Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation
We do not always accomplish what is best for our patients. Is "more procedures, more drugs" a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, b...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2019-05-01
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| Series: | Monaldi Archives for Chest Disease |
| Subjects: | |
| Online Access: | https://www.monaldi-archives.org/index.php/macd/article/view/1049 |
| _version_ | 1811246642497585152 |
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| author | Marika Werren Roberto Copetti Nicola Gaibazzi Franco Giada Andrea Faggiano Chiara Ricci Pompilio Faggiano |
| author_facet | Marika Werren Roberto Copetti Nicola Gaibazzi Franco Giada Andrea Faggiano Chiara Ricci Pompilio Faggiano |
| author_sort | Marika Werren |
| collection | DOAJ |
| description | We do not always accomplish what is best for our patients. Is "more procedures, more drugs" a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, but they can be harmful. So, why do we keep performing them? Many reasons, surely one of the main is the constant fear of malpractice legal-medical consequences; this led to the development of a defensive medicine, no longer focused on the health of the patient. For this reason, the Italian Association of Cardiac Prevention and Rehabilitation (GICR-IACPR) joined an international project "Choosing Wisely", supported by the Slow Medicine Initiative, a network which states that "Less is more”. The purpose of "Choosing Wisely " project is to improve the quality and safety of health services through the reduction of practices that, according to available scientific knowledge, do not bring significant benefits to the patients, but can, on the contrary, expose them to risks. This GICR-IACPR paper proposes to avoid five widespread practices in cardiology, at risk for inappropriateness and lacking of clinical evidence of benefit:
• Do not perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery
• Do not perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk
• Do not perform Holter electrocardiographic monitoring in patients suffering from syncope, near syncope or dizziness, in whom a non-arrhythmic origin has been documented
• Do not routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding prophylaxis in patient with single drug antiplatelet therapy in absence of additional risk factors.
• Avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve disease |
| first_indexed | 2024-04-12T14:56:49Z |
| format | Article |
| id | doaj.art-137e50fac14d46b1936d082c92fc00be |
| institution | Directory Open Access Journal |
| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-04-12T14:56:49Z |
| publishDate | 2019-05-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-137e50fac14d46b1936d082c92fc00be2022-12-22T03:28:13ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642019-05-0189210.4081/monaldi.2019.1049Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and RehabilitationMarika Werren0Roberto Copetti1Nicola Gaibazzi2Franco Giada3Andrea Faggiano4Chiara Ricci5Pompilio Faggiano6Istituto di medicina fisica e riabilitazione “Gervasutta”, Cardiac Rehabilitation UnitOspedale di Cattinara - Azienda Sanitaria Universitaria Integrata, Emergency Medicine UnitAzienda Ospedaliero-Universitaria di Parma, Cardiology UnitAulss 3 Serenissima Venice, Sports Medicine Unit, Cardiac RehabilitationUniversity of MilanUniversity of Brescia, Gastroenterology UnitSpedali Civili, University of Brescia, Cardiology DivisionWe do not always accomplish what is best for our patients. Is "more procedures, more drugs" a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, but they can be harmful. So, why do we keep performing them? Many reasons, surely one of the main is the constant fear of malpractice legal-medical consequences; this led to the development of a defensive medicine, no longer focused on the health of the patient. For this reason, the Italian Association of Cardiac Prevention and Rehabilitation (GICR-IACPR) joined an international project "Choosing Wisely", supported by the Slow Medicine Initiative, a network which states that "Less is more”. The purpose of "Choosing Wisely " project is to improve the quality and safety of health services through the reduction of practices that, according to available scientific knowledge, do not bring significant benefits to the patients, but can, on the contrary, expose them to risks. This GICR-IACPR paper proposes to avoid five widespread practices in cardiology, at risk for inappropriateness and lacking of clinical evidence of benefit: • Do not perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery • Do not perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk • Do not perform Holter electrocardiographic monitoring in patients suffering from syncope, near syncope or dizziness, in whom a non-arrhythmic origin has been documented • Do not routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding prophylaxis in patient with single drug antiplatelet therapy in absence of additional risk factors. • Avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve diseasehttps://www.monaldi-archives.org/index.php/macd/article/view/1049Appropriatenesscardiovascular preventioncardiac rehabilitationchoosing wisely |
| spellingShingle | Marika Werren Roberto Copetti Nicola Gaibazzi Franco Giada Andrea Faggiano Chiara Ricci Pompilio Faggiano Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation Monaldi Archives for Chest Disease Appropriateness cardiovascular prevention cardiac rehabilitation choosing wisely |
| title | Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation |
| title_full | Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation |
| title_fullStr | Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation |
| title_full_unstemmed | Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation |
| title_short | Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation |
| title_sort | choosing wisely in cardiology five proposals from the italian association for cardiovascular prevention and rehabilitation |
| topic | Appropriateness cardiovascular prevention cardiac rehabilitation choosing wisely |
| url | https://www.monaldi-archives.org/index.php/macd/article/view/1049 |
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