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Biomedical subjects

Raffaele Griffo

Publications and source records attributed to Raffaele Griffo.

14 recordsLinked to original sources
PubMed2005

GlObal Secondary Prevention strategiEs to Limit event recurrence after myocardial infarction: the GOSPEL study. A trial from the Italian Cardiac Rehabilitation Network: rationale and design.

BACKGROUND: Cardiac rehabilitation programmes are a proven treatment for individuals with recent myocardial infarction, resulting in reduced morbidity and mortality compared to usual care. Unfortunately, following completion of a cardiac rehabilitation programme, risk factors and lifestyle behaviours may deteriorate. The GlObal Secondary Prevention strategiEs to Limit event recurrence after myocardial infarction (GOSPEL) study investigates the benefits of a programme of continued educational and behavioural interventions to achieve optimal long-term secondary prevention goals. DESIGN: This will be a multicentre, randomized, controlled study carried out in 78 Italian cardiac rehabilitation centres. METHODS: After completion of an initial cardiac rehabilitation programme, patients with recent (<3 months) myocardial infarction were randomized to either a long-lasting (over 3 years) multifactorial continued educational and behavioural programme (intensive approach) or usual care (control) group. Intensive approach patients participated in extensive cardiac rehabilitation sessions, monthly from months 1 to 6, then every 6 months for 3 years. Each session consisted of aerobic exercise, comprehensive lifestyle and risk factor counselling, and clinical assessment. Usual care patients returned to their family physicians' care, and attended the reference centre only for the 6-month and then annual scheduled assessment. The efficacy of the two different strategies will be evaluated in terms of morbidity and mortality as primary endpoint. RESULTS: From January 2001 through December 2002, 3241 patients were enrolled. Results will be available in mid 2006. CONCLUSIONS: The GOSPEL trial, the rationale and design of which we present here, was designed to test a new strategy of secondary prevention delivery and to raise standards of long-term secondary prevention in Italy. With a cohort of over 3200 patients, GOSPEL is the largest randomized, multifactorial lifestyle and risk factor intervention trial after myocardial infarction conducted so far.

Counseling↗
PubMed2004

[PUFA in patients with ischemic cardiopathy].

n-3 Poliunsaturated Fatty Acids (PUFA) are essential; foods rich in n-3 are fat fish and some vegetal oil. PUFA are precursors of Eicosanoids, involved in the processes of inflammation, thrombosis and immunity. Firstly, observational studies measured reduction of cardiovascular disease (CVD) incidence with greater PUFA dietary intake. Experimental studies discovered antiahrrhytmic, antiatherogenic, antiaggregating and antiinflammatory properties. Retrospective analysis found lower incidence of sudden death (SD) in fish consumers. Randomized, prospective trials after myocardial infarction showed, in people either eating fish or receiving an n-3 PUFA supplement, a reduction of SD, explained by specific effect on membrane ion channels. The lack of results on atherothrombosis do not match with most experimental results, and should better be evaluated in absence of aspirin therapy. Low evidence supports use of n-3 PUFA in angina or revascularization procedures. Recent observations denote positive effect on endothelial function of large and resistance arteries. Actually evidence-based medicine suggest: improve of fish consumption for primary prevention of CVD; n-3 PUFA supplementation for hypertrigliceridemia and secondary prevention of SD after myocardial infarction, which is also cost-effectiveness.

Anti-Arrhythmia Agents↗
PubMed2004

[Postoperative atrial fibrillation: etiopathogenesis, prevention and therapy].

Atrial fibrillation is the most frequent complication after cardiac surgery. Its onset leads to a threefold higher risk for stroke compared with patients in sinus rhythm and other adverse events such as thromboembolic events and heart failure. The direct consequence is an increased length of hospital stays with obvious economic implications. These reasons have led the attention of many investigators to point out the rule of possible predisposing factors and underlining mechanisms in order to establish an effective preventive treatment. The present paper is aimed to review the state-of-the-art knowledge about post-operative atrial fibrillation and its complex etiopathogenesis which is in turn responsible for the lack of consensus regarding routine prophylaxis.

Atrial Fibrillation↗
PubMed2004

Use of digitalis in the treatment of heart failure: data from the Italian Network on Congestive Heart Failure (IN-CHF).

BACKGROUND: Since the large multicenter DIG trial has shown no effects of digitalis on the all-cause mortality of patients with chronic heart failure (HF), the broad prescription of this drug in patients with HF appears to be at the very least, questionable. The aims of this study were: to analyze prescription patterns of digitalis, from 1995 to 2000, in a large group of outpatients with HF; to analyze the independent predictors of digitalis prescription and to evaluate the impact of the results of the DIG trial on the prescription rate of this drug. METHODS: From 1995 to 2000, 11 070 HF outpatients (mean age 64 +/- 12 years, ejection fraction 35 +/- 12%) were enrolled in a large Italian database. RESULTS: Out of 11 070 patients, 7198 (65%) were treated with digitalis. At multivariate analysis, the following variables were independently associated with digitalis prescription; atrial fibrillation (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.9-3.8), ejection fraction < 30% (OR 1.7, 95% CI 1.5-1.9), NYHA class III-IV vs II-III (OR 1.3, 95% CI 1.2-1.5), admission for HF during the previous year (OR 1.4, 95% CI 1.2-1.5). After the publication of the DIG trial, there was a significant reduction in the rate of digitalis prescription: the percentage of patients taking digitalis fell from 68% in 1996-1997 to 61% in 1998-1999 (p < 0.001). CONCLUSIONS: Over 60% of Italian outpatients with HF were treated with digitalis; as expected, patients with a low ejection fraction, atrial fibrillation and in a more advanced stage of HF are more likely to receive this drug. Finally, after the publication of the DIG trial, the rate of digitalis prescription significantly decreased.

Adult↗
PubMed2003

[The ISYDE project. A survey on Cardiac Rehabilitation in Italy].

In 2001-2002 the Italian Working Group on Cardiac Rehabilitation (CR) developed the ISYDE project, a survey on CR in Italy. In 2001, the CR units were 144 (57% in the North of the country), 58% in general hospitals, 23% in private hospitals, 8% in rehabilitative hospital, and only 2% in university clinics. Patients admitted to CR were 60,819 (vs 37.049 in 1996, +64%); 86% of CR units treated > 100 pts/year (vs 66% in 1996; +32%). Patients were admitted to CR units after cardiosurgery in 55% of cases, after myocardial infarction in 22%, and for chronic heart failure in 9.6%, without significant differences respect to 1996. A special survey investigated the work-up performed in patients with recent myocardial infarction. The admission ranges from 11th to 20th day, the mean duration of the CR programs ranges from 21 to 34 days. Most of italian CR units have a definite program for risk stratification and secondary prevention. In particular, the programs of exercise training, educational interventions concerning diet, lifestyle, and smoking cessation, and psychological intervention are well designed, developed, and evaluated before discharge in most cases. In conclusion, although in recent years the number of CR units are increasing, and the quality of care may be well-established by serial evaluations scheduled before discharge and during the long-term follow-up, a further development is mandatory to face the needs of cardiac patients in the post-acute and chronic phase of a cardiac disease.

Health Surveys↗
PubMed2003

[Role of echocardiography after cardiac surgery during rehabilitation].

In this review, specific aspects and implications of echocardiography in patients who had undergone recent cardiac surgery will be analysed. This imaging method, which is fully effective in clinical practice, actually possesses diagnostic characteristics, which during assessments of patients, are found to be noninvasive and easily repeatable. They are of great value amongst this particular group of patients for discovering any possible complications from the surgical procedures. Technical problems and methodology will be described regarding the specificity of the patient during the early days after cardiac surgery (for instance the difficulties of executing in certain post-operative conditions such as pain, injuries or worsening of acoustic window). Informative contribution and specific assessment in patients following myocardial revascularisation surgery, reconstructive or valvular replacement surgery, and left ventricle or thoracic aorta surgery will be analysed. The role of echocardiography in the identification and monitoring of the main complications related to the operation will also be described. The increasing diagnostic potential and assessment of the investigation is thanks to its systematic use which lasts for the intensive phase of cardiac rehabilitation, but assumes specific and adequate operator competence for optimum use in clinical examinations.

Echocardiography↗
PubMed2003

[Implementing cardiovascular prevention in the real world: presentation of an integrated hospital-field model].

Numerous studies have documented that cardiovascular prevention in subjects at high risk has a large impact on the clinical outcomes. Data also show the efficacy of an early, intensive, well-structured, professionally expert, multidisciplinary intervention, making use of adequate behavioural and pharmacologic instruments, on the global risk. Such intervention is, however, available at present for very few healthcare users, while the majority, above all in primary prevention, receive a programme of low impact, with poor feedback between the hospital specialist and general practitioner (GP), and often limited to the simple prescription of treatment or to specialist check-ups and/or general advice on lifestyle. The project of implementation takes as its starting point this analysis and the premise that for an intervention of cardiovascular prevention to be effective, particularly in the long term, and really applicable to the broad population, it must be governed primarily by the GP--providing that s/he be adequately trained, utilize new and more dynamic caring modes, and be able to count concretely both on integration with the specialist and on the support of a multidisciplinary team for specific interventions. The paper presents the various stages of the project: from definition of the resources available (health district, GPs, hospital specialists) to the need for GP training, to the modes of operation: instruments for risk calculation, procedures followed, model of integration between GP and specialist, identification of the goals and indicators. This is a low cost project in terms of both the human and structural resources employed, utilizing what is already available in the healthcare system of our country. One of its most original aspects is the medical visit jointly conducted by the GP and hospital specialist, which realizes in concrete terms the integration of the skills: GPs can finally confront in the field the specialist of referral, acquire new skills, improve their daily mode of operating, while they will be gratified by a work more in line with their professional image, and become promoters of health. Finally, this project highlights the propositive and operative role assumed by cardiac rehabilitation and prevention, which, after developing over the years a specific know-how on the subject, now transmits these skills to other healthcare resources and creates a link with the local territory, so providing an appropriate response to the need to put into practice primary and secondary cardiovascular prevention.

Cardiac Rehabilitation↗
PubMed2003

[Recommendations for cardiovascular rehabilitation in diabetes mellitus].

Cardiac rehabilitation is accepted as an important component in the management of heart disease. Diabetes Mellitus is a chronic disease frequently associated to ischemic heart disease and both disease require continuing medical care, aggressive treatment of other risk factors, educational programs for self management of disease to prevent acute complication. The scientific community should offer standard of care for management of diabetic patients with coronary artery disease, and should design new strategies to promote prevention in this high risk patients. The need to define characteristics and peculiar problems of diabetics patients with ischemic heart disease encouraged the Board of the Italian Group of Cardiac Rehabilitation and Prevention (GICR) to set up a working group composed of cardiologists and diabetologists chosen on the basis of their proven specific experience. The document is subdivided in six parts. In the first section is described the cardiovascular risks in patients with diabetes and the importance of post-prandial hyperglycemia and glycemic variability. We analyse also the difference in prevalence of ischemic heart disease in Italian diabetic patients compared with other countries. In the second section we described clinical presentation of ischemic heart disease in diabetic patients such as acute myocardial infarction and unstable angina, and the revascularization procedures (balloon angioplasty and coronary bypass surgery). We analysed the differences between the procedures and the evidence-based results. In patients with myocardial infarction we analysed the evidence-based therapy and specific advantages of aspirin, beta-blockers and ace-inhibitor in diabetic patients. In this section we also posed particular attention to the clinical course of patients who underwent bypass grafting and to the impact of diabetes on short and long-term results and on main intervention-related complications including deep infections, mediastinitis, neurological problems, renal failure. In the third section we evaluated the factors responsible of atherosclerosis progression and their treatment, and we underlined that cardiac rehabilitation is less effective for patients with diabetes mellitus. Suggestions proposed in this paper about risk factors are in line with the recommendations of standards guidelines of American Diabetics Association. In patients with concomitant diabetes and ischemic heart disease we suggest blood pressure <130/80, LDL-cholesterol <100 mg/dl, triglycerides <150 mg/dl and daily physical activity. In the fourth section we analysed therapeutic regimens and management of diabetes. We posed particular attention on insulin therapy in acute phase of myocardial infarction and in recent coronary bypass grafting, and chronic use of oral antidiabetic drugs or insulin. In the fifth section we provided some recommendations on the organization of educational programs and physical activity in these patients. In the last section we provided some information on diagnosis of coronary artery disease in diabetes, aim of screening and in which patients is need to perform diagnostic tests. We described the available diagnostic tests with the differences in each method.

Adrenergic beta-Antagonists↗
PubMed2003

[Oral anticoagulant drugs in clinical practice].

In current clinical practice, oral anticoagulant therapy is one of the most widely employed treatments in order to prevent embolic events in cardiovascular diseases. This therapy is bound to become more and more employed because of increasing mean age of general population and related increase of clinical settings which may require anticoagulation. Nowadays, available drugs for oral anticoagulation are vitamin K antagonists which inhibit the coagulation factors depending upon this vitamin for their synthesis. In this review we will examine: --their mechanism of action and its clinical implications related with the initial phase of therapy and the likelihood of side effects as cutaneous necrosis; --their pharmacokinetics which explain most of drug interactions; --affecting therapy factors: age of patients, impaired absorption, genetic polymorphisms of cytochrome P450, drug resistance, coagulation factors defects, particular clinical situations, vitamin K dietary intake; --different properties of various anticoagulant drugs; --toxicity; --problems related to monitoring anticoagulation intensity. At last, we will present the new pharmacological perspectives offered by direct inhibitors of the coagulation factors.

Administration, Oral↗