bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of the COVID-19 pandemic on offering and acceptance in a cardiac rehabilitation programme: introduction of a remote CR programme
Authors: Sestayo Fernandez M , Alonso Vazquez M , Gonzalez Maestro A , Gonzalez Salvado V , Gonzalez Juanatey J R , Pena Gil C 
Published: October 2022

Abstract

Background
The impact of the COVID-19 pandemic on multimodal cardiac rehabilitation (CR) programmes has forced a continuous readjustment of clinical practice. Our regional healthcare system was faced with providing quality remote CR to ischaemic heart disease (IHD) patients in a scattered, mostly rural population, for which three new CR modalities replaced the previous in-person CR program: 1) telephone follow-up programme, 2) TELEA online platform for patient follow-up and 3) TELEA online follow-up & online training sessions.

Purpose
To study the impact of the COVID-19 pandemic on CR offering and acceptance and the reasons for patient refusal, and to assess the outcome of new remote CR modalities in this setting.

Methods
Single center, observational retrospective study from all consecutive patients with IHD eligible for CR from 2015 to 2021. A descriptive analysis of patient baseline characteristics, CR modality, offering and acceptance rates, and reasons for refusal per year was performed. Additionally, a comparative analysis of “pre-COVID period” (Jan 2015–Feb 2020) vs. “COVID period” (Mar 2020–Dec 2021) was performed to assess the impact of the pandemic on patient recruitment and the usefulness of remote CR modalities to enhance participation.

Results
N=2626 patients (20% women, 69.7±45.8 years) were offered CR from 2015 to 2021. CR offering decreased from the pre-COVID (78.6%) to the COVID period (52.6%), while participation increased (67.9% and 79.7%, respectively) Figure 1. Reasons for CR refusal significantly changed with an odds ratio (OR) of 5.63 and confidence interval (CI) 95% (3.2–9.9). In the pre-COVID period main reasons for CR refusal was “transportation difficulties” (47%); while during the COVID-19 period, the main reason shifted to “lack of interest” (78.2%) (Table 1).

Conclusions
Offering CR decreased during the COVID pandemic possibly due to stricter inclusion criteria. However, the implementation of new remote CR modalities allowed not only to maintain similar levels of acceptance but also to improve it despite the unfavourable setting, and helped to amend transportation difficulties as the leading reason for refusal. Remote CR may be a useful tool, combined with in-person programs, to enhance participation in CR.

Funding Acknowledgement
Type of funding sources: None.
Do patients prefer face-to-face or telephone consultations in an outpatient cardiology department?
Authors: Goode C , Manorekang R , Durham N 
Published: October 2022

Abstract

Introduction
There has been a significant rise in the telephone clinic consultations in preference to face-to-face (FTF) clinics in the UK during the COVID 19 pandemic. The cardiology department in a district general hospital has also seen increased use of telephone clinics. We wanted a greater understanding of the impact of telephone consultations on patient satisfaction.

Methods
A patient satisfaction survey was designed based on the joint Royal College of Physicians training board (JRCPTB) patient satisfaction survey. The survey (Image 1) was sent via post to 300 patients reviewed by the cardiology outpatient department during November 2021. 150 who had telephone appointments and to 150 patients who had FTF appointments. Descriptive statistics and student T test were used to compare differences between the two groups with a p value of &lt;0.05.

Results
There were 171 responses returned over a four-week period giving a 57% response rate. Of these, 75 respondents had a telephone appointment and 96 who had FTF appointments. 49% of the FTF patients were male compared to 55% of the telephone clinic respondents. The majority of patients were aged 70–89 in both groups and most patients were retired (79.2% for FTF and 65.3% on the telephone consultation group).
More patients felt the doctor was polite and considerate in FTF clinics compared to telephone consultation (97% compared to 92% positive responses, p value – 0.02). There was no significant difference in patients feeling listened too, being allowed time to ask questions, understanding their condition and being involved in decision making between the two groups (Table 1).
Of the FTF group, 81% preferred FTF clinics with only 3% preferring telephone clinics and 16% with no preference. Of the telephone group 53% stated a preference for FTF clinics, with 11% having a preference for phone clinics and 36% having no preference.
Patients rated overall experience more positively with FTF appointments (95%) compared to telephone clinics (85%, p value 0.02).

Conclusion
Telephone consultations performed at a comparable level to FTF clinics although patients demonstrate an overall preference for FTF clinics.

Funding Acknowledgement
Type of funding sources: None.
Machine-learning score using stress CMR for death prediction in patients with suspected or known CAD
Authors: Pezel T , Sanguineti F , Garot P , Unterseeh T , Champagne S , Toupin S , Morisset S , Hovasse T , Ah-Sing T , Nicol M , Hamzi L , Dillinger J G , Henry P , Bousson V , Garot J 
Published: October 2022

Abstract

Background
In patients with suspected or known coronary artery disease (CAD), traditional prognostic risk assessment is based upon a limited selection of clinical and imaging findings. Machine learning (ML) methods can take into account a greater number and complexity of variables.

Purpose
To investigate the feasibility and accuracy of ML using stress CMR and clinical data to predict 10-year all-cause mortality in patients with suspected or known CAD, and compared its performance to existing clinical or CMR scores.

Methods
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range: 5.0–8.0) included all consecutive patients referred for stress CMR. Twenty-three clinical and 11 stress CMR parameters were evaluated. Machine learning involved automated feature selection by random survival forest, model building with a multiple fractional polynomial algorithm, and 5 repetitions of 10-fold stratified cross-validation. The primary outcome was all-cause death based on the electronic National Death Registry. The external validation cohort of the ML score was performed in another center.

Results
Of 31,752 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2,679 (8.4%) died with 206,453 patient-years of follow-up. ML score (ranging 0 to 10 points) exhibited a higher area-under-the-curve compared with C-CMR-10-score, ESC-score, QRISK3-score, FRS and stress CMR data alone for prediction of 10-year all-cause mortality (ML: 0.76 vs. C-CMR-10-score: 0.68, ESC-score: 0.66, QRISK3-score: 0.64, FRS: 0.63, extent of inducible ischemia: 0.66, extent of LGE: 0.65, all p&lt;0.001). The ML score exhibited also a good area-under-the-curve in the external cohort (AUC: 0.75).

Conclusions
The ML score including clinical and stress CMR data exhibited a higher prognostic value to predict 10-year death compared with all traditional clinical or CMR scores.

Funding Acknowledgement
Type of funding sources: None.
Impact of ambulance off-load delays on mortality in patients with chest pain
Authors: Dawson L , Andrew E , Stephenson M , Nehme Z , Bloom J , Cox S , Anderson D , Lefkovits J , Taylor A J , Kaye D , Smith K , Stub D 
Published: October 2022

Abstract

Background
Ambulance off-load delays in transferring patient care to emergency departments (EDs) are increasingly common, but it is unclear whether clinical outcomes are impacted.

Methods
Population-based cohort study of ambulance attendances for non-traumatic chest pain transported to ED in Victoria, Australia (1/1/2015–30/6/2019) excluding patients transported to hospital with “lights and sirens” or triaged as ED category 1. Multivariable models were used to assess the relationship between ambulance off-load times and 30-day mortality and ambulance re-attendance for chest pain.

Results
The study included 213,544 ambulance attendances for chest pain (mean age 62 [SD 18] years; 51% female). Median ambulance off-load times increased across the study period from 21 minutes (interquartile range [IQR] 15–30) in 2015 to 24 minutes (IQR 17–37) in 2019. Patients were divided into tertiles according to off-load times with 69,247 patients included in tertile 1 (0–17 minutes), 73,109 patients in tertile 2 (18–28 minutes), and 71,188 patients in tertile 3 (&gt;28 minutes). In multivariable models, ambulance off-load delays were associated with higher unadjusted and adjusted rates of 30-day mortality (1.57% tertile 3 vs. 1.29% tertile 1, adjusted risk difference 0.28% [95% CI 0.16% - 0.42%], p&lt;0.001) and ambulance re-attendance for chest pain (9.89% tertile 3 vs. 8.59% tertile 1, adjusted risk difference 1.30% [95% CI 1.00% - 1.61%], p&lt;0.001). Similarly, in analysis using off-load times as a continuous variable with restricted cubic splines, a non-linear increase in adjusted odds ratio for mortality was observed (Figure 1).

Conclusions
Delays in ambulance off-load times appear to be associated with increased mortality and ambulance re-attendance risk among chest pain cohorts. This study has important policy implications given the increasing frequency of off-load delays in many healthcare settings.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Alfred health
Impact of estimated pulse wave velocity on cardiovascular outcomes in a general population
Authors: Kim B S , Lee Y , Shin J H 
Published: October 2022

Abstract

Background
Estimated pulse wave velocity (ePWV), a simple surrogate estimate of carotid-femoral pulse wave velocity which was gold standard for measuring aortic stiffness, has been demonstrated to predict cardiovascular (CV) outcome. However, there was limited data on its predictive capacity for CV outcomes in the general population. The study aim was to investigate the independent association between ePWV and CV outcomes in general population.

Methods
A total of 10,030 subjects aged between 40 and 69 years were followed over 18-year period in the Ansan-Ansung cohort study. Levels of ePWV, which was calculated from an equation based on age and mean blood pressure, were categorized according to quartiles. A major adverse cardiovascular event (MACE) was defined as a composite of myocardial infarction, coronary artery disease, stroke, heart failure, peripheral artery disease, and cardiovascular death.

Results
The incidence rates of CV death, and MACE were 7.0% and 22.1% in the fourth (highest) quartile of ePWV and 0.1% and 4.5% in the first (lowest) quartile of ePWV. After adjusting for relevant covariates, patients with third and fourth quartile of ePWV showed significantly higher risk of CV death (hazard ratio [HR] 3.92; 95% confidence intervals [CI] 1.09–14.15 in third quartile and HR 8.53; 95% CI 2.13–34.10 in fourth quartile), and MACE (HR 1.54; 95% CI 1.15–2.08 in third quartile and HR 1.56; 95% CI 1.05–2.32) compared to the reference of first (lowest) quartile of ePWV. However, there were no improvement of C statistic for CV death and MACE when adding ePWV to the Cox regression models with 10-year atherosclerotic cardiovascular disease (ASCVD) risk.

Conclusion
These results suggest that ePWV predicted CV death and MACE in general population. The value of ePWV, a simple and useful indicator of aortic stiffness, is expected to serve as a potential marker to identify high risk groups of CV event in general population.

Funding Acknowledgement
Type of funding sources: None.
Time matters. Global assessment of quality, duration and mismatch between real practice working conditions and physician needs performing outpatients cardiological consultations
Authors: Sala O , Moscatelli S 
Published: October 2022

Abstract

Background
Nowadays time-shortage to perform medical consultations is a common issue of cardiologist practice worldwide.

Purpose
The aims of this work are to assess the practical working conditions in which outpatient cardiologists work, the severity of the time-pressure issue, what impact time shortage has in terms of work accuracy and the local differences across the World.

Methods
A multiple choice survey was submitted randomly to participants during the ESC congress in presence (2019) and throughout several social media pages of Physicians Associations. The respondents were asked about available time for single outpatient consultation, additional staff available, respect of ESC guidelines and a self evaluation over their own job quality and avoidable time-related mistakes. The respondents were 60 cardiologists from 22 countries, mostly Europeans.

Results
Most cardiologists suggested that the appropriate time for consultation should be between 30 and 45 minutes, while in the real World is commonly 20 minutes or less. Time-pressure affects the outcome since inadequate time allocation is a significant source of inaccuracies. Furthermore the results likely underestimate the severity of the problem, for several methodological limitations of the study

Conclusions
Scientific associations should define a recommended minimum outpatient consultations execution time, since time affects quality and it is a current unmatched clinician's need worldwide.

Funding Acknowledgement
Type of funding sources: None.
Improving the provision of accurate driving advice to cardiac inpatients on discharge – a matter of both public and patient safety
Authors: Nair D , Rees O , Harbham P 
Published: October 2022

Abstract

Background/Introduction
Cardiovascular disease can have a significant impact on an individual's ability to drive. The Driver and Vehicle Licensing Agency (DVLA) provides clear guidance on the legal obligation and limitations of drivers with cardiac conditions and the General Medical Council (GMC) sets out the responsibility of physicians' in providing and documenting this advice clearly. Failure to adhere to these requirements has safety implications for both patients and the public, and medico-legal implications for practitioners.

Purpose
We sought to audit the percentage of patients receiving the correct driving advice on discharge and improve any inadequacies found through a two-stepped intervention in a tertiary cardiac centre

Methods
A retrospective analysis of the clinical notes of patients discharged from cardiac wards over a 3-week period was conducted and documentation of accurate driving advice was assessed. Using Plan-do-study-act (PDSA) methodology, two cycles of change were implemented.
During PDSA cycle 1, a poster outlining cardiology specific DVLA advice was created. The poster was displayed throughout all cardiac wards to educate and encourage healthcare workers to communicate and document driving advice to patients.
During PDSA cycle 2 a teaching session highlighting relevant DVLA advice and the importance of documenting this advice was delivered to all healthcare workers within the Cardiology department. The poster was also integrated into the department's staff induction booklet.

Results
The baseline audit showed that only 2.5% (1/40) of discharge documentation included accurate driving advice. After the second PDSA cycle, there was a statistically significant improvement to 52.5% (21/40) (P&lt;0.0001). Qualitative feedback was obtained in the form of questionnaires and it was found that confidence and knowledge of driving advice improved amongst the junior doctor cohort.

Conclusion
This study highlights the medico-legal implications for physicians and the risks to patient and public from inadequate documentation of driving advice in cardiac patients. We have demonstrated a quick and effective method to improve documentation of driving advice in cardiology patients which is easily reproducible in different settings.

Funding Acknowledgement
Type of funding sources: None.
Association between cardiovascular comorbidities and hospital admission in SARS-CoV-2 patients
Authors: Douen A D , Tan S T , Siu W S , Panetti R P , Sukoo-Pertab M S , Bowser C B , Busari O B , Romney W R , Ramdass P R , Juang G J , Toreli A T 
Published: October 2022

Abstract

Background
SARS-CoV-2 infection affects the cardiovascular system and can result in vascular dysregulation and dysfunction. However, the hospitalization rates due to pre-existing cardiovascular disease and concomitant SARS-CoV-2 infection are not fully known.

Purpose
To further elucidate the association between hospitalization and SARS-CoV-2 patients with pre-existing cardiovascular disease. We hypothesize that pre-existing cardiovascular disease is positively associated with hospitalization in patients who test positive for SARS-CoV-2.

Methods
This is a retrospective study of patients 18 years and older who tested positive for SARS-CoV-2 between March 2020 and April 2021. Patients with cardiovascular co-morbidities, specifically hypertension, coronary artery disease (CAD), heart failure, were analyzed. The primary outcome was hospitalization. Secondary outcomes were all-cause mortality, myocardial infarction (MI), vasopressor use, hypotension, intubation, and acute kidney injury. Multivariate logistic regression analysis adjusted for demographics and comorbidities.

Results
We identified 23,076 patients who tested positive for SARS-CoV-2; the hospitalization rate was 11.8% (2,721 patients). The incidence was 722 (26.5%) for CAD, 2068 (76%) for hypertension, 534 (91.3%) for heart failure, 188 (6.9%) for ESRD, 1484 (58.6%) for diabetes in patients who were hospitalized. The adjusted odds ratio (OR) of hospitalization was of 1.54 (95% Confidence Interval [CI]: 1.112–2.125; p&lt;0.009) in patients with CAD, 5.730 (95% CI: 4.685–7.009; p&lt;0.001) in patients with hypertension, 3.639 (95% CI: 2.308–5.737; p&lt;0.001) in patients with heart failure. Use of angiotensin-converting enzyme inhibitor (ACEI) (p&lt;0.001) was associated with reduced hospitalization, while the use of hydralazine (p&lt;0.001), beta-blockers (p&lt;0.001), and calcium channel blockers (p&lt;0.001) were associated with increased hospitalization.

Conclusion
SARS-CoV-2 positive patients with CAD, hypertension or heart failure were associated with increased hospitalization. Admitted patients were more likely to be taking calcium channel blockers, beta-blockers, and hydralazine. In contrast, these patients were also less likely to be taking ACEI.

Funding Acknowledgement
Type of funding sources: None.
The effect of COVID-19 on training in cardiology: a survey of UK cardiology trainees
Authors: Camm C J F , Chapman A R , Gilpin T R , Westwood M , Greenwood J P , Calver A , Allen C J 
Published: October 2022

Abstract

Background
The COVID-19 pandemic has had an unprecedented impact on delivering cardiology services. In the UK and many other countries, cardiologists in training were redeployed to other services. To date, the impact of COVID-19 and the requisite NHS response on cardiology training has been unclear.

Purpose
To assess the impact of the COVID-19 pandemic on cardiology training in the UK.

Methods
An annual survey of UK cardiology trainees was conducted through the national trainee organisation. In 2021, trainees were asked questions regarding their training experience, procedural exposure, and how they had been impacted by COVID-19. Reported procedural numbers were compared with those reported in 2017–2019. Chi squared analyses were used to compare categorical variables with Mann-Whitney U tests used for continuous variables.

Results
A total of 576 trainees completed the survey (70% male, mean age 33±3 years). Of 545 respondents who detailed the impact of COVID-19 on training opportunities, 70.5% (n=384) reported a negative or very negative impact. A similar picture was seen when asked about procedure, diagnostic, and outpatient training opportunities (Figure 1). Those completing core cardiology training in 2021 reported performing significantly fewer coronary angiograms (median 170, IQR 85–315) compared with those completing core cardiology training 2017–2019 (median 285, IQR 165–460, p&lt;0.001).
Fifty percent of trainees (n=285) reported being redeployed for a median duration of 4 months (IQR 3–5 months). There was substantial regional variation in both the proportion of trainees redeployed (Figure 2, p&lt;0.001) and the median length of redeployment (p=0.008). Those redeployed were more likely to report negative training experiences as a result of COVID-19 (p&lt;0.001). Redeployed trainees completing core cardiology training in 2021 reported undertaking significantly fewer echocardiograms (median 205, IQR 100–300) compared with those not redeployed (median 280, IQR 200–300, p=0.01). Thirty-five percent of all trainees reported being close to burnout, with redeployed trainees being more likely to feel this way (p&lt;0.001). When asked about methods to redress lost training opportunities, 37% of trainees wanted to prolong their training time with a median of 6 months felt to be required (IQR 6–8 months).

Discussion
This large survey of the UK experience illustrates the substantial negative impact of COVID-19 on the quality of cardiology training. Redeployment alone resulted in an estimated 95 person-years of lost training time. Coordinated national and regional strategies are required to avoid the creation of a generation of under-trained consultant cardiologists.

Funding Acknowledgement
Type of funding sources: None.