European Society of Cardiology

Background: The transition from paediatric to adult healthcare is a critical period for young individuals with endocrine conditions. Despite numerous published recommendations, Europe still lacks recent, comprehensive, evidence-based, and practically applicable guidelines for endocrine healthcare transition. Objective: The aim of the study was to develop European consensus guidance for transition from paediatric to adult care in endocrine conditions through a structured, evidence-based approach. Methods: A systematic literature review identified 351 recommendations from 55 articles (2011–2023). Articles were included if they provided recommendations on the transition from paediatric to adult care for patients with endocrine diseases or general (non-disease-specific) transition guidance. The guidance was developed by a core multidisciplinary group (n = 7) and refined through focus groups with 18 experts from 10 European countries, representing both paediatric and adult care settings. Patient representatives have reviewed and approved it. Results: The guidance includes recommendations across 11 domains: structure of transition service, patient empowerment, patient-professional relationship, multidisciplinary team organisation, healthcare provider education, timing and planning, care coordination, management of non-attendance, psychological support, parent/caregiver role, and readiness tools. Each recommendation was rated as either “recommend” (strong) or “suggest” (conditional) based on expert consensus and available evidence. Conclusion: This ESE-ESPE guidance provides a comprehensive, practical framework for endocrine healthcare transition, applicable across different European healthcare settings. The recommendations emphasise structured programs, care coordination, and patient-centred approaches to optimise transition outcomes.

Heart failure (HF) is characterized by increasing prevalence, high morbidity and mortality, poor quality of life, and substantial healthcare costs. Despite advancements in pharmacologic and device-based therapies, translating evidence from randomized controlled trials into clinical practice remains suboptimal. The Global Registries and Surveys Programme-Heart Failure (GRASP-HF) is a pan-European, snapshot, observational study, aiming at assessing the real-world implementation of evidence-based HF management. GRASP-HF captures both acute and chronic HF presentations to assess the adherence to the 2021 and 2023 European Society of Cardiology (ESC) HF Guidelines. It also serves as a platform for the accreditation of HF centres for the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme. This manuscript outlines the rationale, methodology, and design of GRASP-HF. Unlike previous registries, GRASP-HF ensures that all patients are consecutively enrolled over a pre-defined 2-month period, minimizing selection bias. GRASP-HF offers a real-time perspective on diagnostic strategies, use of guideline-recommended medical therapy and implementation of quality-of-care indicators. In addition, GRASP-HF addresses less explored domains by other registries, such as frailty, rare aetiologies (e.g. amyloidosis, genetic cardiomyopathies, Takotsubo syndrome), as well as non-fatal events during hospitalization and follow-up. GRASP-HF is also designed to inform ESC educational strategies and to benchmark progresses in HF care across European and non-European centres. In conjunction with ICARe-HF, annual repetition of GRASP-HF aims to facilitate continuous feedback between evidence, practice, and quality improvement. GRASP-HF will assist National Cardiac Societies in shaping national and institutional policies and will contribute with data-driven insights to future guideline development.

The article is devoted to two additions in the description of the Evolutionary concept of psychosomatogenesis developed by the author. It is suggested that the effect of the psychosomatic mechanism described by the author, which creates preferences in maintaining health and thus contributes to the selection of individuals inclined to psychic evolutionizig, compensates for the naturally existing tendency to more frequent death and loss of health by individuals implementing new behaviours and exploring new habitats. This allows to explain the lack of prevalence in generations of individuals inclined to psychic evolutionizig. A new description of the space of models of psychosomatic mechanisms is given and the place of the model formed by the author in his psychosomatic concept is indicated in it.

Laboratorio de Hemodinamica y Cardiologia Intervencionista Hospital Universitario Central de Asturias. Facultad de Medicina, Universidad de Oviedo. Oviedo, Espana FESC Fellow of the European Society of Cardiology 1Profesor Titular de Cardiologia, Facultad de Medicina, Universidad de Oviedo y Director del Laboratorio de Hemodinamica y Cardiologia Intervencionista del Hospital Universitario Central de Asturias Sztejfman y colaboradores presentan en este numero de la Revista Argentina de Cardiologia (1) la experiencia de una unidad de evaluacion de pacientes candidatos a una nueva tecnologia: el Implante de valvula aortica transcateter (IVAT) (transcatheter aortic valve implantation, TAVI). En su trabajo describen su funcionamiento y las dificultades administrativas para la aplicacion de la tecnica en la practica clinica. La introduccion de nuevas tecnologias diagnosticas y terapeuticas es uno de los condicionantes mas importantes del aumento de los costos sanitarios. Es por ello por lo que esta incorporacion no puede estar basada unicamente en criterios de eficacia, sino que es obligado tener en cuenta los costos que implica. Aunque siempre ha sido asi, actualmente este aspecto ha adquirido importancia capital dado que el constante aumento de los costos sanitarios no ha ido acompanado de un aumento paralelo de los recursos, que obliga a los financiadores, tanto publicos como privados, a tomar dificiles decisiones sobre como asignar los siempre escasos recursos disponibles. En las siguientes lineas analizaremos estos dos aspectos: eficacia y costos.

Cardiometabolic medicine is centre stage currently as it integrates organ dysfunction in the pancreas, kidney, liver, and the heart induced by the pandemic of obesity leading to a high risk of heart failure with preserved or reduced ejection fraction, myocardial infarction, stroke, and pre-mature death. This novel specialty requires special, generalized training across several specialties in order to provide optimal care of the increasing number of patients with that condition.

Valve durability is a key consideration as the patient population eligible for transcatheter aortic valve implantation (TAVI) expands to include lower-risk and younger individuals who are expected to live many years after the procedure. This registry aimed to assess the incidence of long-term structural valve deterioration (SVD) beyond 5 years post-TAVI. Consecutive living patients who underwent TAVI up until 2014 using any commercially available transcatheter heart valve (THV) at 22 participant centres were enrolled in the European Valve Durability TAVI Registry. All patients underwent comprehensive echocardiographic assessments (61% were evaluated independently by a central core laboratory) within 6 months of enrolment and at least 5 years post-TAVI; SVD was defined according to Valve Academic Research Consortium 3 definitions. A total of 597 patients (aged 79.6±7.1 years at the time of TAVI; 47.2% male, mean Society of Thoracic Surgeons score 5.0%) were included. At a median of 6.1 years of follow-up (interquartile range 5.2-7.3 years), the crude incidence of moderate/severe SVD was 9.5% (n=57; moderate: 6.2%, n=37; severe: 3.4%, n=20). Predictors of SVD identified by Cox regression analysis were use of an intra-annular THV (hazard ratio [HR] 38.44, 95% confidence interval [CI]: 10.8-136.3; p<0.001), a small THV size (HR 4.82, 95% CI: 2.42-9.60; p<0.001) and moderate/severe postprocedural paravalvular leak (HR 3.64, 95% CI: 1.59-8.32; p=0.002). The incidence of moderate/severe SVD during long-term follow-up after TAVI is low, with severe SVD being even rarer than moderate SVD. SVD occurs more frequently in patients treated with older-generation intra-annular valves and in those with small-sized THVs.

Patients with acute kidney disease (AKD) may need treatment by hemodialysis and/or apheresis, which is often started in haste due to the life-threatening condition. To illuminate patients' lived experiences of being in acute need of such therapy due to AKD, we performed semi-structured interviews analyzed with qualitative content analysis. Eleven patients out of 104 were eligible and completed interviews. Six main categories were found - shock and emotional chaos, loneliness in an unfamiliar situation, a need for tailored information, emotional support from next of kin, the dialysis and/or apheresis experience varied, and the disease-conditioned life. An overarching theme emerged as, 'Will I survive? Will I be cured?' Clear and repeated information and personalized contact were requested to reduce anxiety and give hope during a time of crisis.