Search

Aim.The purpose of this study was to examine the association of increasing concentrations of endothelin-1 and soluble forms of ST2 protein (sST2) in the blood plasma of patients with chronic heart failure (CHF) who underwent implantation of a cardioverter-defibrillator, with the development of cardiovascular events (death from cardiovascular diseases, decompensated CHF, acute coronary syndrome or acute ischemic stroke) to determine whether these biomarkers can be used as predictors of an unfavorable course of the disease.Material and methods. A 6-month cohort study included 40 patients with CHF who received an ICD 4-12 weeks before their inclusion in the study. At the beginning of the study the concentrations of endothelin-1 and sST2 in plasma by ELISA were analyzed, along with conventional diagnostic techniques typical of a specialized cardiology clinic.Results.Phenotype with a favorable course of the disease was identified in 21 patients (group 1), and with a unfavorable course was seen in 19 (group 2). The concentration of endothelin-1 and sST2 in the blood plasma of the 2nd group patients was higher than in patients of the 1st group. The link of cardiovascular events with high levels of soluble ST2 protein and endothelin-1 in blood plasma has been identified. Variation of the decision rule threshold on the ROC-curve has allowed sST2 concentration of 34.93 ng/ml to be determined as a cutoff point. Accuracy of two-class classification (determination of the posterior probability of cardiovascular events) after identifying such cut-off point was characterized by 93% sensitivity and 72% specificity (area under ROC-curve – 0.87). If the value of the plasma concentrations of sST2 more 34.93 ng/ml the relative risk of cardiovascular events was 4.4 (95% CI 1.7–11.1). The use of endothelin-1 surplus in plasma (cut-off point – 0.34 fmol/ml) in predicting cardiovascular events was lower: the sensitivity – 88%, specificity – 68% (area under ROC-curve – 0.74). When the concentration of endothelin-1 in blood plasma was more than 0.34 fmol/ml the relative risk of cardiovascular events was 2.7 (95% CI 1.2–6.3).Conclusion.The increase in the sST2 and endothelin-1 concentration in blood plasma may be considered as a predictor of cardiovascular events in CHF patients after implantation of cardioverter-defibrillator.

OBJECTIVE: To determine the frequency of new coronary artery disease (CAD) cases during the years 2015, 2016 and 2017 in patients presenting to a cardiology clinic and to look for its current trends in Khyber Pakhtunkhwa (KP), Pakistan. METHODS: This descriptive study was conducted in a private clinic of interventional cardiologist, based in Lady Reading Hospital, Peshawar, Pakistan from January to March 2018. We retrospectively analyzed the echocardiography data and review of clinical records from January 2015 to December 2017 and identified cases of incident CAD based on Regional Wall Motion Abnormalities on echo. SPSS V20.0 was used for analysis. We applied the unpaired t-test to look for an increasing trend in CAD between 2015-2016, 2016-2017 and 2015 through 2017. RESULTS: A total of 3865 patients of incident coronary artery disease were identified from January 2015 to December 2017. The number of incident CAD patients was 998 in 2015, 1362 in 2016 and 1505 in 2017. We applied the unpaired t-test on the number of post myocardial infarction patients for an increasing trend in 2015 vs 2016, 2016 vs 2017 and 2015 vs 2017 which showed a p-value of

Özet :Amaç: Önceden diyastolik kalp yetmezliği sistolik kalp yetmezliğinin gibi değerlendirilirken günümüzde bunların birbirinden ayrı patofizyolojik mekanizmalarla ilerlediği bilinmektedir. Biz bu çalışmada serum Sistatin C konsantrasyonu ile kalbin diyastolik fonksiyonları arasındaki ilişkiyi göstermeyi denedik. Yöntem: Bu çalısmaya Mayıs 2010 ve Eylül 2010 tarihleri arasında Düzce Universitesi Tıp Fakültesi Hastanesi Kardiyoloji polikliniğine başvuran bireyler dahil edildi. Deneklerin diyastolik parametreleri değerlendirildi ve Sistatin C düzeyleri çalışıldı.Denekler diyastolik fonksiyonlarına göre normal ,grade 1, grade 2 olarak üç gruba ayrıldı ve serum sistain-c düzeyi ile bu gruplar arasında ilişki araştırıldı. Bulgular: Bu çalışmada, Grade I ve Grade II diyastolik disfonksiyonu olan denekler ile diyastolik fonksiyonu olmayan denekler serum Sistatin C seviyelerine göre karşılaştırıldı. Diyastolik disfonksiyon olan gruplarda Sistatin C düzeyinde anlamlı düzeyde artmış olduğu gösterildi (normal -grade 1:p

The genetic counseling profession is growing rapidly, as is its presence in cardiology. In this review, we will survey recent innovations and research in cardiovascular genetic counseling, as well as findings from the broader genetic counseling field that are relevant to cardiovascular genetic counseling. Research into the structure of services finds that genetic counselors are increasingly being embedded within cardiology departments and that cardiologists value their expertise and contributions. Findings from other genetic counseling subspecialties and from clinical psychology suggest this trend toward moving genetic counselors into the cardiology clinic will increase access, timeliness, and uptake of genetics services. Studies on the selection and interpretation of genetic tests in cardiology have shown that there is a need for specialized expertise in these areas. This has led clinical genetic counselors, in collaboration with their physician colleagues, to take a more active role in assessing whether genetic variants contribute to disease. Evidence on the psychological and behavioral impact of cardiovascular genetic counseling is beginning to emerge with several non-randomized and one randomized study showing benefit. As investigators, genetic counselors are leading studies that generate practice-shaping insights into inherited cardiovascular disease, including the genetic underpinnings of disease, natural history, prognosis, psychological impact, and genetic test interpretation. Genetic counseling is in its early days as an academic and scientific discipline, yet there are, nonetheless, several notable recent findings that are shaping the field.

BACKGROUND Medical technologies for consumers aim to help prevent, manage, and even forecast cardiovascular events, but their emotional impact is not fully known. The value of mobile-electrocardiogram (mECG) technology to an existing group of cardiac patients is unknown. The purpose of this study was to examine the impact of readily available mECG capability for a sample of implantable cardioverter defibrillator (ICD) patients. METHODS Patients with ICDs (N = 51) were recruited and consented in a large academic cardiology clinic. Participants were given a mECG device and asked to take a 30-ss reading at least once per day for 30 days. Technology satisfaction, cardiac anxiety, shock anxiety, and ICD device acceptance were measured pre- and post-mECG usage. RESULTS mECG technology was regularly used (M = 36.6 readings completed per month) and positively appraised by ICD patients (mean of 4.4 out of possible 5). Self-reported symptoms of general cardiac anxiety were not significantly affected by the utilization of mECG technology. ICD specific measures were mixed with increased overall ICD device acceptance but also increased shock anxiety. CONCLUSIONS ICD patients positively viewed and used mECG technology regularly as prescribed. However, the overall psychological impact of mECG was mixed and suggests that ICD patients may have idiosyncratic adjustments to the increased access of cardiac device data.

ZusammenfassungWir berichten über einen Fall einer jungen Patientin mit Zwangsstörung, die zugleich an einer schweren kardialen Grunderkrankung litt. Durch die somatische Komorbidität war die leitliniengerechte Durchführung der Expositionstherapie mit Reaktionsmanagement zunächst nicht möglich, ohne die Patientin vital zu gefährden. Durch eine enge Kooperation mit einer kardiologischen Abteilung konnte eine innovative Lösung gefunden werden, welche die Durchführung der Expositionstherapie ermöglichte. Der Fallbericht ist ein Beispiel für gelungene interdisziplinäre Zusammenarbeit und soll den Leser darauf aufmerksam machen, dass vor der Einleitung von Expositionsbehandlungen in seltenen Fällen auch somatische Kontraindikationen zu prüfen sind.

Background: Hypertension is the leading cardiovascular risk factor worldwide, with the greatest burden in low-income settings. Blood pressure (BP) control is usually low resulting in high rates of uncontrolled patients and complications. Low awareness resulting in poor therapeutic adherence represents an important factor for insufficient blood pressure control in developing countries. Methods: This was a three months non-randomized control trial at the cardiology clinic of the Yaounde Central Hospital. We included adults with essential and uncontrolled hypertension. The intervention consisted of group educative sessions every week focusing on knowledge of hypertension risk factors, complications, treatment, comorbidities, home self-monitoring of BP. Home blood pressure figures, drug compliance, and knowledge regarding hypertension were evaluated before and after. Results: 17 participants (8 women) with a mean age 56.2 ± 8.1 years. During intervention, mean SBP decreased by 30 mmHg while mean DBP drooped by 11 mmHg using home BP measures. Knowledge regarding hypertension, adherence and drug compliance increased by 36.5%, 88.2% and 81.4% respectively. Conclusion: Therapeutic group education resulted in a significant improvement in BP control amongst uncontrolled hypertensive patients in sub Saharan Africa.

The purpose of this research is to conduct cost minimisation analysis of coronary angiography interventions with Transradial (TRA) and Transfemoral (TFA) approach. Thus, operators will be guided in relation with intervention selection and cardiovascular area on the subject matter will be enriched which is quite inadequate with a cost analysis sample. The research has been conducted by evaluating and examining of data of the patients who had coronary angiography. Population of the research consists of angiography interventions in the scope of the research carried out within the year of 2013 in a Cardiology Clinic of a tertiary hospital. Patient records were randomly selected. At the end of the research, the findings have revealed that the costs of TRA and TFA have been respectively Turkish Liras (TRY)746,214 and TRY 710,040. The cost of TRA approach is higher than TFA approach. On the other hand, experts’ opinion is that TRA approach is a more reliable alternative compared to TFA approach. In the selection process of the approach to be used by the operators, it would be beneficial for the patients when both the cost and results of the intervention are considered simultaneously.

A 56-year-old man was seen in cardiology clinic with exertional chest pain, most marked when walking uphill. He was a heavy smoker but had no other cardiovascular risk factors. His 12-lead ECG was normal, and a CT coronary angiogram (CTCA) was organised with a suspected diagnosis of angina.

Key Points Question Is the transition to remote cardiology ambulatory visits during the COVID-19 pandemic associated with disparities in patient access to care, ordering of diagnostic tests, and/or medication prescribing? Findings In this cross-sectional study of 176 781 ambulatory cardiology visits, patients using COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals, have private insurance, and have cardiovascular comorbidities. Compared with pre-COVID in-person visits, clinicians during COVID-era video and telephone visits had a significantly lower odds of ordering any medication as well as most tests. Meaning Remote cardiology clinic visits were used more often by certain traditionally underserved patient groups but were also associated with less frequent testing and prescribing., This cross-sectional study examines ambulatory cardiology clinic visit data and whether the transition to remote visits during COVID-19 is associated with disparities in patient use of care, diagnostic test ordering, and medication prescribing., Importance The COVID-19 pandemic has led to an unprecedented shift in ambulatory cardiovascular care from in-person to remote visits. Objective To understand whether the transition to remote visits is associated with disparities in patient use of care, diagnostic test ordering, and medication prescribing. Design, Setting, and Participants This cross-sectional study used electronic health records data for all ambulatory cardiology visits at an urban, multisite health system in Los Angeles County, California, during 2 periods: April 1, 2019, to December 31, 2019 (pre-COVID) and April 1 to December 31, 2020 (COVID-era). Statistical analysis was performed from January to February 2021. Exposure In-person or remote ambulatory cardiology clinic visit at one of 31 during the pre-COVID period or COVID-era period. Main Outcomes and Measures Comparison of patient characteristics and frequencies of medication ordering and cardiology-specific testing across 4 visit types (pre-COVID in-person (reference), COVID-era in-person, COVID-era video, COVID-era telephone). Results This study analyzed data from 87 182 pre-COVID in-person, 74 498 COVID-era in-person, 4720 COVID-era video, and 10 381 COVID-era telephone visits. Across visits, 79 572 patients were female (45.0%), 127 080 patients were non-Hispanic White (71.9%), and the mean (SD) age was 68.1 (17.0) years. Patients accessing COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals (24 934 pre-COVID in-person visits [28.6%] vs 19 742 COVID-era in-person visits [26.5%] vs 3633 COVID-era video visits [30.4%] vs 1435 COVID-era telephone visits [35.0%]; P

Perbedaan jenis geometri hipertrofi ventrikel kiri dikaitkan dengan risiko penyakit kardiovaskular yang berbeda. Ekokardiografi dengan bantuan kriteria voltase elektrokardiografi (EKG) hipertrofi ventrikel kiri dapat membedakan jenis geometri hipertrofi ventrikel kiri. Tujuan penelitian mengetahui peranan berbagai kriteria voltase EKG hipertrofi ventrikel kiri untuk membedakan jenis geometri hipertrofi ventrikel kiri. Dilakukan penelitian potong lintang periode Juni–November 2015 terhadap 100 pasien di poliklinik dan rawat inap kardiologi RSUP H. Adam Malik Medan. Dilakukan anamnesis, pengukuran indeks massa tubuh, serta pemeriksaan EKG dan ekokardiografi. Jika hasil kriteria EKG hipertrofi ventrikel kiri Sokolow-Lyon tidak dipenuhi maka didapatkan geometri ventrikel kiri normal dengan sensitivitas 60%, spesifisitas 72,22%, dan akurasi 71%. Untuk jenis geometri eksentrik hipertrofi ventrikel kiri didapatkan bila Cornel voltase tidak dipenuhi, sensitivitasnya 25%, spesifisitas 71,88% dan akurasi 55%. Untuk jenis hipertrofi geometri konsentrik bila rasio RV6/V5 >1 dipenuhi, sensitivitasnya 55,56%, spesifisitas 56,36% dan akurasi 56%. Jika rasio RV6/V5 >1 tidak dipenuhi, jenis geometri konsentrik remodeling hipertrofi ditentukan dengan sensitivitas 55,56%, spesifisitas 49,45% dan akurasi 50%. Pada penelitian ini juga didapatkan sensitivitas dan spesifisitas kriteria Sokolow-Lyon untuk hipertrofi ventrikel kiri secara ekokardiografi dengan sensitivitas 72,22% dan spesifisitas 60,00%, kriteria Cornel voltase untuk hipertrofi ventrikel kiri secara ekokardiografi dengan sensitivitas 77,78% dan spesifisitas 70,00%, dan kriteria rasio RV6/V5 untuk hipertrofi ventrikel kiri secara ekokardiografi dengan sensitivitas 51,11% dan spesifisitas 70,00%. Secara keseluruhan, sensitivitas dan spesifisitas termasuk lemah. Simpulan, berbagai kriteria EKG ventrikel kiri dapat membedakan jenis geometri hipertrofi ventrikel kiri. Kriteria EKG hipertrofi kiri voltase, yaitu Sokolow-Lyon dan Cornel voltase sensitivitas dan spesifisitas lebih baik dibanding dengan rasio RV6/V5. ACCURACY OF CRITERIA VOLTAGE ELECTROCARDIOGRAPHY LEFT VENTRICULAR HYPERTROPHY TO DISTINGUISH TYPES OF LEFT VENTRICULAR HYPERTROPHY GEOMETRY The different types of left ventricular hypertrophy geometry is associated with different risk of cardiovascular disease. Echocardiography is the gold standard for diagnosis of left ventricular hypertrophy. Electrocardiographic (ECG)left ventricular hypertrophy voltage criteria can distinguish the type of geometry of left ventricular hypertrophy. The purpose of this study to find out the role of various voltage ECG criteria to distinguish the type of geometry of left ventricle hypertrophy. A cross-sectional study doing from June to November 2015 on 100 patients in cardiology clinic and inpatient at Adam Malik Hospital, Medan, through anamnesis, body mass index measurement, ECG and echocardiography examinations. If the Sokolow-Lyon ECG criteria for left ventricular hypertrophy did not met, normal left ventricular geometry was diagnosed with 60% sensitivity, 72.22% specificity and 71% accuracy. The eccentric left ventricular hypertrophy geometry was diagnosed if Cornel voltage was not fulfilled, with 25% sensitivity, 71.88% specificity and 55% accuracy. The concentric hypertrophy geometry was diagnosed if the RV6/V5 ratio >1, with 55.56% sensitivity, 56.36% specificity and 56% accuracy. If the RV6/V5 ratio >1 are not met, concentric hypertrophic remodeling geometry was diagnosed with a sensitivity of 55.56%, a specificity of 49.45% and an accuracy of 50%. This study also found the sensitivity and specificity for left ventricular hypertrophy in echocardiography of Sokolow-Lyon criteria were 72.22% and 60.00%, the Cornel voltage criteria with a sensitivity of 77.78% and a specificity of 70.00%, and RV6/V5 ratio criteria with a sensitivity of 51.11% and a specificity of 70.00%. The overall sensitivity and specificity was low. In conclusion, various criteria of ECG left ventricular geometry voltage can differentiate left ventricular hypertrophy geometry types. Sokolow-Lyon and Cornell voltage criteria are more sensitive and specific than the RV6/V5 ratio.

Background: Coronary heart disease is the leading cause of death in Saudi Arabia. We designed this study with the objective to determine the prevalence of risk factors of this disease within patients diagnosed with CHD. Aim: our aim is to observe the current prevalence of risk factors of coronary heart disease (CHD), with respect to the lifestyle. We will attempt to identify the possible causes of such habits. Patients and Method: a cross-sectional study among 300 Saudi patients, with known coronary heart disease, was conducted with help of a questionnaire. The study was conducted at the cardiology department of King Abdul Aziz Hospital & Oncology Center in the city of Jeddah. Results: the prevalence of CHD was higher in the male gender by a ratio of 2:1. Also, the prevalence increases with age, the highest being found in age group over 75 years old which is 8 times higher than was observed in age group 35-44 years. 72.5% females and 52.6% males of these atherosclerotic patients was either overweight or obese. The same trend is seen in negative habits of 10 years duration, such as lack of exercise as high as 75.6 % in males and 81.3% in females. Intake of fatty/fast food was found to be 64.85% in both sexes. Intake of sweet/ sugary food was also high, and unfortunately consumption of fruits and vegetables was low. The current smoking trend is 45.9% in men and 21.95% in women. Conclusion: The risk factors assessed in the study were gender, age, obesity, smoking history, physical inactivity, and eating habits. Unfortunately, physical inactivity, bad eating habits, and smoking were found to be very common. The patients must be encouraged to practice healthy lifestyle modifications to reduce morbidity and mortality.

The purpose of this evidence-based practice project was to incorporate a heart failure (HF) self-care case management program in an outpatient cardiology clinic to improve self-care behaviors and reduce hospital readmissions with HF patients recently discharged from the hospital. Using Riegel's

Se realizó un proceso investigativo observacional descriptivo, de corte transversal, con enfoque mixto; con el propósito de caracterizar los factores de riesgo cardiovascular en pacientes hipertensos atendidos en la consulta externa de cardiología Hospital IESS- Riobamba, en el periodo de enero-junio, 2013. La población de estudio estuvo constituida por 3889 individuos, de la cual se seleccionó una muestra de 1256 atendiendo a diferentes criterios. Los respectivos datos se recolectaron mediante la revisión de documentos, para lo cual se diseñó la correspondiente guía. En el entorno de investigación predominó el sexo femenino, para un 60,0 %; así como las edades mayores de 65 años. El sedentarismo resultó el principal factor de riesgo presente con un 66.98 % de incidencia. La mayoría de la muestra estudiada se catalogó como de bajo riesgo cardiovascular 74 % y solo el 6,06 % se enmarcó en la categoría de muy alto a sufrir esa enfermedad durante los 10 años siguientes.

Inferior vena cava filters have gained increasing popularity in recent decades and knowledge on rare complications becomes vital to practicing physicians. A 30-year-old African American male with diabetes mellitus, hypertension, end-stage renal disease, history of deep venous thrombosis and placement of venacaval filter who was seen in the cardiology clinic for cardiac risks stratification prior to renal transplant. Patient denied any cardiac symptoms. A transthoracic echocardiogram was performed and showed two linear echoes bright densities in the right atrium and right ventricle embedded which was later found to be fractured filter struts by computed tomography. We discuss the various outcomes associated with non-retrieval of retrievable inferior vena cava filters.

Aim. To study the effect of rivaroxaban compared with warfarin on the incidence of cardioembolic stroke and systemic thromboembolic complications (TEC), bleeding in patients with non-valvular atrial fibrillation (AF). Material and methods. Patients (n=126) older than 18 years, appealed to the Cardiology Clinic with non-valvular AF were included into an open non-randomized study. The patients were divided into 2 groups based on their socio-economic status: 77 patients received rivaroxaban and 49 - warfarin. The incidence of acute coronary syndrome, ischemic stroke and other TEC, bleeding as well as (only for patients taking warfarin) international normalized ratio (INR) and time in the therapeutic INR range were evaluated. Results. The incidence of ischemic stroke was not significantly different between groups, at the same time the incidence of other TEC was significantly higher in the warfarin group (0 vs 8%, p=0.011). The incidence of minor bleedings was significantly prevailed in warfarin group (0 vs 20%; p=0.0004). The time in the target INR range in the warfarin group was only 43%. 93.5% of patients continued to receive rivaroxaban after 9 months, and warfarin – 67.4% of patients. Conclusion. The results of our own clinical studies of rivaroxaban in patients with non-valvular AF have demonstrated efficacy comparable to that of warfarin. Rivaroxaban was superior to warfarin in safety.

Background Murmur is one of the commonest reasons for referral to paediatric cardiologists. This has caused a long waiting time for clinic and increased parental anxiety. Objectives To assess the local cardiology services for suspected congenital heart diseases in neonates and infants at Princess Alexandra Hospital Harlow, Essex, UK Methods Retrospective data was collected from period of May 2018 to November 2018 from online database and patient notes including all the neonates and infants referred and seen in paediatric cardiology clinic during this period. Results Total 30 patients were studied. 56.6% were females and 43.3% were males. The mean waiting time was 4 months. Commonest reason for referral was heart murmur in 40% patients and 2nd common reason was family history of congenital heart diseases in 30%. Echocardiogram was normal in 20% and the commonest defects were VSD and ASD 20% each. Amongst those having heart murmurs 16.6% were normal and discharged, 8.3% had PFO and discharged and 8.3% had tiny PDA. Our local referral pathways recommend discussion with consultant before referral but only 10% patients were discussed with the consultant and 83.3% had no documentation regarding discussion with consultant. In only 105 of referrals the local referral pathway was followed. Conclusion The commonest reason for referral to cardiology clinic for infants and neonates is heart murmur. If we develop our local murmur guidelines then it will be easy to decide whom we need to see in cardiology clinic and this can avoid un-necessary cardiology clinic referrals without missing the pathologies. We intend to develop our local murmur guidelines as a next step to quality improvement project. Recommendations Create awareness amongst doctors about cardiology clinic referral form for neonates and infants with suspected congenital heart disease through teaching sessions and during induction of new doctors. The referral form should be duly signed by the consultant making referral and the cardiology consultant accepting and the signed form should be attached in the patient notes in correspondence. We need to develop out local cardiology guidelines for neonates and infants with heart murmur and/or suspected congenital heart disease so that un-necessary referrals can be avoided without missing the congenital heart defects.

Coronary Arteritis in IgG4-Related Disease A 47-year-old man with known IgG4-related disease presented to the cardiology clinic. Cardiac imaging revealed aneurysmal dilatation of the right coronary...

A 53-year-old man with history of coronary artery disease (CAD) status after percutaneous coronary intervention of left anterior descending (LAD), diabetes mellitus type II and dyslipidaemia presented to our cardiology clinic with exertional, episodic chest pain and palpitations. His physical

Introduction Recognised in the 2019 NHS Long-term plan was the need to streamline services, with less face-to-face outpatient (OP) care by utilising digital technology and creating ‘virtual clinics’ (VC). A team of Cardiologists and General Practitioners (GP) collaborated to create a VC via a web-based video link, enabling discussion of patients being considered by primary care for referral to the Cardiology clinic. All available GPs were present to enable an educational aspect to the discussion, and the aim of the VC was to: (i) identify appropriate patients requiring OP review, (ii) enable early selection of required investigations, and (iii) identify patients not requiring further assessment. We aimed to assess the safety and efficacy of this approach. Methods VC’s were established between a Consultant Cardiologist and two primary care practices, and all referrals required an ECG. Each patient was presented by the referring GP, and the Consultant Cardiologist issued correspondence and co-ordinated any required tests and follow-up. A 13 month period of this practise was reviewed with 135 patient events screened via a cross-matched record of patients. Data was recorded for: indication for and outcome of discussion; likelihood patient would have had test or referral made without this service (as assessed by Cardiology); and whether patients discussed had a subsequent unplanned admission or cardiac assessment. Results 8/135 were excluded (duplicate; admitted prior to VC; not discussed; or re-discussed for learning). Efficacy Outcomes of the VC are summarised in table 1. The overall number of patients a GP ‘would’ have referred was 113 (89%), and the number that ‘would’ have had tests booked 98 (77%), across the two practises. This left an overall OPA post VC of 11% vs a potential 89% ‘would’ have been referred (100 potential appointments avoided), and an overall test rate post VC 48% vs 77% ‘would’ have had tests (37 potential tests avoided). Safety Unplanned Cardiology input post-VC included 1 subsequent chest pain clinic, a different issue to the original VC discussion, and 1 admission with syncope, which was the issue that was discussed in VC but with no pathology identified during admission. Conclusion We demonstrated a significant reduction in OP Cardiology appointments and hospital investigations, proving improved resource utilisation, and the associated safety data was reassuring. As a result, this service demonstrates a novel approach to technology-enabled streamlining of primary to secondary care services in a safe and efficient manner. Conflict of Interest None

A forty-two-year-old female patient was admitted to cardiology clinic with complaint of dyspnoea with exertion, which progressed over the last few months. The patient’s medical history was unremark...

Introduction. Transcatheter aortic valve replacement is an important therapeutic option for aortic stenosis (AS) patients who have high surgical risk. TAVR is a complex procedure. Proper preparation of the patient is of significant importance for the final success and affects the morbidity and mortality of the TAVR directly. Pre-TAVR computed tomography is one of the corner stones of these preparation steps, and many patients get some incidental diagnoses. Materials and Methods. In this trial, we have investigated 155 patients who had underwent TAVR between February 2013 and March 2017 at Hacettepe University Adult Hospital Cardiology Clinic. Results. Total number of incidental diagnoses was 541, and 451 of them were the first diagnoses. Total number of cardiovascular findings and noncardiovascular findings was 369 and 172, respectively. The most common cardiovascular finding is atherosclerotic heart disease (139, 89.6%). The most common noncardiovascular finding is pulmonary nodule (41, 26.4%). 143 of 155 patients had at least one incidental diagnosis after the reassessment, and 33 different diagnoses were identified with computed tomography. The mean STS-PROM was 8.38% (range 2.8% to 23%), and the mean STS-PROM was calculated 9.4% (range 3.6% to 23%) after the reassessment of computed tomography. Conclusion. Preprocedural evaluation is one of the most important steps in TAVR. Computed tomography imaging provides extensive information, not only for procedure planning. Our findings emphasize that computed tomography has a crucial role for the preprocedural evaluation of TAVR candidates.

Access to clinical care in specialty services is challenging in today's ever-changing and complex world of health promotion. Typically, physicians (MD) and nurse practitioners (NP) provide many specialty cardiology services at the Veterans Health Administration (VA) where the study was conducted, while the registered nurses (RN) remain underutilized. These healthcare providers are tasked with supervising cardiac stress tests, which decreases appointment availability for new consults and follow-up visits in the cardiology clinic. Delegating the cardiac stress test supervision to nurses may improve access to cardiac care. The purpose of this study was to determine if RN supervised stress testing affects access to cardiology care. The study utilized a quantitative, comparative design to evaluate if a change in the role of the cardiology RN affected access to cardiology care. The number of cardiology appointments before the intervention were compared to those after the intervention. The appointments were divided into four categories for analysis: 1) appointments scheduled greater than 30 days, 2) appointments referred to community physicians, 3) the number of rescheduled appointments, and 4) the total number of appointments scheduled. The results indicate the number of appointments scheduled over the 30-days was significantly reduced (p = .02) and the total number of appointments (p = .04), but community referrals and rescheduled appointments were not (p =.26, p =.36, respectively). During the data collection, one of the healthcare providers was no longer available to provide care for two out of the three months included in the study. Therefore, the number of appointments after the intervention were not a reflective comparison of cardiology clinic access. Despite the discrepancy in the number of healthcare providers, delegating the stress test supervision to nurses significantly reduced the number of patients scheduled over 30-days and the total number of scheduled appointments. Increasing the skill set of the cardiology RN in the procedural setting can amplify the benefits of team-based care, safe delivery of care, the development of best practices, and most importantly access to cardiology care.

An infant with coarctation of the aorta and Williams syndrome was noted to have petechiae in cardiology clinic prior to planned surgical intervention. Workup revealed acquired von Willebrand syndrome secondary to the high shear force generated by the aortic coarctation. He was treated with intra- and postoperative Humate P; there were no postoperative bleeding complications. His acquired von Willebrand syndrome resolved postoperatively.

Kalkan, Asim/0000-0002-5800-0201; Tatli, Ozgur/0000-0003-0263-7630 WOS: 000451638900009 PubMed: 30345775 OBJECTIVE: This preliminary study aims to examine a change in the blood levels of irisin in patients with acute pericarditis (AP) and acute myopericarditis (AMP) and examine the diagnostic value of the serum irisin level in AP and AMP. METHODS: 10 patients, who applied to the emergency service and cardiology clinic with chest pain and who were diagnosed with AP and 5 patients, who were diagnosed with AMP as a result of routine examinations, were included in the study. The basal laboratory parameters, echocardiography findings and serum irisin levels of the patients and during check one month later were examined. RESULTS: While the basal irisin levels were found to be significantly low in the AMP group and high during the check (6.6 +/- 1.58, 8.19 +/- 1.43, respectively), no statistically significant difference was determined (p = 0.23). It was observed that the basal and control irisin levels did not vary significantly in the AP group (8.03 +/- 1.6, 8.19 +/- 1.43, respectively) (p = 0.84). CONCLUSION: In this preliminary study, the basal irisin levels were found to be significantly low in the AMP group, while there was no statistically significant difference between the basal irisin levels and control irisin levels in the AP and AMP groups.

BACKGROUND: Food insecurity (FI) increases a child's risk of adverse developmental consequences, illnesses, and hospitalizations. Growth, development, and nutrition are key concerns for pediatric cardiology patients. Through a previous QI initiative evaluating FI in our outpatient cardiology clinic, 6% of families were affected by FI, and patients with severe congenital heart disease (CHD) may be at particular risk. As severe CHD may be detected in fetal life, families undergoing fetal echocardiography may represent an especially vulnerable population for FI. As such, we launched an expanded FI screening initiative utilizing the Hunger Vital …

Objective: This article describes the women population and work at a unique Women’s Health Cardiology Clinic in order to raise cardiovascular disease awareness with an emphasis on women-specific risk factors, and thus to improve women’s clinical outcomes. This expectantly will aid in opening similar centers allowing more women to get superior care. Methods: Electronic medical records of women referred to the Women’s Health Cardiology Clinic were analyzed. The statistical analysis is descriptive in nature. Women’s Health Cardiology Clinic personnel work as a multidisciplinary team, and patients receive specialized diagnostic tests and treatments. Referrals are by physicians according to traditional and women’s specific risk factors for cardiovascular disease. Results: 985 women visited the Women’s Health Cardiology Clinic, accumulating 2062 visits. Median age was 57.5 years. The majority of the women were menopausal (575 women, 58%), 62 pregnant with complications and 25 oncology patients. At least, 30% of women had diabetes/hypertension/or dyslipidemia. 72 women had a history of either cerebrovascular event or acute coronary syndrome, and 139 women had evidence of atherosclerosis. Overall, 388 women underwent endothelial function test, 40% of these women had a score indicating endothelial dysfunction. 277 women underwent a psychological intervention. Conclusion: Described here are the experiences from a multidisciplinary Women’s Health Cardiology Clinic using a gender-specific cardiovascular care approach for women geared toward improved health and wellbeing. It is of utmost importance that this report will raise women-specific cardiovascular disease risk factors awareness in order to promote women’s cardiovascular and overall health.

BackgroundFrailty measurement is recommended when assessing older adults with cardiovascular disease to individualise prevention and treatment. We sought to address this by incorporating routine gait speed measurement by clinicians into an outpatient preventive cardiology clinic.MethodsQuality improvement (QI) project initiated at VA Boston in January 2015 to measure usual gait speed in m/s over a 4 m distance for patients aged 70 and older. The primary outcome was completion and documentation of 4 m usual gait speed. Data were manually extracted from the electronic health record. Frequency distributions and descriptive statistics are presented.InterventionsSeveral change interventions were implemented over a 5-year period (January 2015–December 2019) addressing (1) stakeholder engagement and project champions, (2) staff education, (3) assessment space, (4) electronic health record template update and (5) sustaining the initiative. Statistical process control charts were used to monitor proportion of gait speed measurement and to detect shifts resulting from 5 phase change interventions.ResultsDuring this QI project, 178 patients aged 70 and older attended the clinic, accounting for 1042 individual clinic visits. Gait speed was measured at least once for 157 patients; 21 were never assessed. At the end of the first month (January 2015), gait speed was measured during 40% of clinic visits and rose to a median measurement rate of 78% at clinic visits during the 2018–2019 study period. An unanticipated result was the spread of the initiative to other cardiology clinics.ConclusionsGait speed measurement was successfully embedded into clinic assessments for older adults at a cardiology clinic following targeted interventions. This project highlights the feasibility of incorporating a brief frailty assessment such as gait speed, into non-geriatric medicine clinics.

Background Communicating a complex cardiac history to healthcare professionals can pose a challenge to caretakers of pediatric cardiology patients. We sought to develop and implement a pediatric cardiology patient passport. We hypothesize that the passport will help facilitate communication and information sharing between caretakers and other healthcare professionals. Design Based on input from pediatric cardiologists at a major institution, we designed and implemented a patient passport in our pediatric cardiology clinic. Inclusion criteria included patients with a diagnosis of congenital heart disease, conduction abnormality, or arrhythmia. A patient/caretaker survey was conducted to determine the utilization and utility of the passport. Results A total of 100 patients were enrolled in the study between October 2016 and November 2018. The survey was completed by 43% (n = 43) of passport recipients. 88% (n = 35) were “extremely likely” or “somewhat likely” to use the passport in the future. 97% (n = 38) said they “definitely would recommend” or “might recommend” the passport to other pediatric cardiology patients and their families. 97% (n = 38) felt the passport will be helpful in the future when transitioning to adult cardiology. 43% (n = 17) of respondents had used the passport by the time of the survey. Of those who used the passport, 88% (n = 15) felt that the passport made communicating with the healthcare professional easier. No respondents (n = 0) said that the passport was not helpful in their interaction. Conclusions Introduction of a patient passport in an outpatient cardiology clinic may be beneficial. Our results suggest that patient caretakers feel that a patient passport can help facilitate both communication and information sharing with other healthcare professionals.

Background Takotsubo cardiomyopathy often presents with the clinical signs of ST-elevation myocardial infarction (STEMI). The increase in scientific publications addressing this relatively rare condition may result in higher awareness and diagnosis of takotsubo cardiomyopathy. Aim To assess the observed prevalence per year of takotsubo cardiomyopathy in a large registry of patients with STEMI, during a 12-year inclusion period. Method All patients presenting with STEMI at a large regional cardiology clinic were entered into a database (n = 8,413, mean age 63 ± 13 years). Takotsubo cardiomyopathy was diagnosed in 42 patients (0.5 %). Years of evaluation were defined as ‘early years’ (January 2002 to December 2007; n = 4350) and ‘later years’ (January 2008 to December 2013). Multivariable analyses were performed to adjust for differences in demographical and clinical variables. Results In later years, the age of STEMI patients was slightly higher (64 ± 13 vs. 63 ± 13 years, p < 0.001), with more patients with clinical symptoms of shock (10 vs. 7 %, p < 0.001) or a history of percutaneous coronary intervention or hypertension (10 vs. 8 %, p = 0.001 and 37 vs. 34 %, p < 0.001). Smoking and a positive family history were less often observed during later years (39 vs. 46 %, p < 0.001 and 37 vs. 42 % p < 0.001). Patients with takotsubo cardiomyopathy were more often female (81 vs. 27 %, p = 0.001). Takotsubo cardiomyopathy was more often diagnosed in the later period (0.7 vs. 0.3 %, OR 2.4, 95 % CI 1.2–4.6, p = 0.009). The higher prevalence of takotsubo cardiomyopathy in recent years remained significant after adjustment for differences in patient characteristics (OR 2.1, 95 % CI 1.1–4.3). Conclusion Takotsubo cardiomyopathy is currently more often diagnosed in patients with STEMI compared with in earlier years. This is probably due to the increased scientific and clinical awareness among doctors, but the prevalence is still low.

BACKGROUND Hospital to Home (H2H) is a national quality improvement initiative sponsored by the Institute for Healthcare Improvement and the American College of Cardiology, with the goal of reducing readmission for patients hospitalized with heart disease. We sought to determine the impact of H2H within the Veterans Affairs (VA) health care system. METHODS Using a controlled interrupted time series, we determined the association of VA hospital enrollment in H2H with the primary outcome of 30-day all-cause readmission following a heart failure hospitalization. VA heart failure providers were surveyed to determine quality improvement projects initiated in response to H2H. Secondary outcomes included initiation of recommended H2H projects, follow-up within 7 days, and total hospital days at 30 days and 1 year. RESULTS Sixty-five of 104 VA hospitals (66%) enrolled in the national H2H initiative. Hospital characteristic associated with H2H enrollment included provision of tertiary care, academic affiliation, and greater use of home monitoring. There was no significant difference in mean 30-day readmission rates (20.0% ± 5.0% for H2H vs 19.3% ± 5.9% for non-H2H hospitals; P = .48) The mean fraction of patients with a cardiology visit within 7 days was slightly higher for H2H hospitals (3.0% ± 2.4% for H2H vs 2.0% ± 1.9% for non-H2H hospitals; P = .05). Patients discharged from H2H hospitals had fewer mean hospitals days during the following year (7.6% ± 2.6% for H2H vs 9.2% ± 3.0 for non-H2H; P = .01) early after launch of H2H, but the effect did not persist. CONCLUSIONS VA hospitals enrolling in H2H had slightly more early follow-up in cardiology clinic but no difference in 30-day readmission rates compared with hospitals not enrolling in H2H.