National CVD Prevention Coordinators (NCPCs) for Italy: Pompilio Faggiano, Brescia, and Salvatore Novo, Palermo, Italy
Report repared by Prof. Salvatore Novo with the collaboration of Antonino Mignano, MD, Fellow in Cardiology and Silvana Vallone, Doctor in Psycology of Rehabilitation
Salvatore Novo, FESC, FACC
Full Professor of Cardiovascular Diseases, University of Palermo, Italy
Director of the Division of Cardiology with Rehabilitation, Reference Regional Centre for the Diagnosis and Care of Heart Failure
Centre for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and Secondary Prevention, University Hospital “Paolo Giaccone” of Palermo, Italy
Contact: email
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Health care
Italy's healthcare system is judged by the WHO's ranking as the 2nd best in the world. Italy has the highest life expectancy in the world together with Australia, Switzerland and Japan.
Healthcare in Italy is provided by the National Health System (NHS) to all citizens. It is organised under the Ministry of Health on a regional basis and covers about 75% of health demand while 25% is supplied by private system in agreement with the NHS.
Primary health care is delivered by general practitioners (GPs); secondary care by cardiologists in the region or in rehabilitation’s centers. Tertiary care is available through general or university Hospitals that provide special instrumental or laboratory examinations or hospitalisation. Simple medical or surgical care is provided in day hospital and group of instrumental examinations in day service.
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Risk factors
Smoking and physical activity: in the last years the level of physical activity has slightly improved in both genders. Despite the anti-smoking law introduced in 2003, around 20% of men and women are currently smokers.
Hypertension: from 2002 to 2012, in the population aged 35 to 74 years, the mean systolic blood pressure (SBP) fell in both genders while the diastolic blood pressure (DBP) dropped only in women. The control of hypertension in treated patients improved in both genders.
Hypercholesterolemia: the prevalence of elevated cholesterol has increased in the population. The control of hypercholesterolemia has improved yet it remains insufficient.
Diabetes and obesity: the prevalence of diabetes has decreased about 0.2% in both genders, while the control of diabetes improved from 2005 to 2013. Obesity has increased from 1998 to 2008 in patients with high level of education and even more among lower educated persons.
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Main actors & prevention methods
The main stakeholders are:
- General practitioners (GPs)
- Cardiologists of the NHS working in the territory or as freelancers affiliated with the NHS
- Cardiologists working in centres of rehabilitation
- Cardiologists working in general and university hospitals
GPs represent the frontline for primary prevention and provide first line screening examinations. Cardiologists working at level II-IV focus attention on the prevention of cardiovascular diseases (CVD) in high risk subjects and on secondary prevention and hospitalisation when needed
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Prevention activities
Prevention initiatives implemented by the NHS include information about the importance of cardiovascular risk factors (RFs) and in particular focus on the reduction of cigarette smoking and on the fight of obesity during childhood.
One of the most important initiatives is “The Heart Project – Progetto Cuore” of the National Health Institute (ISS) that provides from 1988 important information about CVD epidemiology, risk factors and risk stratification, collecting data from over than 4500 primary care physicians by means of the network of centres affiliated to the National Epidemiological Observatory on Prevention of Cardiovascular Diseases (OEC).
The Italian Foundation of Heart and Circulation (H&CF) of the Italian Society of Cardiology (SIC) and the Health Care Foundation (HCF) of the National Association of Cardiologist working in Hospitals (ANMCO) organise together on behalf of the Italian Federation of Cardiology (FIC) in the last week-end of September the World Day of the Heart with free prevention screening.
The H&CF, in collaboration with the Ministry of Education, University and Research (MIURI) runs the project “Cardiology in the classroom” focused on training students and teachers of secondary schools. There is consensus in the Italian Scientific Cardiological Societies about the need to perform an ECG in screening young athletes in order to prevent sudden death.
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Cardiac Rehabilitation
Cardiac rehabilitation is provided by a multidisciplinary team including nurses, physiotherapists, nutritionists, dieticians, psychotherapists and consultant cardiologists working in general and University Hospitals and in Centres of Rehabilitative Cardiology. There are 103 centres in the public health system and a further 79 in the private sphere affiliated with the NHS.
The programme usually consists of:
- an initial assessment within days of the hospital admission
- group exercise programs and educational sessions over six weeks
- physical stress test (or cardiopulmonary test or six minute walking test for patients with severe heart failure), at the end of the programme.
The program of rehabilitation is based on the guidelines elaborated by ANMCO, SIC and the Italian Group of Functional Evaluation and Cardiac Rehabilitation (GIVFR). Patients referred to the Centres of Rehabilitative Cardiology include those with recent myocardial infarctions and low ejection fraction, post-PCI (percutaneous coronary intervention) and post-CABG (coronary artery bypass graft) or valve intervention and patients with heart failure, the most part in NYHA (New York Heart Association) class II and III. This programme is provided free of charge for patients.
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Aims for the future
The NHS, scientific societies and foundations and various heart-related organisations have all acknowledged the importance of CVD prevention strategies and rehabilitation services. They endorse a number of key clinical priorities, including the integration of hospital and community-based preventive care. The main target areas for the next five years are:
- reducing the percentage of patients with elevated levels of blood pressure, cholesterol and blood glucose
- decrease the percentage of obese people, overweight and with the metabolic syndrome
- increase the percentage of CVD patients in secondary prevention with risk factor values at target
- improve access to cardiac rehabilitation and advise the general population regarding smoking cessation, healthy eating and increasing physical activity.
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Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
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