La cardiologia vista attraverso i social media

The use of social media (SoMe) has spread worldwide among doctors, scientific societies, and researchers. SoMe offer a powerful platform to accelerate or create new contacts, spread scientific news, and increase visibility. A social media promotion strategy for cardiovascular medicine papers seems to be associated with increased online visibility and a higher number of citations. This effect is independent of the type of article and the total number of followers of the authors. Indeed, SoMe are democratic and even non-senior researchers may be popular on Twitter: your title is not as important as what you do on Twitter. Nevertheless, some physicians may be over-celebrated due to their presence on SoMe. This is why a new author index, the K-index, has been proposed. The K-index correlates the citations of a scientist with the number of Twitter followers. Even scientific journals and societies have recognized the importance of SoMe and in the last years they have appeared on SoMe with official accounts. Therefore, besides the classic impact factor, publishers now pay more and more attention to other parameters, such as the Altmetric score, which takes into account the number of citations, but also the number of downloads, mentions on SoMe, newspapers and tv news, web sites, and blogs. The COVID-19 pandemic has boosted the importance of SoMe for scientific content distribution, particularly for congresses. For all these reasons, it is important to understand the pros and cons of SoMe. It is also possible that SoMe will become a new education medium for continuing medical education.

Bedside multi-organ point-of-care ultrasound (PoCUS) and focused cardiac ultrasound (FoCUS) experience in a multidisciplinary low intensity COVID-19 department during the current pandemic scenario

Background: COVID-19 has caused devastation in the past year. PoCUS including lung ultrasound (LUS) and FoCUS as a clinical adjunct has played a significant role in medical management of these patients. The use of US is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19. Limitations due to insufficient data are opportunities for future research. Aim of the study: To evaluate PoCUS and FoCUS in daily practice, in order to better understand their role in SARS-CoV-2 positive patients. Materials and Methods: Retrospective evaluation in a multidisciplinary COVID 19 department during the current pandemic scenario. PoCUS and FoCUS activity have been performed using a multi-frequency probes equipment. Results: 70 SARS-CoV-2 positive patients (M/F 34/36, mean age 68.1±5.5) have been admitted in a multidisciplinary low intensity (Pa O2/Fi O2 ≥300) COVID 19 department from December 27th, 2021 for 36 consecutive days. 47% had pneumonia, 78% of which were no-vax patients. 47% were discharged home, 7.1% transferred to the intensive care unit for clinical deterioration, 8.6% to the post-acute ward, while 4.3% died. PoCUS and FoCUS were performed in 55.3% (internal US 38.4%, CUS 30.8%, procedures 30.8%). 2 newly diagnosed gastrointestinal neoplasms have been identified. Conclusions: in SARS-CoV-2 positive patients PoCUS and FoCUS are rapid, bedside, goal-oriented, diagnostic test that are used to answer specific clinical questions, not only for pulmonary disease but also to better evaluate relevant underlying comorbidities.

Position paper ANMCO: Cardio-oncologia in era COVID-19

The COVID-19 pandemic and its impact on patients with cancer and cardiovascular disease have confirmed the particular vulnerability of this population. Indeed, not only a higher risk of contracting the infection has been reported, but also an increased occurrence of a more severe course and unfavorable outcome. Beyond the direct consequences of COVID-19, the pandemic has an enormous impact on global health systems. Screening programs and non-urgent tests have been postponed;clinical trials have suffered a setback. Similarly, in the area of cardiology care, a significant decline in ST-elevation myocardial infarction accesses and an increase in cases of late presenting heart attacks with increased mortality and complication rates have been reported. Health care systems must therefore get ready to tackle the "rebound effect" that will likely show a relative increase in the short and medium term incidence of diseases such as heart failure, myocardial infarction, arrhythmias and cardio- and cerebrovascular complications. Scientific societies are taking action to provide general guidance and recommendations aimed at mitigating the unfavorable outcomes of this pandemic emergency. Cardio-oncology, as an emerging discipline, is more flexible in modulating care pathways and represents a beacon of innovation in the development of multi-specialty patient management. In the era of the COVID-19 pandemic, cardio-oncology has rapidly modified its clinical care pathways and implemented flexible monitoring protocols that include targeted use of cardiac imaging, increased use of biomarkers, and telemedicine systems. The goal of these strategic adjustments is to minimize the risk of infection for providers and patients while maintaining standards of care for the treatment of oncologic and cardiovascular diseases. The aim of this position paper is to evaluate the impact of the COVID-19 pandemic on the management of cardio-oncologic patients with the-state-of-the-art knowledge about SARS-CoV-2 and COVID-19 in order to optimize medical strategies during and after the pandemic.

Lipid-lowering therapy with PCSK9 monoclonal antibodies during the COVID-19 pandemic: Novel insights and perspectives

The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) which causes Coronavirus Disease 2019 (COVID-19) has resulted in a pandemic. A large proportion of patients are treated with lipid lowering medication and questions regarding the safety of continuing this therapy have arisen. Proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies are novel drugs that reduce low-density lipoprotein cholesterol (LDL-C) to previously unprecedented levels. The PCSK9 protein is often upregulated during sepsis and inflammation and is postulated to have a detrimental effect on host response and survival. This has led to argue for a possible role of PCSK9 monoclonal antibodies in treating the dysregulated immune response during SARS-CoV-2 infection. In order to effectively reduce overcrowding and block the spread of the virus through person-to-person transmission during the coronavirus epidemic, in the ASL ROMA 1 a local health unit of the Lazio Region based in the city of Rome and providing health services to more than 1.100.000 residents, a PCSK9 monoclonal antibodies medication delivery service has been instituted, providing multiple benefits to our patients treated with PCSK9 monoclonal antibodies (N=168) during home quarantine. The mean value of LDL-C at the end of the first lockdown period was on target according to current secondary prevention guidelines in all patients (<55 mg/dL). Therefore, our main suggestions are that counteracting therapy discontinuation could represents a crucial issue during pandemics and that this novel function of PCSK9 should have important implications in optimizing their clinical use in the context of infectious/inflammatory disease.

Cied management during the covid-19 pandemic: A single center experience

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to a substantial reduction in elective healthcare services, in order to reduce the burden on healthcare system and infection spread. Most in-office visits for the follow-up of patients with cardiovascular implantable electronic devices (CIED) were cancelled or postponed. Remote management of CIEDs offers well established benefits and it is a valuable alternative to a face-to-face visit. We report the characteristics and outcomes of patients with CIED undergoing in-office visit in our center during the lockdown. Methods: We collected the clinical records of all consecutive patients reporting to our institute's CIED clinic for device follow-up during the government-imposed lockdown due to the COVID-19 pandemic (from 1 March to 4 May, 2020). Among patients with remote monitoring systems, an in-person visit was performed only in case of a device alarm. Files of patients without remote control were evaluated in order to establish the need of a face-to face visit. The out-patient visit was confirmed if one of the criteria reported in Table 1 was satisfied. Each patient with scheduled follow-up during the lockdown was contacted by phone to either confirm the visit in case of satisfaction of one of the above reported criteria or to inform that the scheduled visit was postponed of 6 months. Results: A total of 648 visits were scheduled for periodical CIED interrogation, 10% of patients had a device equipped with remote monitoring systems. Three hundred forty-three in-person visits were confirmed. However, only 198 patients (30% of scheduled interrogations) presented for the scheduled visit. Patients characteristics are reported in Table 2. Five visits involved patients with remote monitoring. The main reason for in-office visit was a pacing dependence (Table 3). Overall, only 14% (n. 27) of performed visits required a medical intervention including: change in CIED programming, change in pharmacological treatment, hospitalization. Conclusion: During the COVID-19 pandemic, in-office evaluation of CIED patients was significantly reduced when compared to scheduled visits. The majority of in-office visits was not followed by a medical intervention. Therefore, all these follow-up visits could have been avoided. A wider use of remote monitoring would allow a further reduction of nonessential in-person clinic visit.

ANMCO POSITION PAPER: Considerations on in-hospital cardiological consultations and cardiology outpatient clinics during the COVID-19 pandemic

Infections by SARS CoV2-COVID-19 have become in a short time a worldwide health emergency. Due to cardiovascular implications of COVID-19 and to very frequent previous cardiovascular disorders of COVID-19 patients, it is presently crucial that Cardiologists are fully aware of COVID-19 related epidemiological, pathophysiological and therapeutic problems, in order to manage at best the present emergency by appropriate protocols developed on the basis of the competences acquired and shared on the field. The aim of this document is to propose algorithms for the management of cardiovascular diseases during COVID-19 emergency with the objective of providing patients with optimal care, minimizing contagion risk and appropriately managing personal protective equipment.

Anmco position paper: The role of cardiology in the management of the health needs in the post-Covid-19 era

At the end of 2019 a new Coronavirus appeared in China and, from there, it spread to the rest of the world. On 24th May, 2020, the confirmed cases in the world were more than 5 million and the deaths almost 350.000. At the end of May, Italy reported more than 27.000 cases among healthcare professionals and 163 deaths among physicians. The National Health Systems from almost all over the world, including Italy's, were unprepared for this pandemic, and this generated important consequences of organizational nature. All elective and urgent specialized activities were completely reorganized, and many hospital units were partially or completely converted to the care of the COVID-19 patients. A significant reduction in hospital admissions for acute heart disease were recorded during the SARS-CoV-2 pandemic and, in order to gradually resume hospital activities, the Italian National Phase 2 Plan for the partial recovery of activities, must necessarily be associated with a Phase 2 Health Plan. In regards to the cardiac outpatient activities we need to identify short term goals, i.e. reschedule the suspended outpatient activities, revise the waiting lists, review the 'timings' of the bookings. This will reduce the number of available examinations compared to the pre-Covid-19 era. The GP's collaboration could represent an important resource, a structured telephone follow-up plan is advisable with the nursing staff's involvement. It is equally important to set medium-long term goals, the pandemic could be an appropriate moment for making a virtue of necessity. It is time to reason on prescriptive appropriateness, telemedicine implementation intended as integration to the traditional management. It is time to restructure the cardiological units related to the issue of structural adjustment to the needs for functional isolation. Moreover, the creation of 'grey zones' with multidisciplinary management according to the intensity of care levels seems to be necessary as well as the identification of Covid dedicated cardiologies. Finally, the pandemic could represent the opportunity for a permanent renovation of the cardiological and territorial medicine activities. © 2020 Oxford University Press. All rights reserved.

ANMCO POSITION PAPER: Network Organization for the Treatment of Acute Coronary Syndrome Patients during the Emergency COVID-19 Pandemic

The COVID-19 pandemic has become a global health emergency. In Italy, the number of people infected by SARS-COVID-2 is rapidly increasing and what emerges from the current data is that the majority do not present any symptoms or only minor flu-like symptoms. In about 20% of the patients, the disease progresses towards more complex forms (interstitial pneumonia to acute respiratory distress and multiple organ failure) with the need of hospitalization in CICU and advanced ventilator assistance. The transmission of the virus occurs very easily from the symptomatic patient s droplets from coughing and sneezing and from direct contact with persons or surfaces. In a patient presenting with ST elevation (STEMI) myocardial infarction or STEMI-like, if positive to COVID-19, the reperfusion therapeutic strategy depends on the local organization and on the possibility to access without delay a PCI COVID Center, on the basis, obviously, of the risk/benefit assessment of the individual case. However, we advise to try pursuing, in the first instance, the mechanical revascularization strategy, according to the available local possibilities.