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Stengel S, Gölz L, Kolb J, Tarbet K, Völler S, Koetsenruijter J, Szecsenyi J, Merle U. First insights into multidisciplinary and multispecialty long COVID networks-a SWOT analysis from the perspective of ambulatory health care professionals. Front Med (Lausanne) 2023; 10:1251915. [PMID: 38020101 PMCID: PMC10665561 DOI: 10.3389/fmed.2023.1251915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Multidisciplinary and multispecialty approaches with central integration of primary care, individualized long-term rehabilitative care, and multidisciplinary care pathways are recommended by international consortia to face the challenges of care of long COVID. Two regional long COVID networks-Rhein-Neckar (RN) and Ludwigsburg (LU) have emerged as ad hoc examples of best practice in Southern Germany. The aim of the community case study is to provide first insights into the experiences of the networks. Methods The exploratory observational study was conducted between April and June 2023, focusing on an observation period of just under 24 months and using a document analysis supported by MAXQDA and SWOT analysis with ambulatory health care professionals in two online group discussions. Results The document analysis revealed that both networks have defined network participants who have agreed on common goals and patient pathways and have established ways of communicating, organizing, and collaborating. Both networks agreed on a primary care-based, multidisciplinary and multispecialty approach. The main differences in realization emerged in LU as a focus on the ambulatory setting and very concrete application to individual patients, while RN showed a focus on an intersectoral character with participation of the specialized university hospital sector, knowledge transfer and a supra-regional approach with the involvement of the meso and macro level. The SWOT analysis (n = 14 participants, n = 6 male, 7 physicians (4 disciplines), 7 therapists (5 professions)) showed strengths such as resulting collaboration, contribution to knowledge transfer, and improvement of care for individual patients. As barriers, e.g., lack of reimbursement, high efforts of care, and persistent motivation gaps became apparent. Potentials mentioned were, e.g., transferability to other diseases such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, promotion of addressing a "difficult topic" and promotion of intersectoral care concepts; risks mentioned were, e.g., limited network resources and negative effects on the development of other structures. Conclusion Resulting implications for practice and research address a call to policy makers and funders to support further research to find out what generalizable results regarding usefulness, effectiveness, and efficiency including transferability to other post-infectious diseases can be derived.
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Affiliation(s)
- Sandra Stengel
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Lea Gölz
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Karin Tarbet
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Völler
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
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Dweck MR, Loganath K, Bing R, Treibel TA, McCann GP, Newby DE, Leipsic J, Fraccaro C, Paolisso P, Cosyns B, Habib G, Cavalcante J, Donal E, Lancellotti P, Clavel MA, Otto CM, Pibarot P. Multi-modality imaging in aortic stenosis: an EACVI clinical consensus document. Eur Heart J Cardiovasc Imaging 2023; 24:1430-1443. [PMID: 37395329 DOI: 10.1093/ehjci/jead153] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
In this EACVI clinical scientific update, we will explore the current use of multi-modality imaging in the diagnosis, risk stratification, and follow-up of patients with aortic stenosis, with a particular focus on recent developments and future directions. Echocardiography is and will likely remain the key method of diagnosis and surveillance of aortic stenosis providing detailed assessments of valve haemodynamics and the cardiac remodelling response. Computed tomography (CT) is already widely used in the planning of transcutaneous aortic valve implantation. We anticipate its increased use as an anatomical adjudicator to clarify disease severity in patients with discordant echocardiographic measurements. CT calcium scoring is currently used for this purpose; however, contrast CT techniques are emerging that allow identification of both calcific and fibrotic valve thickening. Additionally, improved assessments of myocardial decompensation with echocardiography, cardiac magnetic resonance, and CT will become more commonplace in our routine assessment of aortic stenosis. Underpinning all of this will be widespread application of artificial intelligence. In combination, we believe this new era of multi-modality imaging in aortic stenosis will improve the diagnosis, follow-up, and timing of intervention in aortic stenosis as well as potentially accelerate the development of the novel pharmacological treatments required for this disease.
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Affiliation(s)
- Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Krithika Loganath
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Thomas A Treibel
- Barts Heart Centre, Bart's Health NHS Trust, W Smithfield, EC1A 7BE, London, UK
- University College London Institute of Cardiovascular Science, 62 Huntley St, WC1E 6DD, London, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicester LE1 7RH, UK
- The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, 1081 Burrard St Room 166, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science and Public Health, Via Giustiniani, 2 - 35128, Padua, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80125 Naples, Italy
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - João Cavalcante
- Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| | - Erwan Donal
- Cardiology and CIC, Université Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes, France
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Corso Giuseppe Garibaldi, 11, 48022 Lugo RA, Italy
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
- Faculté de Médecine-Département de Médecine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 4333 Brooklyn Ave NE Box 359458, Seattle, WA 98195-9458, USA
| | - Phillipe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
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Santaló-Corcoy M, Corbin D, Tastet O, Lesage F, Modine T, Asgar A, Ben Ali W. TAVI-PREP: A Deep Learning-Based Tool for Automated Measurements Extraction in TAVI Planning. Diagnostics (Basel) 2023; 13:3181. [PMID: 37892002 PMCID: PMC10606167 DOI: 10.3390/diagnostics13203181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to open-heart surgery for treating severe aortic stenosis. Despite its benefits, the risk of procedural complications necessitates careful preoperative planning. METHODS This study proposes a fully automated deep learning-based method, TAVI-PREP, for pre-TAVI planning, focusing on measurements extracted from computed tomography (CT) scans. The algorithm was trained on the public MM-WHS dataset and a small subset of private data. It uses MeshDeformNet for 3D surface mesh generation and a 3D Residual U-Net for landmark detection. TAVI-PREP is designed to extract 22 different measurements from the aortic valvular complex. A total of 200 CT-scans were analyzed, and automatic measurements were compared to the ones made manually by an expert cardiologist. A second cardiologist analyzed 115 scans to evaluate inter-operator variability. RESULTS High Pearson correlation coefficients between the expert and the algorithm were obtained for most parameters (0.90-0.97), except for left and right coronary height (0.8 and 0.72, respectively). Similarly, the mean absolute relative error was within 5% for most measurements, except for left and right coronary height (11.6% and 16.5%, respectively). A greater consensus was observed among experts than when compared to the automatic approach, with TAVI-PREP showing no discernable bias towards either the lower or higher ends of the measurement spectrum. CONCLUSIONS TAVI-PREP provides reliable and time-efficient measurements of the aortic valvular complex that could aid clinicians in the preprocedural planning of TAVI procedures.
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Affiliation(s)
- Marcel Santaló-Corcoy
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Denis Corbin
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | | | - Frédéric Lesage
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- Department of Electrical Engineering, Polytechnique Montreal, Montreal, QC H3T 1J4, Canada
| | | | - Anita Asgar
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Walid Ben Ali
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
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Paolisso P, Beles M, Belmonte M, Gallinoro E, De Colle C, Mileva N, Bertolone DT, Deschepper C, Spapen J, Brouwers S, Degrieck I, Casselman F, Stockman B, Van Praet F, Penicka M, Collet C, Wyffels E, Vanderheyden M, Barbato E, Bartunek J, Van Camp G. Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics. Heart 2023; 109:634-642. [PMID: 36598073 DOI: 10.1136/heartjnl-2022-321874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team. OBJECTIVE To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS). METHODS Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre. Based on the outpatient strategy, patients were divided into HVC group, if receiving at least one visit at HVC, and SOC group, if followed by routine cardiac consultations. RESULTS 2129 patients with mAS and asAS were divided into those followed in HVC (n=251) versus SOC group (n=1878). The mean age was 76.5±12.4 years; 919 (43.2%) had asAS. During a follow-up of 4.8±1.8 years, 822 patients (38.6%) died, 307 (14.4%) were hospitalised for heart failure and 596 (28%) underwent aortic valve replacement (AVR). After propensity score matching, the number of consultations per year, exercise stress tests, brain natriuretic peptide (BNP) determinations and CTs were higher in the HVC cohort (p<0.05 for all). A shorter time between indication of AVR and less advanced New York Heart Association class was reported in the HVC cohort (p<0.001 and p=0.032). Compared with SOC, the HVC approach was associated with reduced all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030). At multivariable analysis, the HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007). CONCLUSIONS In patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.
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Affiliation(s)
- Pasquale Paolisso
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Monika Beles
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Marta Belmonte
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Cristina De Colle
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Niya Mileva
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Dario Tino Bertolone
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Jerrold Spapen
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Sofie Brouwers
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Bernard Stockman
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Martin Penicka
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Carlos Collet
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Eric Wyffels
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | | | - Emanuele Barbato
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Jozef Bartunek
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Guy Van Camp
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
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Villines TC. Improving education and training opportunities in cardiac CT. J Cardiovasc Comput Tomogr 2022; 16:384-385. [DOI: 10.1016/j.jcct.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hur DJ, Wang DD, Choi AD. From to evidence and advocacy: The evolving paradigm of CCT competency for structural heart disease. J Cardiovasc Comput Tomogr 2022; 16:412-414. [DOI: 10.1016/j.jcct.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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