Encuesta burnout (¿estás quemado?) en Especialistas de Cardiología SAC / Burnout Survey among SAC Cardiologists

RESUMEN Introducción. Los profesionales de la salud se encuentran expuestos a un fenómeno ocupacional que resulta del estrés crónico en el ámbito laboral llamado síndrome de burnout (SBO). Este se ha convertido en uno de los riesgos laborales psicosociales más importantes en la sociedad actual y genera costos significativos en el ámbito de la salud. Objetivos. Evaluar la prevalencia de SBO por percepción subjetiva y mediante la aplicación del inventario del síndrome del Desgaste Ocupacional "Burnout" de Maslach (MBI) en los especialistas de cardiología del padrón de la Sociedad Argentina de Cardiología (SAC), y las diferencias acordes al sexo. Material y métodos. Estudio observacional, de corte transversal, mediante una encuesta anónima realizada en abril de 2023 a los especialistas del padrón SAC. Se recabaron datos sobre impresión subjetiva de SBO (sentirse "quemado"), sexo, edad, tiempo de ejercicio profesional. Fue opcional completar el inventario MBI (subescalas) para establecer el diagnóstico de burnout. Resultados. Participaron 756 profesionales, 51,4 % fueron mujeres. El 62 % tenían más de 40 años y el 61 % tenía más de 10 años de ejercicio profesional. Del total de médicos encuestados, el 94,4 % eligió realizar el test de Maslach (MBI), siendo esto más frecuente en las mujeres (96,6 % vs 91,3 %, p < 0,001). La prevalencia de SBO por un MBI de alto puntaje (≥67puntos) fue del 75 % y la prevalencia de percepción de SBO fue del 69 % (p < 0,001). De los que se autopercibieron "quemados" (69 %), el 96,8 % contestó el inventario MBI y se confirmó el diagnóstico de SBO por MBI de alto puntaje en el 78 %. De los que se autopercibieron "no quemados" (31 %), el 89,3 % completó el inventario MBI con diagnóstico de SBO en la subescala cansancio emocional (24 %), despersonalización (18 %) y realización personal (10 %) más allá de no tener la impresión subjetiva de estar "quemado". Los menores de 40 años tuvieron más SBO por MBI de alto puntaje (50 % vs 28 %, p= 0,001) al igual que los profesionales con menos de 10 años en el ejercicio de su profesión (45 % vs 20 % en aquellos con tiempo mayor, p < 0,001). El SBO fue más prevalente en las mujeres que en los hombres, tanto por autopercepción (77 % vs 56 %, p < 0,001) como por el inventario de Maslach (80 % vs 74 %, p=0,001), específicamente en la subescala agotamiento emocional (37 % vs 29 %; p < 0,001) y realización personal (37 % vs 41 %, p < 0,001), sin diferencias por sexo en la esfera de despersonalización. Conclusión. El SBO tiene alta prevalencia entre los cardiólogos encuestados, principalmente en mujeres, tanto por autopercepción como por aplicación del inventario MBI. Por otro lado 1 de cada 4 profesionales encuestados que no se autopercibían "quemados" tuvieron un test positivo para SBO. Teniendo en cuenta la alta prevalencia de SBO entre los especialistas en cardiología es imperioso realizar acciones de prevención e intervención concertadas y sostenidas para transformar esta realidad que impacta desfavorablemente tanto en la salud de los pacientes como en la de los propios médicos.

ABSTRACT Background. Healthcare professionals are exposed to an occupational phenomenon as a result of chronic stress in the workplace called burnout syndrome (BOS). Burnout has become one of the most important psychosocial occupational hazards today and generates significant health care costs. Objectives. The aim of our study was to evaluate the subjective perception of the prevalence of BOS among cardiologists of the Argentine Society of Cardiology (SAC) using Maslach Burnout Inventory (MBI), and the differences between sexes. Methods. We conducted an observational, cross-sectional study using an anonymous survey distributed among specialists of the SAC register in April 2023. The information collected included the subjective impression of BOS (feeling "burned out"), sex, age and years of practice. The participants could optionally complete the MBI (subscales) to establish the diagnosis of BOS. Results. A total of 756 professionals participated in the survey; 51.4% were women. Sixty-two percent of the participants were >40 years old, and 61 % had been practicing medicine for more than 10 years. Of all the physicians surveyed, 94.4% completed the MBI, with women more likely to do so than men (96.6% vs. 91.3%, p < 0.001). The prevalence of BOS, assessed by a high MBI score (≥ 67), was 75%, while 69% reported feeling burned out (p < 0.001). Of those who felt burned out (69 %), 96.8 % completed the MBI, and 78% of them received a diagnosis of BOS based on high MBI scores. Of the 31 % who did not feel burned out, 89.3 % completed the MBI. Burnout syndrome was diagnosed in the emotional exhaustion subscale in 24 %, in the depersonalization subscale in 18%, and in the personal accomplishment subscale in 10%. The diagnosis of BOS made by high MBI score was more common in survey participants under 40 years than in older participants (50 % vs. 28 %, p < 0.001) and in professionals who have been practicing medicine for less than 10 years (45 % vs. 20 % in those with more years of practice, p < 0.001). Women were more likely to experience BOS according to their own perception (77 % vs. 56 %, p < 0.001) and MBI score (80 % vs. 74 %, p < 0.001), specifically in the emotional exhaustion (37 % vs. 29 %, p < 0.001) and personal accomplishment (37 % vs. 41 %, p < 0.001) subscales, with No differences by sex in the depersonalization sphere. Conclusion. Burnout syndrome was found to be prevalent among the surveyed cardiologists, particularly in female participants, as indicated by both their own perception and the MBI assessment. In addition, 1 out of 4 professionals surveyed who did not feel "burned out" tested positive for BOS. Given the high prevalence of BOS among cardiologists, coordinated and sustained prevention and intervention actions should be undertaken to change this reality that negatively impacts both patient and physician health.

Evaluation of the size of cardiac structures in patients with high body mass index.

AIMS: Isometric indexation of cardiac structures fails in patients with overweight. The aim of the study was to evaluate the LA indexed volume (LAVOL), left ventricular end-diastolic diameter (LVEDD), left ventricular mass index (LVMI), and the aortic sinus diameter (AOSD) in healthy subjects with normal and high BMI and find the allometric correction exponent. METHODS: Four hundred and thirty patients without cardiac pathology were analyzed. Patients were divided into groups: Group I BMI < 24.9 187 patients, Group II BMI 25-29.9 154 patients, Group III BMI 30-34.9 63 patients, and Group IV 35-39.9 26 patients. A Doppler echocardiogram was performed. The parameters indexed were compared between groups. When allometric growth was verified, the allometric coefficient was calculated. RESULTS: Male sex 242 p (56%), mean age: 44.87 ± 13.10 years, better correlation: LAVOL, LV mass, and AOSD with body surface area (BSA) (LAVOL R: .74, R2 .55, LV mass R: .73, R2 : 0.53, AOSD R: .57, R2 : .35), LVEDD with high (R: .63, R2 : .39) were observed. A significant increase was observed in LAVOL and LVMI in the groups with increased BMI. We observed a decrease in the indexed AOSD and a marginal difference between groups in LVEDD. The allometric correction exponent calculated was as follows: LAVOL: 0.96 and for LVMI: 0.97. CONCLUSIONS: Allometric correction is superior to isometric indexation to assess LAVOL and LVMI in obese and overweight patients. Allometric correction would allow differentiating deviations from VOLAI and IMVI attributable to obesity from those attributable to an associated pathology.

Behavior of right atrial strain in high systolic pulmonary artery pressure.

AIMS: Evaluate the ability of right atrial (RA) strain to predict systolic pulmonary artery pressure (SPAP). METHODS AND RESULTS: A total of 102 patients were prospectively enrolled. Conventional echocardiographic measures were performed. RA volume was calculated. Mean maximum right ventricle (RV) strain and lateral RA strain were obtained. Pearson's correlation test was used. A multivariate analysis was performed to compare SPAP with RA strain, RV strain, and baseline characteristics of the patients. RA strain was compared between patients with SPAP ≤ 37 mm Hg with those with SPAP > 37 mm Hg. A receiver operating characteristic (ROC) curve was constructed. A P < 0.01 value was considered statistically significant. AGE: 58.7 ± 15.7 years. Male: 46 (45.1%). The correlation coefficient between SPAP and RA strain was -0.64 (P < 0.01, 95% confidence interval (CI): -0.75 to -0.50). Quadratic R2 coefficient = 0.52. In the multivariate analysis, RA strain was independently associated with SPAP level. There were significant differences in RA strain between patients with SPAP ≤ 37 mm Hg (63.3 ± 13.3%; 95% CI: 59.4%-65.1%) and >37 mm Hg (32.7 ± 11.1%; 95% CI: 26.5%-38.39%) (P < 0.01). RA strain < 42.5% was capable to predict a SPAP > 37 mm Hg with 93% sensitivity and 94% specificity, area under the curve (AUC) of 98% (95% CI: 94%-100%). CONCLUSIONS: Right atrial strain is independently associated with SPAP level. RA strain lower than 42.5% can predict a SPAP > 37 mm Hg with high sensitivity and specificity.

Análisis de la deformación auricular longitudinal: alteraciones precoces en hipertensos jóvenes controlados / Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension

Objetivos Evaluar alteraciones precoces del strain auricular longitudinal en base al speckle tracking y el índice de rigidez auricular en hipertensos leves. Material y métodos Ingresaron prospectivamente 101 pacientes de entre 30 y 50 años: 32 sujetos sanos sedentarios (Grupo 1), 35 sanos deportistas (Grupo 2) y 34 hipertensos controlados (Grupo 3). Sexo masculino: 68 (67,3%). Se efectuaron mediciones ecocardiográficas convencionales, se registraron el Doppler tisular color y el Doppler tisular pulsado lateral y septal y se calculó el volumen auricular. Se obtuvieron el strain y el strain rate ventricular sistólico y el strain auricular máximo durante el período de reservorio por speckle tracking. Se calculó el índice de rigidez auricular en base a la relación (E/e)/strain auricular máximo. Se utilizó el análisis de ANOVA seguido de la prueba de Bonferroni, considerándose significativa una p < 0,01. Resultados La relación E/A y la velocidad de la onda e tisular fueron mayores y la relación E/e fue menor en el grupo de deportistas. El índice de masa del ventrículo izquierdo no mostró diferencias significativas. El volumen de la aurícula izquierda fue mayor en deportistas sin alcanzar significación estadística. El strain auricular fue menor en hipertensos (36,94 ± 7,71 vs. 46,17 ± 10,05 en el Grupo 1 y 46,80 ± 8,44 en el Grupo 2; IC 95% 3,96-14,47; p < 0,0001) y el índice de rigidez auricular fue significativamente más alto en este grupo (30,49 ± 11,93 vs. 19,94 ± 8,12 en el Grupo 1 y 18,99 ± 5,88 en Grupo 2; IC 95% 5,05-16,05; p < 0,0001). Conclusiones La deformación auricular longitudinal durante el período de reservorio y el índice de rigidez auricular se hallan alterados en hipertensos leves controlados antes de que se detecten otras alteraciones ecocardiográficas.

Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension Objectives The aim of this study was to evaluate early changes in left atrial longitudinal strain based on speckle tracking and the atrial stiffness index in patients with mild hypertension. Methods One hundred and one patients, 30 to 50 years of age, were prospectively enrolled in the study: 32 healthy sedentary patients (Group 1), 35 healthy recreational athletes (Group 2) and 34 mild hypertensive patients (Group 3). Sixty eight patients were men (67.3%). Conventional echocardiographic assessments were performed, color tissue Doppler and lateral and septal pulsed tissue Doppler were recorded and atrial volume was calculated. Left ventricular strain and strain rate and left atrial peak strain during the reservoir period were obtained by speckle tracking. The atrial stiffness index was calculated based on the (E/e)/peak atrial strain ratio. Data was analyzed using ANOVA followed by the Bonferroni test. A p value <0.01 was considered statistically significant. Results The E/A ratio and the tissue e wave velocity were higher and the E/e ratio was lower in the athlete group. Left ventricular mass index did not show statistical differences among groups. Left atrial volume was higher in athletes without attaining significant difference. In hypertensive patients, atrial strain was lower (36.94 ± 7.71 vs. 46.17 ± 10.05 in Group 1 and 46.80 ± 8.44 in Group 2; 95% CI 3.96-14.47; p <0.0001) and the stiffness index was higher (30.49 ± 11.93 vs. 19.94 ± 8.12 in Group 1 and 18.99 ± 5.88 in Group 2; 95% CI 5.05-16.05; p <0.0001). Conclusions Left atrial longitudinal strain during the reservoir period and the atrial stiffness index are altered in patients with mild controlled hypertension before the detection of other echocardiographic changes.

Análisis de la deformación auricular longitudinal: alteraciones precoces en hipertensos jóvenes controlados / Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension

Objetivos Evaluar alteraciones precoces del strain auricular longitudinal en base al speckle tracking y el índice de rigidez auricular en hipertensos leves. Material y métodos Ingresaron prospectivamente 101 pacientes de entre 30 y 50 años: 32 sujetos sanos sedentarios (Grupo 1), 35 sanos deportistas (Grupo 2) y 34 hipertensos controlados (Grupo 3). Sexo masculino: 68 (67,3%). Se efectuaron mediciones ecocardiográficas convencionales, se registraron el Doppler tisular color y el Doppler tisular pulsado lateral y septal y se calculó el volumen auricular. Se obtuvieron el strain y el strain rate ventricular sistólico y el strain auricular máximo durante el período de reservorio por speckle tracking. Se calculó el índice de rigidez auricular en base a la relación (E/e)/strain auricular máximo. Se utilizó el análisis de ANOVA seguido de la prueba de Bonferroni, considerándose significativa una p < 0,01. Resultados La relación E/A y la velocidad de la onda e tisular fueron mayores y la relación E/e fue menor en el grupo de deportistas. El índice de masa del ventrículo izquierdo no mostró diferencias significativas. El volumen de la aurícula izquierda fue mayor en deportistas sin alcanzar significación estadística. El strain auricular fue menor en hipertensos (36,94 ± 7,71 vs. 46,17 ± 10,05 en el Grupo 1 y 46,80 ± 8,44 en el Grupo 2; IC 95% 3,96-14,47; p < 0,0001) y el índice de rigidez auricular fue significativamente más alto en este grupo (30,49 ± 11,93 vs. 19,94 ± 8,12 en el Grupo 1 y 18,99 ± 5,88 en Grupo 2; IC 95% 5,05-16,05; p < 0,0001). Conclusiones La deformación auricular longitudinal durante el período de reservorio y el índice de rigidez auricular se hallan alterados en hipertensos leves controlados antes de que se detecten otras alteraciones ecocardiográficas.(AU)

Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension Objectives The aim of this study was to evaluate early changes in left atrial longitudinal strain based on speckle tracking and the atrial stiffness index in patients with mild hypertension. Methods One hundred and one patients, 30 to 50 years of age, were prospectively enrolled in the study: 32 healthy sedentary patients (Group 1), 35 healthy recreational athletes (Group 2) and 34 mild hypertensive patients (Group 3). Sixty eight patients were men (67.3%). Conventional echocardiographic assessments were performed, color tissue Doppler and lateral and septal pulsed tissue Doppler were recorded and atrial volume was calculated. Left ventricular strain and strain rate and left atrial peak strain during the reservoir period were obtained by speckle tracking. The atrial stiffness index was calculated based on the (E/e)/peak atrial strain ratio. Data was analyzed using ANOVA followed by the Bonferroni test. A p value <0.01 was considered statistically significant. Results The E/A ratio and the tissue e wave velocity were higher and the E/e ratio was lower in the athlete group. Left ventricular mass index did not show statistical differences among groups. Left atrial volume was higher in athletes without attaining significant difference. In hypertensive patients, atrial strain was lower (36.94 ± 7.71 vs. 46.17 ± 10.05 in Group 1 and 46.80 ± 8.44 in Group 2; 95% CI 3.96-14.47; p <0.0001) and the stiffness index was higher (30.49 ± 11.93 vs. 19.94 ± 8.12 in Group 1 and 18.99 ± 5.88 in Group 2; 95% CI 5.05-16.05; p <0.0001). Conclusions Left atrial longitudinal strain during the reservoir period and the atrial stiffness index are altered in patients with mild controlled hypertension before the detection of other echocardiographic changes.(AU)