Current activities of Cardiovascular Rehabilitation in the ambulatory setting of the Lombardy Region

In the present work, the current activities of Cardiovascular Rehabilitation and Prevention (CRP) in the ambulatory setting of the Lombardy Region (Italy) are described. Based on the 2012 Legislation, ambulatory CRP is delivered by means of three programme categories (MAC 6, 7, and 8) with different degrees of intensity. The patient evaluation of global cardiovascular/clinical risk, comorbidity, and disability is the cornerstone for MAC prescription. Following the organization of MAC activities, a survey on 327 patients was carried out by the regional network of the Italian Society of Cardiovascular Rehabilitation (GICR-IACPR). Globally, acute coronary syndromes (with or without coronary revascularization) constituted the main access group to CRP. More than 60% of patients displayed a condition of high risk, comorbidity, and disability. The outcome of ambulatory CRP by means of MAC 6 and 7 was satisfactory, while in the 'less intensive' MAC 8 patients with complete drug up-titration and achievement of secondary prevention targets were no more than 70%.  Riassunto La Cardiologia Riabilitativa e Preventiva (CRP) storicamente riconosce nei percorsi ambulatoriali un importante setting per l’erogazione dell’intervento. In Regione Lombardia negli ultimi anni le attività di CRP sono state oggetto di una profonda riorganizzazione, con il contributo di esperti GICR-IACPR attivi presso lo specifico tavolo tecnico attivato presso la Direzione Generale Sanità. Dal 2012 sono attive le Macroattività Ambulatoriali Complesse e ad alta integrazione di risorse (MAC), che riguardano anche la sfera della CRP. Le MAC si sono poste come integrazione e alternativa al percorso degenziale e sono state classificate in tre livelli a complessità decrescente (MAC 6, MAC 7 e MAC 8 nel nuovo nomenclatore delle attività ambulatoriali). Il network GICR-IACPR ha quindi successivamente condotto una survey su 327 pazienti in tre Centri di CRP, di cui vengono esposti i risultati. Complessivamente, le condizioni di accesso alle MAC più utilizzate sono stati gli esiti di sindrome coronarica (con o senza rivascolarizzazione) e vi è stata una robusta rappresentazione (oltre 60%) di situazioni cliniche a medio/alto rischio clinico, complessità e disabilità. L’outcome dell’intervento in regime di MAC (in termini di recupero funzionale, titolazione della terapia di cardioprotezione e raggiungimento dei target terapeutici) è stato globalmente soddisfacente, seppure minore (non superiore al 70%) nel MAC 8 meno "intensivo"

第792回 千葉医学会例会・第二内科例会 35.

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed

Fit indices of the four- and six-cluster solution identified through K-means cluster analysis.

<p>Fit indices of the four- and six-cluster solution identified through K-means cluster analysis.</p

Z-scores for Type A, Type D-negative affectivity, and Type D-social inhibition for the final six-cluster solution.

<p>Z-scores for Type A, Type D-negative affectivity, and Type D-social inhibition for the final six-cluster solution.</p

Correlations among study variables.

<p>Correlations among study variables.</p

Means and standard deviation for psycho-emotional distress, positive orientation, health and illness representations, lifestyle (Alcohol consumption and Smoking behavior), and clinical evaluation (Total Cardiovascular Risk Index) for the final six-cluster solution.

<p>Results from comparisons and post-hoc tests.</p

Significant χ² analyses for the final six-cluster solution for gender, employment status, number of friends, diet and physical activity: percentages and adjusted residuals.

<p>Significant χ² analyses for the final six-cluster solution for gender, employment status, number of friends, diet and physical activity: percentages and adjusted residuals.</p

Error sum of square plot for the activity cluster solution.

<p>ESS = error sum of squares.</p