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ObjectiveWaiting time is inevitable during cardiovascular (CV) care. This study examines whether waiting room-based CV education could complement CV care.MethodsA 2:1 randomised clinical trial of patients in waiting rooms of hospital cardiology clinics. Intervention participants received a series of tablet-delivered CV educational videos and were randomised 1:1 to receive another video on cardiopulmonary resuscitation (CPR) or no extra video. Control received usual care. The primary outcome was the proportion of participants reporting high motivation to improve CV risk-modifying behaviours (physical activity, diet and blood pressure monitoring) post-clinic. Secondary outcomes: clinic satisfaction, CV lifestyle risk factors (RFs) and confidence to perform CPR. Assessors were blinded to treatment allocation.ResultsAmong 514 screened, 330 were randomised (n=220 intervention, n=110 control) between December 2018 and March 2020, mean age 53.8 (SD 15.2), 55.2% male. Post-clinic, more intervention participants reported high motivation to improve CV risk-modifying behaviours: 29.6% (64/216) versus 18.7% (20/107), relative risk (RR) 1.63 (95% CI 1.04 to 2.55). Intervention participants reported higher clinic satisfaction RR: 2.19 (95% CI 1.45 to 3.33). Participants that received the CPR video (n=110) reported greater confidence to perform CPR, RR 1.61 (95% CI 1.20 to 2.16). Overall, the proportion of participants reporting optimal CV RFs increased between baseline and 30-day follow-up (16.1% vs 24.8%, OR=2.44 (95% CI 1.38 to 4.49)), but there was no significant between-group difference at 30 days.ConclusionCV education delivery in the waiting room is a scalable concept and may be beneficial to CV care. Larger studies could explore its impact on clinical outcomes.Trial registration numberANZCTR12618001725257.

Introduction Photoplethysmography (PPG) in wearable sensors potentially plays an important role in accessible heart rhythm monitoring. We investigated the accuracy of a state-of-the-art bracelet (Corsano 287) for heartbeat detection in cardiac patients and evaluated the efficacy of a signal qualifier in identifying medically useful signals. Methods Patients from an outpatient cardiology clinic underwent a simultaneous resting ECG and PPG recording, which we compared to determine accuracy of the PPG sensor for detecting heartbeats within 100 and 50 ms of the ECG-detected heart beats and correlation and Limits of Agreement for heartrate (HR) and RR-intervals. We defined subgroups for skin type, hair density, age, BMI and gender and applied a previously described signal qualifier. Results In 180 patients 7914 ECG-, and 7880 (99%) PPG-heartbeats were recorded. The PPG-accuracy within 100 ms was 94.6% (95% CI 94.1–95.1) and 89.2% (95% CI 88.5–89.9) within 50 ms. Correlation was high for HR (R = 0.991 (95% CI 0.988–0.993), n = 180) and RR-intervals (R = 0.891 (95% CI 0.886–0.895), n = 7880). The 95% Limits of Agreement (LoA) were −3.89 to 3.77 (mean bias 0.06) beats per minute for HR and −173 to 171 (mean bias −1) for RR-intervals. Results were comparable across all subgroups. The signal qualifier led to a higher accuracy in a 100 ms range (98.2% (95% CI 97.9–98.5)) (n = 143). Conclusion We showed that the Corsano 287 Bracelet with PPG-technology can determine HR and RR-intervals with high accuracy in cardiovascular at-risk patient population among different subgroups, especially with a signal quality indicator.

Objective: To investigate the association of maternal diabetes, maternal smoking and syndromes with congenital heart disease (CHD) in patients attending Aljalila cardiology clinic between January 2020 and May of 2020. Methods: A case control study to assess the association of maternal diabetes, maternal smoking and syndromes with CHD. All patients that presented to the clinic between January 2020 and May of 2020 were included. An interviewer administered questionnaire was used to record the presence of maternal diabetes, maternal smoking, and the type of syndrome and type of CHD. Patients with CHD were included in the case group and patients who did not have CHD were in the control group. Age, gender, and nationality were also collected from the hospital records. Fisher exact test and logistic regression was used to analyze the results. Results: A total of 177 cases and 211 controls were recruited. All the risk factors increase the risk of CHD, with maternal diabetes (OR 6.3, 95% CI 2.7-14.6) having the strongest association, then syndromes (OR 5.1, 95% CI 2.3-11.3) and lastly maternal smoking (OR 4.0, 95% CI 1.0-16.3). The most common type of CHD is ventricular septal defect.

Background: To investigate plasma Connective Tissue Growth Factor (CTGF) levels in Pulmonary Arterial Hyper-tension (PAH) associated with Congenital Heart Disease (PAH-CHD) in children and the relationships of CTGF with hemodynamic parameters. Plasma CTGF levels were calculated in 30 children with PAH-CHD and 30 health volunteers, using the subtraction method. Aim of Study: To assess plasma Connective Tissue Growth Factor (CTGF) levels in children with CHD and study its role in assessment of PAH that can be promising diagnostic and prognostic biomarkers for PAH in children with CHD. Patients and Methods: Our study was conducted in Pedi-atric Cardiology Clinic and Cardiology Catheter Laboratory of Ain Shams University Pediatric Hospital, in the period from Jan. 2019 to May 2020, including 30 patient and 30 healthy controls of matched age and sex. Results: The patients with PAH, 17 were acyanotic and 13 were cyanotic. The health control group and patient groups did not differ significantly in terms of age, gender and BSA (p>0.05). Height, weight and BMI were significantly lower in PAH-CHD group compared with the HCG (p 0.05). In addition, CTGF levels were higher in PAH-CHD group than health control group. Depicts that, PAH-CHD group had higher PASP, PADP, RVSP, mPAP, Qp, Rp and Rp/Rs (p < 0.01). Conclusion: Plasma CTGF levels could be a promising diagnostic biomarker for PAH-CHD in children.

Background:Cyanotic CHD is one of many disorders in paediatrics that influence the health of children in different clinical aspects. One of the fundamental aspects that may be affected is bone mineral density.Objectives:The aim of our study is to assess bone mineral density in children with congenital cyanotic heart disease of different anatomical diagnoses.Design/Methods:Cross-sectional, observational study included 39 patients (20 males) with congenital cyanotic heart disease of different anatomical diagnoses following with the cardiology clinic in Mansoura University children’s hospital. All patients were subjected to anthropometric measures, oxygen saturation assessment, and lumber bone mineral density using dual-energy X-ray absorptiometry.Results:Six patients (15.4%) out of the 39 included patients showed bone mineral density reduction, 13 patients (33.3%) showed bone mineral density with Z-score between −1 and −2, while 20 patients (51.3%) showed bone mineral density with Z-score more than −1.Conclusion:Low bone mineral density can be found in children with cyanotic CHD, making it important to consider bone mineral density assessment and early treatment if needed to avoid further complications.

Controversy surrounds whether to define resting diastolic blood pressure (DBP) as the onset of the fourth or fifth Korotkoff phase (K4, sound muffling, or K5, sound disappearance) in children and adolescents. Although undetectable in some children (due to sounds continuing to zero cuff pressure), K5 is currently recommended for consistency with adult practice and because K4 can be difficult to discern or undetectable. However, to our knowledge, no studies have specifically assessed the reliability of measuring DBP with K4 and K5 in children and adolescents under exercise conditions. We therefore measured DBP before and immediately after a Bruce protocol stress test in 90 children and adolescents aged 12.3 ± 3.5 years (mean ± SD) in a cardiology clinic setting. When detected, K4 and K5 were 63.5 ± 9.2 and 60.2 ± 12.6 mmHg, respectively, at rest and 59.2 ± 14.6 mmHg (p = 0.028 vs rest) and 52.9 ± 18.3 mmHg (p

Background Restrictions as a result of the COVID-19 pandemic have demanded an innovative approach to provide appropriate patient review. We have been running virtual cardiology clinics as per Health Service Executive guidance. Aims Our study aims to determine how virtual clinics change practice vs traditional clinics. Methods A retrospective cohort analysis was conducted on patients attending cardiology clinics in our hospital from 6 January to 13 March 2020 (‘traditional clinic’, n = 1644), compared with clinics during the COVID-19 outbreak, from 16 March to 22 April 2020 (‘virtual clinic’, n = 691), with the same medical staff. Results There was no difference in age (61 vs 60), case mix or new vs return appointments in virtual vs traditional clinics. There were similar rates of clinic participation, 71.8% vs 74.2%. A lower proportion of investigations (e.g. imaging) were booked in virtual (38.5%) vs traditional (55.7%) clinics, p

Aim. Identify the adaptive level of stigma and describe its characteristics. Methods. Adapted for the cardiology clinic questionnaire of N. Sartorius, symptomatic questionnaire SCL-90-R (Simptom Check List-90-Revised), Schutzs Interpersonal relations questionnaire (1958), Tobol test method of the type of attitude to disease and treatment, and the Personal differential questionnaire. The data obtained were processed using the statistical program SPPS 20. Results. The study determined the optimal degree of stigmatization, which performed a positive role in relation to the state of health, helping patients to adequately assess the severity of the pathology, identify themselves with the disease and realize the necessary measure of their own responsibility in the treatment process (from 48 to 60). Clinical and social factors of optimal degree of stigmatization and successful rehabilitation of cardiology clinic patients are identified (resources): the patients higher education and the familys tendency to low-protecting position potentially contribute to the treatment and rehabilitation of cardiology clinic patients with moderate severity of their somatic condition. Clinical and social factors (anti-resources) that prevent the formation of an optimal degree of stigmatization and successful rehabilitation of patients are identified: the operative type of treatment, the overprotective position of the family, which is not justified by a real need, and the low level of education. It is established that the absence of pronounced pathocharacterological features and difficulties in interpersonal interaction of patients with an average level of stigmatization is an argument for determining this level of stigmatization as a resource. According to the results of the study the tasks for the medical psychologist of the cardiology clinic are set: 1) diagnostic, which consists in determining the level of stigmatization, analyzing the ratio of the degree of stigmatization and the degree of severity of cardiovascular pathology, studying individual resources and anti-resources (attitude to the disease and treatment, pathocharacterological features and interpersonal features); 2) psychocorrective, which consists in forming an adequate position in relation to the disease and treatment of patients and their families, restoring intra-family ties, changing inadequate responses to the disease, creating realistic attitudes to treatment in patients and their family members. Conclusion. The average degree of stigmatization is formed in patients in the absence of a pronounced personal and interpersonal problems, allowing them to receive social support in the conditions of restrictions imposed by the disease, and adapt to it. The average level of stigmatization in this case acts as an additional psychological resource for patients.

In this study, we scientifically examined the consultations of the patients being hospitalized from the other departments to the cardiology department during Coronavirus Disease 2019 (COVID-19) pandemia. Consultations to the cardiology department between 01 April-31 May 2020 and 01 April-31 May 2019 were discussed. Demographic characteristics and reasons of consultations were compared. A different approach was f ollowed in COVID-19 patients diagnosed with compared to patients in other clinics. The rate of consulted patients in 2019 year was 14.4% (866/5989). Its rate in 2020 year was found as 18.5% (462/2486) (p

The aim of the study was to develop an ECG hardware and software system for monitoring electrical instability of the myocardium and to assess the diagnostic and prognostic capabilities of this setup in a cardiology clinic. Materials and Methods. The Intecard 7.3 software and hardware system developed in this study makes it possible to measure fluctuations of the ECG amplitude-time parameters using the beat-to-beat mode. Intecard 7.3 evaluates a number of ECG markers that reflect electrical instability of the myocardium. Among them are the fragmented QRS complex, the spatial QRS-T angle, the T-wave alternans, the duration, and dispersion of the QT interval, the turbulence and acceleration/deceleration of the heart rhythm. Clinical trials of Intecard 7.3 were carried out with 734 patients with ischemic heart disease or cardiomyopathy and 112 healthy individuals. Results. Intecard 7.3 reliably identifies fragmented QRS complexes by detecting short spikes of 0%) than that in healthy controls (p

Objective: To describe the prevalence, pattern and atherogenic index of dyslipidaemia among hypertensive patients.Method: Cross-sectional study of hypertensive subjects at first presentation in a community-based cardiology clinic in Delta State, Nigeria. The Delta State University Teaching Hospital Health Research Ethics Committee granted ethical approval for the study. Fasting serum lipid profile was retrieved and atherogenic indices calculated. Data analysis was done using SPSS version 23.0.Result: The mean age of the 227 subjects was 55.4 (±13.6) years, and 111 (48.9%) were males. A total of 154 (67.8%) had at least one abnormal lipid profile level, out of which 56.5% were females (p=0.018). The pattern of dyslipidaemia [isolated (56, 36.4%), two-combined (65, 42.2%), and mixed (33, 21.4%)] did not differ by sex (p = 0.173). The predisposition to high cardiovascular risk was predicted by atherogenic index of plasma (59.5%),atherogenic coefficient (43.6%), Castelli ratios I, II (29.1%, 26.9%).Conclusion: The prevalence of dyslipidaemia was 67.8%. Two-combined dyslipidaemia was the most common pattern Keywords: Dyslipidaemia, atherogenic index, hypertension, prevalence, Nigeria

The neurohumoral and inflammatory pathways proposed for the development and progression of heart failure (HF) remain up-to-date. We aimed to investigate the effect of emergency department (ED) visits and inflammatory markers on mortality in HF patients. Two-hundred patients with stable chronic HF followed by the cardiology clinic were included in this study. The patients were divided into two groups as patients who had visited the ED due to worsening HF symptoms within the last 6 months (ED visit Group) and who had not (No ED visit Group). The demographical properties, clinical characteristics, and laboratory values including inflammatory markers of the patients were recorded. During the follow-up period, 38 patients (19%) died. In HF patients with previous ED visits, the mortality risk was 2.091 times higher (relative risk, RR). It was identified that the HF patients who died during the follow-up had higher initial NLR (p = 0.004), IG% (p = 0.029), hs-CRP (p = 0.001), and NT-proBNP (p = 0.004) values. It was observed that the area under the curve (AUC) values, NLR (AUC: 0.705, p 0.001), IG% (AUC: 0.652, p = 0.003), and hs-CRP (AUC: 0.732, p 0.001) were very strong predictors of the 1-year mortality. According to the cut-off points, the mortality risk (RR) was 3.39 times higher in patients with NLR 3.7 (95% CI 1.783-6.444), 2.39 times higher when IG% 0.4 (95% CI 1.16-4.957), and 4,2 times higher when hs-CRP 9.9 mg/dl (95% CI 2.16-8.16) (p 0.05). The patients with chronic stable HF who visited the ED within the last six months and having increased NLR, IG%, and CRP levels among inflammatory markers were associated with a higher mortality risk at 1 year.

Introduction: Cardiovascular complications caused by chronic obstructive pulmonary disease (COPD) will change the normal function and the shape of the heart’s anatomy. The purpose of this study to determine whether there was a relationship between the degree of severity of COPD and electrocardiogram (ECG) changes. Methods: A cross-sectional analysis conduct on 80 subjects who fulfilled inclusion criteria at the outpatient cardiology clinic H. Adam Malik Hospital Medan. The subject was divided equally based on the severity of COPD and ECG examination was performed. Statistical analysis processed using multivariate with p>0,05 as statistical significance The correlation is presented as Pearson r values and new values are obtained by the ROC curve. Results: The mean age was 57±13 years with males have a majority proportion (85%). P Pulmonale and RBBB were common in severe COPD (GOLD 3 p = 0.001, GOLD 4 p

Introduction: Congestive heart failure (CHF) is a serious condition and lack of medication adherence is one of the most common problems in the treatment of patients with CHF. This study aimed to determine the relationship between medication adherence and affective temperaments in patients with CHF. Material and methods: This cross-sectional study was performed on 150 patients, who were referred to the cardiology clinic of Ali Ibn Abi Talib Hospital of Zahedan, Iran in 2017–2018. Morisky Medication Adherence Scale (MMAS-8), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto questionnaire (TEMPS-A), and Beck Depression Inventory-II (BDI-II) were used to collect data. For statistical analysis, SPSS-18 was used. Logistic regression was done for modeling the relationship between medication adherence. Results: Generally, 54% of the patients were euthymic, while 16%, 23.33%, and 6.66% of them suffered from mild, moderate, and severe depression, respectively. The medication adherence was high, moderate, and low in 30.66%, 46%, and 23.33% of the patients, respectively. There was a significant relationship between medication adherence and depressive (P = 0.049), cyclothymic (P = 0.01), and irritable (P = 0.01) affective temperaments. Only BDI-II score (P = 0.018) was identified as predictors of drug adherence. Conclusions: Despite the statistically significant relationship between depressive, cyclothymic, and irritable temperaments and adherence, affective temperaments cannot be considered as a predictor of adherence in patients with CHF.

Unattended automatic office blood pressure (BP) measurement has given new evidence regarding treatment goals. We aimed to explore any differences between unattended and conventional office BP measurements in different groups of patients visiting a European Society of Hypertension (ESH) Excellence Centre. We performed two unattended (Microlife Watch BP Home) followed by a single attended (mercury sphygmomanometer) BP measurement in 310 patients (mean age 62 ± 15 years, 151 males, 64% hypertensives and 36% normotensive individuals) visiting our ESH Centre for a scheduled follow-up. Office BP

This study aims to determine whether dietary sodium restriction counseling decreases nocturnal voiding frequency in cardiology patients with concomitant nocturia. Patients who had established care at a cardiology clinic from 2015 to 2018 reporting >= 1 average nocturnal void(s) underwent a comprehensive sodium intake interview by their cardiologist, who provided them with individualized strategies for dietary sodium reduction and assessed adherence at follow-up. Average nocturnal voiding frequency and dietary adherence were documented in the medical record. A nocturia database was compiled for retrospective analysis. A total of 74 patients were included. Patients considered to be adherent with dietary sodium restriction at follow-up (n = 56) demonstrated a decrease in median nocturia frequency (2.5 [2.3-3.0] vs 1.0 [1.0-2.0] voids, P < .001). Among nonadherent patients (n = 18), median nocturia frequency did not significantly change from baseline to follow-up (2.0 [1.5-3.8] vs 2.0 [1.5-4.8] voids, P = .423). Median changes were significantly different between the adherent and nonadherent groups (P < .001). Examination of second follow-up available from 37 patients showed a continued effect. In conclusion, adherence with dietary sodium counseling appears to improve nocturia. Accordingly, dietary modification may represent an important adjunct therapy to lifestyle and pharmacologic interventions for decreasing nocturia frequency. Reduction in nocturnal voiding frequency may also reflect an additional benefit of dietary sodium restriction in accordance with best practice standards for cardiovascular disease.

Introduction : Virtual clinic is where health care professional giving consultations, advice and treatment planning. In the midst of COVID-19 outbreak, this is one potential area should be look into. Our study aim to determine the digital access among cardiology patient in Hospital Queen Elizabeth II. Methodology : This is a cross-sectional study conducted involving outpatients in Cardiology Clinic in Hospital Queen Elizabeth II from 1st to 30th June 2020 retrospectively. Secondary data collected from cardiology clinic were obtained and inclusion criteria included patients 18 years of age and above. Results : Mean age is 54 years old (SD 15.45). Out of 693 respondents, 59.7% (n=414) is male. At least 70% of the respondents went to secondary school. More than half came from west coast of Sabah (67.5%). About 84.4% (n=588) of respondent owns at least a mobile phone. 82% (n=482) of them use it to access the internet. Whatsapp usage by patients and caretaker is at 75% (n=525). Discussion: At least two over third of the respondent have a smartphone with an internet access capability. Whatsapp is most preferred platform among the patients. Thus, from these finding, virtual clinic is feasable to be done in this pandemic era and intergrate it into existing standard of carepath. Conclusion: Pilot virtual clinic need to be demonstrated to improve the healthcare system. More research on telehealth should be done to move forward and bridge the gap between patients and health care personnel. Disclaimer: Abstract text might vary slightly from what is displayed in the e-poster., This poster was submitted to the 14th National Conference for Clinical Research (NCCR) in August 18-20, 2021. https://nccrconference.com.my/

The outbreak of COVID-19 and succeeding lockdown curtailment of routine life activities resulted in a profound effect on healthcare systems, globally. There were difficulties in Outpatient follow-up during this time. Since the start of the lockdowns, the general cardiology clinics have faced challenges of social distancing and safe clinical practices to ensure the safety of healthcare workers and cardiology patients. During the lockdowns, telemedicine gained significance in the healthcare industry. It was utilized to triage patients before allowing them to the emergency department. It also offered help in remote monitoring for isolated patients in high dependency patients in hospitals. The aim of this review was to delve into this important aspect in the current literature on both the direct ramifications due to COVID-19 on clinical practice in cardiology clinics. Challenges to the patients and the healthcare personnel. Measures to have a prudent strategy to cope with all these challenges because of the ways in which containment and social distancing measures have derailed daily life.

Cardiac memory is a common cause of deep T-wave inversions (TWI) in the anterior precordial leads and can be difficult to distinguish from alternative causes of TWI such as myocardial ischemia. Cardiac memory is generally a benign condition except in the setting of prolonged QT when it can contribute to the precipitation of torsades de pointes. Herein, we describe the presentation and clinical course of a case of cardiac memory due to intermittent left bundle branch block (LBBB) that presented asymptomatically to our outpatient cardiology clinic with deep anterior TWI. We discuss common causes of and mechanisms underlying cardiac memory and how to distinguish it from alternative causes of TWI based on 12-lead electrocardiogram. In conclusion, intermittent LBBB is an under-recognized cause of cardiac memory that can present as deep anterior TWI mimicking cardiac ischemia, and awareness of this clinical entity may help prevent unnecessary invasive and expensive testing on otherwise healthy patients.

SikoraKamil, Wawryniuk Agnieszka, Łuczyk Robert Jan, Łuczyk Marta. Nutritional status and quality of life of patients after pacemaker implantation.Journal of Education, Health and Sport. 2021;11(5):131-137. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.05.013 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2021.11.05.013 https://zenodo.org/record/4876306 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 15.05.2021. Revised: 21.05.2021. Accepted: 30.05.2021. Nutritional status and quality of life of patients after pacemaker implantation Kamil Sikora1, Agnieszka Wawryniuk2, Robert Jan Łuczyk2, Marta Łuczyk3 1Chair of Internal Medicine and Department of Internal Medicine in Nursing,Faculty of Health Sciences,Medical University of Lublin 2Institute of Health Sciences, Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities 3Department of Oncology, Department of Oncology and Environmental Health Care, Faculty of Health Sciences, Medical University of Lublin Summary Introduction. Nutritional status is one of the factors determining the quality of life of patients. However, there are few reports on the correlation between nutritional status and quality of life in the group of patients with implanted cardiac pacing system. Purpose of research.The aim of the study was to assess the impact of nutritional status on the quality of life of patients with implanted pacemakers. Material and methods. 100 patients after pacemaker implantation, hospitalized at the cardiology clinic and treated at the SPSK 4 cardiology clinic in Lublin were examined. Standardized research tools were used - the WHOQOL-Bref questionnaire to assess the quality of life and the shortened scale to assess the nutritional status (MNA-SF). The results of the obtained research are summarized in the statistical analysis. Results. The average result of the respondents obtained in the MNA scale was 11.86 points with a standard deviation of 2.26. The nutritional status of the most of respondents (61%) was normal. In the studied group 35% were at risk of malnutrition, while 4% were malnourished. Statistically significant relationships between the nutritional status and quality of life were demonstrated in all domains. If the nutritional status of the respondents was better, their overall quality of life was higher, as well as their self-assessment of health. Conclusions. The overall assessment of the nutritional status of the studied patients is within the normal ranges. Nutritional status has an impact on the quality of life of respondents after pacemaker implantation in all QoL domains. High quality of life conform to the correct assessment of the nutritional status in the most of the studied patients. Keywords: quality of life; pacemaker; assessment; nutritional status

Funding Acknowledgements Type of funding sources: None. Background Determining the level of health-related quality of life among cardiovascular patients and looking into the demographic factors and clinical characteristics that might influence the dynamics of their physical and mental health are highly essential for health practitioners to improve current management procedures and interventions. Objective The study was conducted to evaluate the level of health-related quality of life among cardiac patients seen in adult cardiology clinic. Methods This study used a descriptive research design. A total of 117 cardiac patients at the adult Cardiology Clinic in a Tertiary Hospital were interviewed using the MOS-SF – 36 Questionnaire. Statistical correlation analysis was then performed. Results The results showed that the patients are challenged in their physical functioning and general mental health with an average score of 33.33 ± 33.33 aside from their average median score of 55 ± 0.0 in their role limitations due to physical health. In terms of mental health, higher score was reflected for vitality (75 ± 12.5), followed by emotional well-being (67.5 ± 20.0). Demographic and clinical factors that affect their quality of life were also determined. Marital status, family income, educational attainment and participation on cardiac rehabilitation program affect their quality of life. Married, income above Php10,000, college level, college graduate or with post graduate degree and those who participated in the cardiac rehabilitation program have higher level of physical health (W = 1127; p=.007; W = 1729.5; p=.024; W = 1300; p=.043). Consistently, those who are married, a family income of above Php10,000 and are aware on cardiac rehabilitation have higher level of mental health (W = 1189; p=.019; W = 1895; p=.001; W = 1187; p=.005). Although not statistically significant, an increase in age is associated with decrease in the physical health (r=-.176; p=.058). It should not also be discounted that those patients who are employed have higher level of physical health than those who were unemployed (W = 1729.5; p=.052). Moreover, health change are higher for those who participated in the cardiac rehabilitation program (W = 960; p=.003). On clinical characteristics, those who underwent interventions have higher level of health change than those who only received medical management (W = 100.0; p40% left ventricular ejection fraction (W = 264.5; p=.005). Conclusion This study concludes that those patients who are married, employed, with income above Php10,000, who have higher educational status, non-smoker, LVEF of more than 40%, who received interventions and who underwent cardiac rehabilitation have higher level of quality of life.

A man in his 20s with Down syndrome presented to cardiology clinic for evaluation of a murmur. He denied symptoms. He had no prior history of invasive cardiac procedures or cardiac surgery. His examination revealed a murmur. An echocardiogram was performed and a diagnostic image is shown in figure 1. Figure 1 Colour M-mode echocardiographic image of the mitral valve. 1. Based on the colour Doppler M-mode echocardiographic image (figure 1), what is the most likely cause …

Cardiac rhabdomyoma is a hamartoma comprised of cardiac myocytes. It is the classic cardiac manifestation of tuberous sclerosis complex (TSC) which is an autosomal dominant genetic syndrome with multi-organ involvement, but highly variable phenotype. Cardiac rhabdomyoma is most commonly diagnosed in infancy, 70 to 90% of whom have TSC. However, TSC-associated cardiac rhabdomyoma usually shows spontaneous regression within the first two years of life and hence is extremely rare in adults. We present a 34-year-old woman with TSC who was found to have a cardiac rhabdomyoma when she was referred to the cardiology clinic for evaluation and to establish care. Cardiac rhabdomyoma is usually asymptomatic. However, depending on size and location, it can cause outflow or inflow tract obstruction and aberrant electrical conduction. Hence, appropriate surveillance is important.

Purpose To describe reasons for referral, diagnostic procedures, diagnoses and long-term follow-up of first-time referred patients to a fast lane outpatient cardiology clinic (FLOCC). Methods A descriptive report of results obtained in a newly organised outpatient clinic. Data up to final diagnosis were recorded from electronic medical records. Follow-up data were obtained from electronic medical records, contacting patients and/or their general practitioners. Results During the first 3 months of 2007, 419 patients were seen at the FLOCC. Of these patients, 360 were referred by general practitioners, 55 by other specialists and four were self-referrals. The largest referral groups were: chest complaints (44%), palpitations (19%) and dyspnoea (12%). In 65% of the 419 patients, cardiovascular disease was ruled out and they were discharged. Of these, 41% of the diagnoses were made on the same day, with a further 44% after additional investigations, mostly Holter registration. During 10 years of follow-up, 49 patients died: 17 of cardiac, 29 of non-cardiac, mainly cancer, and three of unknown causes. Of the initially discharged patients, 35% were referred again after an average of 4 years (1,443 days), with 47% reporting similar complaints. Conclusion Of the patients referred to our FLOCC, most had chest pain. In one-third of all patients, cardiac disease was ruled out on the same day. Of all the patients discharged, 85% were diagnosed after basic investigations that could be ordered by a general practitioner. Holter registration was the most frequently requested additional investigation. These results support the development of less expensive, easily accessible extramural cardiology clinics.

Depression has been consistently associated with cardiovascular disease (CVD), it is also known to play an essential role in the initiation and exacerbation of CVD. This study was aimed to determine the prevalence and correlates of depression among patients attending the cardiology clinic of the Benue State University Teaching Hospital (BSUTH), Makurdi. The study was conducted among one hundred and six (106) consenting patients attending the cardiology unit of BSUTH from June to August 2017. The result shows that, 52(49.1%) were males while the remaining 54(50.9%) were females. The mean age of the respondents was 53.48±14.77years, twenty-eighty respondents representing 26.4% were married at the time of the study, 15(14.2%) were single while the remaining 63(59.4%) were previously married. Thirty-seven (34.9%) of the study subjects had no formal education and eighty-two (77.4%) of the presentation at the clinic were having a diagnosis of hypertension, 8(7.5%) were being treated for Rheumatic Heart Disease (RHD), 9(8.5%) were diagnosed with cardiomyopathies, 3(2.8%) were diagnosed heart failure and 4 (3.8%) had other cardiovascular diseases. The prevalence of depression was found to be 45.3% in this study, there was a statistically significant relationship between the diagnoses of depression and gender status (p=0.001), marital status (p=0.01), partner relationship (p=0.001), substance abuse (p=0.001). No statistically significant relationship was found between depression and occupational status (p=0.167), level of educational attainment (p=0.401), respondents’ weight (p=0.06), and the nature of cardiovascular diagnoses (p=0.951). We recommended early detection and treatment of depression among patients with cardiovascular diseases.

Objective We analyzed the constructs of social cognitive theory that explain adherence to the Mediterranean diet in patients diagnosed with cardiovascular disease. Methods A cross-sectional study of 337 cardiac patients using a validated questionnaire was conducted and analyzed at an outpatient cardiology clinic, employing social cognitive theory (SCT) as the theoretical framework. Results Dietary adherence was associated with statistically significant improvements in the SCT constructs. Self-regulation to consume healthy diet groups, negative perceived outcomes, and self-efficacy had the most influence on patient ability to maintain the Mediterranean diet. Self-regulation to avoid unhealthy food options like processed, sugary foods and positive perceived outcomes had smaller associations with patient ability to maintain the Mediterranean diet. Conclusions SCT constructs should be utilized by physicians when educating patients on heart healthy dieting as they are highly associated with improved dietary behaviors. Self-efficacy, self-regulation in choosing healthy diet options, and negatively perceived expected outcomes predicted diet quality in cardiac patients. Improvements in these constructs might yield positive results in cardiac patients attempting diet modifications.

Aim: Investigating the relationship between health promoting behaviors and quality of life in patients with hypertension. Methods: In this cross-sectional study, health-promoting behaviors and quality of life in patients with hypertension were assessed in a cardiology clinic of a university hospital in an urban area of Iran. The sample consisted of 93 patients with hypertension who were recruited using a convenience sampling method. Demographic data, Health Promoting Lifestyle Behaviors Profile (HPLP II) and World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaires were used to gather data. Data were analyzed using SPSS software version 21. Results: The mean score of health promoting behaviors was moderate (2.51 ± 0.47) with highest and lowest scores in nutritional (2.80 ± 0.52) and physical activity (1.78 ± 0.62) dimension, respectively. There was a statistically significant relationship between health-promoting behaviors and quality of life. The relationship between health-promoting behaviors and quality of life had the highest power in psychological health dimension (β = 5.353, P < .001) and lowest power in the environmental dimension (β = 0.365, P < .001). Conclusion: Improving quality of life of patients requires paying attention to educational interventions for creating changes in the lifestyle to improve all aspects of quality of life.

We performed a retrospective study of cardiology telemedicine visits at a large academic pediatric center between 2016 and 2019 (pre COVID-19). Telemedicine patient visits were matched to data from their previous in-person visits, to evaluate any significant differences in total charge, insurance compensation, patient payment, percent reimbursement and zero reimbursement. Miles were measured between patient's home and the address of previous visit. We found statistically significant differences in mean charges of telemedicine versus in-person visits (2019US$) (172.95 vs 218.27, p=0.0046), patient payment for telemedicine visits versus in-person visits (2019US$) (11.13 vs 62.83, p≤0.001), insurance reimbursement (2019US$) (65.18 vs 110.85, p≤0.001) and insurance reimbursement rate (43% vs 61%, p=0.0029). Rate of zero reimbursement was not different. Mean distance from cardiology clinic was 35 miles. No adverse outcomes were detected. This small retrospective study showed cost reduction and a decrease in travel time for families participating in telemedicine visits. Future work is needed to enhance compensation for telemedicine visits.

Iatrogenic aortocaval fistula (ACF) is an infrequent cause of heart failure. A 65-year-old man presented to the cardiology clinic eight months after an open abdominal aortic aneurysm (AAA) repair. He developed predominantly right-sided cardiac failure after surgery, with minimal response to guideline-directed medical therapy. A transthoracic echocardiogram revealed decreased right-sided systolic function. A computed tomography angiographic scan of the abdomen revealed a large ACF at the distal end of the AAA repair. The patient was referred for closure surgery. ACF should be considered in a patient with unexplained right heart failure, especially in the setting of a known AAA or recent AAA repair.

Introduction: The demand for cardiovascular care has been increasing but there are numerous barriers to accessing care. No-show rates are higher for specialist visits and place an economic burden on the health care system. Integrating specialists into primary care practices can improve access and cardiovascular outcomes. We sought to describe a real-world experience of integrating a cardiology clinic into a primary care practice at a large health system and its association with access and process metrics. Methods: We compared two cohorts of patients requiring referral to a cardiologist from a primary care clinic at a large academic medical center over two years. The standard-referral cohort was referred to a cardiologist within the health system but outside of the clinic. The integrated-referral cohort was seen by a cardiologist integrated physically and clinically into the primary care clinic during a bi-weekly 4-hour clinic session. Information from both groups included demographics, medical history, referral information, and diagnostic testing. We documented patient access to a sub-specialist (as measured by time from cardiology referral to appointment), no-show rates, and time from referral to diagnostic testing. Results: The cohorts contained 27 and 39 patients, respectively. Overall, patients were 52.5% male, 68.9% non-Hispanic, 68.8% had Medicare or Medicaid as their primary insurance, and 47.6% had a prior cardiology referral. There were no statistically significant demographic differences between groups. Time to cardiologist for the standard-referral group was a mean of 49.3 + 11.1 days versus 12.4 + 1.6 days in the integrated referral group (p-value .004). Time to first diagnostic test was a mean of 60.6 + 35 days versus 20.0 + 15.9 days respectively (p-value .003). The no show rate for the standard-referral group was 33.3% and integrated-referral group was 12.8%, X 2 (1, N=66) = 4.017, p= .045. Conclusion: Integration of a cardiovascular sub-specialist into a primary care practice in a 4-hour bi-weekly session decreased time from referral to appointment, time to first diagnostic test, and no-show rate among patients in a university primary care practice. Further studies regarding the cost benefit analysis of integration would be beneficial.

Introduction Development of cardiac disease-related diagnostic skills—including hypothesis-driven data gathering, heart sound interpretation, and ECG interpretation—is an important component of medical student training. Prior studies indicate trainees' performance of these skills is limited. Simulation provides students with opportunities to practice integrating their developing knowledge in a relevant clinical context. We developed a simulated clinic activity for second-year medical students consisting of standardized patient (SP) cases representing cardiovascular (CV) diseases. Methods Student small groups rotated through four SP encounters. For each case, one student performed the history, after which the whole small group listened to audio files of heart sounds, interpreted an ECG, and collaboratively developed a prioritized differential diagnosis. The CV course director met with students for a large-group debrief, highlighting key learning points. We collected learners' evaluations of the event through an online survey. Results Of students, 276 participated in this activity over the course of 2 years. Nearly all students assessed the activity as extremely or quite effective for applying learning content from the CV course (97%, 2018; 93%, 2019), and for practicing how to approach chest pain, shortness of breath, palpitations, and fatigue (100%, 2018; 95%, 2019). The most helpful aspects were reinforcement of CV disease illness scripts, hypothesis-driven data gathering practice, ECG interpretation, and applying knowledge and skills in a realistic context. Discussion SP encounters representing CV conditions can effectively provide opportunities for students to integrate basic science knowledge and clinical skills. Students assessed the activity as helpful and engaging.

Research on lifestyle programs for patients with coronary artery disease (CAD) has largely recruited from hospitals and/or recruited following acute coronary syndrome. By contrast, this study evaluated a 3-session behavioral health program for patients with stable CAD treated in an outpatient cardiology clinic. Thirty-three patients were randomized to the behavioral lifestyle intervention or to Treatment as Usual (TAU). A priori feasibility and acceptability criteria were met, and reliable change analyses revealed that at post-treatment and 30-day follow-up, significantly more intervention participants than TAU participants exhibited increased self-efficacy compared with baseline.

Objectives To demonstrate how heart rate fragmentation gives novel insights into non-autonomic mechanisms of beat-to-beat variability in cycle length, and predicts survival of cardiology clinic patients, over and above traditional clinical risk factors and measures of heart rate variability. Approach: We studied 2893 patients seen by cardiologists with clinical data including 24-hour Holter monitoring. Novel measures of heart rate fragmentation alongside canonical time and frequency domain measures of heart rate variability, as well as an existing local dynamics score were calculated. A proportional hazards model was utilized to relate the results to survival. Main results: The novel heart rate fragmentation measures were validated and characterized with respect to the effects of age, ectopy and atrial fibrillation. Correlations between parameters were determined. Critically, heart rate fragmentation results could not be accounted for by undersampling respiratory sinus arrhythmia. Increased heart rate fragmentation was associated with poorer survival (p ≪ 0.01 in the univariate model). In multivariable analyses, increased heart rate fragmentation and more abnormal local dynamics (p 0.045), along with increased clinical risk factors (age (p ≪ 0.01), tobacco use (p ≪ 0.01) and history of heart failure (p 0.019)) and lower low- to high-frequency ratio (p 0.022) were all independent predictors of 2-year mortality. Significance: Analysis of continuous ECG data with heart rate fragmentation indices yields information regarding non-autonomic control of beat-to-beat variability in cycle length that is independent of and additive to established parameters for investigating heart rate variability, and predicts mortality in concert with measures of local dynamics, frequency content of heart rate, and clinical risk factors.

Tetralogy of Fallot is the most common cyanotic congenital heart defect consisting of an overriding aorta, right ventricular outflow obstruction, ventricular septal defect, and right ventricular hypertrophy. Without surgical management, approximately only 3% of patients survive past the age of 40 years. Cases of unoperated patients reaching adulthood have been reported; however, few studies describe treatment guidelines for surgical or therapeutic management. In this article, we report the case of a 59-year-old Hispanic male with unoperated tetralogy of Fallot presenting to our cardiology clinic for initial workup and management.

Introduction: Informed consent for research biospecimen donations is traditionally obtained through a face-to-face interaction with research staff and by signing an Institutional Review Board (IRB)-approved printed form. Electronic signatures (eSign) are routinely used in the electronic medical record (EMR) for the consenting of clinical services after patients review printed documentation. Our goal was to develop an electronic self-consenting workflow that mimicked clinical services. Specifically, we tested a research consent process for the biobanking of remnant clinical samples that relies solely on clinical resources in a busy outpatient practice. Materials and Methods: The Biorepositories Core Resource (BCR) unit initiated a new enterprise-wide biobanking infrastructure for consenting patients, termed Biospecimen Use for Research-Related Investigations and Translational Objectives (BURRITO). BURRITO is modeled after an established clinical process called Terms and Conditions of Service (TACOS). The TACOS requires patients to annually review printed documentation and self-consent electronically for clinical services. BURRITO also requires patients to review printed documentation and self-consent with eSign to opt-in for remnant biospecimen banking, but patients must complete this process only once. We captured eSign for consents directly into the EMR without research staff. Results: Patients reviewed the IRB-approved documents and self-consented during their cardiology clinic visit. At checkout, their participation preferences were electronically documented by clinic staff. During a 6-month period, 123 patients agreed to donate. After a review of process, a second 3-month period identified 202 patients agreeing to donate. BURRITO did not require face-to-face interactions with research staff, used a “no-paper” eSign for consent, and created discrete fields in the clinical EMR of the patient's preference. Conclusions: BURRITO electronically documents informed consent using an EMR functionality and the least amount of clinical and research resources. Our results show promise for developing institutionally adopted processes, which could leverage existing clinical workflows for universal research consenting and scalability.