The four elements are all different and fundamentals for our lives.

• FIRE gives us the light to see in the midst of darkness.
• EARTH nourishes us and provides a shared home.
• AQVA quenches our thirst, sustaining our strength.
• AIR gives us the oxygen for all our pursuits.

The philosophy of the ELEMENT STUDY GROUP lies in the organization of the studies and initiatives along four main lines symbolizing the four elements. The ELEMENT STUDY GROUP was established with the aim to provide diverse and fundamental evidence in the field of cardiology. While the primary operations of the ELEMENT STUDY GROUP are based on Italy, it actively engages in international collaborations to conduct extensive studies on a global scale.

The first main line directs its attention towards neglected and fragile populations, whose treatments and strategies are often obscure and less understood. These studies are collected under the “FIRE series”, aiming to gather evidence on patients’ subgroups normally excluded or under-represented in randomized clinical trials.

Shifting the focus from patients to techniques and procedures, the “AQVA series” focused on refining various medical techniques to improve patients’ outcomes by comparing different tools and/or optimization strategies. The main focus of the AQVA revolves around procedures including coronary, structural, and other related ones. The aim is to understand if is feasible to improve validated procedures (PCI, TAVI, etc.) in terms of outcomes, appropriateness, efficacy, sustainability and more.

The third main line is the collaboration with national and international research groups, categorized as the “EARTH series”. These studies largely involve individual patient-level meta-analyses, reviews, or similar analyses, aiming for shared knowledge and data integration to enhance patient prognoses and elevate the quality of life.

Finally, the most ambitious endeavor among these lines of inquiry is the “AIR series”, encompassing larger randomized clinical trials. These trials aim to provide substantial evidence addressing global clinical needs. The other elements suggest points of interest or clinical needs, and under the “AIR series”, trials are designed to generate and draw definitive conclusions.