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Evaluation of the appropriateness of the preclinical phase (stage A and stage B) of heart failure Management in Outpatient clinics in Italy rationale and design of the ‘VASTISSIMO’ study

Mureddu, Gian F.; Nistri, Stefano; Faggiano, Pompilio; Fimiani, Biagio; Misuraca, Gianfranco; Maggi, Antonio; Gori, Anna M.; Uguccioni, Massimo; Tavazzi, Luigi; Zito, Giovanni B.

Journal of Cardiovascular Medicine: July 2016 - Volume 17 - Issue 7 - p 501–509
doi: 10.2459/JCM.0000000000000332
Quality of care

Early detection of heart failure, when still preclinical, is fundamental. Therefore, it is important to assess whether preclinical heart failure management by cardiologists is adequate. The VASTISSIMO study (‘EValuation of the AppropriateneSs of The preclInical phase (Stage A and Stage B) of heart failure Management in Outpatient clinics in Italy’) is a prospective nationwide study aimed to evaluate the appropriateness of diagnosis and management of preclinical heart failure (stages A and B) by cardiologists working in outpatient clinics in Italy. Secondary goals are to verify if an online educational course for cardiologists can improve management of preclinical heart failure, and evaluate how well cardiologists are aware of patients’ adherence to medications. The study involves 80 outpatient cardiology clinics distributed throughout Italy, affiliated either to the Hospital Cardiologists Association or to the Regional Association of Outpatient Cardiologists, and is designed with two phases of consecutive outpatient enrolment each lasting 1 month. In phase 1, physicians’ awareness of the risk of heart failure and their decision-making process are recorded. Subsequently, half of the cardiologists are randomized to undergo an online educational course aimed to improve preclinical heart failure management through implementation of guideline recommendations. At the end of the course, all cardiologists are evaluated (phase 2) to see whether changes in clinical management have occurred in those who underwent the educational program versus those who did not. Patients’ adherence to prescribed medications will be assessed through the Morisky Self-report Questionnaire. This study should provide valuable information about cardiologists’ awareness of preclinical heart failure and the appropriateness of clinical practice in outpatient cardiology clinics in Italy.

aAssociazioni Regionali Cardiologi Ambulatoriali (ARCA)

bAssociazione Nazionale Medici Cardiologi Ospedalieri (Area Prevenzione ANMCO)

cGVM Care & Research, Cotignola (RA), Italy

Correspondence to Gian F. Mureddu, MD, Cardiology Unit, San Giovanni-Addolorata Hospital, Via dell’Amba Aradam 9, 00184, Rome, Italy Tel: +39 06 77055637; fax: +39 06 77056715; e-mail:

Received 13 June, 2015

Revised 16 August, 2015

Accepted 3 October, 2015

© 2016 Italian Federation of Cardiology. All rights reserved.