Management of chronic ischemic heart disease into internal medicine and geriatric departments in Italy
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RESEARCH LETTER TO THE EDITOR
Management of chronic ischemic heart disease into internal medicine and geriatric departments in Italy Francesco Perticone1 · Andrea Fontanella2 · Nicola Ferrara3 · Alberto Ferrari4 Received: 22 June 2019 / Accepted: 17 September 2019 © Società Italiana di Medicina Interna (SIMI) 2019
Dear Editor, Chronic ischemic heart disease (IHD), represented by stable angina pectoris, is currently a major clinical and social problem; its estimated prevalence in Europe is of about 30,000–40,000 people per million inhabitants. However, published data often underestimate the real prevalence of the disease, because they do not take into account asymptomatic IHD, patients who have clinical manifestations of ischemia in the absence of diagnosed IHD, or patients who have a known coronary disease but clinical manifestations different from angina, such as congestive heart failure [1]. The prevalence of chronic IHD is progressively increasing for the following reasons: (a) the aging of population; (b) the reduction in mortality during acute coronary syndrome, with consequent increase of progression to stability; (c) the increase of some risk factors such as obesity and diabetes [2]. Even if stable angina is the most frequent clinical manifestation of chronic IHD, many patients may not experience chest pain, though showing equally inducible ischemia during provocative testing (silent myocardial ischemia), as commonly observed in diabetic subjects. Interestingly, the persistence of angina can be often observed even after a revascularization procedure, as demonstrated by the high number of patients who continue to take antianginal and/or angina-related drugs. In particular, it has been estimated that, 1 year after performing a percutaneous revascularization * Francesco Perticone [email protected] 1
Italian Society of Internal Medicine (SIMI), Rome, Italy
2
Federazione Delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI), Rome, Italy
3
Società Italiana di Geriatria e Gerontologia (SIGG), Florence, Italy
4
Società Italiana dei Geriatri Ospedalieri e del Territorio (SIGOT), Rome, Italy
procedure, the overall prevalence of residual angina is about 24% [3]. These data are confirmed by the use of antianginal drugs before and after revascularization procedures; in fact, it has been shown that many patients continue to take antianginal drugs even for a long time after the revascularization procedure. In addition, recent Italian data [4, 5] confirm the socio-economic impact of angina in terms of access to the General Practitioner (GP), with a considerable number of contacts/patient/year and the number of hospitalizations also in the Internal Medicine and Geriatrics departments. Limited information are available regarding the clinical characteristics of IHD patients and their pharmacological treatment into Internal Medicine and Geriatrics departments. For these reasons, the Italian Society of Internal Medicine (SIMI) in collaboration with Federazione delle Associazioni dei Dirigenti Ospeda
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