Cardiology Consultation Research Articles

Pregnancy in women with congenital heart disease: New insights into neonatal risk prediction

BackgroundAdvances in managing adult congenital heart disease (ACHD) have led to an increased number of women with CHD reaching childbearing age. This demographic shift underscores the need for improved understanding and prediction of complications during pregnancy in this specific ACHD population. Despite progress in maternal cardiac risk assessment, the prediction of neonatal outcomes for ACHD pregnancies remains underdeveloped. Therefore, the aims of this study are (1) to assess neonatal outcomes in a CHD women population, (2) to identify their predictive factors and (3) to propose a new risk score for predicting neonatal complications. MethodsThis registry study included all women born between 1975 and 1996 diagnosed with ACHD who underwent at least one cardiology consultation for ACHD in Cliniques Universitaires Saint-Luc. A multivariate analysis was performed to identify predictors of neonatal complications and these were incorporated into a new risk index. Its validity was assessed using bootstrap method. This score was then compared with scores adapted from the ZAHARA and CARPREG studies for offspring events prediction. ResultsAnalysis of 491 pregnancies revealed 31.4% of neonatal complications. Four significant predictors of adverse neonatal outcomes were identified: cardiac treatment during pregnancy (OR 14.8, 95%CI [3.4-66]), hypertensive disorders of pregnancy (OR 11.4, 95%CI [3.4-39.0]), smoking during pregnancy (OR 10.6, 95% CI [2.8-40.6]), and pre-pregnancy BMI < 18.5 kg/m² (OR 6.5, 95% CI [2.5-16.5]). The risk model demonstrated an AUC of 0.70 (95% CI [0.65-0.75), which remained stable after bootstrap validation. This model significantly outperformed the scores adapted from ZAHARA and CARPREG data. Based on the regression coefficients, a risk score was subsequently developed comprising 5 risk categories. ConclusionsOne third of ACHD pregnancies are complicated by poor neonatal outcome. These complications are determined by 4 independent factors relating to the cardiac and non-cardiac status of the patients, which have been incorporated into a risk score. Our study is one of the first to propose a predictive risk score of neonatal outcomes in ACHD pregancies, and paves the way for other validation and confirmation studies.

Determining the Frequency of Non-Obstructive Coronary Artery Disease in Elective Angiography Cases

Cardiovascular disease particularly ischemic heart disease has emerged as a leading cause of death. Atherosclerosis in epicardium results in CAD without the restriction of coronary circulation but the other processes that may disrupt the myocardial supply and demand in patients exhibiting angina symptoms or indications may be suspected of having non-obstructive CAD. Objective: To find out the prevalence of non-obstructive CAD in patients enrolled for elective angiography. Methods: A cross-sectional descriptive analysis was done in the Cardiology department in King Edward Medical University and Mayo Hospital, Lahore. The duration of study was for six months from 01-08-2022 to 01-02-2023. After approval from hospital ethical committee, 150 patients were enrolled in the study with informed written consent. Demographics including Name, age, BMI, confounding factors like (diabetes, hypertension, smoking and family history) and address were noted. All selected patients underwent coronary angiography via right femoral artery approach by a consultant cardiologist. Non-obstructive coronary artery disease was assessed as per operational definition. All the information was noted on pre-designed proforma (attached). Results: A total of 150 patients were selected for the study. It showed that out of 150 patients, 2.7% (n=4) fall in age group of 18-40 years and 97.3 % (n=146) were in age group of 41-60 years, average age was 51.94±5.26 years and the BMI was 27.96±6.44 kg/m2. There were 62.7 % (n=94) male and 37.3 % (n=56) females. Frequency of diabetes mellitus was 34.7 % (n=52), hypertension was 24.7 % (n=37), smokers 16.7 % (n=25), family history was 12.7 % (n=19) and frequency of non-obstructive CAD was 27.3 % (n=41). Conclusions: It is to be concluded that a considerable percentage of patients enrolled for elective coronary angiography had non-obstructive CAD.

“You Have to Find a Way for This Child to Be at the Center”: Pediatric Cardiologists’ Views on Triadic Communication in Consultations on Congenital Heart Defects

ABSTRACT Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children’s cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists’ views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents’ emotional needs, and (3) the physician’s role as mediator between parent(s) and child. In each category, three elements are discussed: The physician’s agenda, obstacles and challenges, and the physician’s practical methods. Physicians strongly support children’s involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents’ and children’s needs.

Atención primaria y péptidos natriuréticos: diseño de un proceso asistencial para la mejora en el diagnóstico de la insuficiencia cardiaca

IntroductionThere are few data about the optimal use of natriuretic peptides (NP) in the Primary Care (PC) setting. The aim to assess how, through a common coordinated PC-hospital care pathway, the use of NPs in patients with suspected heart failure (HF) is improved. Material and methodsAnalytical, experimental, prospective, non-randomized study. An intervention group composed of 22 PC physicians from 2 health centers is provided with face-to-face training and a consensual protocol is attached with a cut-off point of NT-proBNP> 300 pg/mL as pathological. The control group is made up of the rest of PC physicians in the healthcare area. The aim is to compare the use and results of PN in both groups. Propensity analysis is performed so thar the patient populations with requested PN are comparable. ResultsFrom June 2021 to March 2022, NP was requested in 103 and 105 patients in the intervention/control groups. Both populations were similar, with equal HF risk. Symptomatology was present in 100% of intervention vs 41% of asymptomatic patients in the control group (p <0.001). ECG was performed in 100% vs 33.3%, p <0.001. Optimal NP indication in 76.7% vs 29.5%, p <0.001. In the intervention group more patients with NT-proBNP> 300 pg/mL are referred to cardiology consultations (76.6% vs 27.2%, p 0.001). ConclusionThe optimal indication for NP and its interpretation as a diagnostic tool for HF, in the PC setting seems not to be appropriate, but improvable with a coordinated and multidisciplinary intervention approach.

Fully Screen-Printed and Gentle-to-Skin Wet ECG Electrodes with Compact Wireless Readout for Cardiac Diagnosis and Remote Monitoring.

Recent advances in electrocardiogram (ECG) diagnosis and monitoring have triggered a demand for smart and wearable ECG electrodes and readout systems. Here, we report the development of a fully screen-printed gentle-to-skin wet ECG electrode integrated with a scaled-down printed circuit board (PCB) packaged inside a 3D-printed antenna-on-package (AoP). All three components of the wet ECG electrode (i.e., silver nanowire-based conductive part, electrode gel, and adhesive gel) are screen-printed on a flexible plastic substrate and only require 265 times less metal for the conductive part and 176 times less ECG electrode gel than the standard commercial wet ECG electrodes. In addition, our electrically small AoP achieved a maximum read range of 142 m and offers a 4 times larger wireless communication range than the typical commercial chip antenna. The adult volunteers' study results indicated that our system recorded ECG data that correlated well with data from a commercial ECG system and electrodes. Furthermore, in the context of a 12-lead ECG diagnostic system, the fully printed wet ECG electrodes demonstrated a performance similar to that of commercially available wet ECG electrodes while being gentle on the skin. This was confirmed through a blind review method by two cardiology consultants and one family medicine consultant, validating the consistency of the diagnostic information obtained from both electrodes. In conclusion, these findings highlight the potential of fully screen-printed wet ECG electrodes for both monitoring and diagnostic purposes. These electrodes could serve as potential candidates for clinical practice, and the screen-printing method has the capability to facilitate industrial mass production.

Enhancing patient outcomes: Integrating electronic cardiology consultation in primary care for cancer patients.

The prevalence of cancer patients with concomitant cardiovascular (CV) disease is on the rise due to improved cancer prognoses. The aim of this study is to evaluate the long-term outcomes of cancer patients referred to a cardiology department (CD) via primary care using e-consultation. We analysed data from cancer patients with prior referrals to a CD between 2010 and 2021 (n = 6889) and compared two care models: traditional in-person consultations and e-consultations. In e-consultation model, cardiologists reviewed electronic health records (e-consultation) to determine whether the demand could be addressed remotely or necessitated an in-person consultation. We used an interrupted time series regression model to assess outcomes during the two periods: (1) time to cardiology consultation, (2) rates of all-cause and CV related hospital admissions and (3) rates of all-cause and CV-related mortality within the first year after the initial consultation or e-consultation at the CD. Introduction of e-consultation for cancer patients referred to cardiology care led to a 51.8% reduction (95%CI: 51.7%-51.9%) in waiting times. Furthermore, we observed decreased 1-year incidence rates, with incidence rate ratios (iRRs) [IC95%] of .75 [.73-.77] for CV-related hospitalizations, .43 [.42-.44] for all-cause hospitalizations, and .87 [.86-.88] for all-cause mortality. Compared to traditional in-person consultations, an outpatient care program incorporating e-consultation for cancer patients significantly reduced waiting times for cardiology care and demonstrated safety, associated with lower rates of hospital admissions.

Abstract P292: Lessons Learned From the Implementation of a Peer-to-Peer Cardiology Consultation Program in Federally Qualified Health Centers

Introduction: Conventional access to specialist care for cardiovascular disease can be expensive, geographically limited, and unavailable to communities that need it most. Health consultations that include cardiovascular considerations can improve life expectancy without extra costs. The Doctors With Heart (DWH) is an initiative from the American Heart Association (AHA) initially developed to decrease gaps in care by using telemedicine as a vehicle for cardiovascular consultations between volunteer cardiologists and primary care providers at Federally Qualified Health Centers (Health Centers). Despite efforts to on-board and train Health Centers on the consultation process and benefits to patient care, consultation utilization remained low. Objective: Identify opportunities to enhance DWH to increase consultation utilization by understanding the need for and barriers to conducting consultations among Health Centers already participating in DWH. Methods: An AHA Program Evaluator and the DWH Program Director co-conducted interviews and focus groups with 31 health care professionals from five Health Centers in the Midwest participating in DWH. Thematic analysis revealed key themes across evaluation objectives. Results: Interviewees had mixed feelings about the need for consultations which was largely driven by the barriers they perceived to conducting them. Many interviewees felt consultations could be an effective way to expedite care for patients who need specialty cardiovascular care. They could also help patients with complex but manageable co-morbidities since the patient can receive cardiovascular care within the primary care setting. However, a few providers felt they already had sufficient access to cardiovascular care for their patients. Interviewees identified three key barriers to conducting consultations: time and administrative burden for providers and staff, providers forgetting the consultations exist, and provider hesitations and concerns. During Health Center on-boarding, DWH should work with Health Centers to integrate consultations into existing clinic workflows, identify a program champion at each site, train multiple clinic staff about the program, and secure buy-in from providers. After Health Center on-boarding, DWH and Health Center program champions should find ways to regularly remind providers about the program and determine whether non-provider staff can help providers identify potential consultation cases. Conclusion: While there was an identified need for cardiology consultations among many Health Centers, more support from DWH and Health Center staff and leadership is needed to establish the program within the clinic setting and ensure on-going consultation utilization. DWH can implement strategies to facilitate consultations during Health Center on-boarding and program implementation.

Do serial troponins predict the need for cardiac evaluation in trauma patients after ground-level fall?

PurposeTroponin T levels are routinely checked in trauma patients after experiencing a ground-level fall to identify potential cardiac causes of syncope. An elevated initial troponin prompts serial testing until the...

Disease burden of cardiovascular conditions complicating pregnancy in Sri Lanka: a protocol

Background Cardiovascular diseases (CVD) are the commonest indirect medical cause of maternal deaths worldwide, both in high-income and low and middle-income countries. To minimize the effects of CVD in pregnancy, proper risk assessment and appropriate referral is required. In Sri Lanka, cardiovascular disease complicating pregnancy is a significant cause of maternal mortality, second only to postpartum hemorrhage. Screening for CVD in pregnancy in Sri Lanka is limited to a routine clinical assessment. Evidence-based guidelines are yet to be developed, and this deficit may have resulted in a substantial underestimation of the CVD burden. This study aims to determine the burden of CVD in early pregnancy and develop a risk prediction model to be used in field pregnancy clinics in Sri Lanka to reduce CVD effects in pregnancy. Methods A prospective cohort study was carried out in the Anuradhapura district, Sri Lanka. Following registration to the antenatal care, pregnant women fulfilling the eligibility criteria were invited to attend a special clinic at their relevant Medical Officer of Health (MOH) area. Risk assessment was done through history and a clinical examination, and suspected/probable cases were referred for an echocardiogram by a consultant cardiologist. All the recruited participants in the first trimester were prospectively followed up and screened again between 24–28 weeks of the period of amenorrhoea (POA). Antenatal ward admissions with CVD complicating pregnancy will be extracted, and a telephone interview will be carried out between 6–12 weeks after the expected delivery date to cover postpartum morbidities. Discussion This proposed study will be the largest of its kind carried out in the local setting. The study's findings will be beneficial for policymakers to develop guidelines to reduce maternal cardiovascular disease morbidities and mortalities in Sri Lanka.

An Observational Study of Dialogue about Uncertainty in Clinician-Family Counseling Conversations Following Prenatal Diagnosis of Complex Congenital Heart Disease

ObjectiveFamilies who receive a prenatal diagnosis of complex congenital heart disease (cCHD) often experience severe psychological distress and identify uncertainty as a key source of that distress. This study examined clinician-family conversations during initial fetal cardiology consultations to identify the topics of uncertainty discussed. MethodsIn this observational, qualitative study, initial fetal cardiology consultations were audio-recorded, transcribed verbatim, and coded by two independent coders. A codebook was inductively and deductively developed and applied. This content analysis focused on uncertainty-related codes and associated themes. ResultsDuring 19 consultations including five clinicians, 13 different cardiac diagnoses were discussed (seven with high mortality risk). Median consultation length was 37 min (IQR: 26–51), with only 11% of words spoken by families. On average, 51% of total words spoken focused on uncertainty in relation to cardiac diagnosis, etiology, comorbidities, prognosis, childbirth, therapeutics, and logistics. Family-initiated discussion on uncertainty largely focused on childbirth and pregnancy and postpartum logistics. ConclusionsHalf of dialogue within initial fetal cardiology encounters discussed uncertainty surrounding prenatally diagnosed cCHD. Parent and clinician perspectives should be gathered on the essential content and optimal delivery of uncertainty-related topics. InnovationThis study is conceptually and methodologically innovative as one of the first to examine audio-recorded dialogue between fetal cardiology clinicians and families.

Doctors' Choice of Rehabilitation Measures for Patients Who Have Suffered Covid-19

Relevance. According to WHO, the number of patients with a new coronavirus infection amounted to more than 676 million people for the period from January 2020 to January 2023. It is obvious that the consequences of COVID-19 will prevail in medical practice in the coming years, so medical rehabilitation should be the focus of attention when providing medical care to patients with coronavirus infection.Aims. To investigate the approach to physicians' selection of rehabilitation interventions for patients who have undergone Covid-19.Materials and methods. The analysis of 1832 case histories of patients of one of the temporary covid hospitals in Moscow, who are being treated in the hospital in 2020–2022, was carried out. Statistical analysis was carried out using the StatTech v. 3.1.3 program (developed by Stattech LLC, Russia). Predictive models characterizing adherence to rehabilitation measures were developed using the logistic regression method.Results and discussions. The analysis of predictors of statistically significant regression models showed that when deciding on the appointment of rehabilitation measures or additional consultation when a patient is discharged from the hospital, doctors rely on pathologies already present in patients before COVID-19 disease, without taking into account the occurrence of possible pathology after a new coronavirus infection in any organ system. For example, the appointment of a cardiologist's consultation increases 6 times in the presence of a history of cardiovascular diseases or atherosclerosis and 10 times in the presence of cardiovascular diseases and atherosclerosis at the same time. The presence of bronchial asthma increased the probability of consulting a pulmonologist by almost 3 times, and in the absence of diabetes mellitus, the probability of getting additional advice from an endocrinologist decreased by 11 times.Conclusions. An individual rehabilitation plan should take into account the severity of the COVID-19 disease, the degree of damage to the lung tissue, heart, blood vessels and other organs. The regression models can be used for economic analysis in order to identify the need for working hours and the number of medical workers necessary to ensure the optimal volume and effectiveness of rehabilitation measures for patients who have suffered a new coronavirus infection.

Cardiac Diagnoses in Obstetric Patients: An Observational Trimester-Based Analysis from Patients Undergoing Cardiology Consultations.

The aim of this study is to evaluate the frequency of cardiac complaints and diagnosed cardiovascular diseases across trimesters in pregnant women referred for cardiology consultations. This retrospective observational study was conducted at a second-level state hospital. Pregnant women referred to the cardiology clinic between September 2020 and March 2022 were included. Data collected included demographic information, clinical presentations, trimester of pregnancy, blood pressure, heart rate, anemia status, electrocardiography (ECG), and echocardiographic findings. Cardiac diagnoses were based on clinical evaluation, ECG, and echocardiographic findings. A total of 658 pregnant women were included, with a mean age of 28.18 (± 4.28) years. Most consultations occurred in the third trimester (49.1%). Primary reasons for consultation were palpitations (48%), chest pain (21.3%), leg edema (13.1%), and high blood pressure (11.6%). Anemia was present in 28.7% of the women, and 20.2% had hypertension (HT). Significant differences across trimesters included higher rates of chest pain and presyncope/syncope in the first trimester, and higher rates of palpitations and anemia in the second and third trimesters. The most common cardiac diagnoses were arrhythmias (16.6%), high blood pressure (15.2%), and mitral regurgitation (MR) (12.5%). Hypertension was most frequently diagnosed in the second trimester (P = 0.04). Infective endocarditis, myocarditis, and pericarditis were more common in the third trimester. Cardiac consultations are most frequent in the third trimester, with palpitations, chest pain, and high blood pressure being the most common complaints. Hypertension and MR are the most common cardiac diagnoses. Early and ongoing cardiologic assessment during pregnancy is crucial for managing cardiovascular risks.

Consideraciones cardiovasculares para la práctica de buceo recreativo con escafandra autónoma. Documento de consenso de SEC-Asociación de Cardiología Clínica/SEC-GT Cardiología del Deporte

The practice of recreational scuba diving has increased worldwide, with millions of people taking part each year. The aquatic environment is a hostile setting that requires human physiology to adapt by undergoing a series of changes that stress the body. Therefore, physical fitness and control of cardiovascular risk factors are essential for practicing this sport. Medical assessment is not mandatory before participating in this sport and is only required when recommended by a health questionnaire designed for this purpose. However, due to the significance of cardiovascular disease, cardiology consultations are becoming more frequent. The aim of the present consensus document is to describe the cardiovascular physiological changes that occur during diving, focusing on related cardiovascular diseases, their management, and follow-up recommendations. The assessment and follow-up of individuals who practice diving with previous cardiovascular disease are also discussed. This document, endorsed by the Clinical Cardiology Association of the Spanish Society of Cardiology (SEC) and the SEC Working Group on Sports Cardiology of the Association of Preventive Cardiology, aims to assist both cardiologists in evaluating patients, as well as other specialists responsible for assessing individuals’ fitness for diving practice.

Systemic Sclerosis Sine Scleroderma Presenting as Pulmonary Arterial Hypertension - A Case Report

A 60-year-old married male farmer with a significant medical history, including STElevation Myocardial Infarction (STEMI), coronary artery bypass grafting (CABG), and Raynaud’s disease, presented to the emergency department with sudden-onset syncope and progressive shortness of breath on exertion. The syncope episode involved an abrupt loss of consciousness, with spontaneous recovery and no associated symptoms like jerky movements or tongue biting. The shortness of breath had been gradually worsening over several weeks, becoming noticeable even during minimal exertion. On examination, the patient appeared chronically ill but had stable vital signs cardiovascular examination revealed bilateral pedal edema, while respiratory assessment and Neurological evaluation were normal. Blood tests indicated normal full blood count (FBC) and urea and electrolytes (U+E), but slight elevations in CRP 29 mg/L and ESR 20 mm/hr. Troponin levels remained stable, but brain natriuretic peptide (BNP) was markedly elevated at 2061 pg/mL. The electrocardiogram (ECG) showed right axis deviation and incomplete right bundle branch block (RBBB). A CT scan of the brain ruled out any acute pathology, such as stroke or hemorrhage. A previous echocardiogram (ECHO) had shown a left ventricular ejection fraction (LVEF) of 50-55%, indicating good left ventricular function. Given the findings, the patient was started on Furosemide 40 mg daily and advised to follow a fluid restriction regimen to prevent worsening of overload symptoms. A repeat echocardiogram revealed deterioration in right ventricular (RV) function with a significantly (RVSP) of 80 mmHg, suggesting severe pulmonary hypertension (PHTN). A D-dimer test was negative for pulmonary embolism (PE). Cardiology consultation raised concerns about possible chronic thromboembolic disease, leading to further testing, including a computed tomography pulmonary angiogram (CTPA) and an autoimmune screen, along with potential right heart catheterization (RHC). The CTPA was negative for PE, but the autoimmune screen returned positive results for antinuclear antibodies (ANA &gt;1200) and anticentromere antibodies. Right heart catheterization confirmed pre-capillary pulmonary hypertension (PAH) with pulmonary artery pressure exceeding 44 mmHg and no nitrate response. A rheumatology review, in light of the patient’s history of Raynaud’s disease, positive ANA, and confirmed PAH, led to the diagnosis of Systemic Sclerosis Sine Scleroderma–a form of systemic sclerosis without skin involvement. The patient was initiated on Tadalafil, (PDE-5) for PAH management and prescribed home oxygen therapy, particularly during exertion. He was discharged with a plan for multidisciplinary followup involving rheumatology, cardiology, and pulmonology to manage his complex condition. Conclusion: Multidisciplinary is essential for optimizing outcomes in SSc and PAH.

Telecardiology in the Management of Acute Cardiovascular Diseases: Case of the Ivorian Experience

Objective: Telemedicine is a tool to overcome the lack of access to health facilities in remote populations. The main aim was to assess a field of Telemedicine, Telecardiology in the management of acute electrocardiographic abnormalities in Ivory Coast. Methods: This was a cross-sectional descriptive and analytical study conducted from June 30, 2022 to September 30, 2022 which involved 19 health centers selected in the Teleelectrocardiogramm Project. Results: 529 ECGs were recorded. The prevalence of acute abnormalities was 52.93% (n=280). Atrial fibrillation, acute coronary syndrome, left ventricular hypertrophy and ventricular extrasystoles were the main causes of acute abnormalities. The presence of them was in older people (59.91 versus 54.95 years, p=0.00). Within 06 hours, abnormalities were diagnosed 70.86% of cases without any significant difference (p=0.056). Age class, gender, region of origin and blood pressure profile did not significantly influence the occurrence of ECG acuity. In 85% (n=238) of cases, the teleExpert recommended cardiological consultation via the interpretation platform (83.19%, n=198). In terms of follow-up over one month, more than half of the patients were reachable (n=174) compared to 38% who were unreachable. The main reasons were contactless files (67.92%, n=72), contact errors (13.21%, n=14) and the contact unavailability (11.32, n=12). Patients were informed about their remote diagnoses in 15% of cases (n=26). More than half of the patient evolved favorably (76.44%, n=133). Conclusion: Telecardiology contributes to the diagnosis of acute cardiovascular abnormalities for health centers without specialists. It can help primary care practitioners with immediate triage, which would result in early management.

Effect of the Gupta Score on Pre-operative Cardiology Consultation Requests in Noncardiac Nonvascular Surgery.

Cardiologists are the most frequently consulted specialists during pre-operative evaluations. However, unnecessary cardiology consultations (CC) can increase cardiologists' workload without impacting anaesthesia practice, resulting in delayed surgeries and additional financial burdens. We hypothesize that using Gupta during the preoperative period can reduce these adverse effects. This prospective study included patients scheduled for elective noncardiac, nonvascular surgeries who underwent pre-operative assessment. Patients who had no specific risk index used for preoperative cardiac risk evaluation were classified as Group I, and those evaluated using the Gupta scale were classified as Group II. The study compared preoperative CC, diagnostic tests, surgical delays, major adverse cardiac event (MACE), length of hospital stay and intensive care unit (ICU) stay, mortality, and costs. A total of 898 patients were included in the study, with 487 in Group I and 411 in Group II. The Gupta group reduced the demand for preoperative CC (P<0.001) and preoperative non-invasive diagnostic testing (n = 107, 21.9% vs. n = 36, 8.75%). The time from the anaesthesiology outpatient clinic to surgery was 15 days in Group I and 14 days in Group II (P=0.132). The length of ICU stay was higher in Group I (P=0.019). MACE was 15 patients (3.08%) in Group I and 9 patients (2.19%) in Group II (P=0.076). The cost of patients in Group I was higher than that in Group II (P=0.019). Using Gupta in preoperative evaluation may reduce unnecessary preoperative resource usage, surgical delays, ICU hospitalization rates, additional costs, and mortality.

Does early exposure to cardiothoracic surgery increase interest in the specialty?

The number of applications for cardiothoracic surgery has been steadily dropping over the past decades. We aim to assess whether a 1-day cardiothoracic surgical skills conference could increase interest into the speciality. Participants included in the study had to be medical students or junior doctors. Out of 57 delegates that attended the conference, 52 were enrolled in the study, and completed the pre-conference and post-conference questionnaires. Three introductory lectures were delivered by consultants in cardiothoracic surgery or cardiology in the morning, followed by three practical surgical workshops. We assessed demographics, confidence in and knowledge of procedures, and the change in participants' interest in the speciality pre- and post-conference. This study was conducted at St George's University of London. The interest to pursue a career in cardiothoracic surgery increased by 23% post-conference (p = .035). Confidence and knowledge in all procedures taught improved significantly after the conference (p < .05), with the highest increase seen in anastomosis of vessels (p < .0001). Preclinical students made up 57.7% of participants, majority of whom had not seen more than three surgical procedures. Our conference has shown to increase interest in cardiothoracic surgery and improve exposure to surgical skills, especially to those in early years of medical school. The surgical workshops improved student confidence and knowledge in procedures used within the field and the use of animal tissue improved participant experience. Further research is needed at other medical schools to assess whether a change in surgical skills teaching should be made to medical school curriculums.

IBC-Oxford University2023_BJSPoster_1Laparoscopic Sleeve Gastrectomy in a Patient with Severe Haemophilia A

Abstract Introduction Haemophilia A is an X linked inherited bleeding disorder caused by deficiency in coagulation factor VIII (FV III). To prevent spontaneous bleeding in muscles and joints, patients with severe Haemophilia A should receive prophylactic replacement therapy with dosing adjusted according to body weight. Case presentation A 19-year-old male patient who is well known to have Haemophilia A, that has been diagnosed shortly after birth during routine circumcision. The patient had presented to our clinic with BMI of 53.9 kg/m2. He was counselled for laparoscopic sleeve gastrectomy after failure of many trials to lose weight. He and his father were counselled for procedure pros and cons. Routine preoperative work up had been performed (Full labs, Abdomen Ultrasound, Dietician consultation, Anaesthesia consultation, Cardiology consultation). Haematological consultation had been done and consultant opinion was to give prophylactic factor VIII 7500 IU: 2 hours prior to surgery, 24 hours after surgery, 72 hours after surgery Extra precaution had been taken in the perioperative period in the form of careful cannulation, IM injections had been avoided completely, no anticoagulants, 1:1 Nursing care, careful patient handling and positioning, continuous monitoring (planned ICU admission for first 24 hours then HDU admission for 48 hours), senior Anaesthetist and senior Anaesthesia technician, on-table gastroscopy, smooth bougie tube placement (size 36F), careful haemostasis by way of slow Harmonic sealing, clipping of short gastrics, 1 minute stapler compression (All green reloads), full stapler line plication and omental patching, maintenance of stable blood pressure during surgery. Patient had an uneventful postoperative recovery, apart from mild bilateral subconjunctival haemorrhages that had subsided spontaneously. Conclusion Laparoscopic sleeve gastrectomy can be performed smoothly in patients with Haemophilia A with proper perioperative multidisciplinary care management.

Experts' Perspectives on the Current Practices and Gaps in the Management of Dyslipidemia: A Report from The United Arab Emirates

&lt;P&gt;Background: The prevalence of dyslipidemia in the United Arab Emirates (UAE) can be as high as 72.5%. Patients with dyslipidemia usually present with other metabolic risk factors, increasing their risk of acute cardiovascular diseases (CVD). Despite these alarming findings, local data regarding management practices in the UAE are lacking. The current report gathered the perspectives of experts from the UAE regarding the burden and current practices in managing dyslipidemia, as well as the current unmet needs and treatment gaps. &lt;P&gt; Methods: The present perspective is based on a consensus meeting that gathered the insights of six consultant cardiologists. All experts were affiliated with academic institutions representing the UAE's different geographical areas. &lt;P&gt; Findings and Conclusion: Data regarding the prevalence of dyslipidemia in the UAE and its associated ethnic differences are lacking. It is suggested that there needs to be more adherence to international recommendations for screening lipid profiles in primary care centers, which may lead to underestimating the burden of dyslipidemia. As CVD presents at a younger age in the UAE, screening for lipid profile at 35 is recommended, regardless of CVD risk. The panel emphasized that most dyslipidemia patients in the UAE are categorized as high or very high-risk groups for CVD; however, current risk assessment tools have not been validated in the UAE population and may not be tailored to the Middle Eastern and Asian populations. International guidelines have recommended the high-intensity statins-ezetimibe combination for high and very high-risk patients; the experts stated that the high-intensity statins-ezetimibe combination could be initiated in high-risk groups in the UAE. Several barriers to effectively controlling dyslipidemia in the UAE have been identified, including non-adherence, limited awareness about screening and management recommendations, and physician inertia toward achieving the recommended therapeutic goals.&lt;/P&gt;

Clinical Profile of Hypertensives at The Cardiology Consultation

Systemic hypertension is a global public health problem. It affects all parts of the population. In Algeria, according to the TAHINA 1 study, high blood pressure is the most common chronic pathology (24.8%). Despite numerous recommendations from learned societies 2.3.4.5 and the existence of effective therapies, a high percentage of patients remains uncontrolled 6.7.8. Our work aimed to study the clinical profile of hypertensives who presented to our cardiology consultation at the EPH in Laghouat. This is a longitudinal observational study running from October 2022 to June 2023. We collected 560 patients during daily consultations, lasting 10 months. The results made it possible to describe the present risk factors, dietary habits and socioeconomic conditions.