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Milder TY, Stocker SL, Baysari MT, Day RO, Greenfield JR. 'We are somehow fixated on this being a diabetes drug': a qualitative study exploring the views of cardiologists and nephrologists about sodium-glucose cotransporter 2 inhibitor initiation. Intern Med J 2024; 54:559-567. [PMID: 37548317 DOI: 10.1111/imj.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are now indicated for heart failure and chronic kidney disease (CKD), irrespective of the presence of diabetes. Hence, cardiologists and nephrologists have an important role in initiating these drugs. AIMS To explore cardiologists' and nephrologists' perspectives regarding initiating SGLT2i and their safety monitoring practices when initiating SGLT2i. METHODS Purposive and snowball approaches were used to recruit participants working in diverse areas in New South Wales, Australia. Semi-structured interviews were conducted with 12 cardiologists and 12 nephrologists. Interviews were conducted until thematic saturation was reached. Emergent themes were identified from transcripts. An iterative general inductive approach was used for data analysis. RESULTS There was a reluctance amongst most non-heart-failure subspecialist cardiologists to initiate SGLT2i. Reasons included the perception of SGLT2i as diabetes drugs, concern about side effects, lack of experience and issues with follow-up. In contrast, nephrologists reported feeling confident to initiate SGLT2i. Nephrologists varied in their opinions about the severity of CKD at which SGLT2i initiation was reasonable and monitoring of renal function following initiation. Government subsidisation was an important factor in the decision to prescribe SGLT2i to people without diabetes. CONCLUSIONS Our findings highlight the complex transition from the perception of SGLT2i as diabetes drugs to cardiometabolic and reno-protective agents. Interdisciplinary collaboration may enable greater confidence amongst specialists to initiate SGLT2i, including in patients with CKD. Additionally, there is a need for clear and detailed guidance about SGLT2i prescription in patients with renal dysfunction and renal function monitoring following SGLT2i initiation.
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Affiliation(s)
- Tamara Y Milder
- Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Clinical Science Pillar, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sophie L Stocker
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jerry R Greenfield
- Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Clinical Science Pillar, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
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Wu JC, Wilson BH, Fang JC, Hurwitz JL, Dangas GD. Modernizing Cardiovascular Medicine Board Certification: Leveraging Innovation and Strengthening Continuous Competency and Professional Growth. Circulation 2024. [PMID: 38557064 DOI: 10.1161/circulationaha.124.069553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Joseph C Wu
- President, American Heart Association (J.C.W.)
| | | | - James C Fang
- President, Heart Failure Society of America (J.C.F.)
| | | | - George D Dangas
- President, Society for Cardiovascular Angiography and Interventions (G.D.D.)
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3
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Basch CH, Hillyer GC, Basch CE. Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study. J Med Internet Res 2024; 26:e55351. [PMID: 38530352 PMCID: PMC11005437 DOI: 10.2196/55351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being. OBJECTIVE Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively. METHODS We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with "time on hold" when attempting to schedule an appointment and the presence of online booking capabilities. RESULTS Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options. CONCLUSIONS The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.
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Affiliation(s)
- Corey H Basch
- Department of Public Health, William Paterson University, Wayne, NJ, United States
| | - Grace C Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Charles E Basch
- Department of Health Studies and Applied Educational Psychology, Teachers College Columbia University, New York, NY, United States
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Foley MJ, Rajkumar CA, Ahmed-Jushuf F, Nowbar AN, Simader F, Bello O, Al-Lamee R. Why Does a Cardiologist Believe in a Therapy? The Role of Intuitiveness and Understanding the Mechanism. Circ Cardiovasc Qual Outcomes 2024; 17:e010664. [PMID: 38362766 PMCID: PMC10949971 DOI: 10.1161/circoutcomes.123.010664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Michael J. Foley
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., A.N.N., F.S., O.B., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., R.A.-L.)
| | - Christopher A. Rajkumar
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., A.N.N., F.S., O.B., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., R.A.-L.)
| | - Fiyyaz Ahmed-Jushuf
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., A.N.N., F.S., O.B., R.A.-L.)
| | - Alexandra N. Nowbar
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., A.N.N., F.S., O.B., R.A.-L.)
| | - Florentina Simader
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., A.N.N., F.S., O.B., R.A.-L.)
| | - Olamide Bello
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., A.N.N., F.S., O.B., R.A.-L.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (M.J.F., C.A.R., F.A.-J., A.N.N., F.S., O.B., R.A.-L.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (M.J.F., C.A.R., R.A.-L.)
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5
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Minhas AMK, Parwani P, Fudim M, Virani SS, Khan SS, Cullen MW, Misra A, Ballantyne C, Nambi V, Abramov D. County-Level Cardiologist Density and Mortality in the United States. J Am Heart Assoc 2023; 12:e031686. [PMID: 38014694 PMCID: PMC10727342 DOI: 10.1161/jaha.123.031686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Affiliation(s)
| | - Purvi Parwani
- Division of Cardiology, Department of MedicineLoma Linda University Medical CenterLoma LindaCA
| | - Marat Fudim
- Department of MedicineDuke University Medical CenterDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | - Salim S. Virani
- Aga Khan UniversityKarachiPakistan
- Baylor College of Medicine and Texas Heart InstituteHoustonTX
| | - Sadiya S. Khan
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | | | - Arunima Misra
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Christie Ballantyne
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Vijay Nambi
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Dmitry Abramov
- Division of Cardiology, Department of MedicineLoma Linda University Medical CenterLoma LindaCA
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Akioyamen LE, Abdel-Qadir H, Han L, Sud M, Mistry N, Alter DA, Atzema CL, Austin PC, Bhatia RS, Booth GL, Dhalla I, Ha ACT, Jackevicius CA, Kapral MK, Krumholz HM, Lee DS, McNaughton CD, Roifman I, Schull MJ, Sivaswamy A, Tu K, Udell JA, Wijeysundera HC, Ko DT. Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System. Circ Cardiovasc Qual Outcomes 2023; 16:e010063. [PMID: 38050754 DOI: 10.1161/circoutcomes.123.010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Canadian data suggest that patients of lower socioeconomic status with acute myocardial infarction receive less beneficial therapy and have worse clinical outcomes, raising questions regarding care disparities even in universal health care systems. We assessed the contemporary association of marginalization with clinical outcomes and health services use. METHODS Using clinical and administrative databases in Ontario, Canada, we conducted a population-based study of patients aged ≥65 years hospitalized for their first acute myocardial infarction between April 1, 2010 and March 1, 2019. Patients receiving cardiac catheterization and surviving 7 days postdischarge were included. Our primary exposure was neighborhood-level marginalization, a multidimensional socioeconomic status metric. Neighborhoods were categorized by quintile from Q1 (least marginalized) to Q5 (most marginalized). Our primary outcome was all-cause mortality. A proportional hazards regression model with a robust variance estimator was used to quantify the association of marginalization with outcomes, adjusting for risk factors, comorbidities, disease severity, and regional cardiologist supply. RESULTS Among 53 841 patients (median age, 75 years; 39.1% female) from 20 640 neighborhoods, crude 1- and 3-year mortality rates were 7.7% and 17.2%, respectively. Patients in Q5 had no significant difference in 1-year mortality (hazard ratio [HR], 1.08 [95% CI, 0.95-1.22]), but greater mortality over 3 years (HR, 1.13 [95% CI, 1.03-1.22]) compared with Q1. Over 1 year, we observed differences between Q1 and Q5 in visits to primary care physicians (Q1, 96.7%; Q5, 93.7%) and cardiologists (Q1, 82.6%; Q5, 72.6%), as well as diagnostic testing. There were no differences in secondary prevention medications dispensed or medication adherence at 1 year. CONCLUSIONS In older patients with acute myocardial infarction who survived to hospital discharge, those residing in the most marginalized neighborhoods had a greater long-term risk of mortality, less specialist care, and fewer diagnostic tests. Yet, there were no differences across socioeconomic status in prescription medication use and adherence.
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Affiliation(s)
- Leo E Akioyamen
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
| | - Husam Abdel-Qadir
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
- Women's College Hospital, Toronto, ON, Canada (H.A.-Q., J.A.U.)
| | - Lu Han
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
| | - Maneesh Sud
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Nikhil Mistry
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
| | - David A Alter
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Clare L Atzema
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Peter C Austin
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
| | - R Sacha Bhatia
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Gillian L Booth
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (G.L.B., I.R.,)
| | - Irfan Dhalla
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
| | - Andrew C T Ha
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Cynthia A Jackevicius
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Western University of Health Sciences, Pomona, CA (C.A.J.)
| | - Moira K Kapral
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.)
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Douglas S Lee
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Candace D McNaughton
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Idan Roifman
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (G.L.B., I.R.,)
| | - Michael J Schull
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Atul Sivaswamy
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
| | - Karen Tu
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Department of Family and Community Medicine, (K.T.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- North York General Hospital, Toronto, ON, Canada (K.T.)
| | - Jacob A Udell
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
- Women's College Hospital, Toronto, ON, Canada (H.A.-Q., J.A.U.)
| | - Harindra C Wijeysundera
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Dennis T Ko
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
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Maffey MW, Cavender MA, Bagur R. Deferring PCI Based on IVUS Assessment: On Par With FFR or FLAVOUR of the Week? Circ Cardiovasc Interv 2023; 16:e013649. [PMID: 38018839 DOI: 10.1161/circinterventions.123.013649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Max W Maffey
- Interventional Cardiology, Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, ON, Canada (M.W.M., R.B.)
| | - Matthew A Cavender
- Interventional Cardiology, Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill (M.A.C.)
| | - Rodrigo Bagur
- Interventional Cardiology, Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, ON, Canada (M.W.M., R.B.)
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8
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9
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Driessen S, de Jong VD, van Son KC, Klompenhouwer T, Colardelle Y, Alings M, Moreno C, Anker SD, Castro Cabezas M, Holleboom AG, Grobbee DE, Tushuizen ME. A global survey of health care workers' awareness of non-alcoholic fatty liver disease: The AwareNASH survey. United European Gastroenterol J 2023; 11:654-662. [PMID: 37563849 PMCID: PMC10493357 DOI: 10.1002/ueg2.12445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/04/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The estimated global prevalence and burden of non-alcoholic fatty liver disease (NAFLD) and its advanced stage, non-alcoholic steatohepatitis (NASH), is increasing. Yet, NAFLD remains largely underdiagnosed. In addition to hepatic morbidity and mortality, NAFLD is associated with increased cardiovascular complications, warranting a multidisciplinary approach. Despite its rapidly increasing prevalence, knowledge of NAFLD among healthcare workers is limited, especially with specialists outside the field of hepatology and gastroenterology. OBJECTIVES To investigate knowledge, practice and opinions/attitudes of healthcare workers towards diagnosis and management of NAFLD/NASH. METHODS The survey was designed in collaboration with a multidisciplinary scientific committee established especially for this study. The survey was disseminated to healthcare workers from seven different disciplines through four collaborating societies, social media and at a cardiology-themed conference from February to June 2022. Median and interquartile range were mentioned for numeric responses and proportions for categorical responses or responses on a Likert scale. Likert scale responses were treated as ordinal data and analysed with the appropriate tests. RESULTS The full dataset included 613 respondents from 88 different countries (including 488 physicians). 64% of the surveyed physicians underestimated the prevalence of NAFLD. General practitioners and cardiologists underestimated the prevalence most often (74% and 77%, respectively). Compared to the other disciplines, cardiologists were least familiar with the symptoms and diagnostic criteria and felt least confident in diagnosing and managing NAFLD. Overall, 65% of physicians reported regularly using evidence-based guidelines for managing NAFLD, yet 72% reported challenges in providing lifestyle recommendations. A lack of awareness was the most common reported reason for the lack of screening for NAFLD (68% respectively). CONCLUSIONS Despite the growing burden of NAFLD, there is a significant gap in awareness, knowledge, and management among physicians treating patients with cardiometabolic comorbidities, particularly cardiologists. Hepatologists and gastroenterologists could play a role in educating their fellow physicians.
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Affiliation(s)
- Stan Driessen
- Department of Vascular MedicineAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Vivian D. de Jong
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Julius ClinicalZeistthe Netherlands
| | - Koen C. van Son
- Department of Vascular MedicineAmsterdam University Medical CenterAmsterdamthe Netherlands
- Department of Gastroenterology and HepatologyRadboudumcNijmegenthe Netherlands
| | | | | | - Marco Alings
- Julius ClinicalZeistthe Netherlands
- Department of CardiologyAmphia HospitalBredathe Netherlands
| | - Cristophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive OncologyCUB Hôspital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - Stefan D. Anker
- Department of CardiologyCharité‐UniversitätsmedizinBerlinGermany
| | - Manuel Castro Cabezas
- Julius ClinicalZeistthe Netherlands
- Department of Internal MedicineFranciscus Gasthuis & VlietlandRotterdamthe Netherlands
- Department of Internal Medicine and EndocrinologyErasmus MC Medical CenterRotterdamthe Netherlands
| | - Adriaan G. Holleboom
- Department of Vascular MedicineAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Julius ClinicalZeistthe Netherlands
| | - Maarten E. Tushuizen
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenthe Netherlands
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10
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Sattar Y, Sengodan PM, Cheema MS, Javed N, Ashraf S, Fakhra S, Alharbi A, Syed M, Alam M, Elgendy IY, Haleem A, Kawsara A, Alraies MC, Daggubati R. Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory? Interv Cardiol 2023; 18:e18. [PMID: 37435603 PMCID: PMC10331561 DOI: 10.15420/icr.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 07/13/2023] Open
Abstract
Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. Methods: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. Results: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. Conclusion: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment.
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Affiliation(s)
- Yasar Sattar
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | | | - Mustafa Sajjad Cheema
- Department of Medicine, CMH Lahore Medical College and Institute of DentistryLahore, Punjab, Pakistan
| | - Nismat Javed
- Department of Internal Medicine, BronxCare Health SystemNew York, NY, US
| | - Shoaib Ashraf
- Department of Cardiology, Hackensack University Medical CentreNJ, US
| | - Sadaf Fakhra
- Department of Internal Medicine, University of Nevada, Kirk Kerkorian School of MedicineLas Vegas, NV, US
| | - Anas Alharbi
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Moinuddin Syed
- Department of Cardiology, Boston UniversityBoston, MA, US
| | - Mahboob Alam
- Department of Cardiology, Baylor College of MedicineHouston, TX, US
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of KentuckyLexington, KT, US
| | - Affan Haleem
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Akram Kawsara
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - M Chadi Alraies
- Detroit Medical Centre, Wayne State UniversityDetroit, MI, US
| | - Ramesh Daggubati
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
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11
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Ferrières J, Bruckert E, Farnier M, Krempf M, Mourad JJ, Roux B, Schiele F. Evaluation of hypercholesterolemia management in at-risk patients by cardiologists in France: a case vignette-based study. J Comp Eff Res 2023; 12:e220181. [PMID: 36891969 PMCID: PMC10402750 DOI: 10.57264/cer-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
Aim: This online interactive survey investigated lipid-lowering approaches of French cardiologists in high- and very high-cardiovascular risk patients with hypercholesterolemia. Materials & methods: Physicians assessed three hypothetical patients at three clinic visits, and selected the patients' cardiovascular risk category, target low-density lipoprotein cholesterol (LDL-C) and treatment. Results: A total of 162 physicians completed 480 risk assessments; 58% of assessments correctly categorized the hypothetical patients. Most physicians chose the correct LDL-C target for one of the very high-risk patients, but higher-than-recommended targets were selected for the other very high-risk patient and the high-risk patient. Statins were the most commonly chosen treatment. Conclusion: French cardiologists often underestimate cardiovascular risk in patients with hypercholesterolemia, select a higher-than-recommended LDL-C target and prescribe less intensive treatment than that recommended by guidelines.
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Affiliation(s)
- Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
- INSERM UMR 1295, Toulouse Paul Sabatier University, Toulouse, France
| | - Eric Bruckert
- Department of Endocrinology Metabolism & Cardiovascular Prevention, Pitié Salpêtrière Hospital, E3M Institute & IHU Cardiometabolic (ICAN), Paris, France
| | - Michel Farnier
- Team PEC2, EA 7460, University of Bourgogne Franche-Comté, Dijon, France
| | - Michel Krempf
- Department of Endocrinology, Bretéché Clinic, Nantes, France
| | - Jean-Jacques Mourad
- Department of Internal Medicine, Hôpital Franco-Britannique, Levallois, France
| | | | - François Schiele
- Department of Cardiology, CHU Besançon, University of Franche-Comté, Besançon, EA 3920, France
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Takemoto K, Nakamura M, Yamamoto T, Kawata H, Atagi K. The Efficacy of Acute Myocardial Infarction Intensive Care Unit Management with a Collaborative Intensivists and Cardiologists in Japan: A Retrospective Observational Study. Intern Med 2023; 62:979-985. [PMID: 35989273 PMCID: PMC10125813 DOI: 10.2169/internalmedicine.0345-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Dedicated intensive care unit (ICU) physician staffing is associated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data are available on the role of intensivists in ICU for cardiac disease, especially in Japan. This study investigated the association of collaborative intensivists and cardiologist care with clinical outcomes in patients with acute myocardial infarction (AMI) admitted to the ICU. Methods This study analyzed 106 patients admitted to the ICU at Nara Prefecture General Medical Center in Nara, Japan, from April 2017 to April 2019. Eligible patients were divided into either the high-intensity ICU management group (n=51) or the low-intensity ICU management group (n=55). The primary outcome of in-hospital mortality was compared in the two groups. Results The high-intensity ICU group was found to be associated with a lower mortality rate in a multivariate analysis than the low-intensity group [7.8% vs. 16.4%; odds ratio (OR): 0.07; 95% confidence interval (CI): 0.01-0.54; p=0.01]. There were no significant differences in the length of either the ICU stay or hospital stay or the hospital costs between the two groups. A subgroup analysis revealed that the in-hospital mortality rate was lower in the high-intensity ICU group than in the low-intensity ICU group among patients with Killip class IV (16.7% vs. 34.6%; OR, 0.08; 95% CI, 0.01-0.67; p=0.02). Conclusion The presence of dedicated intensivists in high-intensity ICU collaborating with cardiologists might reduce in-hospital mortality in patients with Killip class IV AMI who require critical care.
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Affiliation(s)
- Kiyoshi Takemoto
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
| | - Michitaka Nakamura
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
| | - Tomonori Yamamoto
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
| | - Hiroyuki Kawata
- Department of Cardiovascular Medicine, Nara Prefecture General Medical Center, Japan
| | - Kazuaki Atagi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
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Zhang R, Purkayastha S, Ying X, Kahn PA, Zhang R, Li S, Qu V, Kini V. Trends in Industry Payments to Cardiologists From 2014 to 2019. Circ Cardiovasc Qual Outcomes 2023; 16:e009820. [PMID: 36926947 DOI: 10.1161/circoutcomes.122.009820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Ruina Zhang
- Department of Medicine, Weill Cornell Medicine, New York, New York. (Ruina Zhang, S.P., X.Y.)
| | - Subhanik Purkayastha
- Department of Medicine, Weill Cornell Medicine, New York, New York. (Ruina Zhang, S.P., X.Y.)
| | - Xiaohan Ying
- Department of Medicine, Weill Cornell Medicine, New York, New York. (Ruina Zhang, S.P., X.Y.)
| | - Peter A Kahn
- Yale School of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, New Haven, Connecticut (P.A.K.)
| | - Ruimin Zhang
- Horace Mann School, New York, New York (Ruimin Zhang)
| | - Sunnie Li
- University of North Carolina at Chapel Hill (S.L.)
| | - Veronica Qu
- Division of Cardiology, Weill Cornell Medicine, New York, New York. (V.Q., V.K.)
| | - Vinay Kini
- Division of Cardiology, Weill Cornell Medicine, New York, New York. (V.Q., V.K.)
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14
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Volgman AS, Dye CA, Sanghani RM. What Can Cardiologists Do to Reduce the High Risk of Maternal Mortality in the United States? Circulation 2023; 147:526-528. [PMID: 36780390 DOI: 10.1161/circulationaha.122.063093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
| | - Cicely A Dye
- Division of Cardiology, Rush University Medical Center, Chicago, IL
| | - Rupa M Sanghani
- Division of Cardiology, Rush University Medical Center, Chicago, IL
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15
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Bahit MC, Salvati A. Sex Disparities in Cardiology: How Are We Doing in Latin America? Circulation 2023; 147:521-522. [PMID: 36780382 DOI: 10.1161/circulationaha.122.063611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- M Cecilia Bahit
- Department of Cardiology, INECO Neurociencias Rosario, Santa Fe, Argentina (M.C.B.)
| | - Ana Salvati
- Fundación Cardiológica Argentina and Department of Cardiology, Clínica Modelo de Morón, Buenos Aires, Argentina (A.S.)
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16
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Sauer AJ. Mental Health Conditions Among Cardiologists: Silent Suffering. J Am Coll Cardiol 2023; 81:587-589. [PMID: 36585351 DOI: 10.1016/j.jacc.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA.
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17
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Piciacchia F, Auricchio A, Behr ER, Wilde AA, Conte G. Family History of Sudden Cardiac Death in the Young and Inherited Arrhythmia Syndromes: Awareness and Attitudes of General Practitioners and Private Practice Cardiologists. Circ Genom Precis Med 2023; 16:e003913. [PMID: 36716170 PMCID: PMC9946158 DOI: 10.1161/circgen.122.003913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Flavia Piciacchia
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (F.P., A.A., G.C.)
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (F.P., A.A., G.C.).,Faculty of Biomedical Sciences, USI, Lugano, Switzerland (A.A., G.C.)
| | - Elijah R. Behr
- ERN GUARDHEART (E.R.B., A.A.M.W.),Cardiology Clinical Academic Group (E.R.B.),St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK (E.R.B.)
| | - Arthur A.M. Wilde
- ERN GUARDHEART (E.R.B., A.A.M.W.),Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands (A.A.M.W.)
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (F.P., A.A., G.C.).,Faculty of Biomedical Sciences, USI, Lugano, Switzerland (A.A., G.C.)
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Ibrahim H, Williams MR. When Fixing Hinders, Why We Should Sometimes Fight the Urge to Fix. Circ Cardiovasc Interv 2022; 15:e012654. [PMID: 36538581 DOI: 10.1161/circinterventions.122.012654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Hall JL, Jhund PS. Novel Methods of the Precision Medicine Platform: A Path to Tackling Heart Disease. Circ Heart Fail 2022; 15:e010024. [PMID: 36378757 DOI: 10.1161/circheartfailure.122.010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (P.S.J.)
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Abdel-Qadir H, Akioyamen LE, Fang J, Pang A, Ha AC, Jackevicius CA, Alter DA, Austin PC, Atzema CL, Bhatia RS, Booth GL, Johnston S, Dhalla I, Kapral MK, Krumholz HM, McNaughton CD, Roifman I, Tu K, Udell JA, Wijeysundera HC, Ko DT, Schull MJ, Lee DS. Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study. Circulation 2022; 146:159-171. [PMID: 35678171 PMCID: PMC9287095 DOI: 10.1161/circulationaha.122.058949] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are limited data on the association of material deprivation with clinical care and outcomes after atrial fibrillation (AF) diagnosis in jurisdictions with universal health care. METHODS This was a population-based cohort study of individuals ≥66 years of age with first diagnosis of AF between April 1, 2007, and March 31, 2019, in the Canadian province of Ontario, which provides public funding and prohibits private payment for medically necessary physician and hospital services. Prescription medications are subsidized for residents >65 years of age. The primary exposure was neighborhood material deprivation, a metric derived from Canadian census data to estimate inability to attain basic material needs. Neighborhoods were categorized by quintile from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazards regression was used to study the association of material deprivation quintile with time to AF-related adverse events (death or hospitalization for stroke, heart failure, or bleeding), clinical services (physician visits, cardiac diagnostics), and interventions (anticoagulation, cardioversion, ablation) while adjusting for individual characteristics and regional cardiologist supply. RESULTS Among 347 632 individuals with AF (median age 79 years, 48.9% female), individuals in the most deprived neighborhoods (Q5) had higher prevalence of cardiovascular disease, risk factors, and noncardiovascular comorbidity relative to residents of the least deprived neighborhoods (Q1). After adjustment, Q5 residents had higher hazards of death (hazard ratio [HR], 1.16 [95% CI, 1.13-1.20]) and hospitalization for stroke (HR, 1.16 [95% CI, 1.07-1.27]), heart failure (HR, 1.14 [95% CI, 1.11-1.18]), or bleeding (HR, 1.16 [95% CI, 1.07-1.25]) relative to Q1. There were small differences across quintiles in primary care physician visits (HR, Q5 versus Q1, 0.91 [95% CI, 0.89-0.92]), echocardiography (HR, Q5 versus Q1, 0.97 [95% CI, 0.96-0.99]), and dispensation of anticoagulation (HR, Q5 versus Q1, 0.97 [95% CI, 0.95-0.98]). There were more prominent disparities for Q5 versus Q1 in cardiologist visits (HR, 0.84 [95% CI, 0.82-0.86]), cardioversion (HR, 0.80 [95% CI, 0.76-0.84]), and ablation (HR, 0.45 [95% CI, 0.30-0.67]). CONCLUSIONS Despite universal health care and prescription medication coverage, residents of more deprived neighborhoods were less likely to visit cardiologists or receive rhythm control interventions after AF diagnosis, even though they exhibited higher cardiovascular disease burden and higher risk of adverse outcomes.
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Affiliation(s)
- Husam Abdel-Qadir
- Women’s College Hospital, Toronto, Canada (H.A.-Q., J.A.U.)
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Leo E. Akioyamen
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Jiming Fang
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
| | - Andrea Pang
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
| | - Andrew C.T. Ha
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Cynthia A. Jackevicius
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Western University of Health Sciences, Pomona, CA (C.A.J.)
| | - David A. Alter
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Peter C. Austin
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Clare L. Atzema
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - R. Sacha Bhatia
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Gillian L. Booth
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada (G.L.B., I.D.)
| | - Sharon Johnston
- Departments of Family Medicine, University of Ottawa, Ottawa, Canada (S.J.)
- Institu du Savoir, Hôpital Montfort‚ Ottawa, Canada (S.J.)
| | - Irfan Dhalla
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada (G.L.B., I.D.)
| | - Moira K. Kapral
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.)
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Candace D. McNaughton
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Idan Roifman
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Karen Tu
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Family and Community Medicine (K.T.), University of Toronto, Toronto‚ Canada
- North York General Hospital, Toronto, Canada (K.T.)
| | - Jacob A. Udell
- Women’s College Hospital, Toronto, Canada (H.A.-Q., J.A.U.)
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
| | - Harindra C. Wijeysundera
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Dennis T. Ko
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Michael J. Schull
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.)
| | - Douglas S. Lee
- University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.)
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.)
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
- Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto‚ Canada
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Nalliah RP, Basu T, Chang CH. Association between periodontal care and hospitalization with acute myocardial infarction. J Am Dent Assoc 2022:S0002-8177(22)00087-3. [PMID: 35459524 DOI: 10.1016/j.adaj.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Each year there are 800,000 myocardial infarctions in the United States. There is an increased risk of hospitalization for acute myocardial infarction (AMI) for those with periodontal disease. Yet, there is a paucity of knowledge about downstream care of AMI and how this varies with periodontal care status. The authors' aim was to examine the association between periodontal care and AMI hospitalization and 30 days after acute care. METHODS Using the MarketScan database, the authors conducted a retrospective cohort study among patients with both dental insurance and medical insurance in 2016 through 2018 who were hospitalized for AMI in 2017. RESULTS There were 2,370 patients who had dental and medical coverage for 2016 through 2018 and received oral health care in 2016 through 2017 and had an AMI hospitalization in 2017. Forty-seven percent received regular or other oral health care, 7% received active periodontal care, and 10% received controlled periodontal care. More than one-third of patients (36%) did not have oral health care before the AMI hospitalization. After adjusting for patient characteristics, we found that patients in the controlled periodontal care group were significantly more likely to have visits during the 30 days after AMI hospitalization (adjusted odds ratio, 1.63; 95% CI, 1.07 to 2.47; P = .02). CONCLUSIONS We found that periodontal care was associated with more after AMI visits. This suggests that there is a benefit to incorporating oral health care and medical care to improve AMI outcomes. PRACTICAL IMPLICATIONS Needing periodontal care is associated with more favorable outcomes related to AMI hospitalization. Early intervention to ensure stable periodontal health in patients with risk factors for AMI could reduce downstream hospital resource use.
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22
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Carvalho de Campos Martins E, Luiz de Melo Bernardi F. Interventional Cardiologists in the Interdisciplinary Stroke Team: We Are Already Here, Contributing! JACC Cardiovasc Interv 2022; 15:559-561. [PMID: 35151609 DOI: 10.1016/j.jcin.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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23
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Albaroudi B, Haddad M, Albaroudi O, Abdel-Rahman ME, Jarman R, Harris T. Assessing left ventricular systolic function by emergency physician using point of care echocardiography compared to expert: systematic review and meta-analysis. Eur J Emerg Med 2022; 29:18-32. [PMID: 34406134 PMCID: PMC8691376 DOI: 10.1097/mej.0000000000000866] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023]
Abstract
Assessing left ventricular systolic function (LVSF) by echocardiography assists in the diagnosis and management of a diverse range of patients presenting to the emergency department (ED). We evaluated the agreement between ED-based clinician sonographers and apriori-defined expert sonographers. We conducted a systematic review and meta-analysis based on Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. We searched Medline, EMBASE, Cochrane, ClinicalTrials.gov, TRIP and Google Scholar for eligible studies from inception to February 2021. Risk of bias was evaluated using Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The level of agreement between clinician and expert sonographers was measured using kappa, sensitivity, specificity, positive and negative likelihood ratio statistics using random-effects models. Twelve studies were included (1131 patients, 1229 scans and 159 clinician sonographers). Significant heterogeneity was identified in patient selection, methods of assessment of LVSF, reference standards and statistical methods for assessing agreement. The overall quality of studies was low, with most being small, single centre convenience samples. A meta-analysis including seven studies (786 scans) where visual estimation method was used by clinician sonographers demonstrated simple Kappa of 0.68 [95% confidence interval (CI), 0.57-0.79], and sensitivity, specificity, positive and negative likelihood ratio of 89% (95% CI, 80-94%), 85% (95% CI, 80-89%), 5.98 (95% CI, 4.13-8.68) and 0.13 (95% CI, 0.06-0.24), respectively, between clinician sonographer and expert sonographer for normal/abnormal LVSF. The weighted kappa for five studies (429 scans) was 0.70 (95% CI, 0.61-0.80) for normal/reduced/severely reduced LVSF. There is substantial agreement between ED-based clinician sonographers and expert sonographers for assessing LVSF using visual estimation and ranking it as normal/reduced, or normal/reduced/severely reduced, in patients presenting to ED.
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Affiliation(s)
| | - Mahmoud Haddad
- Department of Emergency Medicine, Hamad Medical Corporation
| | - Omar Albaroudi
- Department of Emergency Medicine, Hamad Medical Corporation
| | | | - Robert Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne
- Teesside University, Middlesbrough
| | - Tim Harris
- Department of Emergency Medicine, Hamad Medical Corporation
- Barts Health NHS Trust and the Queen Mary University of London, London, UK
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24
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Lima FV, Manandhar P, Wojdyla D, Wang T, Aronow HD, Kadiyala V, Weissler EH, Madan N, Gilchrist IC, Grines C, Abbott JD. Percutaneous Coronary Intervention Following Diagnostic Angiography by Noninterventional Versus Interventional Cardiologists: Insights From the CathPCI Registry. Circ Cardiovasc Interv 2021; 15:e011086. [PMID: 34933569 DOI: 10.1161/circinterventions.121.011086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited contemporary, national data describing diagnostic cardiac catheterization with subsequent percutaneous coronary intervention (ad hoc percutaneous coronary intervention [PCI]) performed by an invasive-diagnostic and interventional (Dx/IC) operator team versus solo interventional operator (solo-IC). Using the CathPCI Registry, this study aimed at analyzing trends and outcomes in ad hoc PCI among Dx/IC versus solo-IC operators. METHODS Quarterly rates (January 2012 to March 2018) of ad hoc PCI cases by Dx/IC and solo-IC operators were obtained. Odds of inhospital major adverse cardiovascular events, net adverse cardiovascular events (ie, composite major adverse cardiovascular event+bleeding), and rarely appropriate PCI were estimated using multivariable regression. RESULTS From 1077 sites, 1 262 948 patients were included. The number of invasive-diagnostic operators and cases performed by Dx/IC teams decreased from nearly 9% to 5% during the study period. Patients treated by Dx/IC teams were more often White and had fewer comorbidities compared with patients treated by solo-IC operators. Considerable variation existed across sites, and over two-fifths of sites had 0% ad hoc PCI performed by Dx/IC. In adjusted analyses, ad hoc performed by Dx/IC had similar risks of major adverse cardiovascular event (OR, 1.04 [95% CI, 0.97-1.11]) and net adverse cardiovascular events (OR, 0.98 [95% CI, 0.94-1.03]) compared with solo-IC. Rarely appropriate PCI, although low overall (2.1% versus 1.9%) occurred more often by Dx/IC compared with solo-IC (OR, 1.20 [95% CI, 1.13-1.26]). CONCLUSIONS Contemporary, nationwide data from the CathPCI Registry demonstrates the number of Dx/IC operator teams and cases has decreased but that case volume is stable among operators. Outcomes were independent of operator type, which supports current practice patterns. The finding of a higher risk of rarely appropriate PCI in Dx/IC teams should be further studied.
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Affiliation(s)
- Fabio V Lima
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (F.V.L., H.D.A., V.K., J.D.A.)
| | - Pratik Manandhar
- Duke Clinical Research Institute, Durham, NC (P.M., D.W., T.W., E.H.W.)
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Durham, NC (P.M., D.W., T.W., E.H.W.)
| | - Tracy Wang
- Duke Clinical Research Institute, Durham, NC (P.M., D.W., T.W., E.H.W.)
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (F.V.L., H.D.A., V.K., J.D.A.)
| | - Vishnu Kadiyala
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (F.V.L., H.D.A., V.K., J.D.A.)
| | - E Hope Weissler
- Duke Clinical Research Institute, Durham, NC (P.M., D.W., T.W., E.H.W.)
| | - Nidhi Madan
- Department of Cardiovascular Diseases, Rush University Medical Center, Chicago, IL (N.M.)
| | - Ian C Gilchrist
- Penn State Heart and Vascular Institute, Hershey, PA (I.C.G.)
| | - Cindy Grines
- Northside Hospital Cardiovascular Institute, Atlanta, GA (C.G.)
| | - J Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (F.V.L., H.D.A., V.K., J.D.A.)
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25
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Oh AR, Park J, Lee S, Yang K, Choi JH, Kim K, Ahn J, Sung JD, Lee SH. Association between Cardiologist Consultation and Mortality of Stable Patients with Elevated Cardiac Troponin at Admission. Diagnostics (Basel) 2021; 11:2229. [PMID: 34943466 PMCID: PMC8700380 DOI: 10.3390/diagnostics11122229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
Elevated cardiac troponin (cTn) showed associations with mortality even in stable patients, but management has not been established. We aimed to investigate whether consultation to cardiologists could reduce mortality of stable patients with cTn elevation at admission. We identified 1329 patients with elevated cTn level at hospitalization from outpatient clinic to any department other than cardiology or cardiac surgery between April 2010 and December 2018. The patients were divided into two groups according to cardiologist consultation at admission. For primary outcome, mortality during one year was compared in the crude and propensity-score-matched populations. In 1329 patients, 397 (29.9%) were consulted to cardiologists and 932 (70.1%) were not. Mortality during the first year was significantly lower in patients consulted to cardiologists compared with those who were not (9.8% vs. 14.2%; hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.35-0.72; p < 0.001). After propensity-score matching, 324 patients were in the cardiologist consultation group and 560 patients were in the no cardiologist consultation group. One-year mortality was consistently lower in the cardiologist consultation group (10.5% vs. 14.6%; HR, 0.58; 95% CI, 0.39-0.86; p = 0.01). Cardiologist consultation may be associated with lower mortality in stable patients with cTn elevation at admission. Further studies are needed to identify effective management strategies for stable patients with elevated cTn.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (A.R.O.); (J.P.); (S.L.)
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (A.R.O.); (J.P.); (S.L.)
| | - Sooyeon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (A.R.O.); (J.P.); (S.L.)
| | - Kwangmo Yang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jin-Ho Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (K.K.); (J.A.)
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
| | - Joonghyun Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (K.K.); (J.A.)
| | - Ji Dong Sung
- Rehabilitation & Prevention Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Seung-Hwa Lee
- Rehabilitation & Prevention Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Department of Biomedical Engineering, National University College of Medicine, Seoul 03080, Korea
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26
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Thomas KL, Mehta LS, Rzeszut AK, Lewis SJ, Duvernoy CS, Douglas PS. Perspectives of Racially and Ethnically Diverse U.S. Cardiologists: Insights From the ACC Professional Life Survey. J Am Coll Cardiol 2021; 78:1746-1750. [PMID: 34674820 DOI: 10.1016/j.jacc.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Sandra J Lewis
- Northwest Cardiovascular Institute, Portland, Oregon, USA
| | - Claire S Duvernoy
- VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, Michigan, USA
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27
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Pallikadavath S, Patel R, Sarania R, Ahmad T, Vali Z, Kandala NI, Sandilands A. Palpitation referrals from primary care to a secondary care cardiology outpatient clinic: assessing adherence to guidelines. Fam Pract 2021; 38:127-131. [PMID: 32918460 DOI: 10.1093/fampra/cmaa094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS Palpitations are a common presentation in primary care. Guidelines have been developed to identify patients with palpitations who require further assessment by a cardiologist in secondary care. However, patients that do not meet guideline thresholds for referrals are still referred to secondary care services. This audit evaluated the adherence to referral guidelines at our trust and assessed the characteristics of patients who were referred appropriately versus those referred without meeting guideline referral thresholds (inappropriate referral). RESULTS Palpitation referrals to a single cardiology outpatient clinic were assessed (n = 66). Half the patients referred for palpitations were referred inappropriately (n = 34, 51.5%). Patients referred inappropriately were more likely to have a benign diagnosis after assessment (91.2%). These patients also had significantly fewer investigations [mean difference of 1.1 (confidence interval: 0.6-1.6)]. Specialist investigations, such as cardiac event recorders (P < 0.05) and cardiac magnetic resonance imaging (P < 0.05) were less likely to be used in inappropriately referred patients. CONCLUSIONS The results from this audit provide early evidence that there are a significant number of patients who are being referred that could be managed in primary care. Further studies are needed to confirm our findings in larger cohorts and to establish the underlying reasons for inappropriate referrals.
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Affiliation(s)
| | - Roshan Patel
- Leicester Medical School, University of Leicester, Leicester
| | - Rishi Sarania
- Leicester Medical School, University of Leicester, Leicester
| | - Talal Ahmad
- Leicester Medical School, University of Leicester, Leicester
| | - Zakariyya Vali
- Leicester Medical School, University of Leicester, Leicester.,Glenfield Hospital, University Hospitals Leicester, Leicester
| | - Ngianga Ii Kandala
- School of Health Science and Social Work, University of Portsmouth, Portsmouth, UK
| | - Alastair Sandilands
- Leicester Medical School, University of Leicester, Leicester.,Glenfield Hospital, University Hospitals Leicester, Leicester
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28
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Joynt Maddox KE, Johnston KJ. Value-Based Cardiovascular Care: Developing Cost Measures for Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2021; 14:e007753. [PMID: 33653115 DOI: 10.1161/circoutcomes.121.007753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.).,Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, MO (K.E.J.M.)
| | - Kenton J Johnston
- Department of Health Management and Policy, College for Public Health and Social Justice (K.J.), Saint Louis University, St. Louis, MO.,Department of Health and Clinical Outcomes Research, School of Medicine (K.J.), Saint Louis University, St. Louis, MO
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29
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30
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Nadamuni M, Minniefield NE, Okorodudu DO. Exposure to Cardiology as a Strategy to Increase the Number of Black Men in Medicine. Circulation 2021; 143:513-515. [PMID: 33555922 DOI: 10.1161/circulationaha.120.051578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mridula Nadamuni
- Departments of Internal Medicine and Pediatrics (M.N.), University of Texas Southwestern, Dallas.,Cardiology (N.E.M.), University of Texas Southwestern, Dallas
| | - Nicole E Minniefield
- Internal Medicine (N.E.M., D.O.O.), University of Texas Southwestern, Dallas.,Division of Internal Medicine, Dallas Veterans Affairs Medical Center, Texas (N.E.M., D.O.O.)
| | - Dale O Okorodudu
- Internal Medicine (N.E.M., D.O.O.), University of Texas Southwestern, Dallas.,Division of Pulmonary and Critical Care Medicine (D.O.O.), University of Texas Southwestern, Dallas.,Division of Internal Medicine, Dallas Veterans Affairs Medical Center, Texas (N.E.M., D.O.O.)
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31
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Rai D, Tahir MW, Waheed SH, Kapoor A, Pandey R, Barssoum K, Hajra A, Balmer-Swain M, Michos ED, Gulati M. National Trends of Sex Disparity in the American College of Cardiology/American Heart Association Guideline Writing Committee Authors Over 15 Years. Circ Cardiovasc Qual Outcomes 2021; 14:e007578. [PMID: 33541108 DOI: 10.1161/circoutcomes.120.007578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, NY (D.R., M.W.T., S.H.W., A.K., R.P., K.B.)
| | - Muhammad Waqas Tahir
- Department of Internal Medicine, Rochester General Hospital, NY (D.R., M.W.T., S.H.W., A.K., R.P., K.B.)
| | - Syed Hamza Waheed
- Department of Internal Medicine, Rochester General Hospital, NY (D.R., M.W.T., S.H.W., A.K., R.P., K.B.)
| | - Ankita Kapoor
- Department of Internal Medicine, Rochester General Hospital, NY (D.R., M.W.T., S.H.W., A.K., R.P., K.B.)
| | - Ritambhara Pandey
- Department of Internal Medicine, Rochester General Hospital, NY (D.R., M.W.T., S.H.W., A.K., R.P., K.B.)
| | - Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, NY (D.R., M.W.T., S.H.W., A.K., R.P., K.B.)
| | - Adrija Hajra
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.H.)
| | - Mallory Balmer-Swain
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, NY (M.B.-S.)
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix (M.G.)
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32
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McCutcheon K, Vanhaverbeke M, Pauwels R, Dabin J, Schoonjans W, Bennett J, Adriaenssens T, Dubois C, Sinnaeve P, Desmet W. Efficacy of MAVIG X-Ray Protective Drapes in Reducing Operator Radiation Dose in the Cardiac Catheterization Laboratory: A Randomized Controlled Trial. Circ Cardiovasc Interv 2020; 13:e009627. [PMID: 33092401 DOI: 10.1161/circinterventions.120.009627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interventional cardiologists are occupationally exposed to high doses of ionizing radiation. The MAVIG X-ray protective drape (MXPD) is a commercially available light weight, lead-free shield placed over the pelvic area of patients to minimize operator radiation dose. The aim of this study was to examine the efficacy of the MXPD during routine cardiac catheterization, including percutaneous coronary interventions. METHODS We performed a prospective, randomized controlled study comparing operator radiation dose during cardiac catheterization and percutaneous coronary intervention (n=632) with or without pelvic MXPD. We measured operator radiation dose at 4 sites: left eye, chest, left ring finger, and right ring finger. The primary outcomes were the difference in first operator radiation dose (µSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the 2 groups. RESULTS The use of the MXPD was associated with a 50% reduction in operator radiation dose (median dose 30.5 [interquartile range, 23.0-39.7] µSv in no drape group versus 15.3 [interquartile range, 11.1-20.0] µSv in the drape group; P<0.001) and a 57% reduction in relative operator dose (P<0.001). The largest absolute reduction in dose was observed at the left finger (median left finger dose for the no drape group was 104.9 [75.7-137.4] µSv versus 41.9 [32.6-70.6] µSv in the drape group; P<0.001). CONCLUSIONS The pelvic MXPD significantly reduces first operator radiation dose during routine cardiac catheterization and percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04285944.
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Affiliation(s)
- Keir McCutcheon
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Maarten Vanhaverbeke
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Ruben Pauwels
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.)
| | - Jérémie Dabin
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Werner Schoonjans
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Johan Bennett
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
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Affiliation(s)
- Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (N.R.)
| | - Ersilia M DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York (E.M.D.)
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD (E.D.M.)
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Abstract
The novel coronavirus disease 2019 (COVID-19), with first presentation of atypical pneumonia, has spread rapidly from Wuhan, China, on December 12, 2019 to over 200 countries, caused 2 310 572 infected individuals and 158 691 mortalities, updated on April 19, 2020. Many studies have published timely to help global healthcare workers to understand and control the disease. Vulnerable patients with risk factors such as elderly, cardiovascular diseases (eg, hypertension, coronary disease, or cardiomyopathy), diabetes, and chronic kidney disease have worse outcomes after COVID-19 infection. COVID-19 could directly cause cardiovascular injuries such as pericarditis, myocarditis, myocardial infarction, heart failure, arrhythmias, or thromboembolic events, which urge cardiologists to be involved in the frontline to practice. Here, we provide a review of COVID-19 on cardiovascular system to assist clinical cardiologists to better understand the disease and being capable of providing comprehensive medical support.
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Affiliation(s)
- Yen-Bo Su
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Jen Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ting-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chian-Shiu Chien
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ping Yang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Jie Chou
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
- Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address correspondence. Dr. Hsin-Bang Leu, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (H.-B. Leu)
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Dávila-Román VG, Checkley W. Lung Ultrasound in Cardiac Intensive Care: More Than Just LUCK? Circ Cardiovasc Imaging 2020; 13:e010909. [PMID: 32536198 DOI: 10.1161/circimaging.120.010909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victor G Dávila-Román
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Department of Medicine, and Global Health Center, Institute of Public Health, Washington University School of Medicine, St. Louis, MO (V.G.D.-R.)
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine (W.C.), School of Medicine, Johns Hopkins University, Baltimore, MD.,Center for Global Non-Communicable Disease Research and Training (W.C.), School of Medicine, Johns Hopkins University, Baltimore, MD
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36
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Anakwue R. Cytotoxic-induced heart failure among breast cancer patients in Nigeria: A call to prevent today's cancer patients from being tomorrow's cardiac patients. Ann Afr Med 2020; 19:1-7. [PMID: 32174608 PMCID: PMC7189886 DOI: 10.4103/aam.aam_24_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We report three cases of heart failure (HF) associated with the use of cytotoxic drugs such as anthracycline, cyclophosphamide, and 5-fluorouracil in the treatment of breast cancer in Nigerians. The patients had systolic and diastolic HF: HF with reduced ejection fraction and preserved ejection fraction. The prevalence of breast cancer is increasing across Africa, and cytotoxics are some of the most common and best drugs used during management. The cardiotoxicity caused by these drugs limits their use as chemotherapeutic agents. Cytotoxic-induced HF is a preventable and manageable cause of cardiovascular disease (CVD) in Nigeria and Africa. This article discusses the pathophysiology of cytotoxic-induced HF and presents the risk factors that impair cardiovascular function. The importance of proper assessment and the prophylactic and therapeutic measures in the management of cytotoxic-induced HF are emphasized. The peculiar challenges in the management of cytotoxic-induced HF in Nigeria were also discussed. The need for early involvement of cardiologists by oncologists to improve on the chemotherapeutic and cardiovascular outcome in the management of patients with breast cancer was stressed. Perhaps, it is time to birth a new discipline of cardiooncology in Nigeria.
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Affiliation(s)
- Raphael Anakwue
- Department of Medicine; Department of Pharmacology and Therapeutics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Nsukka, Nigeria
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37
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Amin AP, Crimmins-Reda P, Miller S, Rahn B, Caruso M, Funk M, Pierce A, Kurz HI, Lasala JM, Zajarias A, Bach RG, Sintek MA, Frogge N, Jain S, Kulkarni H, Singh J. Reducing Acute Kidney Injury and Costs of Percutaneous Coronary Intervention by Patient-Centered, Evidence-Based Contrast Use. Circ Cardiovasc Qual Outcomes 2020; 12:e004961. [PMID: 30857411 DOI: 10.1161/circoutcomes.118.004961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amit P Amin
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Center for Value and Innovation (A.P.A., P.C.-R., S.M., B.R., M.C., M.F.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Patricia Crimmins-Reda
- Center for Value and Innovation (A.P.A., P.C.-R., S.M., B.R., M.C., M.F.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Samantha Miller
- Center for Value and Innovation (A.P.A., P.C.-R., S.M., B.R., M.C., M.F.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Brandon Rahn
- Center for Value and Innovation (A.P.A., P.C.-R., S.M., B.R., M.C., M.F.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Mary Caruso
- Center for Value and Innovation (A.P.A., P.C.-R., S.M., B.R., M.C., M.F.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Meghan Funk
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Center for Value and Innovation (A.P.A., P.C.-R., S.M., B.R., M.C., M.F.), Washington University School of Medicine, St. Louis, MO
| | - Andrew Pierce
- Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Howard I Kurz
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - John M Lasala
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Alan Zajarias
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Richard G Bach
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Marc A Sintek
- Cardiology Division, Washington University School of Medicine, St. Louis, Missouri (M.A.S.)
| | - Nathan Frogge
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | - Sudhir Jain
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
| | | | - Jasvindar Singh
- Cardiovascular Division (A.P.A., M.F., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.), Washington University School of Medicine, St. Louis, MO.,Barnes-Jewish Hospital, St. Louis, MO (A.P.A., P.C.-R., S.M., B.R., M.C., A.P., H.I.K., J.M.L., A.Z., R.G.B., N.F., S.J., J.S.)
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Giorgetti A, Genovesi D, Emdin M. The Role of 18FDG PET/CT in the Assessment of Endocarditis, Myocarditis and Pericarditis. Curr Radiopharm 2020; 14:259-272. [PMID: 32321415 DOI: 10.2174/1874471013666200422102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 11/22/2022]
Abstract
Endocarditis, myocarditis and pericarditis are a heterogeneous group of phenotypic syndromes where the culprit area of inflammation is the heart. Inflammation may be determined by an infective agent, toxins, drugs or an activated immune system. Clinical manifestations can be subtle and diagnosis remains a challenge for cardiologists, requiring high level of suspicion and advanced multimodal cardiac imaging to avoid life-threatening consequences. The purpose of this review is to report the recent advances of PET/CT imaging with 18FDG in helping the management of patients affected by inflammatory heart disease. Two independent reviewers searched in PubMed articles published before or in June 2019 and final decisions on the inclusion of references were done in consensus with a third reviewer. At the end of the selection process 23/206 articles on "cardiac inflammation"; 26/235 articles on "endocarditis", "prosthetic heart valve", "pacemaker", "implantable cardiac device"; 7/103 articles on "myocarditis"; 13/330 articles on sarcoidosis" and 2/19 articles on "pericarditis" were included. Compared with the conventional methods, molecular imaging has the advantage to non-invasively and directly trace the inflammatory process, and to identify earlier the presence and the extent of intra-cardiac and extra-cardiac involvement, to enable quantification of disease activity, guide therapeutic interventions, and monitor treatment success.
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Affiliation(s)
| | - Dario Genovesi
- Fondazione CNR/Regione Toscana "Gabriele Monasterio", Pisa, Italy
| | - Michele Emdin
- Fondazione CNR/Regione Toscana "Gabriele Monasterio", Pisa, Italy
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Khan MS, Mahmood S, Khan SU, Fatima K, Khosa F, Sharma G, Michos ED. Women Training in Cardiology and Its Subspecialties in the United States: A Decade of Little Progress in Representation. Circulation 2020; 141:609-611. [PMID: 32065768 DOI: 10.1161/circulationaha.119.044693] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL (M.S.K.)
| | - Samar Mahmood
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (S.M., K.F.)
| | - Safi U Khan
- Department of Internal Medicine, West Virginia University, Morgantown (S.U.K.)
| | - Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (S.M., K.F.)
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Canada (F.K.)
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (G.S., E.D.M.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (G.S., E.D.M.)
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40
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Affiliation(s)
- Sonya Burgess
- University of New South Wales, Sydney, Australia (S.B.)
| | | | - Sarah Zaman
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia (S.Z.)
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Abstract
OBJECTIVES To determine the frequency of risk factors for hypertension among Chinese cardiologists using a nation-wide survey. DESIGN Multicenter, cross-sectional observational study. SETTING 2441 hospitals across China were surveyed between September 2016 and August 2017. PARTICIPANTS All in-service cardiologists were surveyed (n=28 924). INTERVENTIONS WeChat-based electronic data capture system, a social application in China (Tencent, Nanshan, China), was used for data acquisition. Physician subscribed to the WeChat official account of the China Cardiologist Heart Study, and filled out an online questionnaire that included age, gender, level of in-service hospital, professional title, academic degree, area of expertise and cardiovascular risk factors. All information was required. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the presence of cardiovascular risk factors. The secondary outcome was the impact of the risk factors on the occurrence of hypertension. RESULTS Among 28 924 Chinese cardiologists who completed the questionnaire, 57.6% had blood pressure of 130-139/80-89 mm Hg (5.3% were taking antihypertensive drugs) and 22.0% had blood pressure >140/>90 mm Hg (36.5% were taking antihypertensive drugs). The multivariable analysis showed that age, gender, academic degree, hospital level, body mass index (BMI), smoking and comorbidities were independently associated with hypertension among cardiologists (all p<0.05). Age, female gender, BMI, smoking, family history of cardiovascular diseases (CVDs) and comorbidities were independently associated with taking antihypertensive drugs among hypertensive cardiologists (all p<0.05). Age, hospital level, professional title, BMI, family history of CVDs and comorbidities were independently associated with reaching target blood pressure among hypertensive cardiologists taking antihypertensive drugs. CONCLUSION Chinese cardiologists do not recognise and pay attention to their own blood pressure. Their rate of antihypertensive treatment was low. The identified risk factors could be used to identify cardiologists at higher risk for hypertension and for implementing preventive interventions.
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Affiliation(s)
- Lei Hou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cardiology, Tongren hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Xuejuan Jin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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42
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Gehi AK, Deyo Z, Mendys P, Hatfield L, Laux J, Walker TJ, Chen S, O'Bryan J, Garner K, Sears SF, Akiyama J, Stearns SC, Biese K. Novel Care Pathway for Patients Presenting to the Emergency Department With Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2019; 11:e004129. [PMID: 29330141 DOI: 10.1161/circoutcomes.117.004129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anil K Gehi
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC.
| | - Zachariah Deyo
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Philip Mendys
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Leah Hatfield
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Jeffrey Laux
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - T Jennifer Walker
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Sarah Chen
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - James O'Bryan
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Kelly Garner
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Samuel F Sears
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Jill Akiyama
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Sally C Stearns
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
| | - Kevin Biese
- From the Division of Cardiology, Department of Medicine (A.G., P.M., T.J.W., S.C., J.O., K.G.), University of North Carolina Medical Center (Z.D., L.H.), Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy (Z.D., P.M., L.H.), Gillings School of Global Public Health (J.L., J.A., S.S.), and Department of Emergency Medicine (K.B.), University of North Carolina at Chapel Hill; and Department of Psychology (S.S.), Department of Cardiovascular Sciences (S.S.), and Department of Public Health (S.S.), East Carolina University, Greenville, NC
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43
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Affiliation(s)
| | - Molly Carnes
- Department of Medicine (M.C.) .,Center for Women's Health Research (M.C.).,School of Medicine and Public Health; and Department of Industrial and Systems Engineering (M.C.).,Women in Science and Engineering Leadership Institute (WISELI) (M.C.), College of Engineering, University of Wisconsin-Madison
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44
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Affiliation(s)
- Steven P Marso
- Cardiovascular Services, HCA Midwest Health Heart and Vascular Institute, Overland Park, KS
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45
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Wadhera RK, Yeh RW. Inadequate Surrogates for Imperfect Quality Measures. Circ Cardiovasc Interv 2018; 11:e007216. [PMID: 30354606 DOI: 10.1161/circinterventions.118.007216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rishi K Wadhera
- Brigham and Women's Hospital Heart and Vascular Center (R.K.W.), Harvard Medical School, Boston, MA.,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center (R.K.W., R.W.Y.), Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center (R.K.W., R.W.Y.), Harvard Medical School, Boston, MA
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46
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Asteggiano R, Bramlage P, Richter DJ. European Society of Cardiology Council for Cardiology Practice worldwide survey of transcatheter aortic valve implantation beliefs and practices. Eur J Prev Cardiol 2018; 25:608-617. [PMID: 29473424 DOI: 10.1177/2047487318760029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) continues to gain popularity in the management of patients with severe aortic stenosis (SAS). Distribution of resources to maximise appropriate use remains a priority. Design & methods To determine the current perceptions and behaviours regarding SAS patient management, an 18-point multiple-choice questionnaire was distributed to European Society of Cardiology (ESC) Council for Cardiology Practice (CCP) e-journal and/or electronic newsletter subscribers. Respondents to all questions were considered. Sub-analyses based on respondent age, practice setting and geographical location were performed. Results Of 1245 full respondents, 41.5% were aged ≥ 51 years, 22.7% were aged 41-50 years and 35.8% were aged ≤ 40 years. The majority were located in Europe (77.5%), followed by Asia/Oceania (11.6%), America (7.6%) and Africa (3.4%). In-hospital and out-of-hospital cardiologists accounted for 57.4% of and 28.5% of the sample, respectively, with the remainder being general practitioners/other. The majority of respondents (70.1%) claimed to diagnose between one and five cases of SAS per month. Free access to TAVI was reported by 41.2%, being less common for those aged ≤ 40 years (32.7%; p < 0.001), those located in Asia/Oceania, America and Africa (20.1%, 18.1% and 2.4%, respectively; p < 0.01 in each case) and in-hospital compared to out-of-hospital cardiologists (35.7% vs. 54.5%, respectively; p < 0.001). The most common reason for not referring a patient for an aortic valve intervention was assessment that the patient was high risk/non-operable (55.5%), followed by short life expectancy (30.5%). The most common reason for referring a patient for TAVI over surgical replacement was surgical risk score (56.9%). The most commonly perceived main complication of TAVI was stroke (28.9%), while the most frequently selected main benefit was improvement in quality of life (37.2%). A high proportion (82.5%) of respondents believed that TAVI is/may become a viable option for lower-risk SAS patients in future. Conclusion The population of potential TAVI is significant worldwide, with key barriers to referral being access limitations and poor physician education. Strategies to minimise these factors are paramount.
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Affiliation(s)
| | - Peter Bramlage
- 2 Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Affiliation(s)
- Caroline Bleakley
- From the Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Mark J Monaghan
- From the Department of Cardiology, King's College Hospital, London, United Kingdom.
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Affiliation(s)
- Jordan M Prutkin
- From the Division of Cardiology (J.M.P.) and Department of Family Medicine (J.A.D.), University of Washington, Seattle
| | - Jonathan A Drezner
- From the Division of Cardiology (J.M.P.) and Department of Family Medicine (J.A.D.), University of Washington, Seattle.
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Samad Z, Douglas PS. Vigilance in Mitral Regurgitation: Variation and the Way Forward. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006799. [PMID: 28774933 DOI: 10.1161/circimaging.117.006799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zainab Samad
- From the Division of Cardiology, Department of Medicine, Duke University, Durham, NC (Z.S., P.S.D.); and Duke Clinical Research Institute, Durham, NC (P.S.D.)
| | - Pamela S Douglas
- From the Division of Cardiology, Department of Medicine, Duke University, Durham, NC (Z.S., P.S.D.); and Duke Clinical Research Institute, Durham, NC (P.S.D.).
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