3S G ITAL CARDIOL | VOL 15 | SUPPL 1 AL N 1 2014 Documento ANMCO/GICR-IACPR/GISE L’organizzazione dell’assistenza nella fase post-acuta delle sindromi coronariche Commissione ANMCO/GICR-IACPR/GISE Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Società Italiana di Cardiologia Riabilitativa e Preventiva (GICR-IACPR) Società Italiana di Cardiologia Invasiva (GISE) Cesare Greco, Francesco M. Bovenzi, Sergio Berti, Maurizio Abrignani, Francesco Bedogni, Roberto Ceravolo, Furio Colivicchi, Leonardo De Luca, Pompilio Faggiano, Francesco Fattirolli, Giuseppe Favretto, Pantaleo Giannuzzi, Gian Francesco Mureddu, Giuseppe Musumeci, Zoran Olivari, Carmine Riccio, Roberta Rossini, Pier Luigi Temporelli con l’endorsement di: ARCA (Associazioni Regionali Cardiologi Ambulatoriali) ANCE (Cardiologia Italiana del Territorio) SIMG (Società Italiana di Medicina Generale) realizzato con il contributo scientifico di: Fulvia Seccareccia e Stefano Rosato Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma Post-discharge management of patients with acute coronary syndrome (ACS) requires a comprehensive out- patient network and specific competence regarding risk factor control, optimal pharmacological therapy and adequate follow-up strategies. This combination should allow a significant outcome improvement with re- duced rates of fatal and nonfatal events and hospital readmissions. On October 25-26, 2013, a consensus conference on clinical management after ACS was held in Naples, Italy, under the auspices of two Italian scientific societies, the Italian Association for Cardiac Prevention and Rehabilitation (GICR-IACPR) and the Italian Association of Hospital Cardiologists (ANMCO). The present document constitutes a joint proposal for the management and follow-up of patients discharged alive after ACS. The paper is divided into four sections: in Section 1 on “Epidemiology and prognostic strat- ification”, the clinical and instrumental variables for the identification of patients at higher risk of adverse events (death, heart failure or reinfarction) in the months following an ACS are described on the basis of cur- rently available data; in Section 2 on “Post-discharge care management”, different pathways for follow-up and treatment are proposed, according to the baseline clinical presentation: a cardiac rehabilitation inpatient program is suggested for high-risk patients, an intensive secondary prevention outpatient program for those at high thrombotic risk, and a clinical follow-up for low-risk profile patients. Sections 3 and 4 on “Drug ther- apy targets” and “Strategies to improve adherence and promote lifestyle changes” emphasize the need for structured programs of pharmacological implementation and long-term maintenance of recommended ther- apy and healthy lifestyle. Key words. Acute coronary syndrome; Cardiac rehabilitation; Post-discharge care; Secondary prevention. G Ital Cardiol 2014;15(1 Suppl 1):3S-27S Per la corrispondenza: Dr. Cesare Greco Viale Parioli 47, 00197 Roma e-mail: cgreco@hsangiovanni.roma.it 1. Epidemiologia e stratificazione prognostica . . . . . . . . . . . . . . . . . . 4S 1.1 Il paziente ad alto rischio clinico: scompenso cardiaco e/o disfunzione ventricolare sinistra . . . . . . . . . . . . . . . . . . . . . . . 5S 1.2 Il paziente a rischio trombotico elevato . . . . . . . . . . . . . . . . . 6S 2. I percorsi assistenziali . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7S 2.1 Percorso assistenziale dei pazienti a rischio clinico elevato per scompenso cardiaco e/o disfunzione ventricolare sinistra 9S 2.2 Percorso assistenziale dei pazienti ad elevato rischio trombotico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9S 2.3 Percorso assistenziale dei pazienti a rischio più basso . . . . . . 10S 3. Obiettivi della terapia farmacologica dopo sindrome coronarica acuta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10S 3.1 Il controllo della frequenza cardiaca . . . . . . . . . . . . . . . . . . . 10S - Copyright - Il Pensiero Scientifico Editore downloaded by GIUSEPPE MUSUMECI IP 2.229.133.20 Thu, 21 Apr 2016, 21:23:47