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2.
Open Heart ; 9(2)2022 10.
Article in English | MEDLINE | ID: covidwho-2153063

ABSTRACT

BACKGROUND AND OBJECTIVES: Echocardiography is the cornerstone of heart failure (HF) diagnosis, but expertise is limited. Non-experts using handheld ultrasound devices (HUDs) challenge the clinical yield. Left ventricular (LV) ejection fraction (EF) is used for assessment and grading of HF. Mitral annular plane systolic excursion (MAPSE) reflects LV long-axis shortening. Automatic tools for quantification of EF (autoEF) and MAPSE (autoMAPSE) are available on HUDs. We aimed to explore the importance of user experience and image quality for autoEF and autoMAPSE on HUDs, and how image quality influences the feasibility, agreement and reliability in patients with suspected HF. METHODS: General practitioners, registered cardiac nurses and cardiologists represented the novice, intermediate and expert users, respectively, in this diagnostic accuracy study. 2543 images were evaluated by an external, blinded cardiologist by a five-parameter, prespecified score (four-chamber view, LV alignment, apical mispositioning, mitral annular assessment and number of visible endocardial segments) graded 0-6. RESULTS: Feasibility was higher with increasing image quality. In all recordings, irrespective of user, the average image quality score and the five prespecified scores were associated with the feasibility of autoEF and autoMAPSE (all p<0.001). Image quality was more important for the feasibility of autoMAPSE than autoEF. Image quality was not important for the agreement of autoEF (R2 2%) and autoMAPSE (R2 7%). Combining all user groups, the reliability was lower with larger within-patient variability in image quality of the repeated recordings (p≤0.005). Similar associations were not found in user group specific analyses (p≥0.16). Patients' characteristics were only weakly associated with image quality score (R2≤4%). DISCUSSION: Image quality was important for feasibility but does not explain the low agreement with reference or the modest within-patient reliability of automatic decision-support software on HUDs for all user groups in patients with suspected HF.


Subject(s)
Cardiologists , General Practitioners , Humans , Ventricular Function, Left , Reproducibility of Results , Stroke Volume
3.
Curr Probl Cardiol ; 47(12): 101394, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2028004

ABSTRACT

In the same way that the practice of cardiology has evolved over the years, so too has the way cardiology fellows in training (FITs) are trained. Propelled by recent advances in technology-catalyzed by COVID-19-and the requirement to adapt age-old methods of both teaching and health care delivery, many aspects, or 'domains', of learning have changed. These include the environments in which FITs work (outpatient clinics, 'on-call' inpatient service) and procedures in which they need clinical competency. Further advances in virtual reality are also changing the way FITs learn and interact. The proliferation of technology into the cardiology curriculum has led to some describing the need for FITs to develop into 'digital cardiologists', namely those who comfortably use digital tools to aid clinical practice, teaching, and training whilst, at the same time, retain the ability for human analysis and nuanced assessment so important to patient-centred training and clinical care.


Subject(s)
COVID-19 , Cardiologists , Cardiology , Humans , COVID-19/epidemiology , Cardiology/education , Curriculum , Technology
4.
Turk Kardiyol Dern Ars ; 50(6): 438-444, 2022 09.
Article in English | MEDLINE | ID: covidwho-2025174

ABSTRACT

OBJECTIVE: Despite efforts spent on promotion of gender equity in the academia, the gender gap is feared to have widened after the coronavirus disease 2019 pandemic. Herein, we aimed to compare the distribution of female authorship by Turkish adult cardiologists in journals indexed at PubMed before and after the pandemic. METHODS: In this cross-sectional study, an advanced search on PubMed (https://pubmed.ncbi.nlm.nih.gov/) was carried out based on the following criteria: "entrez date" and keywords "Turkey" and "cardiology" to identify papers that entered the online database in April-September 2019 and April-September 2020. After the study sample was determined, type of the article and details of the author list were recorded. RESULTS: Of 1318 articles screened, 708 met the inclusion criteria. Overall, 85 (12.0%) of first authors and 67 (10.0%) of senior authors were female. Females were less likely to first author original articles, editorials, case reports/series and papers with international participation (9.5%, P = .012; 33.3%, P = .045; 18.3%, P = .033; 4.8%, P = .032, respectively). A higher proportion of females were in first and corresponding author positions in original articles (73.2%, P = .032; 76.5%, P = .019, respectively), but not in other article types (all P > .05), after emergence of the pandemic. CONCLUSION: These suggest that significant gender differences exist with regard to authorships of scientific publications that were submitted by Turkish adult cardiologists. Future studies may aim to evaluate the trends across a wider time span and based on a more extensive scientific output follow-up.


Subject(s)
COVID-19 , Cardiologists , Authorship , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Pandemics , Sex Factors
5.
J Am Coll Cardiol ; 80(11): 1110-1113, 2022 09 13.
Article in English | MEDLINE | ID: covidwho-2007791
6.
Curr Opin Cardiol ; 37(4): 335-342, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1901275

ABSTRACT

PURPOSE OF REVIEW: There continues to be extensive clinical and epidemiological data to suggest that coronavirus disease 2019 (COVID-19) infection is associated with numerous different types of cardiac involvement. RECENT FINDINGS: Myocardial injury has been reported in over 25% of patients hospitalized due to COVID-19 infection and is not only associated with a worse prognosis but with higher mortality, approaching 40%. Currently proposed mechanisms of myocardial injury include direct viral infection, cytokine storm, endothelial inflammation, demand ischemia, interferon-mediated response and stress cardiomyopathy. COVID-19 infection is associated with new-onset arrhythmias and heart failure regardless of history of previous cardiovascular disease. Echocardiographic findings can be useful to predict mortality in COVID-19 patients and cardiac MRI is an effective tool to both assess COVID-19 induced myocarditis and to follow-up on cardiac complications of COVID-19 long-term. Although there is an association between COVID-19 vaccination and myocarditis, pericarditis or arrhythmias, the risk appears lower when compared to risk attributable to the natural infection. SUMMARY: Patients with cardiovascular disease are not only more likely to suffer from severe COVID-19 infection but are at increased risk for further complications and higher mortality. Further data compilation on current and emerging treatments of COVID-19 will have additional impact on cardiovascular morbidity and mortality of COVID-19 infection.


Subject(s)
COVID-19 , Cardiologists , Myocarditis , Arrhythmias, Cardiac/etiology , COVID-19/complications , COVID-19 Vaccines , Humans , Myocarditis/complications , Myocarditis/etiology , SARS-CoV-2
8.
Circ Cardiovasc Qual Outcomes ; 14(2): e007643, 2021 02.
Article in English | MEDLINE | ID: covidwho-1883362

ABSTRACT

Following decades of decline, maternal mortality began to rise in the United States around 1990-a significant departure from the world's other affluent countries. By 2018, the same could be seen with the maternal mortality rate in the United States at 17.4 maternal deaths per 100 000 live births. When factoring in race/ethnicity, this number was more than double among non-Hispanic Black women who experienced 37.1 maternal deaths per 100 000 live births. More than half of these deaths and near deaths were from preventable causes, with cardiovascular disease being the leading one. In an effort to amplify the magnitude of this epidemic in the United States that disproportionately plagues Black women, on June 13, 2020, the Association of Black Cardiologists hosted the Black Maternal Heart Health Roundtable-a collaborative task force to tackle the maternal health crisis in the Black community. The roundtable brought together diverse stakeholders and champions of maternal health equity to discuss how innovative ideas, solutions and opportunities could be implemented, while exploring additional ways attendees could address maternal health concerns within the health care system. The discussions were intended to lead the charge in reducing maternal morbidity and mortality through advocacy, education, research, and collaborative efforts. The goal of this roundtable was to identify current barriers at the community, patient, and clinician level and expand on the efforts required to coordinate an effective approach to reducing these statistics in the highest risk populations. Collectively, preventable maternal mortality can result from or reflect violations of a variety of human rights-the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. This is the first comprehensive statement on this important topic. This position paper will generate further research in disparities of care and promote the interest of others to pursue strategies to mitigate maternal mortality.


Subject(s)
Cardiologists , Maternal Health , African Americans , Female , Humans , Maternal Mortality , Mothers , United States/epidemiology
9.
Pediatr Cardiol ; 43(8): 1913-1921, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1872402

ABSTRACT

The COVID-19 pandemic has had a dramatic impact on practicing physicians, with effects in clinical practice, academic pursuits, research endeavors, and personal lives. Women in medicine have been uniquely impacted. We examined the impact of the pandemic on the careers of pediatric cardiologists in the Northeast with an anonymous online survey. Participants reported demographic data, information on work hours, administrative burden, career satisfaction, academic productivity, and burnout. We approached 490 cardiologists and received 127 completed surveys (response rate 26%; 49% female). Among all respondents, 72% reported increased burnout, 43% reported decreased career satisfaction, and 57% reported decreased academic productivity. In multivariable ordinal regression analysis, when compared to male physicians, females were 2.4 times more likely to report decreased overall career satisfaction (p = 0.027), 2.6 times more likely to report decreased academic productivity (p = 0.028), and 2.6 times more likely to report increased feelings of burnout "to a large degree" (p = 0.022). Among all respondents, decreased career satisfaction was independently associated with increased household responsibility (OR = 4.4, p = 0.001). Increased administrative burden was independently associated with decreased academic productivity (OR = 2.6, p = 0.038). Open-ended responses highlighted loss of community due to remote work and blurring of the boundaries between work and home. Conversely, respondents appreciated flexibility to work remotely. In conclusion, the majority of pediatric cardiologists in the Northeast experienced negative career impacts due to the COVID-19 pandemic. Important gender differences emerged, with female physicians disproportionately reporting increased burnout, decreased career satisfaction, and decreased academic productivity.


Subject(s)
Burnout, Professional , COVID-19 , Cardiologists , Child , Female , Male , Humans , United States/epidemiology , COVID-19/epidemiology , Pandemics , Job Satisfaction , Burnout, Professional/epidemiology , Surveys and Questionnaires
10.
Int J Cardiol ; 359: 99-104, 2022 07 15.
Article in English | MEDLINE | ID: covidwho-1783416

ABSTRACT

Since the beginning of 2020, the corona virus (COVID-19) pandemic redefined in many ways the practice of cardiology, research and cardiology conferences. Virtual conferences replaced most major in-person venues. The number of "elective" structural heart interventions declined and clinical research endured major setbacks in regards to academic and industry-sponsored clinical trials. In this review, we attempt to provide a broad overview of the field for general and interventional cardiologists with a specific interest in structural heart interventions.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Cardiologists , Cardiology , COVID-19/epidemiology , Elective Surgical Procedures , Humans
14.
J Cardiovasc Med (Hagerstown) ; 22(9): 711-715, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1496885

ABSTRACT

CoronaVIrus Disease-19 (COVID-19) had a huge impact on human health and economy. However, to this date, the effects of the pandemic on the training of young cardiologists are only partially known. To assess the consequences of the pandemic on the education of the cardiologists in training, we performed a 23-item national survey that has been delivered to 1443 Italian cardiologists in training, registered in the database of the Italian Society of Cardiology (SIC). Six hundred and thirty-three cardiologists in training participated in the survey. Ninety-five percent of the respondents affirmed that the training programme has been somewhat stopped or greatly jeopardized by the pandemic. For 61% of the fellows in training (FITs), the pandemic had a negative effect on their education. Moreover, 59% of the respondents believe that they would not be able to fill the gap gained during that period over the rest of their training. A negative impact on the psycho-physical well being has been reported by 86% of the FITs. The COVID-19 pandemic had an unparalleled impact on the education, formation and mental state of the cardiologists in training. Regulatory agencies, universities and politicians should make a great effort in the organization and reorganization of the teaching programs of the cardiologists of tomorrow.


Subject(s)
COVID-19 , Cardiologists , Cardiology/education , Communicable Disease Control , Education , Internship and Residency , COVID-19/epidemiology , COVID-19/prevention & control , Cardiologists/education , Cardiologists/psychology , Cardiologists/standards , Clinical Competence/standards , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Education/organization & administration , Education/standards , Fellowships and Scholarships/methods , Fellowships and Scholarships/statistics & numerical data , Humans , Internship and Residency/methods , Internship and Residency/organization & administration , Internship and Residency/standards , Italy/epidemiology , Needs Assessment , SARS-CoV-2 , Societies, Medical/statistics & numerical data , Surveys and Questionnaires
15.
Heart ; 108(6): 458-466, 2022 03.
Article in English | MEDLINE | ID: covidwho-1495503

ABSTRACT

OBJECTIVE: The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS: This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS: In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION: Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER: NCT04412655.


Subject(s)
COVID-19 , Cardiologists/trends , Percutaneous Coronary Intervention/trends , Practice Patterns, Physicians'/trends , ST Elevation Myocardial Infarction/therapy , Time-to-Treatment/trends , Aged , Female , Hospital Mortality/trends , Humans , Incidence , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Registries , Retrospective Studies , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , Time Factors , Treatment Outcome
16.
Circ Heart Fail ; 14(10): e008573, 2021 10.
Article in English | MEDLINE | ID: covidwho-1443687

ABSTRACT

BACKGROUND: An unprecedented shift to remote heart failure outpatient care occurred during the coronavirus disease 2019 (COVID-19) pandemic. Given challenges inherent to remote care, we studied whether remote visits (video or telephone) were associated with different patient usage, clinician practice patterns, and outcomes. METHODS: We included all ambulatory cardiology visits for heart failure at a multisite health system from April 1, 2019, to December 31, 2019 (pre-COVID) or April 1, 2020, to December 31, 2020 (COVID era), resulting in 10 591 pre-COVID in-person, 7775 COVID-era in-person, 1009 COVID-era video, and 2322 COVID-era telephone visits. We used multivariable logistic and Cox proportional hazards regressions with propensity weighting and patient clustering to study ordering practices and outcomes. RESULTS: Compared with in-person visits, video visits were used more often by younger (mean 64.7 years [SD 14.5] versus 74.2 [14.1]), male (68.3% versus 61.4%), and privately insured (45.9% versus 28.9%) individuals (P<0.05 for all). Remote visits were more frequently used by non-White patients (35.8% video, 37.0% telephone versus 33.2% in-person). During remote visits, clinicians were less likely to order diagnostic testing (odds ratio, 0.20 [0.18-0.22] video versus in-person, 0.18 [0.17-0.19] telephone versus in-person) or prescribe ß-blockers (0.82 [0.68-0.99], 0.35 [0.26-0.47]), mineralocorticoid receptor antagonists (0.69 [0.50-0.96], 0.48 [0.35-0.66]), or loop diuretics (0.67 [0.53-0.85], 0.45 [0.37-0.55]). During telephone visits, clinicians were less likely to prescribe ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers)/ARNIs (angiotensin receptor-neprilysin inhibitors; 0.54 [0.40-0.72]). Telephone visits but not video visits were associated with higher rates of 90-day mortality (1.82 [1.14-2.90]) and nonsignificant trends towards higher rates of 90-day heart failure emergency department visits (1.34 [0.97-1.86]) and hospitalizations (1.36 [0.98-1.89]). CONCLUSIONS: Remote visits for heart failure care were associated with reduced diagnostic testing and guideline-directed medical therapy prescription. Telephone but not video visits were associated with increased 90-day mortality.


Subject(s)
COVID-19 , Cardiologists/trends , Heart Failure/therapy , Practice Patterns, Physicians'/trends , Telemedicine/trends , Aged , Aged, 80 and over , Diagnostic Techniques and Procedures/trends , Drug Prescriptions , Drug Utilization/trends , Emergency Service, Hospital/trends , Female , Guideline Adherence/trends , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization/trends , Humans , Male , Middle Aged , Practice Guidelines as Topic , Telephone/trends , Time Factors , Treatment Outcome , Videoconferencing/trends
18.
G Ital Cardiol (Rome) ; 22(8): 638-647, 2021 Aug.
Article in Italian | MEDLINE | ID: covidwho-1365476

ABSTRACT

In recent years, lung ultrasonography has acquired an important role as a valuable diagnostic tool in clinical practice. The lung is usually poorly explorable, but it provides more acoustic information in pathological conditions that modify the relationship between air, water and tissues. The different acoustic impedance of all these components makes the chest wall a powerful ultrasound reflector: this is responsible for the creation of several artifacts providing valuable information about lung pathophysiology. Lung ultrasonography helps in the diagnostic process of parenchymal and pleural pathologies, in the differential diagnosis of dyspnea and in the clinical and prognostic evaluation of the SARS-CoV-2 infection.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Ultrasonography/methods , Cardiologists , Diagnosis, Differential , Dyspnea/diagnostic imaging , Humans , Lung/virology , Lung Diseases/diagnostic imaging , Lung Diseases/physiopathology , Prognosis
19.
Open Heart ; 8(2)2021 08.
Article in English | MEDLINE | ID: covidwho-1346091

ABSTRACT

OBJECTIVES: We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS: The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS: Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION: The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.


Subject(s)
COVID-19 , Cardiac Imaging Techniques/trends , Cardiologists/trends , Healthcare Disparities/trends , Heart Diseases/diagnostic imaging , Practice Patterns, Physicians'/trends , Europe , Health Care Surveys , Humans , Predictive Value of Tests
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