed improvement of both conventional tissue Doppler and diastolic strain parameters by dapagliflozin addition on HF therapy.ConclusionsDapagliflozin impact on diastolic function may explain the symptom amelioration and the improvement of quality of life. And more specifically, the ratio of early diastolic transmitral flow velocity to global strain rate at the early filling phase of diastole (E/SRE)may be considered a reliable index of HF therapy responders.

Published
2021

3. The cardiovascular burden of light smoking

Author

Charalambos Vlachopoulos, Konstantinos Tsioufis, Nikolaos Ioakeimidis, Spyridon Maragkoudakis, Maria Marketou, Vasiliki Katsi, and Fragkiskos Parthenakis

Subjects
cardiovascular risk, Smoke, business.industry, light smoking, General Medicine, Nicotine, Cigarette smoking, cardiovascular disease, Environmental health, Medicine, Risk factor, business, State of the Art Paper, medicine.drug
Abstract

The assumption that light cigarette smoking, meaning smoking one to five cigarettes per day, is not so harmful has been dissipated by several studies. Regardless of the quantity of tobacco cigarettes, smoking remains a leading risk factor for the development and progression of cardiovascular diseases. Smoke is a mixture of several toxic chemicals, such as nicotine, carbon monoxide, and oxidants, implicated in the pathogenesis of cardiovascular and pulmonary diseases. Despite anti-smoking campaigns, a misconception concerning “safe smoking” still exists. The purpose of this literature review is to highlight the deleterious effect of light cigarette smoking and claim the consensus that there is no safe smoking.

Published
2021
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4. Distribution, infrastructure, and expertise of heart failure and cardio‐oncology clinics in a developing network: temporal evolution and challenges during the coronavirus disease 2019 pandemic

Author

Theodoros D. Karamitsos, Vassilios Vassilikos, Ioannis Tsounos, Dimitrios Christakos, Alexandra Frogoudaki, Antonis Sideris, Athanasios Anadiotis, Nikoleta Baka, Christina Chrysohoou, Vasileios Sousonis, Filippos Triposkiadis, Vasiliki Dimitroula, Tsampikos Giakoumakis, Panagiotis Kliridis, Konstantina Toli, Ilias Sichlimiris, Nikolaos Karamichalakis, Georgios Almpanis, John Parissis, Anastasia Kitsiou, Peggy Kostakou, George Hahalis, Georgios Chalikias, Katerina Avgeropoulou, Lina Zitiridou, Stauroula Kosmopoulou, Efstratios Theofilogiannakos, John Christodoulou, Evangelos Sdogkos, Elias Tsougos, Apostolos Karavidas, Maria Georgopoulou, Georgios Spyropoulos, Eftychios Siniorakis, Argyrios Ntalianis, Christoforos Olympios, Christos Katsikas, Stylianos Lampropoulos, Maria Nikolaou, Petros Stravopodis, Pavlos Stougiannos, Gerasimos Filippatos, Konstantinos Tsioufis, Maria Sifaki, Konstantinos Tsatiris, Kalliopi Keramida, Konstantinos Kyrlas, Dimosthenis Drosos, Grigorios Oikonomou, Katerina Fountoulaki, Georgios Kalogiannis, Gerasimos Gavrielatos, Constantinos Bakogiannis, Alexandros Katranis, Dimitrios Farmakis, Sotirios Xydonas, Niki Vlassopoulou, Maria Marketou, Anna Kotsia, Chris Adamopoulos, Nikolaos Kouvelas, Anastasios Theodosis‐Georgilas, Vassilios Giannaris, Maria Bonou, Maria Thodi, Michael Bonios, Soultana Bakaimi, Dimitrios Chrissos, Gregory Giamouzis, Spyridon Maragkoudakis, Evangelos Pisimisis, Nikolaos Kampouridis, Paraskevi Ntoliou, Theodore Bischiniotis, Petros Voutas, Ioannis Kanonidis, Katerina K. Naka, Chris Kapelios, Helena Michalopoulou, Athanasios Trikas, Christos Chatzieleftheriou, Elias Andreanides, Vasiliki Matzaraki, Ioannis Alexanian, Athanasios Vasilopoulos, Emmanouil Lamprogiannakis, Alaa Aboushamala, Eftychia Polyzogopoulou, Panagiotis Koudounis, Eleni Karapatsoudi, Vasiliki Bistola, Eftychia Chamodraka, Antonios Marsonis, Adina Thomaidi, John Zarifis, Gerasimos Siasos, Ioannis Kogias, Athanasios Manginas, Anastastios Spanos, Paraskevi Veneti, Konstantinos Polymeropoulos, Lilika Pappa, Ioannis Mantas, Athanasios Kranidis, E. Leontiadis, Dimitrios Karatzas, Minas Pappas, Sotirios Patsilinakos, Konstantinos Tsitlakidis, Georgios Tsinopoulos, Metaxia Driva, Costas H. Papadopoulos, Konstantina Katsanou, Angeliki Gkouziouta, Stefanos Papastefanou, Alexia Stavrati, Antonios Draganigos, Anastasia Stella Perpinia, Alexandros Douras, Aris Bechlioulis, Nikos Kouris, Georgios Soufras, Georgios Spyromitros, Eleni Angelopoulou, Spyridon Papamentzelopoulos, Evangelos Lazaris, Dionysios Kalpakos, George Giannakoulas, Fragkiskos Parthenakis, Georgios Katsimagklis, Ioannis Paraskevaidis, Dimitrios Tziakas, and Stamatios Adamopoulos

Subjects
medicine.medical_specialty, Cardiac Care Facilities, Coronavirus disease 2019 (COVID-19), National network, Short Communication, Short Communications, Cancer Care Facilities, Cardio‐oncology clinic, Heart Neoplasms, COVID‐19, Surveys and Questionnaires, Pandemic, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, Distribution (pharmacology), Cardio oncology, Intensive care medicine, Heart failure clinic, Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), Heart Failure, Infection Control, business.industry, COVID-19, medicine.disease, Telemedicine, RC666-701, Heart failure, Cardiology and Cardiovascular Medicine, business, Delivery of Health Care
Abstract

The Hellenic Heart Failure Association has undertaken the initiative to develop a national network of heart failure clinics (HFCs) and cardio‐oncology clinics (COCs). We conducted two questionnaire surveys among these clinics within 17 months and another during the coronavirus disease 2019 outbreak to assess adjustments of the developing network to the pandemic. Out of 68 HFCs comprising the network, 52 participated in the first survey and 55 in the second survey. The median number of patients assessed per week is 10. Changes in engaged personnel were encountered between the two surveys, along with increasing use of advanced echocardiographic techniques (23.1% in 2018 vs. 34.5% in 2020). Drawbacks were encountered, concerning magnetic resonance imaging and ergospirometry use (being available in 14.6% and 29% of HFCs, respectively), exercise rehabilitation programmes (applied only in 5.5%), and telemedicine applications (used in 16.4%). There are 13 COCs in the country with nine of them in the capital region; the median number of patients being assessed per week is 10. Platforms for virtual consultations and video calls are used in 38.5%. Coronavirus disease 2019 outbreak affected provision of HFC services dramatically as only 18.5% continued to function regularly, imposing hurdles that need to be addressed, at least temporarily, possibly by alternative methods of follow‐up such as remote consultation. The function of COCs, in contrast, seemed to be much less affected during the pandemic (77% of them continued to follow up their patients). This staged, survey‐based procedure may serve as a blueprint to help building national HFC/COC networks and provides the means to address changes during healthcare crises.

Published
2020
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5. How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association

Author

Stamatios Adamopoulos, Ilias Sichlimiris, Eftychios Siniorakis, Dimitrios Chrysos, Michael Bonios, Nikolaos Kouvelas, Alexandra Frogoudaki, Konstantinos Kyrlas, Spyridon Maragkoudakis, Evangelos Pisimisis, Konstantina Toli, Georgios Katsimagklis, Ioannis Mantas, Charalampos Karvounis, Grigorios Oikonomou, Sotirios Floros, Georgios Kalogiannis, Niki Vlasopoulou, Eftratios Apostolou, Chrysoula Nikolaou, Anastasios Spanos, Kontantina Katsanou, Maria Thodi, Ioannis Paraskevaidis, John Parissis, Anastasios Theodosis‐Georgilas, Dimitrios Tziakas, Anastasia Kitsiou, George Hahalis, Eleni Karapatsoudi, Athanasios Anadiotis, Minas Pappas, Vassilios Giannaris, Angeliki Gkouziouta, Eftychia Chamodraka, Konstantinos Sassalos, E. Leontiadis, Konstantinos Tsitlakidis, Georgios Tsinopoulos, Katerina Avgeropoulou, Elefthereos Thireos, Vasiliki Bistola, Maria Marketou, Paraskevi Ntoliou, Peggy Kostakou, Theodoros G. Papaioannou, Georgios Spyropoulos, Konstantinos Polymeropoulos, Emmanouil Lamprogiannakis, Fragkiskos Parthenakis, Efstratios Theofilogiannakos, Vasiliki Panagopoulou, Sotirios Patsilinakos, Dimosthenis Drosos, Filippos Triposkiadis, Niki Mpaka, Costas H. Papadopoulos, Gregory Giamouzis, Christos Katsikas, Takis Xydas, Stauroula Kosmopoulou, Chris Adamopoulos, Georgios Papingiotis, Gerasimos Gavrielatos, Alexandros Douras, Petros Kikas, Alaa Ampoushamala, Stylianos Lampropoulos, Dimitrios Konstantinou, Elias Tsougos, Spyridon Papamentzelopoulos, Alexandros Katranis, John Christodoulou, Athanasios Manginas, Demitrios Karounis, Katerina K. Naka, Maria Nikolaou, Kalliopi Keramida, Vasiliki Matzaraki, Nikolaos Kampouridis, Lina Zitiridou, Evangelos Lazaris, Pavlos Stougiannos, Antonis Sideris, Soultana Bakaimi, Petros Voutas, Ioannis Kanonidis, Christina Chrysohoou, Ioannis Alexanian, Elias Andreanides, Spyridon Papaioannou, Ekaterini Lambrinou, Maria Sifaki, John Zarifis, Petros Stravopodis, Georgios Bakosis, Athanasios Kranidis, Panagiota Naoum, Athanasios Vasilopoulos, Ioannis Kogias, Constantinos Bakogiannis, Gerasimos Siasos, Evangelos Sdogkos, Apostolos Karavidas, Athanasios Trikas, Dimitrios Karatzas, Panagiotis Stafylas, Panagiotis Koudounis, Antonios Marsonis, Polixeni Brika, Nikolaos Karamichalakis, Georgios Almpanis, Konstantinos Tsioufis, Periklis Syros, Nikos Kouris, Elias Gialafos, Gerasimos Filippatos, Eleni Bousoula, Katerina Fountoulaki, Tsampikos Giakoumakis, Sotirios Xydonas, Dionysios Kalpakos, Metaxia Driva, Maria Georgopoulou, John Nanas, Vassilios Vassilikos, Georgios Spyromitros, George Giannakoulas, Ioannis Tsounos, Dimitrios Farmakis, Alexia Stavrati, Antonios Draganigos, Georgios Nikitas, Argyrios Ntalianis, Christoforos Olympios, and Maria Bonou

Subjects
Heart Failure, Heart failure clinics, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Consensus, business.industry, Association (object-oriented programming), Heart failure, Review, Electronic health care record, Multidisciplinary team, medicine.disease, Medical and Health Sciences, Heart failure network, Discharge letter, lcsh:RC666-701, Emergency medicine, medicine, Humans, Clinical Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF‐specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF‐specific electronic health care record and database platform.

Published
2020

6. BLOOD PRESSURE RESPONSE TO CATHETER-BASED RENAL SYMPATHETIC DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION: DATA FROM A NATIONAL MULTICENTER 1-YEAR-FOLLOW-UP STUDY

Author

Konstantinos Tsioufis, Athanasios Kordalis, Lefki Nikolopoulou, Christodoulos Stefanadis, Costas Thomopoulos, Antonios Ziakas, P. Davlouros, Maria Marketou, Vasilios Papademetriou, Panagiotis Vardas, Kyriakos Dimitriadis, D. Petroglou, Dimitris Tsiachris, Dimitris Tousoulis, Charalampos Karvounis, Ioannis Kallikazaros, Alexandros Kasiakogias, Michail Doumas, and Dimitrios Alexopoulos

Subjects
medicine.medical_specialty, Catheter, Blood pressure, Renal sympathetic denervation, business.industry, Internal medicine, Cardiology, medicine, Resistant hypertension, In patient, 1 year follow up, Cardiology and Cardiovascular Medicine, business
Published
2017
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