AIMS:Atrial function measured by left atrial strain (LAS) could represent an early marker of disease and poor cardiovascular outcome. Given the importance of identifying early markers of adverse outcome beyond let ventricular ejection fraction (LVEF) and left atrial volume (LAV), our aim was to assess the association of LAS with major cardiovascular events, both in the general population and in specific cardiovascular diseases. METHODS AND RESULTS:We systematically searched PUBMED, COCHRANE Central Register of Controlled Trials and WEB OF SCIENCE (WoS) up to October 2023. Studies were included if they assessed LAS, measured by speckle-tracking echocardiography and analyzed as a continuous variable, and cardiovascular outcome. The primary endpoint was a composite of all-cause death and heart failure (HF) hospitalizations. A meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was conducted. Sixteen reports including 13156 participants were eligible. LAS predicted outcome in a population with and without a variety of cardiovascular conditions (HR 0.91; 95% CI 0.86-0.96). The result was confirmed in patients with HF (HR, 0.93; 95% CI, 0.89-0.97), IHD (HR, 0.95; 95% CI 0.91-0.99) or VHD (HR, 0.94; 95% CI, 0.90-0.97), but not in patients with LVH (HR, 0.98; 95% CI, 0.84-1.15). The metaregression conducted considering LVEF values as a covariate showed no significant effect on the main effect size. CONCLUSIONS:LAS represents a powerful predictor of major cardiovascular events in the general population and in patients with different cardiovascular diseases across left ventricular ejection fraction (LVEF) ranges.

BACKGROUND:The optimal timing of reperfusion therapy in acute pulmonary embolism (PE) remains uncertain, despite guideline recommendations supporting urgent intervention in high-risk and selected intermediate-high-risk presentations. OBJECTIVE:The OPTIRAPE registry (Optimal Timing for Reperfusion in Acute Pulmonary Embolism) aims to evaluate the association between reperfusion timing and in-hospital outcomes and to characterize real-world treatment patterns and system-related delays in patients undergoing systemic thrombolysis (ST) or catheter-directed therapies (CDTs). DESIGN AND INTERVENTIONS:OPTIRAPE (NCT07436702) is a prospective, multicentre, observational registry enrolling consecutive adults with acute high-risk or intermediate-high-risk PE undergoing ST or CDTs reperfusion therapy across seven Italian hospitals with 24/7 access to advanced imaging and reperfusion strategies. Treatment decisions are based on the 2019 European Society of Cardiology guidelines and local practice, without protocol-mandated interventions. STUDY OUTCOMES:The primary exposure is time-to-reperfusion, defined as the interval from diagnostic confirmation of high-risk PE, or, in intermediate-high-risk patients, from clinical deterioration to initiation of reperfusion therapy. The primary endpoint is in-hospital mortality. Secondary endpoints include major bleeding, early haemodynamic deterioration, need for mechanical circulatory or respiratory support, recurrent venous thromboembolism, intensive care unit admission, and length of hospital stay. IMPLICATION:OPTIRAPE will provide granular real-world data on reperfusion timing, treatment modality, and inter-hospital variability in severe PE management. It will quantify the relationship between treatment delays and in-hospital outcomes and explore potential time thresholds associated with improved survival, informing future guideline recommendations and supporting the implementation of standardized, time-sensitive reperfusion pathways in acute PE.

Preventing the development and progression of atherosclerotic cardiovascular disease is a challenge that is part of the mission of many clinicians, particularly those working in cardiology. Given the demonstrated cumulative effect of risk factors, early recognition of these factors and the implementation of both pharmacological and non-pharmacological interventions allows for more effective prevention of cardiovascular events. The purpose of this ANMCO position paper is to guide clinicians in the early identification of conditions that increase the risk of developing cardiovascular events and to provide guidance on the most appropriate interventions. The paper briefly reviews the evidence supporting the cumulative impact of traditional risk factors over time. The role of risk stratification tools such as SCORE2, SCORE2-OP, and SCORE2-Diabetes, as well as emerging biomarkers, is discussed. For risk factors such as hypertension, dyslipidemia, and diabetes, the recommended targets and current therapeutic options are illustrated. The pharmacological interventions currently available for managing obesity-associated cardiovascular risk and the indications for antiplatelet treatment in the context of primary prevention are also discussed. Overall, early diagnosis and primary prevention are the foundation of an efficient and economically sustainable healthcare system.

Prevenire lo sviluppo e la progressione delle malattie cardiovascolari aterosclerotiche rappresenta una sfida che fa parte della mission di tanti clinici e di chi si occupa di cardiologia in particolare. In considerazione del dimostrato effetto cumulativo dei fattori di rischio, il precoce riconoscimento degli stessi e l’implementazione di interventi sia farmacologici che non farmacologici consente una più efficace prevenzione degli eventi cardiovascolari. Lo scopo di questo position paper ANMCO è quello di guidare i clinici all’identificazione precoce di tutte quelle condizioni che espongono al rischio di sviluppare eventi cardiovascolari e fornire indicazioni in merito alle modalità di intervento più appropriate. Il lavoro riporta brevemente le evidenze a supporto dell’impatto cumulativo nel tempo dei fattori di rischio tradizionali. Viene discusso il ruolo di strumenti per la stratificazione del rischio quali SCORE2, SCORE2-OP e SCORE2-Diabetes e di biomarcatori emergenti. Per fattori di rischio quali l’ipertensione, le dislipidemie e il diabete vengono illustrati i target raccomandati e le attuali possibilità terapeutiche. Vengono anche discussi gli interventi farmacologici attualmente disponibili per la gestione del rischio cardiovascolare associato all’obesità e le indicazioni al trattamento antiaggregante nel contesto della prevenzione primaria. Globalmente, la diagnosi precoce e la prevenzione primaria rappresentano le fondamenta di un sistema sanitario efficiente ed economicamente sostenibile.

Through the use of teleassistance, nurses play a fundamental role in the management of chronic cardiovascular diseases, contributing to improving patients' perceived quality of life and promoting self-care practices. This model of care actively supports the development of mindful and proactive behaviors by patients in managing their own lifestyle habits. Furthermore, teleassistance is an effective tool in promoting therapeutic adherence, particularly in the post-hospital discharge phase. The literature review carried out in this study confirms these benefits. However, there is a need to explore the effectiveness of nursing teleassistance in relation to other relevant clinical outcomes, such as the reduction of new hospitalizations, post-discharge complications, mortality and healthcare-related costs.

La gestione della congestione nello scompenso cardiaco rappresenta un obiettivo terapeutico cruciale, fortemente correlato a prognosi e qualità di vita. I diuretici dell’ansa giocano un ruolo importante nella gestione del trattamento, ma la loro efficacia può essere limitata da fenomeni di resistenza diuretica e da una titolazione spesso empirica. In tale contesto assume particolare importanza il concetto di “blocco sequenziale del nefrone”, che prevede l’impiego combinato di molecole attive su differenti segmenti tubulari come i diuretici tiazidici. Inoltre, nell’ultimo periodo gli inibitori del co-trasportatore sodio-glucosio di tipo 2 hanno dimostrato un ruolo anche in ambito decongestionante, grazie a un profilo osmotico-diuretico favorevole, sinergico con i diuretici tradizionali, e con scarsa evidenza di effetti avversi significativi su elettroliti, pressione arteriosa e funzione renale. Tuttavia, l’ottimizzazione della decongestione richiede un approccio individualizzato e dinamico, guidato da indicatori clinici e laboratoristici (come la sodiuria precoce), volto a massimizzare la risposta diuretica minimizzando i rischi di disfunzione renale, disionie o alcalosi. L’educazione del paziente e il monitoraggio domiciliare, anche attraverso tecnologie “point-of-care”, emergono come strumenti fondamentali per favorire l’aderenza terapeutica e prevenire l’abuso dei diuretici nella gestione cronica dello scompenso cardiaco.

Background:β-Blockers have been traditionally prescribed after acute myocardial infarction (MI), but contemporary evidence in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF ≥40%) have not provided consistent results. We assessed the robustness of the evidence for the efficacy of β-blocker therapy in this population using contemporary randomized controlled trials (RCTs) and pooled analyses. Methods:We systematically searched PubMed, Scopus, and Embase through August 1, 2025, for phase 3-4 RCTs evaluating β-blockers in patients with LVEF ≥40% during index MI hospitalization. Primary outcomes included robustness of each trial's primary endpoint; secondary outcomes included all-cause and cardiovascular mortality, recurrent MI, heart failure hospitalization, and unplanned revascularization. Fragility index (FI) and fragility quotient (FQ) were calculated. Data were pooled using random-effects meta-analysis. Results:Four trials (REDUCE-AMI, CAPITAL-RCT, BETAMI-DANBLOCK, REBOOT) with 19,245 patients were included. Event rates were low across the various outcomes with limited robustness: FI and FQ values indicated high sensitivity to small changes in events. BETAMI-DANBLOCK suggested modest benefit for recurrent MI, while REDUCE-AMI and REBOOT showed no significant effect. Pooled analysis revealed a 9% relative risk reduction and 0.9% absolute risk reduction for the composite of death, recurrent MI, or heart failure hospitalization (number needed to treat = 111; FI = 5). Conclusion:In patients with MI and LVEF ≥40%, β-blocker therapy confers only modest absolute benefits, with trial results that are fragile. Routine use in this population may not provide consistent or clinically meaningful benefit, underscoring the need for individualized therapy.

Direct oral anticoagulants (DOACs) have demonstrated efficacy in extended-duration secondary prevention in non-cancer patients with venous thromboembolism (VTE), but the robustness of these results has not been fully assessed. We performed a systematic review of phase 3 and 4 randomized placebo-controlled trials evaluating extended-duration DOACs therapy for secondary prevention of VTE. The primary outcome was symptomatic recurrent VTE in non-cancer patients. Secondary outcomes included major and clinically relevant non-major bleeding (CRNMB), number needed to treat (NNT), and number needed to harm (NNH). Fragility indices (FI) and quotients (FQ) were used to evaluate the robustness of trial findings. Four trials enrolling a total of 8,394 patients met the inclusion criteria. Extended-duration anticoagulation with DOACs consistently reduced recurrent VTE compared to placebo, with relative risk reductions of 80-93% and absolute risk reductions of 5-9%, yielding NNTs of 11-19. Extended DOACs therapy consistently showed net clinical benefit, with a pooled NNT of 14.4 versus an NNH of 116.2. Major bleeding was rare, while CRNMBs were slightly more common (although findings were statistically fragile across trials). Extended-duration DOACs therapy reduces recurrent VTE in non-cancer patients with a favourable safety profile compared to placebo in trial populations, supported by robust statistical evidence. These findings support DOACs as a preferred option for extended-duration secondary prevention of VTE.

Congestion management is a key therapeutic target in heart failure, closely linked to both prognosis and quality of life. Loop diuretics play an important role in the management of decongestive therapy, but their efficacy is often limited by diuretic resistance and empiric dosing strategies. In this context, the concept of sequential nephron blockade - combining agents acting on different tubular segments, such as thiazide diuretics - has gained relevance. More recently, sodium-glucose co-transporter 2 inhibitors have emerged as effective decongestive agents, offering modest but sustained osmotic-diuretic effects, synergistic with loop diuretics, and a favorable safety profile with low impact on electrolytes, blood pressure, or renal function. Optimal decongestion, however, requires a tailored and dynamic approach, guided by clinical and laboratory markers (e.g. early spot urinary sodium), aimed at enhancing diuretic response while minimizing risks such as worsening renal function, electrolyte disturbances, or metabolic alkalosis. Patient education and home-based monitoring - potentially supported by point-of-care technologies - are critical to improve adherence and reduce inappropriate diuretic use in the chronic management of heart failure.

Through the use of teleassistance, nurses play a fundamental role in the management of chronic cardiovascular diseases, contributing to improving patients' perceived quality of life and promoting self-care practices. This model of care actively supports the development of mindful and proactive behaviors by patients in managing their own lifestyle habits. Furthermore, teleassistance is an effective tool in promoting therapeutic adherence, particularly in the post-hospital discharge phase. The literature review carried out in this study confirms these benefits. However, there is a need to explore the effectiveness of nursing teleassistance in relation to other relevant clinical outcomes, such as the reduction of new hospitalizations, post-discharge complications, mortality and healthcare-related costs.

AIMS:Adherence to guideline recommendations for secondary prevention appears to be inadequate, even in cardiology centres. To narrow the gap between guideline recommendations and what is implemented in clinical practice, we designed the BRING-UP Prevention project. METHODS AND RESULTS:BRING-UP Prevention is a nationwide, observational, prospective, multicenter study enrolling patients with a prior atherothrombotic event. The study consists of two 3-month enrolment phases followed by a 6-month follow-up, with each phase preceded by an educational intervention. Data presented here mainly focus on the percentage of patients at goal for LDL-cholesterol (LDL-C) (<55 mg/dL) at the 6-month follow-up in the recently completed first enrolment phase. Secondary endpoints are blood pressure, glycaemic and weight control, and smoking cessation. Over 3 months, 189 cardiology centres recruited 4790 patients. Follow-up data at 6 months were available for 4643 patients (97%) and LDL-C was available for 4334 of them. The rate of patients with LDL-C < 55 mg/dL increased from 33% to 58.1%, with absolute and relative increases of 25.1% and 76.1%, respectively. At 6 months, 94.9% of patients were prescribed statins. Atorvastatin and rosuvastatin were the most prescribed statins, mostly at high doses. Ezetimibe was prescribed in 84% of cases. PCSK9i monoclonal antibodies and inclisiran were prescribed in 8.3% of patients. CONCLUSION:BRING-UP prevention achieved its primary goal to increase the percentage of patients at the LDL-C goal, demonstrating that, in many patients, this goal can be achieved by increasing the use of low-cost therapies. CLINICALTRIAL.GOV:NCT06275113.

Recent preclinical and clinical data suggest that moderate physical activity may be safe and beneficial in patients with hypertrophic cardiomyopathy (HCM). Evidence regarding a safe dose of high-intensity exercise remains limited; however, the marked heterogeneity in the morphology and pathophysiology of HCM implies that some individuals are capable of performing even vigorous exercise, including competitive high-intensity sports. Current data indicate that participation in intense exercise and competitive athletics may be considered in a carefully selected subset of predominantly adult patients with a low-risk profile. Studies evaluating the impact of vigorous exercise or moderate-to-high intensity competitive sports on the natural history of HCM remain few and are underpowered to definitively resolve this issue. Nonetheless, emerging evidence now supports a more liberal approach whereby-after appropriate selection, expert clinical evaluation, and shared decision-making-individuals with a low-risk profile may engage in high-intensity physical activity and competitive sports, leading active and fulfilling lives while minimizing risk.

Background:Sudden death remains a major global cause of mortality, yet recent European trends are poorly characterized. We analyzed sudden death mortality across Europe from 2010 to 2020, assessing variations by age, sex, and region. Methods:We extracted sudden death-attributable mortality data from the World Health Organization (WHO) mortality dataset for 2010-2020. Age-adjusted mortality rates (AAMRs) were analyzed using joinpoint regression modeling, expressed as average annual percent change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups. Findings:From 2010 to 2020, there were 2,583,559 attributed sudden death (1,935,741 men and 647,818 women) in 26 European countries. Overall, the AAMR increased [AAPC: +2.9% (95% CI: 2.0-4.1), p < 0.001], with a significantly greater increase in women compared to men (p = 0.01). Regionally, AAMRs decreased in Western Europe [AAPC: -2.0% (95% CI: -2.1 to -0.1), p = 0.02], plateaued in Northern Europe [AAPC: -2.0% (95% CI: -4.7 to 0.8), p = 0.15], while increasing in Southern [+3.3% (95% CI: 1.5-8.2, p = 0.001] and Eastern Europe [AAPC: +3.4% (95% CI: 1.7-5.0), p < 0.001]. At the country level, substantial differences were observed, with Austria and Belgium showing the highest reduction of AAPC (-8.0% and -7.9%, respectively), contrasting with an increase in Spain and Germany (+3.3% and +2.8%, respectively). Interpretation:Rising sudden death mortality in Europe likely reflected evolving sex- and region-specific patterns, including the increasing cardiovascular risk burden among women and broader demographic changes across different parts of Europe. Equitable, multidisciplinary strategies are needed to curb this trend. Funding:None.

Summary: Background: Sudden death remains a major global cause of mortality, yet recent European trends are poorly characterized. We analyzed sudden death mortality across Europe from 2010 to 2020, assessing variations by age, sex, and region. Methods: We extracted sudden death-attributable mortality data from the World Health Organization (WHO) mortality dataset for 2010–2020. Age-adjusted mortality rates (AAMRs) were analyzed using joinpoint regression modeling, expressed as average annual percent change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups. Findings: From 2010 to 2020, there were 2,583,559 attributed sudden death (1,935,741 men and 647,818 women) in 26 European countries. Overall, the AAMR increased [AAPC: +2.9% (95% CI: 2.0–4.1), p < 0.001], with a significantly greater increase in women compared to men (p = 0.01). Regionally, AAMRs decreased in Western Europe [AAPC: −2.0% (95% CI: −2.1 to −0.1), p = 0.02], plateaued in Northern Europe [AAPC: −2.0% (95% CI: −4.7 to 0.8), p = 0.15], while increasing in Southern [+3.3% (95% CI: 1.5–8.2, p = 0.001] and Eastern Europe [AAPC: +3.4% (95% CI: 1.7–5.0), p < 0.001]. At the country level, substantial differences were observed, with Austria and Belgium showing the highest reduction of AAPC (−8.0% and −7.9%, respectively), contrasting with an increase in Spain and Germany (+3.3% and +2.8%, respectively). Interpretation: Rising sudden death mortality in Europe likely reflected evolving sex- and region-specific patterns, including the increasing cardiovascular risk burden among women and broader demographic changes across different parts of Europe. Equitable, multidisciplinary strategies are needed to curb this trend. Funding: None.

AIMS:Hypertriglyceridaemia is a common clinical condition. Triglycerides (TGs) have long been recognised as a risk factor for atherosclerotic cardiovascular disease (ASCVD). Genetics, epidemiological studies and clinical trials have demonstrated a causal relationship between plasma triglycerides and ASCVD. In the bloodstream, TGs are mainly transported by lipoproteins such as VLDL and their remnants, the so-called TG-rich lipoproteins (TRL). A better understanding of the pathological consequences of elevated plasma TG levels is essential, especially in the context of addressing residual cardiovascular risk, when other major risk factors, in particular low-density lipoprotein cholesterol (LDL-C), are optimally controlled. DATA SYNTHESIS:This consensus paper highlights the available evidence on the physiology, metabolism and association with atherosclerosis of TRL and their remnants. We update the current knowledge in a multidisciplinary approach and highlight targeted therapeutic approaches including: i) diet and lifestyle, ii) established treatments such as fibrates and omega-3 fatty acid supplements, iii) novel pharmacological strategies to lower serum TG levels to reduce residual cardiovascular risk in patients on maximal LDL-C-lowering treatment, and iv) new therapeutic options in patients with severe hypertriglyceridaemia. CONCLUSIONS:Managing TRL plasma concentration with a comprehensive approach that includes lifestyle changes and targeted pharmacological strategies is a key clinical approach for addressing cardiovascular (residual) risk and improving patient outcomes, especially in individuals with well-controlled primary target lipid levels such as LDL-C. In case of severe TG elevation, an intensive TG-lowering approach is of paramount importance for reducing the risk of acute pancreatitis.

OBJECTIVES:Comprehensive and updated assessments of arterial hypertension (HTN)-attributable mortality trends across Europe are limited. We evaluated the HTN-attributed mortality trends in Europe between 2012 and 2021, examining variations by age, sex, and European region. METHODS:We extracted heart failure-attributed mortality data from the WHO mortality dataset for 2012-2021. Age-adjusted mortality rates (AAMRs) were analyzed using joinpoint regression modeling, expressed as average annual percentage change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups. RESULTS:From 2012 to 2021, 1 658 592 individuals (773 129 men and 885 463 women) died due to HTN, equating to 3932.3 deaths per 100 000 population. Overall, the AAMR increased (AAPC: +1.6%; 95% CI: 1.2-2.1; P  < 0.001), without significant differences between sexes ( P for parallelism 0.38). HTN-attributable mortality trend had a higher increase among patients aged 70 or older compared to those aged less than 70 years ( P for parallelism 0.007). Regionally, AAMRs increase in Northern (AAPC: +0.7%; 95% CI: 0.1-1.3; P  = 0.002) and Eastern (AAPC: +2.79%; 95% CI: 1.8-3.6; P  < 0.001) while plateaued in Western and Southern Europe (AAPC: -0.5%; 95% CI: -1.2 to 10.2; P  = 0.09). Disparities in hypertension-attributable mortality were observed among countries. CONCLUSION:HTN-attributed mortality in Europe increased between 2012 and 2021. Substantial disparities persist across European regions and countries.

The latest guidelines from both the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) emphasize ambulatory 24-h ambulatory blood pressure monitoring (ABPM) as a complementary and additive tool for the diagnosis and management of arterial hypertension. ABPM offers a comprehensive assessment of various blood pressure (BP) parameters, making it a crucial tool for clinicians. It enables them to develop tailored treatment strategies, improve BP control, and reduce cardiovascular risk. However, interpreting ABPM results can be challenging, especially for clinicians who are new to managing hypertensive patients. This comprehensive guide is designed to equip physicians with the necessary insights to effectively use ABPM in clinical practice, ultimately enhancing patient care and outcomes in hypertension management.

The epidemiological transition has led to an increase in life expectancy and to a growing population of chronic patients, often with heart failure. These patients are frequently affected by comorbidities and frailty, which in turn increase the risk of disability and worsening quality of life, requiring an accurate multidimensional assessment (MDA). In this context, MDA is crucial for integrated and holistic management of elderly patients, considering not only the pathology but the patient in his complexity. MDA requires a multidisciplinary team to ensure a comprehensive and integrated assessment of the elderly patient. MDA tools assess various domains of health, using scales and validated tools to explore physical, functional, mental and socio-economic status. MDA is applied in two phases: an initial screening procedure and an in-depth analysis of individual problems for targeted interventions. MDA can be performed in various care settings, including outpatient clinics, hospitals, nursing homes, home care, and rehabilitation centers. Several studies show that MDA improves survival as well as functional and mental status, reducing hospitalization times and the frequency of institutionalization. This ANMCO position paper discusses MDA tools of older adults with chronic heart disease, highlighting the need for a holistic approach to address comorbidities and frailty in a growing population.

L’impatto della terapia ormonale sostitutiva (TOS) sull’apparato cardiovascolare (CV) nelle donne in menopausa è stato oggetto di un vivace dibattito per molti anni. Dopo una fase contrassegnata da un utilizzo restrittivo in seguito agli esiti dei primi trial randomizzati negli anni 2000, nel corso dell’ultimo decennio si è assistito ad una significativa rivalutazione dei rischi e dei benefici della terapia, soprattutto del rischio CV. Grazie a nuovi studi condotti su popolazioni più selezionate e a sottoanalisi dei precedenti trial, vi è oramai ampia evidenza riguardante l’alto profilo di sicurezza della TOS, e addirittura di protezione sul sistema CV per le donne giovani a basso profilo di rischio CV nella fase iniziale della menopausa. Queste evidenze sono state inserite in tutte le linee guida nazionali ed internazionali per la menopausa e, recentemente, anche in un documento di consenso della Società Europea di Cardiologia. Pertanto, il cardiologo assume un ruolo centrale nella valutazione del rischio e nel trattamento dei fattori di rischio CV modificabili durante la fase di transizione menopausale, periodo critico per le donne poiché associato a significativi cambiamenti nell’equilibrio glico-metabolico. Questo articolo riassume le attuali conoscenze sull’argomento e fornisce una guida pratica per la gestione cardiologica di tali pazienti.

La transizione epidemiologica ha portato ad un aumento dell’aspettativa di vita e ad una popolazione crescente di pazienti cronici, spesso con scompenso cardiaco. Questi pazienti sono frequentemente affetti da comorbilità e fragilità, che a loro volta aumentano il rischio di disabilità e peggioramento della qualità di vita, richiedendo un’accurata valutazione multidimensionale (VMD). In questo contesto, la VMD è cruciale per una gestione integrata e olistica dei pazienti anziani, considerando non solo la patologia ma il paziente nella sua complessità. La VMD richiede un team multidisciplinare per garantire una valutazione completa e integrata del paziente anziano. Gli strumenti della VMD valutano vari domini della salute, utilizzando scale e strumenti validati per esplorare lo stato fisico, funzionale, psichico e socio-economico. La VMD si applica in due fasi: una procedura di screening iniziale e un’analisi approfondita dei singoli problemi per interventi mirati. La VMD può essere effettuata in vari contesti assistenziali, inclusi ambulatori, ospedali, case di riposo, assistenza domiciliare e centri di riabilitazione. Diversi studi dimostrano che la VMD migliora la sopravvivenza e lo stato funzionale e psichico, riducendo i tempi di degenza e la frequenza di istituzionalizzazione. Questo position paper ANMCO discute gli strumenti di VMD degli anziani con cardiopatia cronica, evidenziando la necessità di un approccio olistico per affrontare le comorbilità e la fragilità in una popolazione in crescita.