bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is virtual cardiology training here to stay in the post-COVID era?
Authors: Luther V , Kailey B , Dev D S 
Published: October 2021

Abstract

Background
In April 2020, face-face UK cardiology training was paused due to COVID-19. We adapted by utilising a video-conferencing platform to continue some form of education on a national scale (CardioWebinar). We studied the effectiveness of delivering virtual Cardiology education 1 year into the COVID pandemic.

Methods
Expert speakers throughout the UK were sought after via social media and “word of mouth”. Weekly webinars were organised and advertised (Canva posters) on social media (Twitter), as well as via the British Cardiovascular Society and British Junior Cardiologists' Association (BJCA) media links. Each webinar was scheduled mid-week at 17:30 (UK). Interested attendees registered for free using an online ticketing platform (Eventbrite). Webinars were delivered using an online video conferencing platform (Zoom) which required a £14.99 monthly subscription. Each webinar consisted of a 40-minute presentation followed by Q&A (20mins). All webinars were recorded and later accessible for free on the BJCA TV Gallery. A Learning Management System (LMS) collected feedback after each session and generated certificates of attendance.
We systematically reviewed the LMS feedback from 6 consecutive webinars delivered between Jan-Feb 2021. We further surveyed our most recent (March 2021) attendees via an extended questionnaire exploring their experiences of our virtual education.

Results
55 CardioWebinars have been delivered since April 2020. The speakers have been predominantly Consultant Cardiologists from the UK. Some of the recordings have had &gt;1000 views. Other than the video platform subscription, no cost was incurred in the delivery of this entire programme.
We collected feedback from 392 respondents (∼65 live attendees per webinar) from each session between Jan-Feb 2021. The sessions were rated as “very good-excellent” by 97%. We collected a further 145 extended responses from March 2021 attendees. 90% rated the whole series as “very good –excellent” in supporting their cardiology education during the Covid pandemic, and 84% felt the programme sufficiently covered even the more challenging areas of the curriculum (e.g. aortopathies). 90% of the respondents felt that their work-life schedule allowed them to join the live webinars. The respondents where predominantly from the UK (91%), though included an international audience (9%). Whilst 74% of attendees were cardiology trainees, the remaining 26% included physiologists, nurses, consultants and other junior doctors. 99% felt that virtual education should continue to play a formal part in their training after the COVID pandemic.

Conclusion
Webinars allow everyone interested in cardiac care across the world the opportunity to hear experts teach, and without a travel cost. They are cheap and easy to organise. This study suggests that webinars will remain an integral part of the post-COVID era.

Funding Acknowledgement
Type of funding sources: None.
A new clinical decision support tool based on personalized evidence-based medicine improves outcomes of anticoagulation therapy in patients with atrial fibrillation: an analysis from the AF registry
Authors: Pokushalov E , Losik D , Kozlova S , Konradi A , Sekacheva M , Ponomarenko A , Krivosheev Y , Mikheenko I , Kretov E , Steinberg J S 
Published: October 2021

Abstract

Background
New clinical decision support system (CDSS) MedicBK use algorithms for presents treatment suggestions in frame of guideline-based therapy and personalized evidence-based medicine (EBM) therapy.

Objective
We hypothesized that clinicians with access to CDSS (MedicBK) would provide more personalized EBM anticoagulation treatment and improve outcomes.

Methods
2683 patients at high risk for stroke and 1-year follow-up were enrolled in study and analyzed by CDSS and core laboratory. The primary endpoint was the quantify the performance of the CDSS (MedicBK) algorithm. Secondary endpoints include the following: outcomes for all-cause mortality, thromboembolism (TE), bleeding, and the composite endpoints.

Results
From 2683 patients, 1971 patients were core laboratory-classified as guideline adherent and 824 of them were personalized evidence-based therapy adherent. All 1971 (100%) patients were also detected as guideline adherent by CDSS, whereas only 748 (90.8%) were classified as personalized EBM adherent. The sensitivity for identifying patients with guideline and personalized EBM therapy adherence is therefore 100% and 90.8%. 712 and 1935 patients classified as guideline and personalized EBM therapy non-adherent by the core laboratory. All of them CDSS confirmed the absence of adherence, resulting in a specificity of 100%. The PPV and NPV of detecting with or without adherence to guideline, respectively, are 100% (1971 of 1971 pts) and 100% (712 of 712 pts). The PPV and NPV of detecting personalized EBM therapy adherence or non-adherence, respectively, are 100% (748 of 748 pts) and 96.1% (1859 of 1935 pts).
The composite endpoint of cardiovascular death, any thromboembolism (TE) or bleeding was significantly lower in personalized EBM adherent patients during 1-year follow-up (P=0.02) and increased risk by &gt;40% [HR 1.454 (95% CI 1.037; 2.040)], and non-guideline adherent and non-personalized EBM adherent treatment by &gt;110% [HR 2.113 (95% CI 1.453; 3.074)].

Conclusion
MedicBK appears to be promising to improve adherence to guideline and personalized EBM therapy in general practice. Personalized EBM anticoagulation management is associated with significantly better outcomes.

Funding Acknowledgement
Type of funding sources: None.
Assessment of cognitive dysfunction using the Montreal Cognitive Assessment test: rate, severity and comparison with the Clock test alone in a population of patients referred for TAVI
Authors: Monnin C , Besutti M , Ecarnot F , Guillon B , Chatot M , Chopard R , Yahia M , Meneveau N , Schiele F 
Published: October 2021

Abstract

Background
Although not recommended in routine practice, the detection and quantification of Cognitive Dysfunction (CD) in older patients might have an impact on clinical decisions. We assessed the rate and severity of CD in an unselected population of patients referred for Transcatheter Aortic Valve Implantation (TAVI) using the Montreal Cognitive Assessment (MoCA) and using the Clock Drawing Test (ClockT) alone.

Methods
The MoCA was performed before TAVI by an experienced operator. The ClockT was scored out of 10 points according to the Rouleau rating scale. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if &lt;10. Inter-observer reliability of scoring on the ClockT was estimated with the Bland-Altman method. Agreement between MoCA scores and the ClockT for ruling out and for detecting CD were measured with the Kappa coefficient.

Results
MoCA was performed in 83 consecutive patients referred for TAVI, median age 85 years. The mean time required for assessment was 11±2 min for the MoCA and 3±2 min for the ClockT. The mean MoCA score was 21±4.5: CD was excluded in 17 (20%) pts, mild CD was found in 50 (60%), moderate in 15 (18%) and severe in one (1%). The median ClockT score was 8 (interquartile 6; 9), with excellent inter-observer concordance (Kappa= 0.84). Overall, 51% of the variance of the MoCA score was explained by the ClockT alone according to multiple regression. A ClockT &lt;7 detected a group with significantly lower MoCA score, compared to pts with higher ClockT scores (figure).

Conclusion
Among patients referred for TAVI, CD can be excluded using the MoCA test in 20%, while moderate or severe CD is observed in 18%. The ClockT alone is faster to implement, reliable to interpret and enabled detection of patients with moderate CD when Rouleau scoring was &lt;7.

Funding Acknowledgement
Type of funding sources: None.
Continuous monitoring of advanced hemodynamic parameters shows early cardiovascular changes in a cohort of 492 COVID-19 hospitalized patients
Authors: Nachman D , Eisenkraft A , Maor Y , Constantini K , Goldstein G , Levy R , Halberthal M , Horowitz N A , Golan R , Rosenberg E , Lavon E , Cohen O , Shapira G , Shomron N , Gepner Y 
Published: October 2021

Abstract

Background
COVID-19 exerts deleterious cardiopulmonary effects, leading to worse prognosis in the most effected.

Purpose
The aim of this retrospective multi-center observational cohort study was to analyze the trajectories of key advanced hemodynamic parameters amongst hospitalized COVID-19 patients according to different risk populations using a chest-patch wearable providing continuous remote patient monitoring.

Methods
The study was conducted in five COVID-19 isolation units. Patients admitted to the units were connected to a photoplethysmography based noninvasive remote advanced hemodynamic monitor after completing a basic risk factor survey. Physiological parameters were measured every 15 minutes during the hospitalization, including cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), heart rate, blood pressure (BP), respiratory rate, blood oxygen saturation (SpO2), and body temperature.

Results
492 COVID-19 patients (179 females, average age 58.7 years) were included in the final analysis, with more than 3 million measurements collected during an average of 75.3 hours. Overall, within the first five days of hospitalizations we found a significant increase in SVR, and a significant decrease in SpO2, DBP, CO and CI (p&lt;0.01 for all). The changes were more prominent in high risk populations- males, older age and obesity and had a temporal correspondence to changes in respiratory parameters.

Conclusions
This is the first comprehensive continuous advanced hemodynamic profiling of COVID-19 patients. Worse hemodynamic status was prominent in high risk populations.

Funding Acknowledgement
Type of funding sources: None.
Is natural patient preconsultation data medically relevant for outpatient and primary care in cardiology?
Authors: Martins J , Couvert I , Ielissof C , Tettoni C , Boiron F , Ah-Leung T , Akkouche L , Mann H , Jamal F 
Published: October 2021

Abstract

Digital cardiology may improve the organization and efficiency of outpatient care. The patient direct contribution to medical data is an important cornerstone to save medical time, shorten the decision-making process and improve prevention. However, the medical impact of potential errors in this natural data is unclear.

Purpose
We aimed to evaluate and quantitate the errors and differences between data completed by patient and trained medical teams using a preconsultation medical form in cardiology.

Methods
476 consecutive patients scheduled for an outpatient cardiology consultation (January 2020) were included in the study in one medical center (among a database of more than 13000 patients). All patients had access to a secure digital platform and were encouraged to fill a preconsultation form (risk factors, symptoms and prior medical results). This data was completed and corrected, if necessary, during the medical consultation by a trained outpatient care team and compared to the information provided by patients. An error was defined as either a missing or a wrong value, and a percentage was calculated for each parameter.

Results
387 patients (83%) were included in the analysis (72 did not fill the preconsultation form, 8 did not show up for the appointment). The filling rate averaged 83.6±12%. The global error % averaged 16.5±5% (13.4% missing values). The following parameters had an error % of more than 10%: results of prior cardiac tests (echocardiography 43%, exercise test 25%, arterial Doppler 24%), history of renal failure (32%), Blood pressure value (23%), cholesterol level (20%), family cardiac history (15%), personal cardiac history (12%), history of diabetes (11%). All other parameters had an error % of less than 5% (symptoms, smoking, alcohol consumption, BMI). Despite these significant missing or erroneous data, the availability of this information allowed significant improvement of the care path and more than 80% of patients reported improved commitment and understanding of medical decisions.

Conclusion
Actively including patient in the medical care process is an important issue and is made easy using e-cardiology tools. The results of this study should be considered when building digital medical platforms. Some of the parameters with important errors should be verified from multiple sources before using them in the future decision-making algorithms.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): izyCardio digital e-cardiology companyCardioParc medical centers
Atrial fibrillation screening: feasible approaches and implementation challenges across Europe
Authors: Engler D , Hanson C , Desteghe L , Boriani G , Diederichsen S Z , Freedman B , Pala E , Potpara T , Witt H , Heidbuchel H , Neubeck L , Schnabel R B ,   AFFECT-EU
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) screening has the potential to increase early detection and possibly reduce complications of AF. Guidelines recommend screening, but the most appropriate approaches are unknown.

Purpose
We aimed to explore the views of stakeholders across Europe about the opportunities and challenges of implementing four different AF screening scenarios.

Method
This qualitative study included 21 semi-structured interviews with healthcare professionals and regulators potentially involved in AF screening implementation in nine European countries. Data were analysed using thematic analysis.

Results
Three themes evolved. 1) Current approaches to screening: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity by the reach of screening programmes being limited to those who access healthcare services. 2) Feasibility of screening approaches: single time point opportunistic screening in primary care using single lead ECG devices was considered the most feasible approach and AF screening may be possible in previously unexplored settings such as dentists and podiatrists. Software algorithms may aid identification of patients suitable for screening and telehealth services have the potential to support diagnosis. However, there is a need for advocacy to encourage the use of telehealth to aid AF diagnosis, and training for screening familiarisation and troubleshooting.
3) Implementation requirements: sufficient evidence of benefit is required. National rather than pan-European screening processes must be developed due to different payment mechanisms and health service regulations.
There is concern that the rapid spread of wearable devices for heart rate monitoring may increase workload due to false positives in low risk populations for AF. Data security and inclusivity for those without access to primary care or personal devices must be addressed.

Conclusions
There is an overall awareness of AF screening. Opportunistic screening appears to be most feasible across Europe. Challenges that need to be addressed concern health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit, and a tailored approach adapted to national realities.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020 Screening ScenariosGraphical abstract
Fast track triage for COVID-19 based on a population study: the SODA score
Authors: Lopez-Pais J , Lopez-Otero D , Gonzalez Ferrero T , Cacho Antonio C , Antunez Muinos P , Perez-Poza M , Jimenez Ramos V , Sestayo Fernandez M , Bastos Fernandez M , Sanmartin Pena X , Varela Roman A , Portela Romero M , Lopez Lago A , Perez De Juan Romero M A , Gonzalez Juanatey J R ,   CARDIOVID
Published: October 2021

Abstract

Background
Healthcare systems are under prominent stress due to the COVID-19 pandemic. A fast and simple triage is mandatory to screen patients who will benefit from early hospitalization, from those that can be managed as outpatients. There is a lack of all-comers scores, and no score has been proposed for western-world population.

Aims
To develop a fast-track risk score valid for every COVID-19 patient at diagnosis.

Methods
Single-center, retrospective study based on all the inhabitants of a healthcare area. Logistic regression was used to identify simple and wide-available risk factors for adverse events (death, intensive care admission, invasive mechanical ventilation, bleeding &gt;BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke).

Results
Of the total healthcare area population, 447.979 inhabitants, 965 patients (0.22%), were diagnosed with COVID-19. A total of 124 patients (12.85%) experienced adverse events. The novel SODA score (based on sex, peripheral O2 saturation, presence of diabetes, and age) demonstrated good accuracy for adverse events prediction (area under ROC curve 0.858, CI: 0.82–0.98). A cut-off value of &lt;2 points identifies patients with low risk (positive predictive value [PPV] for absence of events: 98.9%) and a cut-off of &gt;5 points, high-risk patients (PPV 58.8% for adverse events).

Conclusions
This quick and easy score allows fast-track triage at the moment of diagnosis for COVID-19 using four simple variables: age, sex, SpO2, and diabetes. SODA score could improve preventive measures taken at diagnosis in high-risk patients and also relieve resources by identifying very low-risk patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Receiver Operating Characteristic curve of SODA score to predict: A, adverse events (death, ICU admission, invasive mechanical ventilation, bleeding &gt;BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli or stroke). Area under curve 0.858, CI: 0.82–0.98, p&lt;0.001. B, mortality. Area under curve 0.89, CI: 0.58–0.94, p&lt;0.001.Figure 2. Percentage of adverse events in each punctuation of the SODA score (green) and percentage of patients without adverse events (blue). Adverse events: death, ICU admission, invasive mechanical ventilation, bleeding &gt;BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke.
The McGill World Restart a Heart 2020 Campaign: a student-led, patient-engaged, large-scale online simulation program
Authors: Levett J Y , Allard S B , Chamass E , Chami S , Ehlebracht A , Elbaz S , Essebag A , Skiadopoulos C , Bhanji F ,   The McGill WRAH 2020 Campaign Committee
Published: October 2021

Abstract

Background
Cardiac arrest is a leading cause of death, with the majority of cases occurring in homes or public places. Up to 55% are witnessed by family members, colleagues or friends, yet most victims don't receive cardiopulmonary resuscitation (CPR), which can triple the odds of survival. Mortality therefore remains high at over 90%. Enhancing bystander CPR skills is a crucial public health investment.

Objective
Engage the Canadian and global community in a thought-provoking and immersive experience to explore cardiac arrests, destigmatize bystander CPR, and enhance resuscitation knowledge and skills. Partner with patients, leverage innovative technologies, and social media, to develop a digital scalable simulation/educational exercise.

Methods
Interprofessional healthcare students from the Faculty coordinated a University World Restart a Heart (WRAH) 2020 Campaign as part of a global initiative. Amplified by social media influencers, the Campaign team produced a bilingual digital Campaign with succinct and high-impact videos including survivor and non-survivor family perspectives, digital live events, a patient education guide for families of cardiac arrest patients, and an open access eModule. Our Steering Committee comprised University leadership, intensive and emergency care physicians, a cardiac arrest survivor, and the communications team from the Faculty, Centre for Simulation and Interactive Learning, and University Health Centre.

Results
The Campaign garnered an international audience with over 74,636 impressions across social media platforms (Facebook, Instagram, and Twitter), 42,600 views of Campaign videos, and 1,500 views of hour-long webinars. Campaign ambassadors had a combined viewership of over 500,000 followers, and included astronaut physicians, Olympic athletes, adult and pediatric cardiac arrest survivors, and social media influencers. The Campaign launched an innovative bystander resuscitation eModule that delivers scalable screen-based simulation. The patient education guide, in collaboration with the University Health Centre's Patient Education Office, focuses on the chain of survival and expectations for acute management, hospitalization and recovery.

Conclusion
Tens of thousands of individuals reached through the University WRAH 2020 Campaign are now empowered to initiate CPR, which may help reduce the morbidity and mortality of cardiac arrests.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The McGill Fund.
A United States national analysis of basic demographics and commodities in sudden cardiac arrest
Authors: Ji S , Yepes I 
Published: October 2021

Abstract

Background
Cardiac arrest is a condition associated with high mortality rate and can cause significant social-economical burden in United States. Our study aim is to analyze the basic demographic of patients admitted for cardiac arrest and the incidence of complications following cardiac arrest.

Methods
Using the National Inpatient Sample from 2016–2018, we identified all the hospital admissions with a primary diagnosis code at discharge for cardiac arrest during the study period. We identified the basic characteristics including age, gender, race and admitting hospital status. The set primary outcome was inpatient mortality, length of stay (LOS) and total costs of admission. The secondary outcomes were the incidence of acute kidney injury, acute blood loss anemia, acute embolism and thrombosis of deep veins of lower extremity (DVT), pulmonary embolism, non-traumatic intracranial hemorrhage, and thromboembolic stroke. Multivariable logistic regression model analysis was performed to address potential confounders. The Charlson Comorbidity Index (CCI) was used to adjust for the severity of each patient's co-morbidities.

Results
A total of 44,655 patients was admitted for cardiac arrest during the study period. Mean age was 64 years; 56% were men; 63% were white, 20.7% were black, 9.2% were latino, 2.8% were Asian or pacific Islander. The total in-hospital mortality was 73.5%. The average length of stay was 4.2 days and the average total costs of admission was 83,516 dollars. Among the seven demographic characteristics: age, gender, race, hospital size, hospital region, hospital teaching status, insurance type; only hospital teaching status and hospital size were found to significantly impact the mortality. Acute kidney injury was the most common complication in post-cardiac arrest patient (42%), followed by acute blood loss anemia (3.6%), pulmonary embolism (2.3%) and DVT (2.1%). Thromboembolic stroke (0.2%) and non-traumatic intracranial hemorrhage (0.1%) are less common. During subgroup analysis, acute kidney injury was also found out to be a predictive factor of increased mortality (OR 1.64, p&lt;0.001).

Conclusion
Cardiac arrest remains one of the conditions with highest mortality rate. In our study, age, gender or race dit not impact on the outcome of cardiac arrest. Among all the complications from cardiac arrest, acute kidney injury was the most common one and was associated with higher mortality rate.

Funding Acknowledgement
Type of funding sources: None.