Healthcare is changing
La domanda
What have been the most significant innovations in recent years?
Risposta: Few medical disciplines have undergone a transformation comparable to that of cardiology over the last thirty years. Thanks to innovations in pharmacology, technology and interventional procedures, cardiovascular mortality has fallen dramatically and life expectancy has increased by around five years.
One of the most significant breakthroughs concerns heart failure. Today, we have four classes of medication which, when used in combination, reduce mortality and hospital admissions and significantly improve quality of life and life expectancy. It is one of the greatest achievements of modern pharmacology.
The management of myocardial infarction has also changed significantly. New antiplatelet drugs, used in conjunction with revascularisation procedures, have substantially improved the prognosis for patients with acute coronary syndrome. At the same time, the treatment of hypercholesterolaemia has been expanded to include new therapeutic options: in addition to statins, ezetimibe, PCSK9 inhibitors and bempedoic acid are now available, enabling LDL cholesterol levels to be achieved that were unthinkable just a few years ago.
Extraordinary progress has also been made in the field of rare heart diseases. Conditions for which there were once no effective treatments, such as cardiac amyloidosis and Fabry disease, can now be treated with specific drugs capable of significantly slowing their progression.
The greatest technological revolution, however, has been in interventional cardiology. Coronary angioplasty with the implantation of drug-eluting stents has transformed the treatment of acute heart attacks, reducing mortality from STEMI by around 50 per cent. In 2002, another innovation changed the course of cardiology: TAVI, which allows the aortic valve to be replaced without opening the chest. More recently, percutaneous techniques for repairing the mitral and tricuspid valves have extended minimally invasive treatment to almost all major valvular heart diseases.
Extraordinary progress has also been made in the field of arrhythmias. The implantable defibrillator has reduced mortality in patients at high risk of sudden death, whilst catheter ablation for atrial fibrillation, thanks to increasingly advanced technologies, has become an established treatment. Today, a new revolution is already underway: artificial intelligence promises to make cardiology even more proactive, precise and personalised, enabling the analysis of large amounts of data, the identification of risk signals that are difficult to detect, and supporting doctors in choosing the most appropriate diagnostic and therapeutic pathway for each patient.