Le Linee Guida ESC sulla prevenzione cardiovascolare · Le Linee Guida ESC sulla prevenzione cardiovascolare Stefano Urbinati Vice Presidente ANMCO UOC Cardiologia, Ospedale Bellaria,

Le Linee Guida ESC

sulla prevenzione

cardiovascolare

Stefano Urbinati

Vice Presidente ANMCO

UOC Cardiologia, Ospedale Bellaria, Bologna

Simposio

“Curiosare tra le nuove LLGG ESC 2016”

I “soliti” limiti della prevenzione CV

- Penalizzata economicamente

- Sempre subordinata agli investimenti

per l’acuto e per l’interventistica

- Non si sa mai chi ne è responsabile

- E’ cost-effective, ma non a breve termine

- A fronte della riduzione del fumo e di un

più efficace trattamento di ipertensione

e dislipidemie si registra un aumento di

obesità e diabete

JOINT ESC GUIDELINES

2016 European Guidelines on cardiovascular

disease prevention in clinical pract ice

The Sixth Joint Task Force of the European Society of Cardiology

and Other Societ ies on Cardiovascular Disease Prevent ion in

Clinical Pract ice (const ituted by representat ives of 10 societ ies

and by invited exper ts)

Developed with the special cont r ibut ion of the European Associat ion

for Cardiovascular Prevent ion & Rehabilitat ion (EACPR)

Authors/Task Force Members: Massimo F. Piepoli* (Chairperson) (Italy),

Arno W . Hoes* (Co-Chairperson) (The Nether lands), Stefan Agewall (Norway)1,

Chr ist ian Albus (Germany)9, Car los Brotons (Spain)10, Alber ico L. Catapano (Italy)3,

Mar ie-Therese Cooney (Ireland)1, Ugo Corr a (Italy)1, Bernard Cosyns (Belgium)1,

Chr ist i Deaton (UK)1, Ian Graham (Ireland)1, Michael Stephen Hall (UK)7,

F. D. Richard Hobbs (UK)10, Maja-Lisa Løchen (Norway)1, Herber t Lollgen

(Germany)8, Pedro Marques-Vidal (Switzer land)1, Joep Perk (Sweden)1, Eva Prescot t

(Denmark)1, Josep Redon (Spain)5, Dimit r ios J. Richter (Greece)1, Naveed Sat tar

(UK)2, Yvo Smulders (The Nether lands)1, Monica Tiber i (Italy)1,

H. Bart van der W orp (The Nether lands)6, Ineke van Dis (The Nether lands)4,

W . M. Monique Verschuren (The Nether lands)1

Addit ional Cont r ibutor : Simone Binno (Italy)

* Correspondingauthors:Massimo F.Piepoli,Heart FailureUnit, Cardiology Department, Polichirurgico Hospital G.DaSaliceto, Cantone Del Cristo,29121 Piacenza, EmiliaRomagna,

Italy, Tel: + 39 0523 30 32 17, Fax: + 39 0523 30 32 20, E-mail: [email protected], [email protected].

Arno W. Hoes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500 (HP Str. 6.131), 3508 GA Utrecht, The Netherlands,

Tel: + 31 88 756 8193, Fax: + 31 88 756 8099, E-mail: [email protected] .

ESC Commit tee for Pract ice Guidelines (CPG) and Nat ional Cardiac Societ ies document reviewers: listed in the Appendix.

ESC ent it ies having part icipated in the development of this document:

Associat ions: European Association for Cardiovascular Prevention & Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), European Association of

Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA).

Councils: Council on Cardiovascular Nursing and Allied Professions, Council for Cardiology Practice, Council on Cardiovascular Primary Care.

W orking Groups: Cardiovascular Pharmacotherapy

The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the

ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of awritten request to Oxford

University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.

Disclaimer . The ESC Guidelines represent the viewsof the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at

the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recom-

mendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encour-

aged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or

therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and

accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor

do the ESC Guidelines exempt health professionals from takinginto full and careful consideration the relevant official updated recommendations or guidelines issued by thecompetent

public health authorities, in order to manage each patient’scase in light of the scientifically accepted datapursuant to their respective ethical and professional obligations. It isalso the

health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

& The European Society of Cardiology 2016. All rights reserved. For permissions please email: [email protected].

European Heart Journal (2016) 37, 2315–2381

doi:10.1093/eurheartj/ehw106

Eur Heart J 2016; 37: 2315-81

Alcune novità rispetto alle

LLGG tradizionali

1. Non si soffermano solo sugli

obiettivi da perseguire, ma

insistono maggiormente sul

come perseguirli

Guidelines on CVD prevention

Eur Heart J 2016; 37: 2315-81


Eur Heart J 2016; 37: 2315-81

Per noi medici è sempre più “facile”

somministrare dei farmaci

piuttosto che modificare

delle abitudini di vita inveterate

Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81

140 90









Eur Heart J 2016; 37: 2315-81


Come ?

Dove ?

Chi lo fa ?


Guidelines on CVD prevention.

Eur Heart J 2016; 37: 2315-81

Come ?

Dove ?

Chi lo fa ?




LLGG tradizionali

2. E’ importante comprendere

chi abbiamo davanti,

perché la comunicazione

dovrebbe essere diversa per

diverse categorie di persone


Eur Heart J 2016; 37: 2315-81


countries at high CV risk countries at low CV risk


10-year risk of fatal CV event

•Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81




LLGG tradizionali

3. La prevenzione si fa

controllando i fattori di rischio

e non con attraverso una

“abusata” ricerca

di aterosclerosi asintomatica

Cosa non serve per fare prevenzione CV


Cosa non serve per fare prevenzione CV



LLGG tradizionali

4. Considerano alcuni “nuovi”

fattori di rischio





LLGG tradizionali

5. Identificano quali sono i rispettivi

ambiti di responsabilità nell’ambito

della prevenzione CV tra medici,

politici e amministratori sanitari





Eur Heart J 2016; 37: 2315-81

La scommessa

(perduta?) della

Riabilitazione Cardiologica

… interessi della Cardiologia

Riabilitativa a favorire la

Riabilitazione degenziale

… scarso interesse

della Cardiologia per acuti

Lo sviluppo della Riabilitazione Cardiologica

ambulatoriale è sempre stato penalizzato da …

Urbinati S, Olivari Z et al for the BLITZ 4 Inv.

Eur J Prev Cardiol 2015; 22: 1548-56

BLITZ 4 Registry


LLGG tradizionali

6. Quello che viene fatto deve

poter essere “misurato”

(accountability)


Eur Heart J 2016; 37: 2315-81

Documents

Le Linee Guida ESC sulla prevenzione cardiovascolare · Le Linee Guida ESC sulla prevenzione cardiovascolare Stefano Urbinati Vice Presidente ANMCO UOC Cardiologia, Ospedale Bellaria,