Adult Cardiology Research Articles

Mean Levels of B-type Natriuretic Peptide (BNP) in Patients with Mitral Stenosis Caused by Rheumatic Heart Disease

Objective: Mitral stenosis caused by rheumatic heart disease (RHD) is the most common cause of valvular lesion in adults and prevalent in developing countries like Pakistan. Higher natriuretic peptide (BNP) levels can be observed in patients with moderate to severe untreated mitral stenosis and are associated with higher rates of morbidity and mortality. That is why this study aims to determine the association between levels of pro-BNP with severity (mild. Moderate, and severe) of mitral stenosis.
 Patients and Methods: This was a clinical prospective study carried out in the department of adult cardiology, national institute of cardiovascular diseases, Karachi from 8th august 2019 to 7th February 2020. Total 68 patients of either gender with age between 25-70 years had mitral stenosis of moderate to severe intensity (mitral valve area ≤1.5 cm2), diagnosed on echocardiography were included for final analysis. A simple blood sample was taken for the assessment of pro-BNP levels. Questionnaire was used for demographic & clinical data collection and analysed using SPSS version 22.0.
 Results: The overall mean age of study subjects was 42.21±11.50 years, ranging from 25 – 70 years. Among them, females were prevalent (n = 43, 63.2%). The overall mean serum BNP level was 1071.12±807.26 pg/ml and the mean difference of serum BNP level was not significant among groups of gender, age, and diabetes mellitus with p>0.05. Significantly raised levels of BNP were observed in patients with severe mitral stenosis as compared to moderate mitral stenosis, p<0.05
 Conclusion: In conclusion, the mean BNP levels were higher in patients with severe Mitral Stenosis. Therefore, BNP may be used to complement the clinical and echocardiographic assessments in patients with Mitral Stenosis.

Short- and Mid-Term Autograft Outcomes Following the Reinforced Ross Operation

The Ross operation for aortic valve replacement continues to be a controversial option because of concerns related to late autograft dilation and progressive neo-aortic insufficiency. In 2005, the reinforced Ross procedure was described at our institution to address this problem. We aim to analyze the short and mid-term outcomes following this procedure. This is a retrospective study of patients who underwent the reinforced Ross operation between 2004 and 2019. A comprehensive chart review was performed. Echocardiograms were independently reviewed by an adult congenital cardiologist. The time to reintervention was evaluated with a Kaplan-Meier curve. Analysis was conducted in JMP 15.1 (SAS Inc., Cary, NC). Twenty-five patients underwent the reinforced Ross operation. Twenty-three patients (92%) had bicuspid aortic valve and the most common indication for surgery was a combination of aortic insufficiency and stenosis (n = 18, 72%). The mean follow-up was 6.1 ± 5.0 years. All patients were alive at the time of follow-up. Six patients (24%), from early in our experience, required subsequent aortic reintervention. Median time to reintervention was 41.8 months (0-81.5 months). Sixteen (64%) patients had less than moderate aortic insufficiency at last follow-up. Additionally, average aortic root measurements remained unchanged. The reinforced Ross technique was initially proposed as a way to mitigate aortic root dilation seen in the traditional Ross procedure. Our experience suggests an associated learning curve with the majority of aortic reinterventions occurring within the first few years following surgery. Continued follow-up is warranted to assess its long-term durability and functionality.

Endangered patients with congenital heart defect during transition-Germany-wide evaluation of medical data from National Register for Congenital Heart Defects (NRCHD).

Appropriate care over the entire lifespan is essential in the population with congenital heart defect since the number of patients with congenital heart defect is increasing steadily worldwide. More than 90% survive into adulthood nowadays. The transition from pediatric to adult care in patients with congenital heart defect is a major challenge in clinical practice and often fails. Patients with congenital heart defect are generally at higher risk for different acquired secondary diagnoses. This cross-sectional retrospective study analysed data from the German National Register for Congenital Heart Defects to gain insight into the clinically relevant health-status of the transition population among congenital heart defect patients in Germany. Adolescents and young adults with congenital heart defect between the ages of 15 to 25 years (which have been defined as the transition generation) were identified using the National Register of Congenital Heart Defects medical database. Out of 55,687 patients with congenital heart defect, 8,834 adolescents and young adults with congenital heart defect [4,063 female (46.0%); 20.3±3.1 years] were included in the statistical analyses. Statistical analyses were conducted using the student's t-test, χ2-test and Fisher's exact test. Severity of congenital heart defect: simple (23.4%), moderate (45.1%) and complex (31.5%). Most common congenital heart defect: atrial septal defects (14.9%) followed by ventricular septal defects (12.8%) and tetralogy of Fallot (10.5%). Most frequent acquired cardiac diagnosis: arrhythmia (25.5%) followed by secondly pulmonary hypertension (4.5%) and thirdly systemic arterial hypertension (3.6%). Almost 10% had chromosomal abnormalities and other genetic syndromes. Patients had neurological defects overall with 7.3%, followed by musculoskeletal defects with 6.9% and psychological disorders with 5.6%. Adolescents and young adults with congenital heart defect need to bridge the gap between pediatric and adult cardiology as they already show up to 4 cardiac and up to 7 extracardiac acquired secondary diagnoses during the transition period. Otherwise, early detection of an acquired secondary diagnosis, which affects the lives of young adults with congenital heart defect, fails with all its consequences. Transition; congenital heart defect (CHD); epidemiology; health services; National Register for Congenital Heart Defects (NRCHD).

PH Roundtable: Genetics and Pulmonary Hypertension

PH Roundtable: Genetics and Pulmonary Hypertension

Frequency of Atrial Fibrillation in Heart Failure Patients

Background: An increasing number of people around the world suffer from cardiovascular diseases such as atrial fibrillation (AF) and heart failure (HF). Atrial fibrillation (AF) has been linked to poor prognosis in heart failure (HF) patients with mild to moderate LV dysfunction, and it is most prominent in these patients. Despite advancements in care and treatment options like catheter ablation, managing AF is still a therapeutic challenge even with these advances. Aim/Objective: To determine the frequency of atrial fibrillation in heart failure patients. Subjects and Methods: This cross-sectional study was conducted on 246 patients at Adult Cardiology, NICVD, Karachi for Six months after approval from 31-08-2019 till 29-02-2020. Patients' consent was obtained verbally before data were collected prospectively. There were 246 patients with heart failure who had been diagnosed and met the diagnostic criteria. An overview of the event's history was gathered, as well as demographic data. Qualitative variables were presented as frequency and percentages, while quantitative data were given as simple descriptive statistics such as mean and standard deviation. A p-value of 0.05 or lower is considered statistically significant. Results: A total of 246 patients with heart failure were included in this study. The mean age in our study was 56.78±2.81 years. Whereas, mean BNP and ejection fraction in our study was 1144±87.81 pg./ml and 34.65±4.14 %. 136 (55.3%) were male and 110 (44.7%) were female. Out of 246 patients with heart failure, 52 (21.1%) had atrial fibrillation and 194 (78.9%) did not have atrial fibrillation. Conclusion: The results of this research demonstrated that a large percentage of heart failure patients had atrial fibrillation. Thus, it is essential to focus on a comprehensive way of management of heart failure and its comorbidities rather than primarily treating the cardiac symptoms. Keywords: Heart failure and atrial fibrillation.

In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients Presenting with Sustained Ventricular Arrhythmias before Revascularization

Objective: To determine the in-hospital outcomes after primary percutaneous coronary intervention (PCI) of patients with acute ST-segment elevation myocardial infarction (STEMI) and develop sustained ventricular arrhythmia before revascularization. Methodology: This prospective observational study was conducted at the Department of Adult Cardiology, National Institute of Cardiovascular Diseases, from August 31, 2019, to February 29, 2020. All patients with STEMI who had developed sustained ventricular arrhythmias and underwent revascularization via primary PCI were included. The patients were kept under observation during their hospital stay to document in-hospital mortality. Data analysis was done using SPSS version 20. Results: Total 146 patients were included with a mean age of 54.41±12.75 years. There were 93 (63.7%) males and 53 (36.3%) females. When risk factors were assessed, hypertension was noted in 82 (56.2%) patients, diabetes mellitus in 62 (42.5%), 65 (44.5%) were smokers., and 49 (33.6%) were obese. There were 53 (36.3%) patients with a family history of ischemic heart disease. In-hospital mortality was documented in 28 (19.2%) patients. When stratification was done, significant associations were seen with hypertension (p=0.025), diabetes mellitus (p=0.002), and family history (p=0.003). Conclusion: It is to be concluded that mortality is considerably high after PCI in patients with STEMI who developed sustained ventricular arrhythmia before revascularization. Obesity, family history, and diabetes contribute directly to the development of MI. More epidemiological studies are necessary to evaluate risk factors of in-hospital mortality in this already compromised group of patients Keywords: Revascularization, Myocardial Infarction, Sustained Ventricular Arrhythmias, ST-Segment

Influence of Smoking on The Location of Acute Myocardial Infarctions

Objective: To determine the frequency of smokers and to compare the frequency of smokers among patients with inferior and anterior acute myocardial infarction amongst patients presenting with acute myocardial infarction at a Tertiary Care Hospital. Subjects And Methods: This cross-sectional study was conducted on 226 at the Adult Cardiology Department of the National Institute of Cardiovascular Disease (NICVD), Karachi for six months from 20-07-2019 till 20-01-2020. After obtaining verbal consent, researchers prospectively collected data from the participants. The study included 226 patients who were diagnosed with the appropriate conditions. Frequency and percentages were used to present qualitative data, while mean and standard deviation were used to present quantitative data. To see how to effect modifiers affected the outcome, researchers used stratification to keep track of them. For statistical significance, the post-stratification chi-square test was used. Results: A total of 226 presenting with acute myocardial infarction were included in this study. The mean age in our study was 55.92±10.49 years. Out of 226 patients with acute myocardial infarction, 130 (57.5%) and 96 (42.5) smoked and did not smoke respectively. Comparison of smoking status in patients who had anterior and inferior myocardial infarction showed that 39 (53.4%) and 51 (51%) smoked respectively. Conclusion: Smoking is a well-recognized strong modifiable risk factor and predictor of multivessel disease. Smoking cessation has been consistently associated with a mortality benefit in both stable coronary artery disease and post-acute coronary syndromes. Consequently, smoking cessation is one of the cornerstones of secondary prevention despite the improvement in the management of ACS with PCI and pharmacotherapy Keywords: Smoking, coronary vessels, territory and ST elevated myocardial infarction.

Fellowship program directors and trainees across the United States find parental leave policies to be inconsistent, inaccessible, and inadequate.

IntroductionDetermine the consistency, accessibility, and adequacy of parental leave policies for adult and pediatric medicine fellowship programs.MethodsWe administered a 40-question survey to fellowship program directors (PDs) and trainees in adult and pediatric cardiology, hematology/oncology, gastroenterology, and pulmonology/critical care fellowship programs in the United States. We used Chi-square tests to compare proportions for categorical variables and t-tests to compare means for continuous variables.ResultsA total of 190 PDs from 500 programs (38.0%) and 236 trainees from 142 programs (28.4%) responded. Most respondents did not believe that parental leave policies were accessible publicly (322/426; 75.6%), on password-protected intranet (343/426; 80.5%), or upon request (240/426; 56.3%). The PDs and trainees broadly felt that parental leave for fellows should be 5–10 weeks (156/426; 36.6%) or 11–15 weeks (165/426; 38.7%). A majority of PDs felt that there was no increased burden upon other fellows (122/190; 64.2%) or change in overall well-being (110/190; 57.9%). When asked about the biggest barrier to parental leave support, most PDs noted time constrains of fellowship (101/190; 53.1%) and the limited number of fellows (43/190; 22.6%). Trainees similarly selected the time constraints of training (88/236; 37.3%), but nearly one-fifth chose the culture in medicine (44/236; 18.6%). There were no statistically significant differences in answers based on the respondents’ sex, specialty, or subspecialty.DiscussionParental leave policies are broadly in place, but did not feel these were readily accessible, standardized, or of optimum length. PDs and trainees noted several barriers that undermine support for better parental leave policies, including time constraints of fellowship, the limited number of fellows for coverage, and workplace culture. Standardization of parental leave policies is advisable to allow trainees to pursue fellowship training and care for their newborns without undermining their educational experiences.

Abstract 9151: Impact of Adult Congenital Cardiologists on the Care of Adults With Congenital Heart Disease

Introduction: The adult congenital heart disease (ACHD) population has unique medical needs requiring specialized care. We evaluated the association between ACHD physician visits and guideline-adherent care in a cohort of insured ACHD patients. Methods: The Michigan Value Collaborative claims registry was queried for patients aged 18+ with ICD-10 codes for congenital heart disease (CHD) who had continuous insurance coverage from 1/2016 to 12/2020. Anatomic disease severity was stratified as simple or moderate/complex based on 2018 ACC/AHA ACHD guidelines. Patients were counted as seeing an ACHD physician if they had a single claim with a board-certified ACHD physician in Michigan during the 5-year period. Patient distance to nearest ACHD physician clinic was assessed based on home zip code. ACHD guideline adherence was defined as receiving one echocardiogram (all patients), two echocardiograms (moderate/complex disease), cross-sectional imaging (coarctation of the aorta), and/or liver imaging (single ventricle) during the 5-year period. Results: A total of 3,636 ACHD patients were identified with 17.9% (N=650) having moderate/complex CHD. ACHD physicians saw 3.4% (N=103/2986) of patients with simple disease and 23.4% (N=152/650) with moderate/complex disease. Most patients lived <50 miles from an ACHD physician - 87.5% of those who saw ACHD and 84.2% of those who did not - with similar distance distributions between groups (p=0.13). Patients who saw an ACHD physician were significantly more likely to have guideline-recommended imaging ( Figure 1 ). Conclusion: Being seen by a board-certified ACHD physician was associated with greater adherence to guideline-recommended care in this cohort of insured ACHD patients. However, the vast majority of patients did not see an ACHD physician despite having continuous insurance coverage and geographic accessibility. More work is needed to identify the barriers to obtaining ACHD-specific care.

Management of Maternal Complex Congenital Heart Disease During Pregnancy.

The purpose of this review is to discuss the risk stratification and management of pregnancy in women with complex congenital heart disease. Classifying congenital heart defects (CHD) including both anatomy and physiology is important for maternal risk stratification. Although most women with CHD can tolerate the physiological challenge of pregnancy, some may experience serious risks both to their health and that of their foetus. The WHO maternal risk classification model remains the best-validated risk measure. Ideally, women with CHD should have pre-conception assessment with a CHD cardiologist. General principles of management, such as need for expert centre delivery, a multidisciplinary team, epidural and mode of delivery are based on WHO risk in combination with expert assessment of status. CHD is increasingly prevalent in women of child-bearing age. Assessment by an adult CHD cardiologist, ideally pre-conception, is key in assessing and minimising risk to mother and foetus.

Abstract 10395: Did Prescription Practice Change After Publication of a Landmark Trial for Children and Young Adults with Marfan Syndrome

Intro: The Pediatric Heart Network (PHN) trial of β-blockers (BB) vs. angiotensin receptor blockers (ARB) for aortic root dilation in Marfan Syndrome showed similar efficacy, but its impact on prescribing practices is unknown. We hypothesized there would be an increase in single and combination use of BB and ARB after publication in 2014. Methods: Prescription data (2007-2016) were derived from outpatient encounters (IBM Marketscan) for children and young adults aged 6 mo to 25 yrs diagnosed with Marfan Syndrome who had ≥4 encounters with an adult or pediatric cardiologist or geneticist. Excluding 2014 as washout, data were divided into 2 time periods: 2007-2013 and 2015-2016. Categories included BB, ARB, angiotensin converting enzyme inhibitors (ACEI), combination (BB/ARB and/or BB/ACEI), and no drug use. We performed interrupted time-series analysis to assess the immediate level change and the change in slope for the prescription trend. We reported odds ratios (OR) and 95% confidence intervals (CI) from logistic regressions with generalized estimating equation methods to account for correlation of prescriptions within subjects. Results: Of 1499 patients (mean age 14.1 yrs, 59% female), BB had a downtrend [OR 0.91 (0.89, 0.93), p<0.001] and ARB trended higher [OR 1.12 (1.07, 1.18), p<0.001] 2007-2013, while combination, ACEI, and no drug use remained stable. There was no immediate effect after publication (2013-2015). Although the trend persisted for BB and ARB use (see Figure), the change in slope was not significant (2015-2016). Combination, ACEI and no drug use remained consistent. Conclusions: In short term follow-up, the impact of the PHN trial on prescription practices for aortic root dilation in Marfan Syndrome in children and young adults did not reach statistical significance. This may be due to early adoption of ARBs with subsequent confirmation of their usefulness. Longer term data are needed to fully explore the trial’s impact on practice change.

Abstract 12850: The Effect of Regionalization on End-of-Life Hospitalizations for Adult Congenital Cardiology Patients

Introduction: Adult congenital heart disease (ACHD) patients may have shortened life expectancy due to complications of interventions and accrued comorbidities. Specialized ACHD care has become standard of care. The effect of regionalization on ACHD patient death is not known. Methods: The Office of Statewide Health Planning and Development database identified ACHD patients ≥ 18 years who died in California hospitals from 1995 - 2018. Specialized ACHD centers were self-designated, so high and low ACHD surgical volume centers were also compared. Results: Of 3,724 patients, when comparing by volume, more deaths occurred at low (85.2%) than high volume centers (14.8%); when comparing by specialization, more deaths occurred at non-ACHD (78.8%) than ACHD centers (21.2%). Moderate (9.4%) and high complexity (4.4%) lesions were rare. Common causes of death were sepsis (14.6%), myocardial infarction (9.3%), stroke (7.5%), and heart failure (7.1%). High volume centers were more likely the location of death than low volume centers for patients aged 18-64, with private insurance, and who lived >20 miles away (p <0.0001 for all). These held true for ACHD vs non-ACHD centers (p <0.0001 for all). Low volume centers were more likely the location of death than high volume centers for patients from zip codes with relative poverty (p 0.0243). This held true for non-ACHD vs ACHD centers (p 0.0182). Over 24 years, the proportion of patients dying at ACHD centers increased (Figure 1), while the proportion of patients dying at high volume centers decreased. Conclusion: ACHD patients who die at high surgical volume and ACHD self-designated centers are more likely to be young, have private insurance, be referred to centers far from home, and have higher socioeconomic status. These likely reflect disparities in access to specialized ACHD care. Despite regionalization with an increase in specialized ACHD centers over time, the majority of ACHD patients continue to die at non-specialized centers.

P62.01 PREVALUNG: Evaluation of Lung Cancer Prevalence in Patients With Smocking-associated Atherosclerotic Cardiovascular Diseases

Lung cancer is the leading cause of cancer related death in France and Worldwide. Lung cancer screening based on low dose thoracic computed tomography (low dose CT) in patients selected on age and lifelong tobacco consumption has proven to improve lung cancer related mortality. However, the definition and identification of patients eligible for lung cancer screening is a challenge that may limit lung cancer screening program implementation. Epidemiological data shows that 30 to 40% of patients with lung cancer present a history of cardiovascular disease, mainly atheromatous diseases such as peripheral arterial diseases and coronary artery stenoses. We hypothesized that patients with history of smoking who developed atheromatous disease could represent a population at high risk to develop lung cancer. Our main objective was to evaluate the prevalence of lung cancer among patients with atherosclerotic disease and history of tobacco consumption. Our second objective was to evaluate the lung cancer screening program implemented to measure the prevalence. We implemented a monocentric prospective epidemiological study to evaluate the prevalence of lung cancer among 500 patients with inclusion criteria i.e age 45-75 years old, history of at least 10 years of daily tobacco consumption preceding the onset of an atherosclerotic disease. Principal exclusion criteria were history of active carcinoma < 5 years, symptoms of lung cancer, follow-up for lung nodules and grade IV dyspnea. Patients with inclusion criteria are referred for an inclusion visit (V0) with a thoracic surgeon by adult cardiologists, vascular surgeons and adult cardiac surgeons in charge of the patient. After information and inclusion, a low dose CT scan is scheduled within 7 months and a smoking cessation visit is proposed in case of active smoking. Blood and gut microbiota samples are harvested the day of the low dose CT. Positive low-dose CT are discussed weekly at the multidisciplinary thoracic oncologic staff meeting and managed accordingly to the current European and national recommendations. A clinical follow-up is scheduled by phone at 3, 6 and 12 months after the low-dose CT to evaluate oncologic and cardiovascular events. Between November 2019 and April 2021 we included 487 of the 500 patients scheduled, 330 low dose CT were completed, 7 localized primary lung cancer were resected by minimally invasive lobectomy, 1 patient was treated by radiation alone without pathological proof for a lung nodule, 1 patient was related with systemic therapy for a stage IV primary lung cancer and 2 patients are waiting for surgical resection for clinically localized lung cancers. The implementation of a lung cancer screening program dedicated to patients followed-up for tobacco related atherosclerotic diseases is feasible and will allow to evaluate both lung cancer prevalence and short-term benefits of lung cancer screening in this population.

THE CURRENT LANDSCAPE OF CARDIAC CATHETERIZATION TRAINING IN CANADA: A NATIONWIDE SURVEY OF CORE CARDIOLOGY TRAINEES

<h3>BACKGROUND</h3> The Royal College of Physicians and Surgeons of Canada (RCPSC) provides training objectives for cardiac catheterization and hemodynamics for adult cardiology training in Canada. We evaluated current core cardiology trainee perspectives on cardiac catheterization training across Canada and identified potential barriers to pursuing a career in interventional cardiology (IC). <h3>METHODS AND RESULTS</h3> Residents from all cardiology training programs across Canada (n=15 programs) were provided open and closed ended questions regarding the ability of their programs to address the mandatory components of their core angiography rotations. Programs were divided based on size for analysis. A small program was defined as ≤ 10 total trainees, a medium program as 11-15 trainees and a large program as > 15 trainees. Survey responses were received from 82 residents (82/206, 40% response rate). There was equal representation from all three years of training (post-graduate year (PGY)-4: n=24, 30%, PGY-5: n=28, 35%, PGY-6: n=29, 36%) and 39% of respondents were female (n=32). Overall 91% of trainees (n=70/77) felt that their program met the RCPSC requirements for cardiac catheterization. Of the trainees who felt that their training was inadequate, most common reasons indicated were lack of right heart catheterization exposure and lack of structured teaching specifically related to hemodynamics. When stratified by PGY of training or program size, there were no statistically significant differences in comfort with procedural skills or hemodynamic interpretation. The proportion of teaching by faculty was higher in small programs (p=0.039). There was a higher proportion of trainees who indicated that they had no structured cardiac catheterization teaching in medium sized programs (p=0.041). Only 22% of residents (n=18) identified IC as a career goal. Trainee-identified barriers to a career in IC are outlined in Figure 1 and stratified by gender. Lifestyle and family considerations were the two most common barriers with no statistically significant difference between genders (p=1.000 and p=0.18 respectively). Sexism was identified as a barrier only by female trainees (n=12/32, 38%, p < 0.0001) and length of training was identified more frequently as a barrier by male trainees (n=25/50, 50%, p=0.037). <h3>CONCLUSION</h3> Regardless of program size, the majority of Canadian cardiology trainees feel the RCPSC requirements for cardiac catheterization are met by their programs. Lifestyle and family considerations were the most common barriers to interventional training. Sexism was also identified as a common barrier amongst women. Creating an environment that promotes diversity, equity and inclusivity is crucial for all programs across Canada.

Recommendations for Infantile-Onset and Late-Onset Pompe Disease: An Iranian Consensus.

Background: Pompe disease, also denoted as acid maltase or acid α-glucosidase deficiency or glycogen storage disease type II, is a rare, autosomal recessive lysosomal storage disorder. Several reports have previously described Pompe disease in Iran and considering increased awareness of related subspecialties and physicians, the disease's diagnosis is growing.Objective: This guideline's main objective was to develop a national guideline for Pompe disease based on national and international evidence adapting with national necessities.Methods: A group of expert clinicians with particular interests and experience in diagnosing and managing Pompe disease participated in developing this guideline. This group included adult neurologists, pediatric neurologists, pulmonologists, endocrinologists, cardiologists, pathologists, and physiatrists. After developing search terms, four authors performed an extensive literature review, including Embase, PubMed, and Google Scholar, from 1932 to current publications before the main meeting. Before the main consensus session, each panel member prepared an initial draft according to pertinent data in diagnosis and management and was presented in the panel discussion. Primary algorithms for the diagnosis and management of patients were prepared in the panel discussion. The prepared consensus was finalized after agreement and concordance between the panel members.Conclusion: Herein, we attempted to develop a consensus based on Iran's local requirements. The authors hope that disseminating these consensuses will help healthcare professionals in Iran achieve the diagnosis, suitable treatment, and better follow-up of patients with infantile-onset Pompe disease and late-onset Pompe disease.

Implementation of an Ask Me 3 ® education video to improve outcomes in post-myocardial infarction patients

Objective: The Advanced Practice Providers (APPs) in an adult cardiology practice in a large metropolitan city, provide hospital follow-up care to post-myocardial infarction (MI) patients. The APPs identified a problem: patients retained very little of the information they receive during their hospitalization. The purpose of this pilot project was to evaluate the impact of an Ask Me 3 ® post-MI education video on patients’ knowledge of self-care activities. The video was designed to promote secondary prevention of cardiovascular disease and support optimal cardiovascular health.Methods: The project used a pre-test post-test quasi-experimental design to evaluate the feasibility and efficacy of a post-MI education video compared to the standard teaching methods.Results: The sample consisted of 25 total participants, 12 in the control group and 13 in the intervention group. The increase in the intervention group's post- test scores was statistically significant (p value = 0.0056), showing a vast improvement in knowledge with the addition of an “Ask Me 3” education video.Conclusion: An “Ask Me 3” post-MI education video may effectively improve cardiovascular secondary prevention when incorporated with the standard teaching methods. Patients may view the video multiple times, enhancing their knowledge of lifestyle modifications following hospitalization and their overall cardiovascular health.

341The birth of an electronic chronic disease registry bank in Nigeria

Abstract Background Nigeria is rapidly undergoing epidemiological transition resulting in a double burden of infectious and chronic diseases. Efforts have been concentrated on addressing infectious diseases, neglecting chronic diseases. However, the benefit of targeted chronic disease investigation cannot be overemphasized. Methods We conducted a literature search to identify ongoing chronic disease registry efforts in Nigeria. We then contacted the researchers and obtained additional information on the projects including information on the process for data management and number of contributing institutions. Results We found several single institutional efforts but were able to identify five efforts that were cross institutional and promising. These were the Cancer, Paediatric Cardiology, Adult Cardiology, Nephrology and Cardiac Surgery registries. Of the five, the cancer registry was well established with an electronic system and several publications from this registry. Next was the cardiac surgery registry with an online repository. Others did not have proper electronic archives and were often made of single institution efforts. Conclusions To address the data management need, we built a bank of chronic disease registries https://disreg.org/ and established partnerships with research teams. The bank is designed with multiple levels of access control. Additional registries can be plugged into the bank with ease. It provides a warehouse for chronic disease researchers to archive their data in Nigeria and potentially beyond. Key messages The bank will enrich the data available for investigating risk factors of chronic diseases pertinent in our environment.

Takotsubo syndrome in an adolescent with spinal amyotrophy after surgical treatment

Takotsubo syndrome (stress-induced cardiomyopathy) is well known in adult cardiology practice, and it also occurs in children. Takotsubo syndrome develops after emotional or physical stress. There is an acute transient disorder of the left ventricle contractility of the apex. The development of pain syndrome, electrocardiographic changes and troponins elevation imitate myocardial infarction. The key diagnostic point is intact coronary arteries and complete reversibility of local contractility disorders over the time.The article describes the clinical case of takotsubo syndrome in an adolescent with type III spinal muscular atrophy after planned surgery (repeated posterior spondylodesis).Takotsubo syndrome with clinical manifestations of acute left ventricular failure and pulmonary edema developed in the early postoperative period with distinctive electrocardiographic changes (ST segment elevation, local impairment of left ventricular contractility according by echocardiography and ventriculography, and increased levels of troponin). Timely examination and correction of therapy confirm the clinical diagnosis. The regression of symptoms occurred within a few days.

Taking machine learning to heart

Cardiology Both children and adults can have cardiac problems. Congenital problems predominate in childhood, whereas adults are more likely to suffer from conditions associated with age. In both cases, however, accurate diagnosis depends on access to health care and the availability of trained specialists. In two recent studies, Arnaout et al. and Yao et al. showed how machine learning can supplement specialist care in both pediatric and adult cardiology settings. Arnaout et al. analyzed fetal ultrasound images to detect congenital heart disease. Yao et al. used machine learning in conjunction with electrocardiogram imaging to detect adults with low ejection fraction (a measure of the amount of blood that the heart succeeds in pumping), which is a risk factor for subsequent heart failure. In each case, the technology should help to improve diagnostic accuracy and access to appropriate treatment. Nat. Med. 27 , 815, 882 (2021).

Implementing the physical activity vital sign in an academic preventive cardiology clinic.

The aims were to implement physical activity (PA) screening as part of the electronic kiosk check-in process in an adult preventive cardiology clinic and assess factors related to patients' self-reported PA. The 3-question physical activity vital sign (PAVS) was embedded in the Epic electronic medical record and included how many days, minutes and intensity (light, moderate, vigorous) of PA patients conducted on average. This is a data analysis of PAVS data over a 60-day period. We conducted multivariable logistic regression to identify factors associated with not meeting current PA recommendations. Over 60days, a total of 1322 patients checked into the clinic using the kiosk and 72% (n=951) completed the PAVS at the kiosk. The majority of those patients were male (58%) and White (71%) with a mean age of 64±15years. Of the 951 patients completing the PAVS, 10% reported no PA, 55% reported some PA, and 35% reported achieving at least 150min moderate or 75min vigorous PA/week. In the logistic model, females (AOR=1.4, 95%CI: 1.002-1.8, p=.049) vs. males, being Black (AOR=2.0, 95%CI: 1.04-3.7, p=.038) or 'Other' race (AOR=1.5, 95%CI: 1.02-2.3, p=.035) vs. White, unknown or other types of relationships (AOR=0.0.26, 95%CI: 0.10-0.68, p=.006) vs. being married/partnered, and those who were retired (AOR=1.9, 95% CI: 1.4-2.8, p<.001) or unemployed (AOR=2.2, 95%CI: 1.3-3.7, p=.002) vs. full-time workers were associated with not achieving recommended levels of PA. The PAVS is a feasible electronic tool for quickly assessing PA and may prompt providers to counsel on this CVD risk factor.