Social media use by cardiovascular healthcare professionals in Portugal.

INTRODUCTION AND OBJECTIVES: Social media (SoMe) has a flourishing role in cardiovascular (CV) medicine as a facilitator of academic communication not only during conferences and congresses, but also by scientific societies and journals. However, there is no solid data illustrating the use of SoMe by CV healthcare professionals (CVHP) in Portugal. Hence, the main goal of this national cross-sectional survey was to accurately characterize SoMe use by Portuguese CVHPs. METHODS: A 35-item questionnaire was specifically developed for this study, approved by the Digital Health Study Group of the Portuguese Society of Cardiology (SPC), and sent, by e-mail, to the mailing list of the SPC (including 1293 potential recipients). RESULTS AND CONCLUSION: There were 206 valid answers. Fifty-two percent of respondents were female and 58% were younger than 44 years of age with almost two out of three participants being physicians. Ninety-two percent of the survey participants reported that they are currently using SoMe; LinkedIn was the most common platform used for professional purposes. Sixty-four percent believed SoMe had had a positive impact on their clinical practice; 77% and 49% had used SoMe for acquiring and sharing information related to COVID-19, respectively. In conclusion, the majority of Portuguese CVHPs that participated in this survey are actively using SoMe, with a greater participation of those <45 years of age; its clinical impact is positive, with a leading role in the dissemination of evidence during the COVID pandemic.

Early mobilization in coronavirus-19 patients treated with extracorporeal membrane oxygenation.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pneumonia can be associated with refractory respiratory failure requiring extracorporeal membrane oxygenation(ECMO). Although ECMO has helped many COVID patients, optimal management strategies for these patients remain unknown. METHODS: We conducted a retrospective review of all COVID patients requiring ECMO at our hospital. Six months into the pandemic, we changed our management strategy to focus on early mobilization. The early mobilization effort included tracheostomy within 48 h of cannulation, decreasing sedation, and an aggressive physical and occupational therapy program progressing toward early ambulation while on ECMO. The primary outcome measured was survival to discharge. The primary stratification was based on the mobilization strategy. RESULTS: From 2020 to 2021, 47 COVID patients have been supported with ECMO at our institution. Five are still in the hospital on ECMO. 39 (83%) were supported with venovenous ECMO while 8 (17%) were supported with venoarterial or a right ventricular assist device type configuration. All 47 (100%) were cannulated at bedside with transesophageal echocardiographic guidance. The average age was 47 ± 9 years; 36(77%) were male; and 20 (43%) were Hispanic. The median duration of support was 22 (11-44) days. Excluding those who remain in the hospital and on support, overall survival to discharge was 24/42 (57%). When stratified by mobilization strategy, early tracheostomy and mobilization were associated with significantly improved survival (74% [17/23] vs. 37% [7/19], p = .02). There were no changes in patient acuity or duration of support throughout the study period. CONCLUSION: In conclusion, early tracheostomy, decreased sedation, and aggressive mobilization of COVID-19 ECMO patients is associated with improved survival.

Paradigm shift: Beyond the COVID-19 era, is YouTube the future of education for CABG patients?

INTRODUCTION: Patients commonly use YouTube for education, and this may have increased due to COVID-19 related restrictions on access to healthcare professionals. However, YouTube videos lack peer review and regulation. To assess patient education in the COVID-19 era, we analyzed the quality of YouTube videos on coronary artery bypass graft (CABG) surgery. METHODS: We searched YouTube using the phrase "coronary artery bypass graft." Two authors individually used the Journal of the American Medical Association (JAMA), DISCERN, and Health on the Net (HON) systems, to rate the first 50 videos retrieved. Data collected for each video included; number of views, duration since upload, percentage positivity (proportion of likes relative to total likes plus dislikes), number of comments, and video author. Interobserver reliability was assessed using an intraclass correlation coefficient (ICC). Associations between video characteristics and quality were tested using linear regression or t-tests. RESULTS: The average number of views was 575,571. Average quality was poor, with mean scores of 1.93/4 (ICC 0.54) for JAMA criteria, 2.52/5 (ICC 0.78) for DISCERN criteria, and 4.04/8 (ICC 0.66) for HON criteria. Videos uploaded by surgeons scored highest overall (p < .05). No other factors demonstrated significant association with video quality. CONCLUSION: YouTube videos on CABG surgery are of poor quality and may be inadequate for patient education. Given the complexity of the procedure and that beyond the COVID-19 era, patients are more likely to seek education from digital sources, treating surgeons should advise of YouTube's limitations and direct patients to reliable sources of information.

Outcomes of Minority COVID-19 patients managed with ECMO: A single-center experience.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has significantly burdened the global healthcare system since December 2019. Minority populations are found to have a higher incidence of hospitalization and higher mortality when compared to Caucasians. Extracorporeal membrane oxygenation (ECMO) is reserved for COVID-19 patients who develop respiratory failure refractory to conventional management. To our knowledge, no data has been reported on outcome differences between Minority COVID-19 patients and Caucasian COVID-19 patients managed with ECMO. We aimed to investigate the outcome differences between these two groups. METHODS: Our retrospective cohort study had 23 adults (aged 18 and older) diagnosed with COVID-19 by polymerase chain reaction. All patients developed acute respiratory distress syndrome (ARDS), refractory to conventional treatment, and were managed on ECMO support. The primary outcome of interest was mortality; the secondary outcome was the rate of ECMO-related complications. RESULTS: The overall mortality rate of our study was higher (70%) than other reports of the COVID-19 population on ECMO. Caucasians in our study had more severe respiratory acidosis with carbon dioxide retention and appeared to have a higher mortality rate of 85.7% compared to Minorities (62.5%). No differences in complication rates between these two groups were identified. CONCLUSIONS: Our cohort revealed a high overall mortality rate of COVID-19 patients on ECMO support. The Caucasian group was observed to have higher mortality than the Minority group. The high overall mortality was likely attributed to the Caucasian group, which had more severe respiratory acidosis before ECMO initiation, a known predictor of poor prognosis in ARDS patients. Our cohort's ethnic composition may also partially explain the high mortality rate since COVID-19 Minorities are reported to have worse outcomes than Caucasians. Larger and randomized studies are needed to investigate further the mortality and complication differences between Minority and Caucasian patients diagnosed with COVID-19 and managed by ECMO.

Impact of the COVID-19 Pandemic on Cardiovascular Science: Anticipating Problems and Potential Solutions: A Presidential Advisory From the American Heart Association.

The coronavirus disease 2019 (COVID-19) pandemic has had worldwide repercussions for health care and research. In spring 2020, most non-COVID-19 research was halted, hindering research across the spectrum from laboratory-based experimental science to clinical research. Through the second half of 2020 and the first half of 2021, biomedical research, including cardiovascular science, only gradually restarted, with many restrictions on onsite activities, limited clinical research participation, and the challenges associated with working from home and caregiver responsibilities. Compounding these impediments, much of the global biomedical research infrastructure was redirected toward vaccine testing and deployment. This redirection of supply chains, personnel, and equipment has additionally hampered restoration of normal research activity. Transition to virtual interactions offset some of these limitations but did not adequately replace the need for scientific exchange and collaboration. Here, we outline key steps to reinvigorate biomedical research, including a call for increased support from the National Institutes of Health. We also call on academic institutions, publishers, reviewers, and supervisors to consider the impact of COVID-19 when assessing productivity, recognizing that the pandemic did not affect all equally. We identify trainees and junior investigators, especially those with caregiving roles, as most at risk of being lost from the biomedical workforce and identify steps to reduce the loss of these key investigators. Although the global pandemic highlighted the power of biomedical science to define, treat, and protect against threats to human health, significant investment in the biomedical workforce is required to maintain and promote well-being.

Application of the Pluripotent Stem Cells and Genomics in Cardiovascular Research-What We Have Learnt and Not Learnt until Now.

Personalized regenerative medicine and biomedical research have been galvanized and revolutionized by human pluripotent stem cells in combination with recent advances in genomics, artificial intelligence, and genome engineering. More recently, we have witnessed the unprecedented breakthrough life-saving translation of mRNA-based vaccines for COVID-19 to contain the global pandemic and the investment in billions of US dollars in space exploration projects and the blooming space-tourism industry fueled by the latest reusable space vessels. Now, it is time to examine where the translation of pluripotent stem cell research stands currently, which has been touted for more than the last two decades to cure and treat millions of patients with severe debilitating degenerative diseases and tissue injuries. This review attempts to highlight the accomplishments of pluripotent stem cell research together with cutting-edge genomics and genome editing tools and, also, the promises that have still not been transformed into clinical applications, with cardiovascular research as a case example. This review also brings to our attention the scientific and socioeconomic challenges that need to be effectively addressed to see the full potential of pluripotent stem cells at the clinical bedside.

Hemoadsorption for management of patients on veno-venous ECMO support for severe COVID-19 acute respiratory distress syndrome.

BACKGROUND AND AIM: Patients with severe coronavirus disease 2019 (COVID-19) develop a profound cytokine-mediated pro-inflammatory response. This study reports outcomes in 10 patients with COVID-19 supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO) who were selected for the emergency use of a hemoadsorption column integrated in the ECMO circuit. MATERIALS AND METHODS: Pre and posttreatment, clinical data, and inflammatory markers were assessed to determine the safety and feasibility of using this system and to evaluate the clinical effect. RESULTS: During hemoadsorption, median levels of interleukin (IL)-2R, IL-6, and IL-10 decreased by 54%, 86%, and 64%, respectively. Reductions in other markers were observed for lactate dehydrogenase (-49%), ferritin (-46%), d-dimer (-7%), C-reactive protein (-55%), procalcitonin (-76%), and lactate (-44%). Vasoactive-inotrope scores decreased significantly over the treatment interval (-80%). The median hospital length of stay was 53 days (36-85) and at 90-days post cannulation, survival was 90% which was similar to a group of patients without the use of hemoadsorption. CONCLUSIONS: Addition of hemoadsorption to VV-ECMO in patients with severe COVID-19 is feasible and reduces measured cytokine levels. However, in this small series, the precise impact on the overall clinical course and survival benefit still remains unknown.

Cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic. METHODS: A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed. RESULTS: Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID-19, they were most worried with exposing their family to COVID-19 (81%), followed by contracting COVID-19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID-19 burden, with higher COVID-19 burden institutions more likely to resort to PPE conservation strategies. CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.

Cardiovascular clinical trials in the era of a pandemic.

COVID-19 has reached pandemic levels in March 2020 and impacted public health with unpredictable consequences.1, 2 The conduct of clinical research in areas unrelated to COVID-19 has been disrupted and will be further affected. Researchers, trial participants and study personnel have to overcome challenges to sustain proper and safe conduct of clinical trials (i.e. logistical challenges, lower enrollment than expected, difficulties in follow-up and outcome assessment/adjudication, incomplete data collection, research funding prolongation).

COVID-19: An Indian perspective.

Lockdown, quarantine, self-isolation, personal protection equipment, and social distancing have become words of daily usage ever since the world health organization declared coronavirus disease 2019 (COVID-19) as a pandemic. The impact of COVID-19 extends over the medical field, economy, education, and politics. Though the knowledge of the virus is evolving, we are yet to find a solution. India, country with the second largest population, went into a phase of lockdown from 25th March 2020 to 31st May 2020. There was phased measure to "Unlock" starting from 1st June 2020. This has affected the clinical practice and training of the resident. The challenges faced during this unprecedented time are multifaceted which includes overcrowding, healthcare system, and educational background. Indian Association of Cardiovascular-Thoracic Surgeons kept continuing the educational program through a series of "Masterclass."

Radiofrequency ablation for the pre-excitation syndrome of functionally corrected transposition of great arteries.

We reported a 57-year-old female patient who had functionally corrected transposition of the great arteries, severe tricuspid insufficiency, enlarged left atrium and functional right ventricle, which were successfully performed radiofrequency ablation.

COVID-19 infection in left ventricular assist device patients.

We describe two cases of favorable and unexpected recovery in positive patients with coronavirus disease 2019, suffering from multiorgan comorbidity and already assisted with the left ventricular assist device. We have observed that, although in the presence of more comorbidities, when the maintenance of a valid support of the cardiovascular function is guaranteed, the possibility of successfully overcoming the severe acute respiratory syndrome coronavirus 2 infection is still alive.

Young@Heart: empowering the next generation of cardiovascular researchers.

In recognition of the increasing health burden of cardiovascular disease, the Dutch CardioVascular Alliance (DCVA) was founded with the ambition to lower the cardiovascular disease burden by 25% in 2030. To achieve this, the DCVA is a platform for all stakeholders in the cardiovascular field to align policies, agendas and research. An important goal of the DCVA is to guide and encourage young researchers at an early stage of their careers in order to help them overcome challenges and reach their full potential. Young@Heart is part of the DCVA that supports the young cardiovascular research community. This article illustrates the challenges and opportunities encountered by young cardiovascular researchers in the Netherlands and highlights Young@Heart's vision to benefit from these opportunities and optimise collaborations to contribute to lowering the cardiovascular disease burden together as soon as possible.

International study on impact of COVID-19 on cardiac and thoracic aortic aneurysm surgery.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic gripped every nation's health care system and provisions on all levels. In cardiac and aortic surgery, as it is with most specialities, elective surgeries were halted. AIMS OF THE STUDY: We captured reflections, contingencies, and current practices across of high-volume centers in cardiac and aortic surgery globally. We also aimed this study to assess decision on prioritization of the surgical patients, the need for personal protection equipment, and the choice of preoperative investigations in current dynamic and fluid climate. METHODS: A validated web-based questionnaire was constructed and was circulated to the international surgeons amongst high volume cardiac and aortic surgery centers. Their intrinsic feedback on decision making, the impact of the lockdown, and perspectives for the future ahead of us all were noted. A mixed-method approach was constructed. Qualitative data analysis was introduced to signify the impact globally. RESULTS: Overall, 23 centers from 18 countries participated in this international study. About 91.7% of the respondents stopped operating on elective patients during the pandemic. The majority of the surgeons agreed that acute aortic dissection (87.1%) should be operated as an emergency procedure and stable triple vessel disease (87.1%) to be considered as an elective procedure. Three-fifth (60%) of the respondents relied on computerized tomography chest as a preoperative screening modality. CONCLUSION: In the present climate where there is a paucity of evidence, this will give an interim consensus for the cardiac surgeons. With the increase in the cumulative number of patients with COVID-19, careful utilization of the resources regarding hospital beds and manpower is of paramount importance.