Cardiovascular wellbeing

Heart health, post-infarction prevention requires catching up with organisational delays in the regions

Clear pathways, effective coordination between hospital and territory, homogeneous follow-up and continuous monitoring: these are the priorities certified by scientific evidence in post-discharge care after surgery but local models are still 'backward' and too uneven

by Davide Croce *, Giuseppe Patti **, Alessia Pisterna ***

7 January 2026

3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

Regions are experimenting with new models of post-infarction care, but adoption remains slow. Scientific evidence and economic sustainability are established: an organisational infrastructure capable of transforming daily practice is lacking.

A year ago in Sole24Ore Salute, in the article Heart, post-event secondary prevention: recipe to optimise care and NHS spending, we illustrated, through independent research, how the consistent application of guidelines and an early risk stratification algorithm could improve the clinical outcomes of post-infarction patients, while generating a more efficient use of public resources.

Since then, the picture has been further consolidated. New evidence, including from the updated Esc/Eas 2025 guidelines, has reinforced the validity of the early approach, confirming that the model is effective, that the rationale for intensive intervention is robust and that its economic sustainability is no longer in question.

The organisational node

If the scientific framework is clear, the central question remains open: how to turn what works into widespread practice? The history of organisational innovation teaches us that between scientific validation and systemic adoption there is a complex path, where the model has to deal with different contexts, varied professional cultures and inhomogeneous organisational structures.

In this phase, the Regions are playing a decisive role. Many have started 'local validation' processes, verifying the feasibility of the model in their own contexts, comparing the various actors and testing operational tools consistent with the territorial care networks. This is a physiological process: every innovation, before being adopted, must be understood, contextualised and shared.

However, it is also a slow process. Organisational adoption in healthcare takes time because it requires alignment between professionalism, empowerment of care nodes and the construction of new routines. The literature defines this phenomenon as theprofessional adoption curve: the speed of diffusion does not depend on the value of the innovation, but on the capacity of the system to absorb it.

Five Regions compared

The Cardio (Comparison and Analysis for the Reduction of Cardiovascular Damage and Innovation in Outcome) project, supported by an unconditional contribution from Amgen, Novartis and Sanofi, developed through five regional tables in Lombardy, Emilia-Romagna, Lazio, Campania and Sicily, gathered perspectives, differences and opportunities by listening to more than 50 professionals including clinicians, pharmacists, health management and institutional representatives. The objective was not to verify "whether" the model was valid, but "how" it could be integrated into very different regional health services.

A common element emerged: effective secondary prevention no longer depends on the availability of scientific evidence, but on the system's ability to organise itself. Clear pathways, effective coordination between hospital and territory, homogeneous follow-up and continuous monitoring are needed. The fragility of 'post-discharge', repeatedly highlighted in regional comparisons, symbolises this challenge: not clinical, but organisational.

Shared direction but many speeds

The direction is shared, but the pace of adoption remains uneven. Italy has the necessary clinical expertise and a growing willingness to address the issue from a systemic perspective. It is now necessary to accompany adoption with concrete governance, coordination and measurement tools.

Innovation in healthcare is never just a question of therapies: it is a question of organisation. Early strategy works; the task of the system is to make it work everywhere. This requires collective work that unites professionals, institutions and the territory. The project is a first step, enriched also by a training pathway (Fad) that fuels awareness on organisational and sustainability paths. In secondary cardiovascular prevention, more than in other areas, timeliness is not a technical detail: it is an essential element of equity and sustainable access.

* Director Crems - Research Centre for Economics and Management in Health Care Castellanza
** Director of Complex Structure Cardiology 1 at the Ospedale Maggiore Novara
*** Director of Complex Structure Hospital Pharmacy Ospedale Maggiore Novara