NOTA 13 (Cuore e Colesterolo)

Help to the doctor for the prescription of lipid-lowering therapy as per note 13

NOTE 13 AIFA (Italian Medicines Agency) is an articulated and complex text, continuously updated and therefore not easy to know and apply. This application is a rescue to the doctor: in 4 simple data entry steps you can stratify the patient's risk and identify the optimal therapy.

STEP 1: PATIENT DATA

Simply total and LDL cholesterol values, sex and smoking habit

STEP 2: ASSOCIATED CONDITIONS

Conditions that alone stratify the risk as high or very high (a checklist of 8 elements, grouped into 4 categories).

STEP 3: FAMILY DYSLIPIDEMIA

Diagnosed on the basis of simplified criteria: first the biochemical criteria are tested (additionally, only the range of triglycerides is required) and, if these are compatible, some anamnestic-family criteria are also requested (a short check-list of 2- 5 elements).

STEP 4: RISK CARDS

In case of negativity of all the previous steps, the risk is stratified according to the ESC "risk cards", crossing the total cholesterol values, already entered, with those of the age group and the value of systolic blood pressure

RESULT

At this point the final result is provided:

1. estimated risk for the patient (very high, high, moderate, medium, mild) and expected cardiovascular mortality at 10 years;

2. LDL therapeutic target, ie the optimal value to be achieved for that patient;

3. LDL reduction percentage necessary to reach the target;

4. therapy indicated, according to progressive levels, based on the initial response; any "additional therapies" to optimize the lipid profile (HDL, triglycerides) are also indicated, in addition to the control of the LDL target;

5. a "DOSE" button opens the histogram representing the potency of the statins in the various dosages, helping in the choice, depending on the percentage of LDL reduction required calculated.

This application follows the indications of the AIFA note AS FAITHFULLY AS POSSIBLE, taking into account that, due to the complexity of the topic, conditions may be found that are not clearly codified by the note, often due to the actual lack of scientific evidence relating to particular problems.

For further information, it is advisable to consult the text of the Official Gazette directly. It should also be noted that the risk stratification proposed by the Ministry is inspired by, but does not completely follow what is suggested by the ESC guidelines.

Finally, it is emphasized that the application of the rules of NOTE 13 is not a mere bureaucratic fulfillment but a medical act aimed at the prognostic stratification of the patient and the formulation of the most adequate therapy, with considerable implications on the patient's long-term prognosis.

DISCLAIMER: The author declines any responsibility deriving from the use of the application. The user is invited to check the result and apply it correctly to the clinical context.

The NOTE13 application was developed entirely (drafting of the diagnostic-therapeutic algorithm, technical development, graphic solutions) by Dr. Francesco Gemelli, Cardiologist from Rome. For any clarifications,

comments or suggestions, are gladly available and contactable at the following

address: [email protected]