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Clinical outreach is a crucial but understudied health care service delivery model. Physicians staffing rural outreach clinics must allocate a limited resource (i.e., their time) between caring for patients at their main sites and outreach locations. Using a unique 30-year data set of decisions made by cardiologists, the authors estimate a constrained utility maximization model of time allocations across home and outreach locations. The results show that travel distance, potential competition, and patient demand for cardiology services significantly influence allocation decisions. This structural model is used to simulate the impact of a predicted reduction in cardiologist supply. The expected impacts are unevenly distributed, with some rural locations experiencing large decreases in access. The authors evaluate two policies to restore rural access: targeted immigration and a subsidy program. A subsidy program with an estimated annual cost of $406,000 can restore outreach after a 10% reduction in cardiologist supply. This option should be preferred to recruiting and supporting five additional cardiologists under a targeted immigration strategy. This research demonstrates the value of marketing modeling in addressing limited access to health care services and evaluating alternative policies for maintaining access in the face of coming physician shortages. [ABSTRACT FROM AUTHOR]

Background: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates. Methods: This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors. Results: A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73). Conclusions: In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities. [ABSTRACT FROM AUTHOR]

Background: Statin therapy is widely utilized for preventing atherosclerotic cardiovascular disease, both as a primary and secondary measure. Despite the American Association for the Study of Liver Diseases' endorsement of statin use in cirrhotic patients, practitioners exhibit hesitancy, primarily due to concerns regarding hepatotoxicity. This study aimed to evaluate statin prescription patterns in cirrhotic patients by primary care physicians (PCPs) and cardiologists through a survey. Methods: A voluntary survey via Survey Monkey with nine objective-type questions was sent to 220 PCPs and 75 cardiologists within Allegheny Health Network. Survey results were collected, and a chi square test was used to compare the two groups. A P value ≤ 0.05 was considered statistically significant. Results: A total of 64 PCPs (29.1%) and 15 cardiologists (20%) completed the survey. Overall, 12.6% did not prescribe statins for primary prevention of atherosclerotic cardiovascular disease in compensated cirrhotic patients. While all cardiologists prescribed statins for secondary prevention, over 50% preferred lower-intensity options. Conversely, 14.1% of PCPs avoided statin prescriptions for secondary prevention. Cardiologists were significantly more inclined to prescribe statins, especially for cirrhosis due to metabolic dysfunction-associated steatotic liver disease compared to PCPs (73.3% vs 45.3%, P = 0.05). Conclusions: Despite increasing evidence favoring use of statins in cirrhosis for improving portal hemodynamics and decreasing ascites, hepatic encephalopathy, the incidence of hepatocellular carcinoma, and mortality, there is still hesitation on the part of prescribers for the fear of worsening liver disease. Wider dissemination of current guidelines and education practices may help to bridge this gap. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) confers increased risks of premature mortality, non-fatal morbidity, and significant impairment in functional status and health-related quality of life. Routine administration of electronic patient-reported outcome measures (PROMs) and its real time delivery to care providers is known to have the potential to inform routine cardiac care and to improve quality of care and patient outcomes. This study describes a user-centered development and evaluation of the Alberta Provincial Project for Outcomes Assessment (APPROACH) electronic Patient Reported Outcomes Measurement (e-PROM) system. This e-PROM system is an electronic system for the administration of PROMs to patients with CAD and the delivery of the summarized information to their care providers to facilitate patient-physician communication and shared decision-making. This electronic platform was designed to be accessible via web-based and hand-held devices. Heuristic and user acceptance evaluation were conducted with patients and attending care providers. Results: The APPROACH e-PROM system was co-developed with patients and care providers, research investigators, informaticians and information technology experts. Five PROMs were selected for inclusion in the online platform after consultations with patient partners, care providers, and PROMs experts: the Seattle Angina Questionnaire, Patient Health Questionnaire, EuroQOL, and Medical Outcomes Study Social Support Survey, and Self-Care of Coronary Heart Disease Inventory. The heuristic evaluation was completed by four design experts who examined the usability of the prototype interfaces. User acceptance testing was completed with 13 patients and 10 cardiologists who evaluated prototype user interfaces of the e-PROM system. Conclusion: Both patients and physicians found the APPROACH e-PROM system to be easy to use, understandable, and acceptable. The APPROACH e-PROM system provides a user-informed electronic platform designed to incorporate PROMs into the delivery of individualized cardiac care for persons with CAD. [ABSTRACT FROM AUTHOR]

Background: Having knowledge of the dental procedures that necessitate endocarditis prophylaxis is of high importance. Therefore, the aim of the present study was to determine the knowledge level and attitudes of general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan about endocarditis. Methods: This cross-sectional study was carried out on 420 general medical and dental practitioners, dental specialists, and cardiologists in Tehran and Hamadan provinces in 2015. The questionnaire used in this research consisted of three parts as follows: part one: information on cardiac diseases; part two: dental procedures requiring endocarditis prophylaxis; part three: antibiotic diet in endocarditis prophylaxis. Independent t-test, one-way ANOVA, and chi-square tests were conducted to analyze the data. All the analyses were performed in SPSS version 16. Results: The results showed that 86.7 had a relatively favorable and 10.5% of subjects had a favorable level of knowledge about endocarditis. Also, 58.6% of subjects had a poor attitude toward endocarditis prophylaxis. There was a significant relationship between knowledge and attitude, age, gender, and work experience (P < 0.001). There was a significant relationship between knowledge and attitude, and job groups; dental specialists had a more favorable knowledge and positive attitude than others (P < 0.001). Conclusion: We recommended developing more practical training programs in dental schools on cardiac diseases, and dental procedures requiring endocarditis prophylaxis and antibiotic diets. [ABSTRACT FROM AUTHOR]

Background: Hypertension, a chronic medical condition affecting millions of people worldwide, is a leading cause of cardiovascular diseases. A multidisciplinary approach is needed to reduce the burden of the disease, with general practitioners playing a vital role. Therefore, it is crucial that GPs provide high-quality care that is standardized and based on the most recent European guidelines. Quality indicators (QIs) can be used to assess the performance, outcomes, or processes of healthcare delivery and are critical in helping healthcare professionals identify areas of improvement and measure progress towards achieving desired health outcomes. However, QIs to evaluate the care of patients with hypertension in general practice have been studied to a limited extent. The aim of our study is to define quality indicators for hypertension in general practice that are extractable from the electronic health record (EHR) and can be used to evaluate and improve the quality of care for hypertensive patients in the general practice setting. Methods: We used a Rand-modified Delphi procedure. We extracted recommendations from European guidelines and assembled them into an online questionnaire. An initial scoring based on the SMART principle and extractability from the EHR was performed by panel members, these results were analyzed using a Median Likert score, prioritization and degree of consensus. A consensus meeting was set up in which all the recommendations were discussed, followed by a final validation round. Results: Our study extracted 115 recommendations. After analysis of the online questionnaire round and a consensus meeting round, 37 recommendations were accepted and 75 were excluded. Of these 37 recommendations, 9 were slightly modified and 4 were combined into 2 recommendations, resulting in a list of 35 recommendations. All recommendations of the final set were translated to QIs, made up of 7 QIs on screening, 6 QIs on diagnosis, 11 QIs on treatment, 5 QIs on outcome and 6 QIs on follow-up. Conclusions: Our study resulted in a set of 35 QIs for hypertension in general practice. These QIs, tailored to the Belgian EHR, provide a robust foundation for automated audit and feedback and could substantially benefit other countries if adapted to their systems. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) represents the most common sustained arrhythmia necessitating dual focus: acute complication management and sustained longitudinal oversight to modulate disease progression and ensure comprehensive patient care over time. AF is a multifaceted disorder; due to such a great number of potential exacerbating conditions, a multidisciplinary team (MDT) should manage AF patients by cooperating with a cardiologist. Effective management of AF patients necessitates the implementation of a well-coordinated and tailored care pathway aimed at delivering optimized treatment through collaboration among various healthcare professionals. Management of AF should be carefully evaluated and mutually agreed upon in consultation with healthcare providers. It is crucial to recognize that treatment may evolve due to the emergence of new risk factors, symptoms, disease progression, and advancements in treatment modalities. In the context of multidisciplinary AF teams, a coordinated approach involves assembling a diverse team tailored to meet individual patients' unique needs based on local services' availability. [ABSTRACT FROM AUTHOR]

A collective tribute to a colleague, friend, and mentor from those that have known him through his journey of the meanderings of the arterial pulse in health and disease; a journey that extended beyond borders and confines, with far-reaching personal and global impact. The Editorial Board of the Artery Research Journal and the Executive Committee of the Artery Society extend their due respects to Prof. Michael O'Rourke. [ABSTRACT FROM AUTHOR]

Background: Obesity (body mass index ≥ 30 kg/m2) is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and affects most patients with HFpEF. Patients living with obesity may experience delays in HFpEF diagnosis and management. We aimed to understand the clinical journey of patients with obesity and HFpEF and the role of primary care providers (PCPs) in diagnosing and managing patients with both conditions. Methods: An anonymous, US population-based online survey was conducted in September 2020 among 114 patients with self-reported HFpEF and obesity and 200 healthcare providers, 61 of whom were PCPs who treat patients with HFpEF and obesity. Results: Half of patients (51%) with HFpEF reported waiting an average of 11 months to discuss their symptoms with a PCP; 11% then received their diagnosis from a PCP. PCPs initiated treatment and oversaw the management of HFpEF only 35% of the time, and 44% of PCPs discussed obesity treatment medication options with their patients. Only 20% of PCPs indicated they had received formal obesity management training, and 79% of PCPs indicated they would be interested in obesity management training and support. Conclusion: PCPs could play a valuable role in addressing obesity and referring patients with obesity and signs and symptoms of HFpEF to cardiologists. Increased awareness of HFpEF and its link to obesity may help PCPs more quickly identify and diagnose their patients with these conditions. Plain Language Summary: Heart failure with preserved ejection fraction (HFpEF) is a common form of heart failure. Many patients who have HFpEF also have obesity or excess weight. We wanted to understand the medical experience of patients with HFpEF and obesity and the role that primary care providers (PCPs) play in managing patients with these diseases. We surveyed 114 patients with HFpEF and obesity and 200 healthcare providers who treat patients with HFpEF and obesity, 61 of whom were PCPs. One-quarter of patients had a major heart-related event that led to their HFpEF diagnosis. Half of the patients said they had an initial discussion about HFpEF symptoms with a PCP, but only one in ten were diagnosed by a PCP. Few PCPs said they received obesity management training, but most were interested in receiving more obesity management training and support. PCPs play an important role in organizing care for patients with HFpEF and obesity. However, there is room to improve HFpEF awareness and access to obesity management tools and strategies among PCPs. [ABSTRACT FROM AUTHOR]

Introduction: Training in clinical cardiac electrophysiology (CCEP) involves the development of catheter handling skills to safely deliver effective treatment. Objective data from analysis of ablation data for evaluating trainee of CCEP procedures has not previously been possible. Using the artificial intelligence cloud‐based system (CARTONET), we assessed the impact of trainee progress through ablation procedural quality. Methods: Lesion‐ and procedure‐level data from all de novo atrial fibrillation (AF) and cavotricuspid isthmus (CTI) ablations involving first‐year (Y1) or second‐year (Y2) fellows across a full year of fellowship was curated within Cartonet. Lesions were automatically assigned to anatomic locations. Results: Lesion characteristics, including contact force, catheter stability, impedance drop, ablation index value, and interlesion time/distance were similar over each training year. Anatomic location and supervising operator significantly affected catheter stability. The proportion of lesion sets delivered independently and of lesions delivered by the trainee increased steadily from the first quartile of Y1 to the last quartile of Y2. Trainee perception of difficult regions did not correspond to objective measures. Conclusion: Objective ablation data from Cartonet showed that the progression of trainees through CCEP training does not impact lesion‐level measures of treatment efficacy (i.e., catheter stability, impedance drop). Data demonstrates increasing independence over a training fellowship. Analyses like these could be useful to inform individualized training programs and to track trainee's progress. It may also be a useful quality assurance tool for ensuring ongoing consistency of treatment delivered within training institutions. [ABSTRACT FROM AUTHOR]

Objective: The critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri‐ and postmenopausal women. Methods: The Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. Results: The results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association. Conclusions: The experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine‐metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk. Synopsis: The leading scientific societies agree that comorbidities and hormone deprivation are crucial clinical problems to be evaluated in peri‐ and postmenopause requiring specific cardiovascular and endocrinologic investigations. [ABSTRACT FROM AUTHOR]

In 2023 six decades have elapsed since the first experimental work on the heart muscle was published, in which a member of the Institute of Physiology of the Czech Academy of Sciences participated as an author; Professor Otakar Poupa was the founder and protagonist of this research domain. Sixty years – more than half of the century – is certainly significant enough anniversary that is worth looking back and reflecting on what was achieved during sometimes very complicated periods of life. It represents the history of an entire generation of experimental cardiologists; it is possible to learn from its successes and mistakes. The objective of this review is to succinctly illuminate the scientific trajectory of an experimental cardiological department over a 60-year span, from its inaugural publication to the present. The old truth – historia magistra vitae – is still valid. [ABSTRACT FROM AUTHOR]

The 12-lead electrocardiogram (ECG) is an integral component to the diagnosis of a multitude of cardiovascular conditions. It is performed using a complex set of skin surface electrodes, limiting its use outside traditional clinical settings. We developed an artificial intelligence algorithm, trained over 600,000 clinically acquired ECGs, to explore whether fewer leads as input are sufficient to reconstruct a 12-lead ECG. Two limb leads (I and II) and one precordial lead (V3) were required to generate a reconstructed 12-lead ECG highly correlated with the original ECG. An automatic algorithm for detection of ECG features consistent with acute myocardial infarction (MI) performed similarly for original and reconstructed ECGs (AUC = 0.95). When interpreted by cardiologists, reconstructed ECGs achieved an accuracy of 81.4 ± 5.0% in identifying ECG features of ST-segment elevation MI, comparable with the original 12-lead ECGs (accuracy 84.6 ± 4.6%). These results will impact development efforts to innovate ECG acquisition methods with simplified tools in non-specialized settings. [ABSTRACT FROM AUTHOR]

In patients with atrial fibrillation (AF), direct oral anticoagulants (DOACs) have been utilized as an alternative to warfarin, which is known to have several limitations. This study aimed to clarify the selection criteria for anticoagulants, considering both individual patient factors and the differences between various drugs. This study conducted a web-based questionnaire from September 20, 2023 to October 3, 2023, among physicians who were members of a cardiology-specific website. In total, 172 respondents were enrolled in this study. Edoxaban was the most frequently selected anticoagulant (39.1%), followed by apixaban (32.7%) and rivaroxaban (16.8%). Logistic regression analysis revealed that increased concern for adherence enhanced the frequency of selecting edoxaban (odds ratio [OR] = 2.42; p = 0.047), with the opposite trend observed for dabigatran (OR = 0.404; p = 0.029). The selection of apixaban is related to whether the patient is able to maintain a regular lifestyle, including adherence to medication schedules (OR = 1.874; p = 0.031). Furthermore, detailing activities from a medical representative, especially regarding a new indication, were found to influence drug selection for rivaroxaban (OR = 2.422; p = 0.047). This study revealed that edoxaban is the most frequently selected anticoagulant. Although prescribing cardiologists select drugs based on background factors, adherence to medication and information from medical representatives were also crucial factors in the selection process. [ABSTRACT FROM AUTHOR]

Aims Motivational interviewing (MI) has been recognized as highly effective for treating chronic diseases and various conditions, with encouraging results demonstrating its effectiveness in promoting health behaviour change. The current study was proposed to evaluate the feasibility of MI on adherence to care practices, emotional intelligence (EI), and dispositional optimism among patients with permanent pacemakers. Methods and results This study was a parallel arm randomized controlled trial. Seventy clients with permanent pacemakers were randomly allocated to a six-session MI intervention (n = 35) or a waiting list control group (n = 35). A statistically significant improvement in the mean scores of adherence to care practices, EI, and dispositional optimism, along with a significant reduction in pessimism, was registered among the study group compared with the control group. Conclusion Following the intervention for 1- and 2-month follow-up measurements, there were statistically significant improvements in self-care practice adherence. After 1 month of intervention, there were statistically significant gains in EI and dispositional optimism, but at the 2-month follow-up measurement, this improvement had somewhat lessened. The findings suggest that MI may be a feasible and practical approach for improving adherence to care practices, EI, and dispositional optimism in patients with permanent pacemakers. Registration ClinicalTrials.gov: NCT05883514 [ABSTRACT FROM AUTHOR]

Aims Implantation of an implantable cardiac monitor (ICM) is a simple procedure, but adds significant and increasing workload to the arrhythmia service. In 2020, we established a nurse-led ICM implantation service. We aimed to analyse patient satisfaction, adverse events during implant, and ICM re-interventions with nurse-led ICM implantation (N-Implant) compared to physician-led ICM implantation (P-Implant). Methods and results From January 2020 to December 2021, we included all consecutive patients implanted with an ICM in a prospective registry. We collected data on patient characteristics, implant procedure, and follow-up. Patients were interviewed by phone four weeks after ICM implantation. Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-Implants. More N-Implants were performed in the outpatient clinic compared to P-Implants (95% vs. 8%; P < 0.001). Two N-Implant patients experienced vaso-vagal reaction during implantation (1%), whereas no adverse events occurred during P-Implant (P = 0.51). A total of 297 patients (93%) completed the questionnaire. Duration of pain was shorter and wound closure after 2 weeks better following N-Implant (P = 0.019 and P = 0.018). A minor bruise or swelling at the implant site was reported more frequently after N-Implant (P = 0.003 and P = 0.041). Patient satisfaction was excellent with both N-Implant and P-Implant (99% and 97%; P = 0.16). After a median follow-up of 242 days (range 7–725 days), five ICMs (2%) were explanted prematurely, without differences among groups. Reasons for premature explants were local discomfort (n = 2), infection, MRI, and ICM malfunction. Conclusion Nurse-led ICM implantation has excellent patient satisfaction without compromising safety. N-Implant both expands nursing competencies and reduces physician workload. [ABSTRACT FROM AUTHOR]

Object: To enable high-quality physics-guided deep learning (PG-DL) reconstruction of large-scale 3D non-Cartesian coronary MRI by overcoming challenges of hardware limitations and limited training data availability. Materials and methods: While PG-DL has emerged as a powerful image reconstruction method, its application to large-scale 3D non-Cartesian MRI is hindered by hardware limitations and limited availability of training data. We combine several recent advances in deep learning and MRI reconstruction to tackle the former challenge, and we further propose a 2.5D reconstruction using 2D convolutional neural networks, which treat 3D volumes as batches of 2D images to train the network with a limited amount of training data. Both 3D and 2.5D variants of the PG-DL networks were compared to conventional methods for high-resolution 3D kooshball coronary MRI. Results: Proposed PG-DL reconstructions of 3D non-Cartesian coronary MRI with 3D and 2.5D processing outperformed all conventional methods both quantitatively and qualitatively in terms of image assessment by an experienced cardiologist. The 2.5D variant further improved vessel sharpness compared to 3D processing, and scored higher in terms of qualitative image quality. Discussion: PG-DL reconstruction of large-scale 3D non-Cartesian MRI without compromising image size or network complexity is achieved, and the proposed 2.5D processing enables high-quality reconstruction with limited training data. [ABSTRACT FROM AUTHOR]

Management of intracoronary calcium (ICC) continues to be a challenge for interventional cardiologists. There have been significant advances in calcium treatment devices. However, there still exists a knowledge gap regarding which devices to choose for the treatment of ICC. The purpose of this manuscript is to review the principles of intravascular lithotripsy (IVL) and clinical data. The technique of IVL will then be compared to alternative calcium treatment devices. Clinical data will be reviewed concerning the treatment of coronary, peripheral artery and valvular calcifications. Controversies to be discussed include how to incorporate IVL into your practice, what is the best approach for treating calcium subtypes, how to approach under-expanded stents, what is the ideal technique for performing IVL, how safe is IVL, whether imaging adds value when performing IVL, and how IVL fits into a treatment program for peripheral arteries and calcified valves.

Obesity is a complex, chronic disease requiring a multidisciplinary approach to its management. In clinical practice, body mass index and waist-related measurements can be used for obesity screening. The estimated prevalence of obesity among adults worldwide is 12%. With the expected further increase in overall obesity prevalence, clinicians will increasingly be managing patients with obesity. Energy balance is regulated by a complex neurohumoral system that involves the central nervous system and circulating mediators, among which leptin is the most studied. The functioning of these systems is influenced by both genetic and environmental factors. Obesity generally occurs when a genetically predisposed individual lives in an obesogenic environment for a long period. Cardiologists are deeply involved in evaluating patients with obesity. Cardiovascular risk profile is one of the most important items to be quantified to understand the health risk due to obesity and the clinical benefit that a single patient can obtain with weight loss. At the individual level, appropriate patient involvement, the detection of potential obesity causes, and a multidisciplinary approach are tools that can improve clinical outcomes. In the near future, we will probably have new pharmacological tools at our disposal that will facilitate achieving and maintaining weight loss. However, pharmacological treatment alone cannot cure such a complex disease. The aim of this paper is to summarize some key points of this field, such as obesity definition and measurement tools, its epidemiology, the main mechanisms underlying energy homeostasis, health consequences of obesity with a focus on cardiovascular diseases and the obesity paradox. Level of evidence V: report of expert committees. [ABSTRACT FROM AUTHOR]

This article discusses the need to improve the experience of individuals with chronic heart failure (CHF) who are nearing the end of their lives. Despite advancements in medical treatments for heart failure, the goal of therapy remains to delay disease progression. Palliative care is recognized as an important aspect of CHF management, focusing on improving the quality of life for patients and their families. The article suggests several priorities for improving care, including training healthcare professionals in palliative care, recognizing the role of general practitioners, utilizing nurse practitioners and community-based nurses, conducting research on patient preferences, transitioning cardiologists to be part of the palliative care team, and evolving societal expectations to prioritize a good death. [Extracted from the article]

The last decade has witnessed a paradigm shift in cancer therapy, from non-specific cytotoxic chemotherapies to agents targeting specific molecular mechanisms. Nonetheless, cardiovascular toxicity of cancer therapies remains an important concern. This is particularly relevant given the significant improvement in survival of solid and haematological cancers achieved in the last decades. Cardio-oncology is a subspecialty of medicine focusing on the identification and prevention of cancer therapy–related cardiovascular toxicity (CTR-CVT). This review will examine the new definition of CTR-CVT and guiding principles for baseline cardiovascular assessment and risk stratification before cancer therapy, providing take-home messages for non-specialized cardiologists. [ABSTRACT FROM AUTHOR]

In 1950, the leaders of independent India celebrated the contributions that surgeons could make to modernising India. Surgeons, however, faced a difficult choice. Some wanted to invest in generalist surgeons to make basic surgical care available to all Indians. Others wanted to invest in specialists to ensure that India participated in cutting‐edge surgical research and care. These debates shaped the emergence of cardiac surgery at two centres: the Christian Medical College in Vellore and the King Edward Memorial Hospital in Bombay. CMC invested in thoracic surgery in the 1940s to offer new treatments for tuberculosis. This gave surgeons the opportunity to explore new techniques of cardiac surgery. Debate quickly emerged about whether investments in cardiology and cardiac surgery made sense. In the end, the specialities were supported in order to attract paying patients. A parallel controversy took place at KEM, where the dean debated the Bombay Municipal Corporation about the role of surgical research at a public hospital. The Rockefeller Foundation influenced both sites, offering financial support if they adopted an American model of full‐time faculty clinician‐researchers. The two case studies reveal how unusual dynamics could contribute to the establishment of new medical specialities in India. [ABSTRACT FROM AUTHOR]

Objectives To establish conversion coefficients (CCs), between mean absorbed dose to the brain and eye lens of the cardiologist and the air kerma-area product, P KA, for a set of projections in cardiac interventional procedures. Furthermore, by taking clinical data into account, a method to estimate the doses per procedure, or annual dose, is presented. Methods Thermoluminescence dosimeters were used together with anthropomorphic phantoms, simulating a cardiologist performing an interventional cardiac procedure, to estimate the CCs for the brain and eye lens dose for nine standard projections, and change in patient size and x-ray spectrum. Additionally, a single CC has been estimated, accounting for each projections fraction of use in the clinic and associated P KA using clinical data from the dose monitoring system in our hospital. Results The maximum CCs for the eye lens and segment of the brain, is 5.47 μGy/Gycm2 (left eye lens) and 1.71 μGy/Gycm2 (left brain segment). The corresponding weighted CCs: are 3.39 μGy/Gycm2 and 0.89 μGy/Gycm2, respectively. Conclusions Conversion coefficients have been established under actual scatter conditions, showing higher doses on the left side of the operator. Using modern interventional x-ray equipment, interventional cardiac procedures will not cause high radiation dose levels to the operator when a ceiling mounted shield is used, otherwise there is a risk that the threshold dose values for cataract will be reached. Advance in knowledge In addition to the CCs for the different projections, methods for deriving a single CC per cardiac interventional procedure and dose per year were introduced. [ABSTRACT FROM AUTHOR]

Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF. [ABSTRACT FROM AUTHOR]

Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of 'assisting only'. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its 'Seal of Approval' for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries. [ABSTRACT FROM AUTHOR]

This paper presents an overview of the development of an integrated patient-centred cardiac care registry spanning the initial 5 years (September 2017 to December 2022). The Netherlands Heart Registration facilitates registration committees in which mandated cardiologists and cardiothoracic surgeons structurally evaluate quality of care using real-world data. With consistent attendance rates exceeding 60%, a valuable network is supported. Over time, the completeness level of the registry has increased. Presently, four out of six quality registries show over 95% completeness in variables that are part of the quality policies of cardiology and cardiothoracic surgery societies. Notably, 93% of the centres voluntarily report outcomes related to open heart surgery and (trans)catheter interventions publicly. Moreover, outcomes after implantable cardioverter-defibrillator and pacemaker procedures are transparently reported by 26 centres. Multiple innovation projects have been initiated by the committees, signalling a shift from publishing outcomes transparently to collaborative efforts in sharing healthcare processes and investigating improvement initiatives. The next steps will focus on the entire pathway of cardiac care for a specific medical condition instead of focusing solely on the outcomes of the procedures. This redirection of focus to a comprehensive assessment of the patient pathway in cardiac care ultimately aims to optimise outcomes for all patients. [ABSTRACT FROM AUTHOR]

Little is known about the procedural characteristics, case volumes, and mortality rates for early- vs non–early-career interventional cardiologists in the United States. This study examined operator-level data for patients who underwent percutaneous coronary intervention (PCI) between April 2018 and June 2022. Data were collected from the National Cardiovascular Data Registry CathPCI Registry, American Board of Internal Medicine certification database, and National Plan and Provider Enumeration System database. Early-career operators were within 5 years of the end of training. Annual case volume, expected mortality and bleeding risk, and observed/predicted mortality and bleeding outcomes were evaluated. A total of 1,451 operators were early career; 1,011 changed their career status during the study; and 6,251 were non–early career. Overall, 514,540 patients were treated by early-career and 2,296,576 patients by non–early-career operators. The median annual case volume per operator was 59 (Q1-Q3: 31-97) for early-career and 57 (Q1-Q3: 28-100) for non–early-career operators. Early-career operators were more likely to treat patients presenting with ST-segment elevation myocardial infarction and urgent indications for PCI (both P < 0.001). The median predicted mortality risk was 2.0% (Q1-Q3: 1.5%-2.7%) for early-career and 1.8% (Q1-Q3: 1.2%-2.4%) for non–early-career operators. The median predicted bleeding risk was 4.9% (Q1-Q3: 4.2%-5.7%) for early-career and 4.4% (Q1-Q3: 3.7%-5.3%) for non–early-career operators. After adjustment, an increased risk of mortality (OR: 1.08; 95% CI: 1.05-1.17; P < 0.0001) and bleeding (OR: 1.08; 95% CI: 1.05-1.12; P < 0.0001) were associated with early-career status. Early-career operators are caring for patients with more acute presentations and higher predicted risk of mortality and bleeding compared with more experienced colleagues, with modestly worse outcomes. These data should inform institutional practices to support the development of early-career proceduralists. [Display omitted] [ABSTRACT FROM AUTHOR]

Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess initiatives to manage the cost and outcomes of specialty care in organizations that participate in Medicare accountable care organizations (ACOs). STUDY DESIGN: Cross-sectional analysis of 2023 ACO survey data. METHODS: Analysis of responses to a 12-question web-based survey from 101 respondents representing 174 ACOs participating in the Medicare Shared Savings Program or the Realizing Equity, Access, and Community Health ACO model in 2023. RESULTS: Improving specialist alignment was a high priority for 62% of the 101 respondents and a medium priority for 34%. Only 11% reported that employed specialists were highly aligned and 7% reported that contracted specialists were highly aligned. A subset of ACOs reported major efforts to engage specialists in quality improvement projects (38%) and to convene specialists to develop evidence-based care pathways (30%). They also reported supporting primary care physicians through providing specialist directories (44%), specialist e-consults (23%), and sharing specialist cost data (20%). The most common challenges reported were the influence of fee-for-service payment on specialist behavior (58%), lack of data to evaluate specialist performance (53%), and insufficient bandwidth or ACO resources to address specialist alignment (49%). CONCLUSIONS: Engaging specialists in accountable care is an emerging area for ACOs but one with numerous challenges. Making better data on specialist costs and outcomes available to Medicare ACOs is essential for accelerating progress. [ABSTRACT FROM AUTHOR]

The delayed titration of guideline-directed drug therapy (GDMT) is a complex event influenced by multiple factors that often result in poor prognosis for patients with heart failure (HF). Individualized adjustments in GDMT titration may be necessary based on patient characteristics, and every clinician is responsible for promptly initiating GDMT and titrating it appropriately within the patient's tolerance range. This review examines the current challenges in GDMT implementation and scrutinizes titration considerations within distinct subsets of HF patients, with the overarching goal of enhancing the adoption and effectiveness of GDMT. The authors also underscore the significance of establishing a novel management strategy that integrates cardiologists, nurse practitioners, pharmacists, and patients as a unified team that can contribute to the improved promotion and implementation of GDMT. [ABSTRACT FROM AUTHOR]

Little is known about the experiences of frontline professionals in Kazakhstan. Although studies of frontline workers have been conducted worldwide, it is imperative that caution should be exercised when extrapolating findings from disparate societies and generalizing them to Central Asian countries. As such, the purpose of this study was to explore and describe the firsthand experiences, perceptions, and knowledge gained from the experience of Kazakh frontline physicians and nurses during the COVID-19 pandemic. An exploratory-descriptive qualitative (EDQ) study was conducted over the course of a year in COVID-19 hospitals in Kazakhstan, with physicians (n = 23) and nurses (n = 7). Each participant was interviewed three times between May 2021 and May 2022. Braun and Clarke's six-step method was used for the thematic analysis. Three overarching themes and subthemes were identified: (1) Longitudinal Journey ("Nobody knew, nobody understood, nobody was ready"; "It's just life"); (2) Facets of Professionalism ("In my lifetime this is something unique"; "Who else if not us"; "We survived the war and the enemy"); and (3) Facets of Resilience ("God's providence"; "A good word heals too"). In light of the lack of research that has previously been conducted in Kazakhstan, the results of this study offer important new insight into the experiences of medical professionals during the COVID-19 epidemic. [ABSTRACT FROM AUTHOR]

Aims Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of myocardial infarction. We aimed to investigate SCAD survivors' perceptions of their quality-of-care and its relationship to quality-of-life. Methods and results An anonymous survey was distributed online to SCAD survivors involved in Australian SCAD support groups, with 172 (95.3% female, mean age 52.6 ± 9.2 years) participants in the study. The survey involved assessment of quality-of-life using a standardized questionnaire (EQ-5DTM-3L). Respondents rated the quality-of-care received during their hospital admission for SCAD with a median of 8/10 [interquartile range (IQR) 7–10]. Respondents ≤ 50 years vs. >50 years were more likely to perceive that their symptoms were not treated seriously as a myocardial infarction (χ2 = 4.127, df = 1, P < 0.05). Participants rated clinician's knowledge of SCAD with a median of 4/10 (IQR 2–8) and 7/10 (IQR 3–9) for Emergency and Cardiology clinicians, respectively (P < 0.05). The internet was the most selected source (45.4%) of useful SCAD information. The mean EQ-5DTM summary index was 0.79 (population norm 0.87). A total of 47.2% of respondents reported a mental health condition diagnosis, with 36% of these diagnosed after their admission with SCAD. Quality-of-life was significantly associated with perceived quality-of-care: EQ-5DTM index/(1-EQ-5DTM index) increased by 13% for each unit increase in quality-of-care after adjusting for age and comorbidities (P < 0.001). Conclusion While SCAD survivors rated their overall hospital care highly, healthcare providers' knowledge of SCAD was perceived to be poor, and the most common source of SCAD information was the internet. Mental health conditions were common, and a significant association was observed between perceived quality-of-care and SCAD survivors' quality-of-life. [ABSTRACT FROM AUTHOR]

Background: The 2023 Multisociety Guideline for the Management of Chronic Coronary Disease (CCD) updates recommendations for CCD, formerly known as "stable ischemic heart disease." This condition encompasses a spectrum of coronary vascular pathologies from subclinical to clinical ischemic heart disease. Hypothesis: The new "ABC" mnemonic offers clinicians a streamlined framework for applying Class One Recommendations (COR1) and integrating recent updates into CCD management. Methods: A critical analysis of the 2023 CCD guidelines was conducted, with this review highlighting key elements. Results: The review outlines crucial changes, including novel recommendations supported by current clinical evidence. The focus is on these developments, clarifying their importance for day‐to‐day clinical practice. Conclusions: The review encourages a synergistic approach between primary healthcare providers and cardiologists to develop comprehensive strategies for lifestyle modification and medication therapy in CCD care. Furthermore, it suggests that utilizing comprehensive risk assessment tools can refine medical decision‐making, ultimately enhancing patient care and clinical outcomes. Key points: Evaluate the need for ongoing beta‐blocker therapy more than 1 year following myocardial infarction based on comorbidities (Class of recommendation 2b(COR2b)).Sodium‐glucose cotransporter 2 inhibitors and glucagon‐like peptide‐1 receptor agonists are recommended for selected chronic coronary disease patients, even in those without diabetes (COR1).Low‐dose colchicine (0.5 mg once daily) can be considered for risk reduction in secondary prevention patients with residual inflammatory risk, based on the Low Dose Colchicine 2 (LoDoCo2) trial findings (COR2b). [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the utility of the RAND/UCLA appropriateness method (RAM) in validating expert consensus-based multiple-choice questions (MCQs) on electrocardiogram (ECG). Methods: According to the RAM user's manual, nine panelists comprising various experts who routinely handle ECGs were asked to reach a consensus in three phases: a preparatory phase (round 0), an online test phase (round 1), and a face-to-face expert panel meeting (round 2). In round 0, the objectives and future timeline of the study were elucidated to the nine expert panelists with a summary of relevant literature. In round 1, 100 ECG questions prepared by two skilled cardiologists were answered, and the success rate was calculated by dividing the number of correct answers by 9. Furthermore, the questions were stratified into "Appropriate," "Discussion," or "Inappropriate" according to the median score and interquartile range (IQR) of appropriateness rating by nine panelists. In round 2, the validity of the 100 ECG questions was discussed in an expert panel meeting according to the results of round 1 and finally reassessed as "Appropriate," "Candidate," "Revision," and "Defer." Results: In round 1 results, the average success rate of the nine experts was 0.89. Using the median score and IQR, 54 questions were classified as " Discussion." In the expert panel meeting in round 2, 23% of the original 100 questions was ultimately deemed inappropriate, although they had been prepared by two skilled cardiologists. Most of the 46 questions categorized as "Appropriate" using the median score and IQR in round 1 were considered "Appropriate" even after round 2 (44/46, 95.7%). Conclusions: The use of the median score and IQR allowed for a more objective determination of question validity. The RAM may help select appropriate questions, contributing to the preparation of higher-quality tests. [ABSTRACT FROM AUTHOR]

Anderson–Fabry disease (AFD) is a lysosomal storage disorder characterized by glycolipid accumulation in cardiac cells, associated with a peculiar form of hypertrophic cardiomyopathy (HCM). Up to 1% of patients with a diagnosis of HCM indeed have AFD. With the availability of targeted therapies for sarcomeric HCM and its genocopies, a timely differential diagnosis is essential. Specifically, the therapeutic landscape for AFD is rapidly evolving and offers increasingly effective, disease-modifying treatment options. However, diagnosing AFD may be difficult, particularly in the non-classic phenotype with prominent or isolated cardiac involvement and no systemic red flags. For many AFD patients, the clinical journey from initial clinical manifestations to diagnosis and appropriate treatment remains challenging, due to late recognition or utter neglect. Consequently, late initiation of treatment results in an exacerbation of cardiac involvement, representing the main cause of morbidity and mortality, irrespective of gender. Optimal management of AFD patients requires a dedicated multidisciplinary team, in which the cardiologist plays a decisive role, ranging from the differential diagnosis to the prevention of complications and the evaluation of timing for disease-specific therapies. The present review aims to redefine the role of cardiologists across the main decision nodes in contemporary AFD clinical care and drug discovery. [ABSTRACT FROM AUTHOR]

Cardiologists are encountering a growing number of cancer patients with ischaemic heart disease (IHD). Several factors account for the interrelationship between these two conditions, in addition to improving survival rates in the cancer population. Established cardiovascular (CV) risk factors, such as hypercholesterolaemia and obesity, predispose to both IHD and cancer, through specific mechanisms and via low-grade, systemic inflammation. This latter is also fuelled by clonal haematopoiesis of indeterminate potential. Furthermore, experimental work indicates that IHD and cancer can promote one another, and the CV or metabolic toxicity of anticancer therapies can lead to IHD. The connections between IHD and cancer are reinforced by social determinants of health, non-medical factors that modify health outcomes and comprise individual and societal domains, including economic stability, educational and healthcare access and quality, neighbourhood and built environment, and social and community context. Management of IHD in cancer patients is often challenging, due to atypical presentation, increased bleeding and ischaemic risk, and worse outcomes as compared to patients without cancer. The decision to proceed with coronary revascularization and the choice of antithrombotic therapy can be difficult, particularly in patients with chronic coronary syndromes, necessitating multidisciplinary discussion that considers both general guidelines and specific features on a case by case basis. Randomized controlled trial evidence in cancer patients is very limited and there is urgent need for more data to inform clinical practice. Therefore, coexistence of IHD and cancer raises important scientific and practical questions that call for collaborative efforts from the cardio-oncology, cardiology, and oncology communities. [ABSTRACT FROM AUTHOR]

The article presents an interview with Giovanni Campanile, a functional cardiologist, discussing cardiovascular health approaches, highlighting holistic practices and critiques of traditional cardiology, particularly stent efficacy. Topics include the influence of early experiences with his father's medical practice, lifestyle interventions for preventing and reversing heart disease, and the significance of advanced tests like Cleerly analysis and lipid panels in assessing cardiovascular risk.

Background: Sodium‐glucose cotransporter 2 inhibitors (SGLT2i) are now indicated for heart failure and chronic kidney disease (CKD), irrespective of the presence of diabetes. Hence, cardiologists and nephrologists have an important role in initiating these drugs. Aims: To explore cardiologists' and nephrologists' perspectives regarding initiating SGLT2i and their safety monitoring practices when initiating SGLT2i. Methods: Purposive and snowball approaches were used to recruit participants working in diverse areas in New South Wales, Australia. Semi‐structured interviews were conducted with 12 cardiologists and 12 nephrologists. Interviews were conducted until thematic saturation was reached. Emergent themes were identified from transcripts. An iterative general inductive approach was used for data analysis. Results: There was a reluctance amongst most non‐heart‐failure subspecialist cardiologists to initiate SGLT2i. Reasons included the perception of SGLT2i as diabetes drugs, concern about side effects, lack of experience and issues with follow‐up. In contrast, nephrologists reported feeling confident to initiate SGLT2i. Nephrologists varied in their opinions about the severity of CKD at which SGLT2i initiation was reasonable and monitoring of renal function following initiation. Government subsidisation was an important factor in the decision to prescribe SGLT2i to people without diabetes. Conclusions: Our findings highlight the complex transition from the perception of SGLT2i as diabetes drugs to cardiometabolic and reno‐protective agents. Interdisciplinary collaboration may enable greater confidence amongst specialists to initiate SGLT2i, including in patients with CKD. Additionally, there is a need for clear and detailed guidance about SGLT2i prescription in patients with renal dysfunction and renal function monitoring following SGLT2i initiation. [ABSTRACT FROM AUTHOR]

Introduction: This research seeks to evaluate the occupational radiation dose, quantified as the whole-body Annual Mean Effective Dose (AMED), received by anesthesia personnel in interventional cardiology. Methods: Thermoluminescent dosimetry data was collected over five years (2019– 2023) for a total of 175 anesthesia staff. Technologists comprised approximately 72.4% of the participants (55% male and 45% female), while consultants accounted for 27.6% (70% male and 30% female). Statistical tests, including Independent Samples T-Test and One-Way ANOVA, compared AMED across genders, job titles, and years. Results: The study's findings on AMED across all staff from 2019 to 2023 showed marked variability in AMED. There was a significant rise in AMED from 0.72 mSv in 2019 to 0.92 mSv in 2020, then a decline to 0.82 mSv in 2021, with further decreases to 0.67 mSv in 2022 and finally to 0.65 mSv in 2023 (p < 0.001). The average AMED over the five-year span (2019– 2023) was 0.76 ± 0.4 mSv. In terms of gender, the overall AMED for males was 0.73 ± 0.36 mSv and for females 0.79 ± 0.45 mSv, showing no significant statistical difference (p = 0.272). Significant differences in exposure were observed between the technologists who experienced a higher overall AMED (0.8 ± 0.43 mSv) compared to consultants (0.63 ± 0.29 mSv, p = 0.008). Discussion: Despite these variations, AMED values remained lower than the annual occupational dose limit of 20 mSv, indicating generally low radiation exposure for anesthesia staff. This study emphasizes the importance of ongoing monitoring and enhanced protective measures to safeguard the health of medical professionals working with radiation. [ABSTRACT FROM AUTHOR]

Background Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community. Aim To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England. Methods We applied systems thinking methodology to examine the relationship between work- as- imagined and work- as- done for coordination of care for patients with HFpEF . We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie. Results Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between work- as- imagined and work- as- done. Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs. Conclusions There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has been developed for echocardiography1-3, although it has not yet been tested with blinding and randomization. Here we designed a blinded, randomized non-inferiority clinical trial (ClinicalTrials.gov ID: NCT05140642; no outside funding) of AI versus sonographer initial assessment of left ventricular ejection fraction (LVEF) to evaluate the impact of AI in the interpretation workflow. The primary end point was the change in the LVEF between initial AI or sonographer assessment and final cardiologist assessment, evaluated by the proportion of studies with substantial change (more than 5% change). From 3,769 echocardiographic studies screened, 274 studies were excluded owing to poor image quality. The proportion of studies substantially changed was 16.8% in the AI group and 27.2% in the sonographer group (difference of -10.4%, 95% confidence interval: -13.2% to -7.7%, P

β-blockers are commonly used in heart failure with preserved ejection fraction (HFpEF), even in the absence of a compelling indication and despite the potential to cause harm. Identifying reasons for β-blocker prescription in HFpEF could permit the development of strategies to reduce unnecessary use and potentially improve medication prescribing patterns in this vulnerable population. We administered an online survey regarding β-blocker prescribing behavior to physicians trained in internal medicine or geriatrics (noncardiology physicians) and to cardiologists at 2 large academic medical centers. The survey assessed the reasons for β-blocker initiation, agreement regarding initiation and/or continuation of β-blockers by another clinician, and deprescribing behavior. The response rate was 28.2% (n = 231). Among respondents, 68.2% reported initiating β-blockers in patients with HFpEF. The most common reason for initiating a β-blocker was for treatment of an atrial arrhythmia. Notably, 23.7% of physicians reported initiating a β-blocker without an evidence-based indication. When a β-blocker was considered not necessary, 40.1% of physicians reported they were rarely or never willing to deprescribe. The most common reason for not deprescribing a β-blocker when the physician felt that a β-blocker was unnecessary was the concern about interfering with another physicians treatment plan (76.6%). In conclusion, a significant proportion of noncardiology physicians and cardiologists report prescribing β-blockers to patients with HFpEF, even when evidence-based indications are absent, and rarely deprescribe β-blockers in these scenarios.

The European Heart Journal's article titled "The ESC Working Group on e-Cardiology" discusses the mission and activities of the ESC Working Group on e-Cardiology. The group was established in 1996 to promote the use of information technology in cardiology and aims to integrate scientific research and education in the field of e-cardiology. The group focuses on advancing computational, digital, and mobile technology in cardiovascular healthcare and collaborates with other ESC bodies on digital health-related matters. The group publishes position papers, organizes conferences and webinars, and promotes the adoption of advanced digital technologies in cardiology. They also invite individuals interested in e-cardiology and digital health to join their community. [Extracted from the article]

The article discusses the projected increase in costs associated with cardiovascular disease (CVD) from 2020 to 2050. It highlights the impact of an aging population, as well as increasing rates of obesity, hypertension, and diabetes among young and middle-aged adults, particularly in low-income communities. The article emphasizes the need for effective interventions to address these disparities, especially among minority populations. It also suggests potential solutions such as value-based payment reforms, telemedicine, and wearable health monitoring devices. The article concludes by emphasizing the importance of a comprehensive approach to address the challenges posed by the growing elderly population and decreasing disparities in healthcare. [Extracted from the article]

Becker muscular dystrophy (BMD) is a rare genetic disorder that is associated with significant cardiac compromise, including heart failure and cardiomyopathy. Given the significant cardiac impact of the disease, patients are commonly hospitalized under the care of cardiologists. While it is imperative to address the acute cardiac challenges these patients face, it is crucial to not disregard the musculoskeletal derangement that occurs from this underlying disease and how acute hospitalization can exacerbate these issues. While literature focuses heavily on providing management protocols to address these acute cardiac complications, it is also important for providers to feel supported in addressing the functional implications that hospitalized BMD patients may face. An early PM&R consultation in the inpatient setting can be useful in identifying and addressing the functional impairments and subsequent comorbidities of BMD patients. PM&R teams can provide oversight from multiple avenues including the psychosocial, neurocognitive, durable medical equipment, and pain management perspectives and assist with transition of care to the postacute rehabilitation setting. The ultimate goal of the PM&R provider is to work alongside the primary service and patient in order to assist with retaining independence, improving patient satisfaction, and most importantly improving quality of life both inside and outside of the hospital setting. [ABSTRACT FROM AUTHOR]