Search

Aims To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads with a dwell time of >10 years (Group A) vs. younger leads (Group B) using mechanical extraction systems. Methods and results Between October 2011 and July 2022, we performed TLE in 318 patients. Forty-six (14.4%) extracted ICD leads in 46 (14.5%) patients that had been implanted for >10 years. The median dwell time of all extracted ICD leads was 5.9 years. Cardiovascular implantable electronic device-related infection was an indication for TLE in 31.8% of patients. Complete ICD leads removal and complete procedural success in both groups were similar (95.7% in Group A vs. 99.6% in Group B, P = 0.056% and 95.6% in Group A vs. 99.6% in Group B, P = 0.056, respectively). We did not find a significant difference between major and minor complication rates in both groups (6.5% in Group A vs. 1.5% in Group B and 2.2% in Group A vs. 1.8% in Group B, P = 0.082, respectively). One death associated with the TLE procedure was recorded in Group B. Conclusion The TLE procedures involving the extraction of old ICD leads were effective and safe. The outcomes of ICD lead removal with a dwell time of >10 years did not differ significantly compared with younger ICD leads. However, extraction of older ICD leads required more frequent necessity for utilizing multiple extraction tools, more experience and versatility of the operator, and increased surgery costs.

Objective: The main aim of the article is to analyse the respondents’ attitudes towards selected pro-environmental practices of enterprises providing accommodation services and the factors conditioning their involvement in the activities implemented in the facilities. Methodology: The study is empirical in nature and is based on the results of an empirical survey that was carried out in the period December 2021–April 2022 in Poland. The survey used the diagnostic survey method, and 575 respondents took part in it. The main hypothesis assumes that customers of accommodation facilities appreciate the pro-environmental activities used in them. Findings: The survey results show that the respondents are sensitive to environmental issues and try to apply in practice the principles leading to environmental protection. They also emphasise that they would be more willing to stay in “green” facilities, although the application of sustainable development principles is not a key factor for them in choosing a facility. Value Added: The survey of 575 respondents indicated, similar to other studies, a positive attitude towards activities aimed at protecting the environment. At the same time, however, it showed that tourists are not always willing to make sacrifices during their stay related to either their comfort or the price of the service. This fact has practical implications for hotel managers and must be taken into account. Recommendations: The survey confirmed that consumers have a positive perception of environmental activities in hotels, so activity in this area can be an element of building their competitiveness.

Population Based Algorithms (PBAs) are excellent search tools that allow searching space of parameters defined by problems under consideration. They are especially useful when it is difficult to define a differentiable evaluation criterion. This applies, for example, to problems that are a combination of continuous and discrete (combinatorial) problems. In such problems, it is often necessary to select a certain structure of the solution (e.g. a neural network or other systems with a structure usually selected by the trial and error method) and to determine the parameters of such structure. As PBAs have great application possibilities, the aim is to develop more and more effective search formulas used in them. An interesting approach is to use multiple populations and process them with separate PBAs (in a different way). In this paper, we propose a new multi-population-based algorithm with: (a) subpopulation evaluation and (b) replacement of the associated PBAs subpopulation formulas used for their processing. In the simulations, we used a set of typical CEC2013 benchmark functions. The obtained results confirm the validity of the proposed concept.

Background: Patients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native saphenous vein graft (SVG) PCI after CABG. Methods: We performed a retrospective study in a tertiary reference cardiac center of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Arterial graft PCIs were excluded. Multivariable Cox regression analysis with propensity matching was performed, and major adverse cardiac events (MACE) outcomes including death or myocardial infarction (MI) or revascularization were assessed at 1-year after each index procedure. Results: A total of 435 PCI were performed in 401 patients (209 had native PCI and 192 had graft PCI). Target lesions were classified as following: 235 (54%) native coronary arteries and 200 (46%) SVG. Propensity matching resulted in 167 matched pairs. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.725, 95% confidence interval [CI] 1.049–2.837) which was primarily driven by increased incidence in revascularization (HR 2.218, 95% CI 1.193–4.122) and MI (HR 2.248, 95% CI 1.220–4.142) and with no significant difference in mortality (HR 1.118, 95% CI 0.435–2.870). Conclusions: Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization.

The MacNew questionnaire is a disease-specific quality of life measure that has been used in patients with myocardial infarction and heart failure. We aimed to investigate the impact of transcatheter aortic valve implantation (TAVI) on health-related quality of life (HRQoL) using MacNew Questionnaire and identify predictors associated with a change in its score. This was a prospective multi-center study performed across 5 National Health Service hospitals in the United Kingdom performing TAVI between 2016 and 2018. HRQoL was assessed using MacNew Questionnaire, Euro Quality of Life-5D-5L, and Short Form 36 questionnaires collected at baseline, 3-, 6- and 12 months after the procedure. Out of 225 recruited patients, 19 did not have TAVI and 4 withdrew their consent, and hence 202 patients were included. HRQoL was assessed in 181, 161, and 147 patients at 3, 6, and 12 months, respectively. Using MacNew, there was a significant improvement in all domains of HRQoL as early as 3 months after TAVI which was sustained up to 12 months with improved discrimination of change in HRQoL compared with other scales. Poor mobility at baseline and history of myocardial infarction were independent predictors of reduced improvement in HRQoL at 3 months. HRQoL increased in all subgroups of patients including frail ones. In conclusion, the MacNew assessment tool performed well in a representative TAVI cohort and could be used as an alternative disease-specific method for assessing HRQoL change after TAVI.

Data clustering is an important method used to discover naturally occurring structures in datasets. One of the most popular approaches is the grid-based concept of clustering algorithms. This kind of method is characterized by a fast processing time and it can also discover clusters of arbitrary shapes in datasets. These properties allow these methods to be used in many different applications. Researchers have created many versions of the clustering method using the grid-based approach. However, the key issue is the right choice of the number of grid cells. This paper proposes a novel grid-based algorithm which uses a method for an automatic determining of the number of grid cells. This method is based on the kdist function which computes the distance between each element of a dataset and its kth nearest neighbor. Experimental results have been obtained for several different datasets and they confirm a very good performance of the newly proposed method. Published version The paper is financed under the program of the Polish Minister of Science and Higher Education under the name ”Regional Initiative of Excellence” in the years 2019-2022; project number 020/RID/2018/19; the amount of financing PLN 12,000,000.00.

The purpose of this research is to analyze the shopping behavior of international students (Asian vs. European) studying in Poland. Participants were recruited from universities located in Warsaw between June and September 2020. A total of 806 questionnaires were collected, 87 of which were eliminated due to non-response. The research sample consisted of 719 people. We conducted an exploratory factor analysis and cluster analysis for the entire study population and separately for European and Asian students. In exploratory factor analysis, two factors were extracted for the entire population, while three factors each were extracted for the European and Asian student groups. In cluster analysis, we obtained four clusters each for the entire study population and the group of European and Asian students. Our study found that among Asian students, compared to European students, there was a greater change in shopping behavior during the COVID-19 pandemic, expressed by a greater preference for online shopping, greater purchases of fruits and vegetables, purchases of local products, and shorter shopping time.

Objective: The key objective of the article was to seek the answer to the question how the limitations of the first COVID-19-related lockdown affected small businesses offering accommodation services and how the businesses fared during the unlocking period. The side objective of the paper was to identify the actions undertaken in said businesses aimed at providing safety for the guests as well as to show the expectations such businesses had when it came to government aid. Methodology: In order to meet the objectives and to verify the working hypothesis, empirical research using the diagnostic survey method was conducted at the end of 2020. The article provides the results of the pilot survey carried out on a selected group of microbusinesses providing accommodation services. The link to the questionnaire was sent to 1000 entities, of which 47 completed it correctly. Findings: The tourist industry is among those affected most by the COVID-10 pandemic. The research revealed that during the first lockdown, the closure of accommodation businesses had a relatively strong impact on the subjects of the research. The situation remained similar during the first months of lifting of the restrictions. The summer brought a slight recovery albeit not as big as was expected. Nevertheless, strong premises were found which supported the hypothesis saying that such subjects – due to their size-dependent nature – fared relatively well in all three sub-periods. For the most part, such entities re-started their operations in spring. In many of them, the level of employment remained unchanged despite the significant drop in their incomes – mainly resulting from a lower number of foreign visitors and - to a lesser extent – from lower prices. The struggle for customers forced the subjects to introduce various solutions aimed at providing safety, which proved a considerable financial and organisational burden. Value added: The research is one of the first attempts in Poland to measure the impact of lockdown on the functioning of accommodation businesses and one of the few focusing on microbusinesses. The findings show to what extent the lockdown affected the operations of the entities in question, how the lifting of restrictions changed the situation in the summer, and what actions were taken to minimize the risk of infection. Recommendations: The findings show that the analysed entities are able to function in sanitary regime and that they support solutions which will allow them to offer their services in as safe a way as possible. On the other hand, they expect strong support from the state including subsidies or exemptions. It is to be expected that the need for this form of aid will grow even stronger after further lockdowns.

Nearly 20 years after the SARS (Severe Acute Respiratory Syndrome) epidemic, we are facing another COVID-19 pandemic. Therefore, the aim of our study was to analyse the impact of the COVID-19 pandemic on the tourism behaviour of international students in Poland. We paid attention to the overall impact of the pandemic on life, travel, choice of tourist destination, tourism activity, ecotourism preference, and health and safety issues. We formulated two research questions: What areas of international student tourism behaviour were affected by the COVID-19 pandemic? What differences in travel behaviour occurred between international students from Europe and Asia? Participants were recruited from universities located in Warsaw between June and September 2020. A total of 806 questionnaires were collected, 87 of which were eliminated due to non-response. The research sample consisted of 719 people. Six factors were identified in the survey results: tourism inclination, impact on tourist destination, hygiene and accommodation, impact on life, impact on tourism, and mode of tourism. Impact on life and impact on tourism were attributed to the general impact dimension; tourism inclination and mode of tourism can be summarized as attitude and preference. Food and accommodation were assigned to hygiene and safety dimensions. In almost all aspects, the impact of the COVID-19 pandemic on people’s lives was greater for Asian respondents. Asian respondents were more likely to say that they would avoid COVID-19-affected areas when choosing tourist destinations in the future, and avoid travelling to crowded large cities after COVID-19 ended. European survey participants’ responses were more moderate.

The purpose of this paper is to present differences in the perception of current and desired organizational culture between two different types of workers – academic and administrative staff – in non-public universities in Poland. A synthetic review of the literature on organizational culture at universities and the workplace attitudes of the two groups of university employees was conducted and presented. Research in the form of a survey based on Cameron and Quinn's model was conducted in three non-public universities in Poland. A sample of opinions of 115 workers was gathered and analyzed. It was found in the study that according to academic workers, the present culture was market culture, whereas for administrative workers, it was hierarchy culture. Both groups chose clan culture as the preferred culture. The findings may be useful for higher education decision makers in their attempts to transform universities into market-oriented, yet friendly workplaces. The study's limitations include a relatively small sample of respondents. A further, more comprehensive research into the subject will be worth conducting.

OBJECTIVES Multiple studies have suggested that women have worse outcomes than men following mitral valve (MV) surgery—most of those studies reported on conventional sternotomy (CS) MV surgery. Therefore, we aimed to explore whether or not the minimally invasive mitral valve surgery (MIMVS) approach might mitigate a worse survival in women following MV surgery. METHODS We identified patients with isolated primary MV operations with or without tricuspid valve repair performed between 2007 and 2019. Patients were propensity score-matched across the MIMVS and CS surgical approaches. Sex was excluded from the matching process to discern whether female patients had a different likelihood of receiving minimally invasive surgery than males. A Cox proportional hazards model was fitted in the matched cohort and adjusted for the imbalance in baseline characteristics using the propensity score. RESULTS Of 956 patients (417 MIMVS, 539 CS; 424 females), the matched set comprised 342 pairs (684 patients; 296 females) of patients who were well balanced across MIMVS and CS groups with regard to preoperative clinical characteristics. We observed a 47/53% female/male ratio in the CS group and a 39/61% in the MIMVS group, P = 0.054. In both matched groups, women were older than males. A Cox model adjusted for propensity scores showed no survival difference with sex, surgical type or interaction. CONCLUSIONS Women present to the surgical team at an older age. They appear less likely to be considered for a MIMVS approach than men. Neither sex nor surgical approach was associated with worse survival in a matched sample.

The study presents an overview of the history of administrative judiciary in Poland and the current directions of its changes. In particular, the evolution of the scope of cognition of administrative courts, the progressing computerization process and the discussion on the model of adjudication were indicated. At the same time, the challenges related to the presented directions of changes were noticed and potential solutions were indicated that would help to face them. In conclusion, it was assumed that the development of administrative judiciary ensures respect for the individual’s subjective rights in relations with administrative bodies. Opracowanie przedstawia zarys historii sądownictwa administracyjnego w Polsce oraz aktualne kierunki zmian, którym podlega. Wskazano, w szczególności, na ewolucję zakresu kognicji sądów administracyjnych, postępujący proces informatyzacji i dyskusję nad modelem orzekania. Zauważono przy tym wyzwania, jakie wiążą się z przedstawionymi kierunkami zmian i wskazano na potencjalne rozwiązania, które pomogą zmierzyć się z nimi. W konkluzji przyjęto, że rozwój sądownictwa administracyjnego zapewnia poszanowanie praw podmiotowych jednostki w jej relacjach z organami administracji.

Background: Adequate contact between the catheter tip and tissue is important for optimal lesion formation and, in some procedures, it has been associated with improved effectiveness and safety. We evaluated the potential benefits of contact force-sensing (CFS) catheters during non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) of idiopathic ventricular arrhythmias (VAs) originating from outflow tracts (OTs). Methods: A group of 102 patients who underwent NF-RFCA (CARTO, Biosense Webster Inc., Irvine, CA, USA) of VAs from OTs between 2014 to 2018 was retrospectively analyzed. Results: We included 52 (50.9%) patients in whom NF-RFCA was performed using CFS catheters and 50 (49.1%) who were ablated using standard catheters. Arrhythmias were localized in the right and left OT in 70 (68.6%) and 32 (31.4%) patients, respectively. The RFCA acute success rate was 96.1% (n = 98) and long-term success during a minimum 12-month follow-up (mean 51.3 ± 21.6 months) was 85.3% (n = 87), with no difference between CFS and standard catheters. There was no difference in complications rate between CFS (n = 1) and standard catheter (n = 2) ablations. Conclusions: There is no additional advantage of CFS catheters use over standard catheters during NF-RFCA of OT-VAs in terms of procedural effectiveness and safety.

This study investigated the prevalence of parentification in a nationwide cross-sectional study. There were N = 47,984 Polish adolescents aged 12–21 (M = 15.60; SD = 1.98; female 52.7%, male 47.3%). The results indicated that more adolescents experienced emotional parentification (toward parents 35.9%; toward siblings 25.2%) as compared to instrumental parentification (toward parents 7.2%; toward siblings 15.5%), which is noteworthy, since emotional parentification is the most detrimental form of parentification in USA samples. Overall, 15.5% of the participants reported a sense of injustice related to their family caregiving roles and 61.2% reported satisfaction related to their family caregiving roles. The results are important given the dearth of prevalence studies.

Our study aims to analyze factors determining the green brand equity (GBE) based on a systematic literature review (SLR) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We posed 3 research questions and searched five databases (Scopus, Web of Sciences, Google Scholar, EBSCO, and Elsevier) for studies containing the term ‘green brand equity’ and the combination of two terms: ‘brand equity’ and ‘green’. Additionally, the backward and forward snowballing methods were applied. In our SLR, we included empirical studies published between 2006 and 2021 as peer-reviewed papers in English. Exclusion criteria included studies with theoretical models, studies describing brand equity not related to GBE, Ph.D. thesis, short reports, workshop papers, practice guidelines, book chapters, reviews, and conference publications. Finally, 33 articles were analyzed as part of the SLR in two fields: general information (authorship, year of publication, type of study, research country or location, sample size, and product categories), and research specifications (factors or variables, number and type of hypotheses, scale or measurement items, type of statistical analysis, and selected indicators of statistical methods). Image, trust, value, satisfaction, and loyalty appeared to be the most studied determinants of GBE. Less frequently analyzed were quality, awareness, attributes, particular promotional activities, and the fact of purchase. The results obtained are important in practical terms, showing what to consider when creating GBE in different categories of products and services.

Background: Atrial fibrillation (AF) is thought to be a progressive arrhythmia. The impact of sex and position of right ventricular lead is not well recognized. Whilst nonparoxysmal AF compared with paroxysmal AF has been associated with increased mortality in the general population, its prognostic significance nin patients with a dual‑chamber (DDD) pacemaker is less clear. Aims: The aim of the study was to determine the incidence of permanent AF in patients with a DDD pacemaker, analyze the effect of selected baseline characteristics on permanent AF development, and examine the impact of permanent AF on patient survival. Methods: A retrospective cohort study included 3932 consecutive patients who underwent DDD pacing system implantation between 1984 and 2014. Follow‑up was completed in August 2016. We included 3771 patients (96%) with post‑operative follow‑up and known vital status. Occurrence of permanent AF and all‑cause mortality were the study endpoints. Results: During mean follow‑up of 6.5 years, permanent AF occurred in 717 patients (19%). Sex (hazard ratio [HR], 1.316; 95% CI, 1.134–1.528, for men), age at implant (HR, 1.041; 95% CI, 1.033–1.049, 1-year increase), history of AF (HR, 3.521; 95% CI, 3.002–4.128) were independently associated with permanent AF development, whereas position of right ventricular lead (apical versus nonapical) and primary pacing indication (atrioventricular block versus sick sinus syndrome) were not related to permanent AF. Permanent AF was a significant risk factor for increased mortality (age- and sex‑adjusted HR, 1.475; 95% CI, 1.294–1.682). Conclusions: Permanent AF occurrence was independently predicted by advanced age at implant, male sex, and preexisting AF and associated with worse survival.

Coraz ważniejszą grupą, mającą rosnące znaczenie dla konsumpcji turystycznej, są osoby młode. W prezentowanym artykule autorzy skoncentrowali się na charakterystyce i analizie specyfiki konsumentów pokolenia Y w wieku poniżej 30. roku życia. Zaprezentowane zostały wyniki badania ankietowego, które zostało przeprowadzone wśród studentów. Weryfikacji poddano hipotezy mówiące o dużym znaczeniu Internetu zarówno w procesie planowania wyjazdu, jak i przy dzieleniu się wrażeniami z pobytu. Drugą istotną kwestią, na którą wskazały otrzymane wyniki, jest relatywnie duże znaczenie komfortu podczas wyjazdu. Jednocześnie jednak jawi się potrzeba kontynuacji badań, zwłaszcza mających na celu porównanie wybranych zachowań z innymi grupami wiekowymi.

OBJECTIVE: To ascertain the level of psychological distress, using validated psychology tools, among British National healthcare workers (HCW) during the first wave of the Covid-19 crisis. METHODS: A multi-centre, anonymized, all-comer staff survey across 3 hospitals in Lancashire, England during the Covid-19 first wave (April to June 2020), consisting of Patient Health Questionnaire (PHQ-9), Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and Impact of Events Scale (IES-6). RESULTS: Among 1113 HCW, median (IQR) PHQ-9, GAD-7, PSS-10, and IES-6 score was 7 (3 to 11), 6 (3 to 11), 19 (13 to 24), and 9 (5 to 14), respectively. Potential predictors of higher levels of psychological distress included living alone, disabled dependents, history of depression/anxiety, and being female. CONCLUSIONS: The study indicates a high prevalence of psychological distress during the acute Covid-19 period among HCW, identifies groups at risk and areas of future research.

Introduction Acute heart failure (AHF) hospitalisation is typically lengthy, costly and associated with 10% mortality. Outpatient based management (OPM) of AHF appeared effective in observational studies. We conducted a pilot randomised controlled trial (RCT) comparing OPM with standard inpatient care (IPM). Hopelessness independently predicted mortality in patients with risk factors of ischaemic heart disease. We hypothesize that patients randomised to OPM may be more hopeful and have better mental well-being, with better quality of life, patient and carer satisfaction. Methods We randomised patients with AHF, considered to need IV diuretic treatment for >2 days, to IPM or OPM. We recorded all-cause mortality (index-episode), and the number of full days alive and out-of-hospital (DAOH) within 60 days after randomisation. Quality of life (EQ5D-VAS), mental well-being [Short Warwick-Edinburgh Mental Wellbeing scale] and hope (Adult State Hope Scale) scores which have been validated as accurate in detecting fluctuations in hope were assessed up to 60 days follow-up. We calculated mean NHS cost savings and 95% central range (CR) from bootstrap analysis. Results Eleven patients were randomised to IPM and thirteen to OPM. There was no statistically significant difference in all-cause mortality during the index episode (1/11 vs 0/13) and up to 60 days follow-up (2/11 vs 2/13) [log rank p=0.86]. (Figure 1). Patients randomised to IPM accrued a median of 47 [IQR 36, 51] vs 59 [41, 60] DAOH in OPM (p=0.13). 2 patients randomised to IPM (vs 6 OPM) were readmitted within 60 days [p=0.31]. Hope scores increased more with OPM within 30 days after randomisation but by 60 days, dropped to lower levels compared with the group allocated to IPM (not statistically significant). (Table 1). In-patients’ mental well-being score was higher at baseline but more out-patients had increased total well-being scores by the 60-day follow-up visit (p=0.04). (Table 2). 100% patients in both arms were satisfied according to the ‘NHS Family and Friends Test’ but interestingly 100% would choose OPM again whilst only 90% would choose Inpatient care again. Similarly, 100% carers were satisfied in the OPM arm whilst 60% only were satisfied if the patient was randomised to inpatient care. 100% carers would choose OPM again, vs 60% IPM carers.OPM was associated with mean cost savings of £2,658 (95% CR 460 - 4,857) per patient during the index episode. Conclusions Patients with acute HF randomised to OPM accrued more DAOH (albeit not statistically significant in this small pilot RCT). There was no increase in mortality but there was a higher risk of readmissions (not statistically significant). OPM was associated with improved mental well-being. But the initial increase in hope diminished within 60 days, possibly as a result of increased readmissions. The pilot RCT generated important hypotheses that need further testing in a large multicentre RCT. Conflict of Interest none

Introduction: To compare vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) treatment in patients with left ventricular (LV) thrombus. The primary outcome was stroke or systemic embolism (SSE). Secondary outcomes were thrombus resolution, bleeding, and death. Areas covered: Five observational studies were included (total n = 700; VKAs n = 480; DOACs n = 220). There was a trend toward less SSE with VKAs compared to DOACs (5.2% vs. 9%; odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.29–1.01, p = 0.05). No significant difference between VKAs and DOACs in rates of thrombus resolution (61.6% vs. 56.8%; OR = 1.00, 95% CI = 0.58–1.73, p = 0.99), bleeding (8.2% vs. 4.4%; OR = 1.62, 95% CI = 0.69–3.77, p = 0.27), or death (12.7% vs. 11.8%; OR = 1.09, 95% CI = 0.59–2.0, p = 0.79) was noted. In non-primary percutaneous coronary intervention setting, VKAs were associated with less SSE in prespecified analysis (5.2% vs.10.6%; OR = 0.48, 95% CI = 0.25–0.93, p = 0.03). Expert opinion: The current meta-analysis suggests a trend toward higher SSE with the use of DOACs compared to VKAs. Our recommendation is for VKAs to retain the preferred management of LV thrombus with cautious off-label use of DOACs.

Introduction: The number of people being admitted to hospital in England due to heart failure (HF) has risen by a third in the last five years. Implantable cardiac devices with integrated heart failure diagnostics are capable of combining daily measurements of multiple device-derived parameters and provide a heart failure risk score (HFRS) which might help predict HF worsening. Methods: Between 2015 and 2019 231 consecutive HF device patients were co-managed (CM) by specialist HF nurses in a tertiary centre. Follow-up was truncated at last device transmission in 2019. HF nurses’ interventions to alerts were recorded prospectively. HF-related hospitalisations were collected from hospital records. We analysed the predictive value of baseline variables on the count of days in high HFRS in a negative binomial regression model. The device settings: Optivol CareAlert switched ON vs OFF were compared. Results: 200 patients with CRT-D were followed up for 2.6 [1.0-2.8] years (Figure). Baseline characteristics and their effect on the incidence rate ratio (IRR) of days in high HFRS are presented in Table. A total of 3,486 transmissions were assessed, median 7.3 [5.9-10.0] per patient-year; 591 high HFRS episodes occurred in 115 (58%) pts. Optivol OFF increased the rate of high HFRS being transmitted >30 days after its end (45% vs 35%, P=0.018) and increased the time from episode start to transmission (36 [16-68] vs 24 [8-53] days, P Conclusion: Patients who have not had a single high HFRS during follow-up did not need admission for decompensated HF.

Background Proactive patient monitoring is of paramount importance in effective management of heart failure (HF) patients. Cardiac implantable electronic devices (CIEDs) used in HF patients are able to derive long-term trends in physiologic parameters and provide timely warning to clinicians. Little is known, however, on the real-world experience with device-generated HF risk-stratifying algorithms. Purpose Heart Failure Risk Score (HFRS) takes into account nine parameters and is calculated automatically based on long-term clinical trends. Remote transmissions provide information on the risk of HF event in next 30 days categorized as low, medium or high based on a maximum daily risk status in prior 30 days. We aimed to evaluate the ability of HFRS to alert HF specialists on the actual HF risk status. Methods The prospective registry included all patients with CIEDs featuring integrated Heart Failure Risk Score (HFRS) followed via Medtronic CareLink remote monitoring system and enabled for Co-management (CM) from May 2015 to August 2019 in a tertiary centre. High HFRS does not trigger automatic alert transmission. Study follow-up spanned between start of CM and last transmission in 2019. Inclusion criteria were CRT-D in situ, active Home Monitor, switched on OptiVol 2.0 remote alert and transmission data available on CareLink following study period completion. Transmissions were scheduled 3-monthly. Results Out of 229 consecutive patients, 132 met study criteria. Mean age was 74±10 years, 18% were female. Median follow-up duration was 2.7 years (IQR 1.3). Total number of transmissions was 2652, median per patient was 18 (IQR 13); scheduled, unscheduled and care alerts constituted 42%, 44% and 14%, respectively. One third of transmissions were automatically sent for CM review. There were 398 high HFRS episodes. OptiVol fluid index was below the threshold throughout 128 (32%) episodes. Missed episodes (not transmitted within 30 days from the final day of high HFRS) amounted to 130 (33%) and the reasons behind this included OptiVol alerting before the first day of high HFRS or persistently elevated when HFRS changed from low/medium to high (52%), low OptiVol index during the episode (38%) or other (10%). Median duration of high HFRS was 7 days (IQR 12, range, 1–187). Among timely picked-up high HFRS episodes, 38% were transmitted during the relevant episode and 62% afterwards with median delay of 10 days (IQR 15) from the last day of high HFRS; 21% of transmissions showing high HFRS were not highlighted for CM review which correlated with low OptiVol index, P Conclusions In a real-world clinical setting high HFRS was frequently under-reported. The investigation into clinical implications is warranted. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Our department has benefited from unrestricted grants from Boston Scientific and Medtronic Inc during the last 5 years.

Background Patients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native versus graft PCI after CABG. Methods We performed a retrospective study in a tertiary reference cardiac centre of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Major adverse cardiac events (MACE) included death or myocardial infarction (MI) or revascularization. All outcomes were assessed at 1-year after each index procedure. Results A total of 445 PCI were performed in 410 patients (209 had native PCI and 201 had graft PCI). The groups of patients with native vessel PCI and graft PCI were statistically comparable regarding their baseline characteristics. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.818, 95% confidence interval [CI] 1.148–2.878). Conclusion Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization. MACE outcomes Funding Acknowledgement Type of funding source: None

Background Cardiac resynchronisation therapy (CRT) in patients with permanent atrial fibrillation (AF) is usually less effective than in sinus rhythm patients. Recent evidence has shown that His bundle pacing (HBP) might be a valuable alternative to conventional pacing systems resulting in more physiologic electrical activation of the heart. Currently, there is a need to identify the optimal way of CRT + HBP programming in patients with congestive heart failure (CHF) and permanent AF to achieve high cardiac output and improve physical capacity and survival. Purpose The aim of this study was to evaluate the impact of CRT + HBP programming on cardiac output in the early post-operative measurements. Methods We included consecutive patients with: 1. permanent AF, 2. CHF in NYHA class III-IV, 3. bundle branch block with QRS >130 ms or QRS During the early post-operative phase, we aimed to optimize CRT + HBP settings in order to achieve the highest cardiac output assessed by repeated echocardiographic measurements of aortic velocity time integral at various pacing programs (Table 1). Then, we selected the optimal pacing settings of CRT + HBP for each individual patient. Results Study included 17 consecutive patients aged 71.5±6.3 years, 12 were male. Mean LVEF was 24% and median NYHA class was III. The most efficacious method of pacing in terms of aortic VTI was HBP combined with left ventricular pacing (LV) which resulted in median VTI of 22.5. HBP + LV was superior to right ventricular pacing (RV): VTI of 22.5 vs 18.5, P=0.003 and outperformed biventricular pacing: VTI 22.5 vs 18.7, P=0.019. Detailed results are shown in Figure 1. Conclusion His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output and it performed significantly better than RV pacing only or biventricular pacing. Our observation supports the use of His bundle pacing in CRT systems in patients with CHF and permanent AF. Figure 1 Funding Acknowledgement Type of funding source: None

Right ventricular (RV) impairment may have prognostic value in patients undergoing mitral valve surgery. It is unclear whether RV dysfunction predicts long-term mortality, especially in the era of minimally invasive mitral surgery.We performed a retrospective analysis of consecutive patients referred for conventional (The study cohort included 359 patients followed up for a median period of 4.2 (1.8) years. MIMVS approach was performed in 127 (35.4%) and conventional approach in 232 (64.6%) patients of whom 36 (28%) and 45 (19%), respectively, had RV impairment. EuroSCORE II was significantly higher in patients with RV impairment compared with patients with preserved RV function, irrespective of the surgical approach. Consequently, in both groups, patients with RV impairment had significantly higher mortality compared to patients with preserved RV function. RV impairment adjusted for EuroSCORE II predicted mortality in the whole cohort (HR 2.139, 95% CI 1.249-3.663) and in conventional approach (HR 2.361, 95% CI 1.249-4.465) in contrast to MIMVS (HR 1.570, 95% CI 0.493-4.997).In this real world cohort, patients with RV impairment and/or dilation had reduced long-term survival following both conventional surgery and MIMVS. Patients should be referred to surgery prior to worsening of RV function.

Introduction Outpatient based management of heart failure is gaining popularity in the UK. Observation data and a small pilot randomised controlled trial suggested it is safe and clinically effective. However, the cost-effectiveness of this novel treatment approach is not known. Patient level costing is thought to be more accurate providing extra granularity when reviewing the cost of patient pathways. Methods We used the Trust’s patient level costing models from financial years 2018/19 and 2019/20 to calculate total treatment costs for the patients in the pilot prospective trial which randomised acute heart failure patients to receive inpatient vs outpatient based therapy. Patient level costing for inpatients would include hospital bed, nursing cost, consultant /ward doctor cost, non-pay costs (pharmacy including iv drugs, diagnostics e.g. pathology, radiology, ECG, echocardiography). Where patient level costs are unavailable, for example Community contacts, we have used a national average cost. Community centre visit - HRG code of N29AF 2018/19 National average cost £71 Home visit - HRG code of N29AF 2018/19 National average cost £71 GP visit - National average cost of £30 [1] All other costs used are from the Trust costing model. We also tested the feasibility of collecting quality of life data using EQ5D-5L and the visual analogue scale (VAS) where 100 means the ‘best health you can imagine’ and 0 is the worst. EQ-5D-5L 5 items each with a different domain: mobility, self-care, activities, pain and depression. Each is scored from 1-5 where 5 is the worst (severe limitation/unable to do). Value sets are used to transform the health profile into an index value that can be interpreted as a health utility; these range from -0.594 to 1.000 where a value below zero is taken to describe a health state whose quality is ‘worse than death’. Results 24 patients were randomised to 13 outpatients and 11 inpatients between July 2018 and June 2019: Inpatients received 5.8 ± 2.8 days of treatment, outpatients received 8.5 ± 5.2 (p=0.12). No patient was in CCU, HDU or ITU or received dialysis/haemofiltration. 1 patient randomised to inpatient care died during the index episode, but none died in the outpatient group. There was one extra AE Outpatients costed £31435 (£2418 on average). Therefore total average saving was £2663 per patient. Treatment groups varied little in their quality of life. EQ-5D-5L VAS scores are significantly higher for outpatient. [Figure 1] Indeed a linear mixed model confirms that treatment arm is significantly associated with higher VAS scores; an outpatient reports a VAS score 13 points higher on average than an inpatient, and there is evidence that the score increases slightly over time (0.18 points per day, equivalent to ≈ 11 points over the 60 day period) for all patients. [Table 1] This is not true of EQ-5D utility indices; estimates for treatment and time are non-significant (p=0.78 and p=0.88 respectively). Conclusion Outpatient based AHF management appears cost-effective. Total average saving was £2663 per patient. Treatment groups varied little in their quality of life. EQ-5D-5L VAS scores are significantly higher for outpatient. Conflict of Interest No conflict of interest

Introduction Worsening heart failure (HF) leading to hospital admission is common and associated with substantial morbidity and mortality. For many patients, the preferred place of care, including end-of-life care, is at home or in the community, but this is often thwarted by the need for intravenous (IV) diuretic therapy. Alternative models of ambulatory care exist but safety and efficacy should be compared to standard care in randomised controlled trials (RCT). Methods We randomised patients with pulmonary or peripheral oedema who no longer required supplementary oxygen and who were considered to need at least two more days of IV diuretic treatment. A left ventricular ejection fraction 100pg/mL within the previous two years were also required. Patients who were admitted to hospital as well as those seen in the emergency department or out-patient clinic could be enrolled. Patients were randomised to be admitted (conventional care) or for out-patient care (at home, in the community centre, or in a hospital ‘Furosemide lounge’. The primary safety outcome was all-cause mortality during the index episode and primary effectiveness outcome was the number of full days alive and out of hospital (which did not include day-care in the Furosemide lounge) within 30 days after randomisation. Statistical analysis was based on ‘intention to treat’. Results Of 24 patients enrolled, eleven were randomised to in-patient and thirteen to out-patient care. There was no statistically significant difference in all-cause mortality. Only one patient, who was randomised to inpatient care, died. Patients randomised to in-patient care accrued 16 [IQR 12.5 to 20.5] days alive out of hospital compared to 29 [IQR 20.5 to 29] days for those assigned to out-patient care (p=0.015). Two patients randomised to in-patient care required readmission within 30-days compared to five assigned to out-patient care. Using these data, we calculate that a trial using this primary endpoint would require 92 patients to show, compared to standard in-patient care, that outpatient care leads to at least two more days alive and out of hospital with 90% power. Conclusion In this feasibility RCT, out-patient intravenous diuretic treatment was associated with a favourable outcome compared to standard inpatient care which might also be a cost-effective and an approach to care preferred by many patients. Conflict of Interest No conflict of interest

Introduction Heart Failure mortality is high -7% if patients are under the care of Cardiologists, or 11% if under general physicians (according to the national heart failure audit in 2013). It is unclear whether cardiologists are ‘cherry-picking’ patients who are less frail with fewer co-morbidities. Hypothesis and Aim Cardiologists select patients who are less frail with fewer co-morbidities. We also aimed to compare the compliance to NICE quality standard and length of stay between patients admitted to general medical wards, cardiology ward in the Lancashire Cardiac Centre, and an Acute Cardiac Ward (ACW)-‘Ward 19’, led by Consultant Cardiologists, supported by a team of Cardiology juniors and nurses, adjacent to our Acute Medical Unit (AMU) in the District General Hospital (DGH) part of the Trust. Methodology The study was carried out in Blackpool Victoria Hospital. The data was collected from 99 patients admitted to Blackpool Victoria Hospital. Data was collected retrospectively (random sample from 2016-8). Results There is no significant difference in Derby Frailty Index between patients admitted to DGH wards, the ACW and Tertiary Cardiac Centre wards. The Rockwood frailty score was slightly higher in the DGH wards compared with the ACW, but not significantly different with the tertiary centre wards. More co-morbidities were observed in patients in the DGH wards compared with the ACW but not significantly different compared with the tertiary centre. However, there is no significant difference in the age of patients, or proportion of patient on palliative care. Importantly, the proportion of people who suffered ‘falls’/ reduced mobility was not significantly different between the groups. Thus, our observation that more patients in Cardiology/ACW were receiving MRA could not be explained by lower blood pressure for instance. Limitations There is significant difference in terms of heart failure treatment received in patients admitted under general medicine vs cardiology. However, tendency to falls in 1/3 of DGH patients may be a clinically important reason that may contribute to lower use of MRA in DGH (even though the small study has not found a statistically significant difference in % of patients who suffer falls). Notably, 13% DGH patients were discharged without echocardiography. Tendency for DGH wards to have higher frailty score, also multiple markers of frailty–incontinence, confusion, falls/reduced mobility (though not statistically significant) does suggest the cohort is more frail. Equally, they are probably appropriately placed for the MDT delivery of comprehensive geriatric assessment. The key is to ensure they receive cardiology/HF specialist input. Conclusion We have found no definitive evidence to suggest Cardiologists are cherry-picking patients, in terms of age, creatinine, Derby Frailty index, falls, reduced mobility and palliative care. Patients in the ACW were slightly less frail (Rockwood score) with fewer comorbidities, but the proportion of patients who fall and BP is similar to DGH patients. Despite that, more Cardiology patients are on appropriate HF medication than DGH patients. More research is required to test whether it is possible to safely reduce the length of stay in patients in Cardiac wards and whether frail heart failure patients may cope with outpatient based therapy for acute decompensation. Conflict of Interest No conflict of interest

AIMS A novel therapy offering cardiac resynchronization therapy (CRT) with an additional lead placed in His bundle has been reported in a few case reports and case series as improving the hemodynamical and clinical condition of patients with permanent atrial fibrillation (AF) in whom other therapeutic methods have not been successful. METHODS Fourteen consecutive patients with permanent AF, heart failure (HF), bundle branch block (BBB) with QRS complex width >130 ms, and impaired left ventricular ejection fraction (LVEF) underwent implantation of implantable cardioverter defibrillator (ICD)/CRT systems with His bundle pacing (HBP). During the follow-up, we assessed the efficacy of ICD/CRT systems with HBP in HF treatment. RESULTS The study cohort consisted of 14 patients with the mean age of 67.35 ± 10 years. The mean duration of QRS was 159.2 ± 28.6 ms, mean LVEF was 24.36 ± 10.7%, and mean follow-up duration was 14.4 months. One patient died due to HF aggravation during the follow-up. In the remaining 13 patients, the mean LVEF significantly improved from 24% to 38%, P = 0.0015. The left ventricular end-diastolic dimension decreased from 72 mm to 59 mm, P

The current study aimed to examine the impact of COVID-19 pandemic on patient-related delay with ST-segment elevation myocardial infarction (STEMI) at a tertiary center in the United Kingdom. The study demonstrated a significant delay in symptom-to-first medical contact and a higher cardiac troponin-I level on admission in patients with STEMI during the COVID-19 pandemic versus the pre-COVID era.

Objective: To identify the lodging preferences of users (to define the comfort level preferences of tourists/consumers) of southern Sonora, considering their perceptions, which allows to improve strategies to satisfy the user’s needs in the future. Methodology: The research was descriptive and quantitative. The participants were between 18 and 60 years old, of every socioeconomic level, gender, occupation, and level of education. The sample comprised 300 from the region of Sonora in Mexico. Findings: Regarding the methodological contribution, this research presents an instrument to collect the opinions of the accommodation users, which is expected to be replicated in other studies on a larger population scale. This research is empirical and collects the opinion of a group of people, showing their preferences regarding the factors and characteristics they consider when choosing a type of accommodation. In addition, companies operating in this field could define their competitive advantages considering the results of this research. Value Added: The article points to a practical solution of the knowledge of preferences of users of different accommodation modalities and identifies which were most frequently selected by the respondents. Recommendations: Research shows the existence of significant differences between family and other companies. Therefore, it is advisable to look for the specifics and, as a consequence, potential sources of competitiveness in specific markets, of which the tourist market is important.

A 31-year-old patient who had cardiac pacemaker (DDD) implanted at the age of 16 due to complete atrioventricular block was admitted because of suspicion of lead-dependent infective endocarditis (LDIE). Echocardiographic examination revealed a vegetation measuring 31 x 20 mm in connection with excessive loop of atrial lead and endocardium adjacent to tricuspid valve. The patient was qualified for hybrid procedure: surgical removal of the vegetation and transvenous extraction of intracardiac leads. Considering the stable condition of the patient, it was decided to postpone the procedure and intensive treatment with antibiotics and anticoagulation therapy with low molecular weight heparin was continued. Pharmacological treatment resulted in a reduction of vegetation dimensions to 25 x 15 mm, which allowed for changing the qualification of the procedure to transvenous lead extraction (TLE) of the DDD system. The procedure was carried out without complications. After normalization of inflammatory parameters and disappearance of the vegetation, a new stimulation system was implanted on the same side of the chest. During one-year follow-up, there was no recurrence of the infection.

The objective of this paper is to present selected aspects of management information in regard to prospective tourist destinations for young Poles. The focus of the study is on the preferences of respondents in determining their destination choice. The verified hypotheses have indicated that there are several leading motives for their decision making, and they can be utilized as a foundation for marketing communication that targets young students. The results show that the crucial elements deal with comfort and convenience associated with the destination, along with the attractiveness of the destination.

The objective of this paper is to identify selected aspects of the management of information about prospective tourist destinations by young people (students) from Canada, Poland, and Trinidad and Tobago. On the basis of a questionnaire study, the ranking of preferences of respondents (i.e., the main criteria of destination choice) has been presented. Students were selected as respondents - as a “convenient sample” - in this privately funded study. A variety of aspects related to comfort (and convenience) and attractiveness have been identified as most important to the choice of destination. These are also leading motives that may form a platform for advertising campaigns and suggestions for regional development. This examination has been done mainly with the use of analysis of averages, Spearman correlation coefficients, and various approaches to factor analysis. It turns out that despite very different characteristics of respondents from the three countries, both their preferences and motives for promotion of the destination are very similar. Conclusions can be helpful for travel agencies and those responsible for the development of tourism infrastructure, as well as for the organization of further studies on the subject. The combination of various statistical tools used when examining the subject and the finding - that is, the similarity of preferences between travelers - can be regarded as new value when examining the subject.

Objective: Tourist regions are characterized by a very high complexity and micro-enterprises are the largest group of entities which determine the competitiveness of the destination. However, management of such businesses has a strong specificity. The goal of this paper is to identify the capabilities of managing competitiveness and marketing of this group of entities. Methodology: Literature review, examining and discussing the current knowledge regarding the competitiveness of family tourist micro-enterprises. Findings: On the one hand, small companies have significant limitations compared to larger companies. However, the family nature of the company allows for high flexibility of management. Decisions can usually be made faster and easier, which means that they are able to adapt their offer to the expectations of customers faster and better than large entities. Also, an atmosphere of hospitality and friendship can be easily created. What is more, cooperation with other local entities should result in the ability to offer higher value to consumers. Value Added: Authors, on the bases of literature review have proposed a model that shows relations as an element of building competitiveness of a family tourist micro-enterprises. It appears that these firms have unique opportunities to develop relationships with their customers. Cooperation, quality and communication have been described as key variables responsible for this process, that should result in generating the benefits of re-selecting the services of the company as well as giving them positive recommendations. Recommendations: In the area of family businesses in tourism, there is still lack of empirical studies. That is why, the issues presented in this work should be subjected to empirical verification. Future research should concentrate on the specificity of managing a tourist family micro-enterprise and on possible sources of competitive advantage of a tourist family micro-enterprise in the eyes of customers. Especially, described model should be empirically verified.