BACKGROUND:Despite advances in therapy, heart failure (HF) remains a syndrome characterized by high morbidity and mortality. The PONTE-HF/ACS registry aims to assess the outcomes of a structured outpatient follow-up between hospital and community care for patients with HF or recently hospitalized for acute coronary syndrome. The purpose of this study is to evaluate one of the main process indicators of the registry for patients with HF, namely the prescribed pharmacological therapy, with particular reference to therapy with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNi), beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). METHODS:Between January 2024 and September 2025, 1203 patients were enrolled: 496 with HF and reduced ejection fraction (HFrEF), 189 with HF and mildly reduced ejection fraction (HFmrEF), 302 with HF and preserved ejection fraction (HFpEF), and 216 with HF and improved ejection fraction. RESULTS:In HFrEF patients, after enrollment, therapy was prescribed as follows: ACEi/ARB/ARNi in 89% of cases (64% ARNi), beta-blockers in 97%, MRA in 85%, and SGLT2i in 85%. Quadruple therapy with and without ARNi was prescribed in 69% and 51% of cases, respectively. The percentage of patients receiving at least 50% of the recommended dose was 63% for ARNi, 41% for ACEi/ARB, 70% for beta-blockers, and 98% for MRA. CONCLUSIONS:The PONTE-HF/ACS registry shows good optimization of therapy in enrolled patients with HFrEF. Achieving this important process indicator highlights the quality of care provided by the HF outpatient network in the Apulia region and confirms the relevance of the registry for the analysis and optimization of diagnostic-therapeutic pathways in patients with HF.
Environmental sustainability represents an emerging priority for cardiology, owing to the close interconnection between planetary health and human health, with cardiovascular diseases constituting the main clinical outcome. The global healthcare sector accounts for approximately 4-5% of total greenhouse gas emissions, and cardiology contributes substantially to this burden because of its high resource intensity in diagnostic testing, interventional procedures, and energy consumption. At the same time, environmental factors such as air pollution, extreme temperatures, defined as values significantly above or below the regional average caused by climate change, and exposure to emerging contaminants, including heavy metals (lead, cadmium, arsenic) and micro- and nanoplastics are increasingly recognized as major determinants of cardiovascular risk. Chronic exposure to these pollutants is associated with oxidative stress, systemic inflammation, and accelerated progression of atherosclerosis. Strategies for sustainable cardiology primarily aim to reduce emissions related to energy use and supply chains. Priority actions include adopting circular economy principles (reduce, reuse, recycle), improving the appropriateness and optimization of diagnostic testing favoring lower environmental impact modalities, such as echocardiography, over carbon-intensive techniques and implementing telemedicine to reduce patient and provider travel. Furthermore, primary cardiovascular prevention can be considered an effective "double-benefit strategy", capable of simultaneously reducing disease burden and the demand for emission-intensive healthcare. In this context, healthcare professionals and scientific societies, including ANMCO, are called upon to lead a cultural shift by integrating environmental sustainability as a core ethical principle of contemporary cardiology practice.
Substance use represents a relevant yet underrecognized determinant of cardiovascular diseases, acting through substance-specific and often multifactorial mechanisms. This document proposes the concept of substance-related cardiovascular diseases (Sr-CVD) as a possible novel nosological entity, outlining its main clinical implications. Available epidemiological and pathophysiological evidence is reviewed, and the clinical, instrumental, and therapeutic-management features of the main cardiovascular conditions associated with substance use are described. These elements support clinical suspicion, differential diagnosis, and a precision medicine approach. In cases where a definite causal relationship cannot be established, the term "cardiovascular diseases in individuals with substance use" is proposed to identify a population at increased cardiovascular risk with specific clinical needs. Sr-CVD represent a heterogeneous group of conditions requiring a structured and multidisciplinary clinical approach. The introduction of this conceptual framework may improve the recognition, management, and prevention of substance-related cardiovascular damage.
Acute decompensated heart failure (ADHF) is a critical condition requiring prompt intervention to alleviate fluid overload, which is strongly associated with increased morbidity and mortality. However, there is still limited evidence on factors associated with a successful decongestion at discharge. To identify clinical predictors of successful decongestion at discharge in patients hospitalized with ADHF. The BRING-UP-3 HF study is an observational, prospective, multicenter observational study conducted across a large and representative sample of 179 Italian cardiology sites. For this analysis, we included patients hospitalized with ADHF. We assessed clinical predictors of successful decongestion at discharge, defined as the combination of clinical decongestion (≥1 kg weight loss or in New York Heart Association [NYHA] class I/II at discharge) and biochemical decongestion (NT-proBNP at discharge <1500 pg/mL or BNP at discharge <250 pg/mL or ≥30% reduction in natriuretic peptides between admission and discharge). A multivariable logistic regression model was used to identify predictors of successful decongestion. After excluding patients with missing data for natriuretic peptides, weight, and NYHA class, 681 patients (median age 73 years, 60% female) were included. Full decongestion was achieved in 469 (69%) patients. Factors significantly associated with full decongestion included younger age, higher estimated glomerular filtration rate (eGFR) at admission, lower natriuretic peptide levels, no history of ADHF hospitalization, and absence of anemia, atrial fibrillation, or valve regurgitation. Patients with full decongestion were more likely to receive renin-angiotensin system inhibitors (RASi)/angiotensin receptor neprilysin inhibitors (ARNi) and less likely to be prescribed loop or non-loop diuretics at discharge (Figure 1). Key predictors of successful decongestion at discharge were younger age, presence of peripheral edema, absence of mitral valve regurgitation and anemia, higher tricuspid annular plane systolic excursion (TAPSE), and baseline use of mineralocorticoid receptor antagonists (Figure 2). In contrast, loop diuretic use at admission was negatively associated with successful decongestion at discharge (Figure 2). In patients with ADHF, full decongestion was achieved in approximately two-thirds of patients and was associated with specific clinical characteristics. Full decongestion was associated with a higher prescription of RASi/ARNi and a lower prescription of diuretics at discharge. Younger age, absence of mitral regurgitation, and no baseline loop diuretic use were significant predictors of successful decongestion.Figure 1.Baseline CharacteristicsPredictors of a successful decongestion
