Outpatients and Day Hospital activities

Presentation

The outpatient clinic of the Monasterio Foundation is the place where specialist activities naturally meet and intersect for the management of the heart patient, with and without comorbidities.
Coordinated by Dr Roberta Poletti, with the help of Dr Michela Romano (nursing coordinator), the outpatient clinic relies on specialists from the Cardiology and Cardiovascular Medicine Unit, the Interventional Electrophysiology Unit, the Respiratory Medicine and Lipoapheresis Units, the Diabetology and Obesity Department, and the Thyroid Disease Assessment Department of the Nuclear Medicine Unit.

Outpatient services

Patients with cardiovascular risk, heart disease, pulmonary disease – known or suspected – access the outpatient clinic by means of a referral from a general practitioner, or referred by specialists from the AOUP or the Nord Ovest association of local health districts.
The most common access route is the cardiology visit.
Subsequently, the patient can be redirected to one of the specialist clinics (cardiomyopathy, cardiovascular medicine, channelopathies, structural heart disease, interventional cardiology, amyloidosis, arrhythmology, hypertension, heart surgery, GUCH) or to a general cardiology check-up..
Often, the cardiology specialist is assisted by other specialists involved in the patient’s care, as occurs in the case of diabetics, those with hereditary dyslipidaemias or bronchial pathologies. The cardiologist specialist can also schedule outpatient, day service, or day hospital or “ordinary” admissions based on the clinical indications. The patient is again redirected to the outpatient check-up to round off the beneficial pathway at the Monasterio.

Dedicated diagnostic pathways include:

Instrumental tests

• Echocardiography Outpatient Clinic (baseline colour Doppler ultrasound, Cardiac colour Doppler ultrasound with contrast medium and Transcranial monitoring, Transoesophageal Echo, Stress Echo with physical or pharmacological testing)
• Dynamic electrocardiogram (24-hour Holter monitor)
• Cyclo-ergometer exercise ECG outpatient clinic
• 24-hour Holter pressure clinic
• Pacemaker/ICD Programming clinic

Specialist Visits

• Cardiomyopathy outpatient clinic, dedicated to the diagnosis and treatment of patients suffering from dilated, hypertrophic, arrhythmogenic cardiomyopathy and other rarer forms such as restrictive and non-compaction cardiomyopathies
• Particular attention has been paid to cardiac involvement from chemotherapy or radiotherapy treatments in the course of cancer with the establishment of a CardiOncology Outpatient Clinic
• Arrhythmia and Channelopathy Outpatient Clinic in collaboration with the Interventional Electrophysiology Unit
• Cardiovascular Inflammation (CVI) Lab: Diagnostic-therapeutic pathway dedicated to myocarditis, myopericarditis in the phase of aetiological characterisation, with the possibility of complementary virological, microbiological, instrumental (with CMR and nuclear imaging) investigation, in collaboration with the relevant Units and pathology, especially with an endomyocardial biopsy approach (collaboration with Diagnostic and Interventional Cardiology Unit and with the AOUP Experimental Pathology Unit) and multi-specialist aetiological classification (infectious and rheumatological/immunoallergological)
• In recent years, a Centre for the Diagnosis and Treatment of Cardiac Amyloidosishas been established at the Unit, in liaison with the Regional Reference Centre (Dr. Federico Perfetto and Dr. Francesco Cappelli). In particular, in the classification of amyloidosis, the Unit benefits from collaboration with the Haematology Unit of the University of Pisa. There is a specific amyloidosis clinic in operation at the outpatient clinic
• CardioTOF: management of patients with chronic liver disease with an indication for orthotopic liver transplantation. Patients referred by the Liver Surgery and Liver Transplantation Unit of the AOUP are assessed from a cardiological and respiratory point of view, with the help of the Diagnostic Imaging Unit of the Monasterio for proper prognostic stratification
• Clinical classification of patients with Patent Foramen Ovale (PFO), an activity integrated with the AOUP Neurology Unit for the diagnostic pathway, with the possible indication for a percutaneous closure procedure, which is carried out in collaboration with theClinical classification of patients with Patent Foramen Ovale (PFO), an activity integrated with the AOUP Neurology Unit for the diagnostic pathway, with the possible indication for a percutaneous closure procedure, which is carried out in collaboration with the Paediatric and Adult Congenital Cardiology Unit of the Ospedale del Cuore in Massa (Director: Dottor Giuseppe Santoro), and the subsequent follow-up
• management of heart failure:
  • Refractory HF with classification in the Advanced Heart Failure Outpatient Clinic (in line with the patient’s transition towards an intervention (TAVI, percutaneous mitral intervention, VAD implant or heart transplant, in collaboration with the Siena Centre), or palliative care with collaboration in the context of end-of-life with Integrated Home Care and Hospices (in collaboration with the Director, Dr Angela Gioia, Nordovest Local Healthcare Authority)
  • complex HF with functions to coordinate the activities of dedicated Integrated Home Care in the Pisa area, in increasing collaboration with the General Practitioners Regional Association
• The identification and management of cardiac involvement in the context of hereditary myopathies takes place in collaboration with the Neurology Unit headed by Professor Gabriele Siciliano in the AOUP
• Modern Next Generation Sequencing equipment in the Molecular Cardiology Laboratory of the Laboratory Medicine Unit enables diagnostic definition of the disease genotype. The Unit has also promoted (JUST Project, supported by the Pisa Foundation) a Regional Registry of Juvenile Sudden Death in collaboration with the Forensic Medicine of the University of Pisa (Professor Marco Di Paolo) and the University of Florence (Professor Iacopo Olivotto and Elisabetta Cerbai)