The FADOI (Federation of Associations of Hospital Doctors on Internal Medicine) position paper on cardiovascular prevention in the higher risk complex patients

Abstract

Prevention is a very topical issue that any modern health system cannot ignore. The discussion about the concept of cardiovascular (CV) prevention is very wide and has been lasting for a long time. In this context, the research has never been stopped. A schematic classification of different types of prevention, as well as raised by the literature, implies some limitations, not always suitable to our complex patients. According to evidence-based medicine we should refer to the best available guidelines. Unfortunately the quality of <em>evidence-based</em> guidelines is far from optimal. The Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) faced the problem of CV prevention in the higher risk complex patients with its experts in ischemic heart disease, heart failure, stroke, chronic kidney disease, peripheral arterial disease and diabetes mellitus, by asking the following questions: i) which are the methods of risk assessment and prognostic stratification (also with respect to the existing comorbidities)?; ii) which are the tailored actions to implement for the <em>individual patient</em>? For the purposes of a CV risk evaluation in complex patient we cannot be satisfied with a single <em>high baseline risk strategy</em>: we should resize our assessment parameters to the real world, implementing a <em>high multidimensional CV complexity risk assessment strategy</em>, in respect of an anthropological approach to the complexity of our patients. Essentially, hospital internists are called to exercise a proactive role of <em>experts for each single complex patient</em>, also in CV prevention.