Save a life every six thanks to the improvement of quality and the innovation of care in cardiology
There are almost 340 thousand interventions for diagnosis and care, technically the “diagnostic and interventional procedures”, performed in 2015 in the 258 centers of hemodynamics, 97% of those operating on the national territory, which send their activities of activity to the register established by Gise , Italian Society of Interventional Cardiology.
The Register of Gise Activity is a systemized collection, which the scientific society of interventional cardiology has been taking care of for over 30 years, of each individual diagnostic examination (coronary alage) or coronary, vascular or structural intervention is performed in Italian hemodynamics centers centers. Constitutes a very rich database of information, which collects the data of almost 1.000 procedures performed every day in our country. “Thanks to this database, which Gise makes available to those who administer our health care, we are able to evaluate and analyze what is done, with the aim of contributing to the appropriateness and quality of care, through optimization of available resources “, explained Giuseppe Musumeci, president of Gise, illustrating today in the Senate the analysis of the 2015 data, during the presentation of the 37th National Congress of the Company to be held in Genoa from 11 to 14 October.
“What emerges is a positive picture for the quality of insured treatments for Italians, online, if not improving, compared to the standards of the major world health systems. In fact, in our country in the last 30 years the mortality from cardiovascular causes has decreased by 16%, allowing to save 1 life every 6 people at risk, “commented Musumeci. Last year, 281 were made in the hemodynamics centers of our country.364 coronarographies, about 146 thousand of which have turned into an angioplasty intervention to treat coronary heart disease.
Very significant are some data that emerge from the Gise Register, relating in particular to: primary angioplastics (33.728), Angioplastics with medicated stents (des or drug-eluting-care, 120.224), structural interventions on cardiac valves (4.154), the use of the most modern imaging techniques such as optical coherence tomography for the analysis of coronary airosclerotic plates (Oct, 9.879) or the measurement of the fractional flow reserve with pressure guide (FFR, 9.879) to evaluate the severity of a partial occlusion of the coronaries.
The primary coronary angioplastics have tripled in the last 12 years (they were 11.881 in 2003). “This means – Musumeci said – guarantee a person affected by myocardium infarction with the best possible cure: mechanical reperfusion through a catheter with balloon and the system of a stent. If carried out within six hours of the infarction it represents the best way to save a life, reduce the risk of another heart attack, recurring ischemias and improve long -term survival. Today our country, in a fairly uniform way on the national territory, also thanks to the specific Gise ‘IMA Web’ project shared with Italian Society System 118 (SIS 118) and the Italian Society of Emergency Medicine-Ultra-Center (SIMEU), is next Upon reaching the share of 600 primary Angioplastics per million inhabitants considered the optimal standard at an international level.”
The use of medicated stents is also growing (+55% compared to 2005). “In particular, it increases the use of new generation, with a reduction in the risk of new occlusion (Resttenosis) and thrombosis and mortality,” said Musumeci, remembering, among other things, the specific contribution of Gise to the activity of the Technical Commission that deals with the drafting of the national tender for coronary ruins called by the Consip, the company of the Ministry of Economy and Finance responsible for the purchase of goods and services for public administrations: “A collaboration aimed at optimizing purchases of the medical devices most used by interventional cardiology, maintaining high attention on quality, safety and innovation. Thanks to Consip professionals for having wanted to involve representatives of the medical-scientific companies such as ours, enhancing the skills of those who work in the sector and know all the aspects; The collaboration with them was extremely effective as we found great competence, seriousness, efficiency and high professionalism “.
An index of greater appropriateness of care – according to Musumeci – is also the use of OCT (+120% compared to 2005), a new imaging technique with higher resolution than the classic endovascular ultrasound (IVUS), to evaluate the extension and composition of the atherosclerotic plaque that causes coronary narrowing and which is used when angiography is not considered sufficient.
Finally, structural interventions, in particular to treat heart valve diseases, such as aortic stenosis, i.e. the narrowing of the valve lumen, caused mostly by calcific deposits on the valve flaps, which prevents the correct flow of blood from the heart to the aorta, or mitral insufficiency which causes blood regurgitation from the left ventricle to the left atrium due to failure of the valve of the same name to close. “These are procedures that have been developed by transcatetere, that is, through peripheral vessels, without opening the chest and heart and without leaving scars: through this road it is possible to replace the aortic valve – The intervention is called Tavi and 3 have been performed.457 in 2015 – or repair the mitral valve with the Mitraclip system, 697 operations last year,” said Musumeci. “These are interventions that require high specialization, not intended for all operators, nor for all patients – specified – but which constitute the advanced front of technological innovation. They allow to save lives, restoring a good quality of existence and to significantly improve, in the case of mitral insufficiency, the prognosis of the patient with heart failure.”
“Ten years ago these transcatheter procedures did not exist – clarified Sergio Berti, President of the GISE Foundation – and although they have permanently entered clinical practice also in Italy, as in the main advanced countries, they still present difficulties from an administrative point of view. In fact, there are no specific coding classification system that allow them to identify them univocally. The problem was highlighted by Agenas in the evaluation document of the National Program Program (PNE) 2014.
He then led the agency to ask the scientific societies, Gise and Sicch-Socy-social of heart surgery, to contribute to the drafting of a document of “guidelines for the coding of the Tavi procedures and other transcatheter structural interventions on the cardiac valves” which He wants to offer a possible solution to an now long -standing problem, waiting for the Italian DRG system to be revised in the current Italian DRG system – the IT-RRG – project; Specific procedure codes and DRG codes are prepared. We know that the document has exceeded the examination of the Ministry of Health and must now be implemented in the conference of the Regions. We hope this can happen by the end of this year “, Berti finished.