Atrio-Ventricular Dyssynchrony After Cardiac Resynchronization Therapy: An Unusual Contributor to Heart Failure Symptoms.

Cardiac resynchronization therapy (CRT) is the mainstay for the management of systolic heart failure with LVEF <35% and evidence of dyssynchrony despite optimal medical therapy. After CRT placement, persistent dyssynchronization is possible and can contribute to heart failure symptoms despite a well-functioning CRT device. Echo-guided imaging can be beneficial for the optimization of CRT in selected patients who have evidence of continued dyssynchrony despite a well-functioning CRT device.

Augmenting Traditional Cardiac and Medical Care in Africa via Telemedicine: A Pilot Study.

Background A critical decrease in the number of healthcare providers in developing countries is one of the major burdens to healthcare access in these countries. Many factors contribute to the lack of healthcare providers, including low doctor-to-population ratio, emigration of doctors to other countries, long travel distances to hospitals, increasing cost of healthcare, and concentration of doctors in urban cities. Several measures have been taken by both governmental and nongovernmental organizations in these countries to mitigate this crisis with varying outcomes. In this study, we investigate the use of technology in the form of telemedicine in a developing country. We evaluate patient predisposition to the use of telemedicine, their experience, and some challenges involved in the use of telemedicine in this setting. Methodology We set up an electronic medical record system, OpenMRS, and added telemedicine modules to the system. Then, we recruited doctors and gave them privileges on OpenMRS after carefully vetting their credentials. Finally, we set up a website through which patients could request telemedicine consultations. We registered a telephone number in Nigeria so that patients could also request consultations via SMS. Consult requests were then entered into OpenMRS. Doctors logged in periodically and checked for patients awaiting consults. They called patients, diagnosed them, requested further diagnostics, and/or sent prescriptions to patients via SMS directly from OpenMRS. Results Data were collected over the first year of telemedicine service in Nigeria. These data were then analyzed to understand the effectiveness, patient experience, cost efficiency, and general utilization of this service. In the first year, there were 510 new patient registrations and 572 total consultations. Patient age ranged from less than one year to 77 years, with a median of 29 years. Among the users of the service, 51.8% (264) were female. For consult requests, 52.2% of requests were via the web, and others were via SMS requests. There were over 50 reviews of the service on the website and social media, and 95% of users reported a positive experience. Conclusions From preliminary data, telemedicine can potentially be a good adjunct to help doctors reach their patients, especially in rural areas where there is an immense shortage of healthcare professions. Although most patients reported a positive experience, further investigations are needed to validate our experience.