Majority Of Cardiologists Research Articles

Clinical Decision Support Requirements for Ventricular Tachycardia Diagnosis Within the Frameworks of Knowledge and Practice: Survey Study.

Ventricular tachycardia (VT) diagnosis is challenging due to the similarity between VT and some forms of supraventricular tachycardia, complexity of clinical manifestations, heterogeneity of underlying diseases, and potential for life-threatening hemodynamic instability. Clinical decision support systems (CDSSs) have emerged as promising tools to augment the diagnostic capabilities of cardiologists. However, a requirements analysis is acknowledged to be vital for the success of a CDSS, especially for complex clinical tasks such as VT diagnosis. The aims of this study were to analyze the requirements for a VT diagnosis CDSS within the frameworks of knowledge and practice and to determine the clinical decision support (CDS) needs. Our multidisciplinary team first conducted semistructured interviews with seven cardiologists related to the clinical challenges of VT and expected decision support. A questionnaire was designed by the multidisciplinary team based on the results of interviews. The questionnaire was divided into four sections: demographic information, knowledge assessment, practice assessment, and CDS needs. The practice section consisted of two simulated cases for a total score of 10 marks. Online questionnaires were disseminated to registered cardiologists across China from December 2022 to February 2023. The scores for the practice section were summarized as continuous variables, using the mean, median, and range. The knowledge and CDS needs sections were assessed using a 4-point Likert scale without a neutral option. Kruskal-Wallis tests were performed to investigate the relationship between scores and practice years or specialty. Of the 687 cardiologists who completed the questionnaire, 567 responses were eligible for further analysis. The results of the knowledge assessment showed that 383 cardiologists (68%) lacked knowledge in diagnostic evaluation. The overall average score of the practice assessment was 6.11 (SD 0.55); the etiological diagnosis section had the highest overall scores (mean 6.74, SD 1.75), whereas the diagnostic evaluation section had the lowest scores (mean 5.78, SD 1.19). A majority of cardiologists (344/567, 60.7%) reported the need for a CDSS. There was a significant difference in practice competency scores between general cardiologists and arrhythmia specialists (P=.02). There was a notable deficiency in the knowledge and practice of VT among Chinese cardiologists. Specific knowledge and practice support requirements were identified, which provide a foundation for further development and optimization of a CDSS. Moreover, it is important to consider clinicians' specialization levels and years of practice for effective and personalized support.

A Review of the Role of Tests of Coronary Reactivity in Clinical Practice.

Vasoreactivity testing is used by cardiologists in the diagnosis of coronary spasm endotypes, such as epicardial and microvascular spasm. Intracoronary injection of acetylcholine and ergonovine is defined as a standard class I method according to the Coronary Vasomotion Disorder (COVADIS) Group. Because single vasoreactivity testing may have some clinical limitations in detecting the presence of coronary spasm, supplementary or sequential vasoreactivity testing should be reconsidered. The majority of cardiologists do not consider pseudonegative results when performing these vasoreactivity tests. Vasoreactivity testing may have some limitations when it comes to documenting clinical spasm. In the future, cardiologists around the world should use multiple vasoreactivity tests to verify the presence or absence of epicardial and microvascular spasms in the cardiac catheterisation laboratory.

A Cardiologists' Survey on the Use of Anticoagulants and Antiplatelets in Patients With Atrial Fibrillation and Acute Coronary Syndrome or Those Undergoing Percutaneous Coronary Intervention in India.

The management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) requires appropriate antithrombotic regimens for stroke prevention and in-stent thrombosis. Current practice recommendations are largely based on consensus options as there is limited evidence from randomized clinical trials. Hence, by surveying a group of cardiologists across India, we sought to better understand the current practice patterns of using oral anticoagulants (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) and antiplatelet therapy in those patients in India. A cross-sectional questionnaire-based survey was conducted across India to better understand the clinical practices in AF management. A total of 151 cardiologists participated in this survey. The most commonly prescribed combination therapy in patients with AF and ACS/undergoing PCI was triple therapy (NOAC + dual antiplatelet [aspirin and P2Y12 inhibitor]) (54.30%) followed by NOAC + single antiplatelet (33.11%).Only 11.26% of cardiologists prescribed VKA + dual antiplatelet therapy. Among anticoagulants, cardiologists prescribed NOACs to 66.11%of patients andVKAs to 25.54%of patients. Among P2Y12 inhibitors, ticagrelor (50.99%) and clopidogrel (47.02%) were the most preferred medication. The physician reported patient adherence rates to NOACs were higher compared to VKAs. Around 41.06% of cardiologists reportedly changed antiplatelet therapy for patients from dual antiplatelet to single antiplatelet therapy in three months; 36.42%, in one month; and 19.21% in six months after PCI. Around 61.59% of cardiologists stopped prescribing antiplatelet therapy for patients by one year. Our survey demonstrated that the majority of cardiologists used triple therapy (NOAC + dual antiplatelet), followed by NOAC + single antiplatelet for managing patients with AF and ACS or undergoing PCI in line with the available guidelines.

Preferences and attitudes of cardiologists in the management of cancer patients.

651 Background: With recent improvements in survival of cancer patients and emphasis on high-value care at end-of-life, the management of cardiovascular disease in patients with cancer is increasingly important. To our knowledge, there is no current US data examining how the presence and extent of cancer influence cardiologists’ decision-making for common cardiovascular conditions. Methods: An anonymous online vignette-based survey of cardiologists was conducted at five US institutions investigating how the extent of gastrointestinal and thoracic malignancies (prior/localized, metastatic) would influence treatment recommendation for atrial fibrillation (AF), aortic stenosis (AS), unstable angina (UA) and obstructive coronary artery disease (CAD). Results: Thirty-three percent (86/259) of cardiologists completed the survey between September and November 2019. Participants were 67% male, 51% below age 40, and 58% had five or more years of clinical experience. Majority of cardiologists practiced at teaching hospitals (72%) and were non-interventional (63%). Cardiologists were more likely to recommend procedural interventions in patients with localized cancer than with metastatic disease: AF (LAAO: 20% vs 8%), AS (AVR: 83% vs 11%), UA (LHC: 70% vs 27%) and obstructive CAD (PCI: 81% vs 38%) (Table). In patients with metastatic cancer, most cardiologists sought an oncology (82%) or a palliative care (69%) consult. Conclusions: Cardiologists were less likely to recommend invasive cardiovascular therapies to patients with metastatic cancer. This preference pattern likely reflects the influence of comorbidities and quality of life expectation on cardiologists’ treatment recommendations but may also be related to the stigma of advanced cancer. Better communication between cardiologists and oncologists is necessary to a personalized care of patients with cancer and cardiovascular disease that would maximize treatment benefit with least morbidity.[Table: see text]

Perceptions and knowledge gaps on CHA2DS2-VASc score components: a joint survey of Chinese clinicians and clinical pharmacists

Background The CHA2DS2-VASc score is a guideline-recommended stroke risk stratification scheme for patients with atrial fibrillation (AF). Accurately calculating the CHA2DS2-VASc score and recognizing the stroke risk in AF patients is the foundation of optimal anticoagulation therapy. This survey aims to obtain a comprehensive understanding of perceptions and knowledge gaps on CHA2DS2-VASc scores among Chinese medical professionals for future education programs. Methods A cross-sectional survey was conducted among clinicians, including cardiologists, neurologists, emergency physicians (EPs), general practitioners (GPs) and clinical pharmacists (CPs) using a self-administered questionnaire on the Chinese mainland. The survey contained 21 questions in combination with single-choice questions, multiple-choice questions, and an open-ended question, which was distributed online via email or social media. Results A total of 562 participants (40.9% cardiologists, 19.2% neurologists, 8.5% EPs, 10.3% GPs, and 21.0% CPs) completed the survey. Most respondents across all specialties reported skills requiring improvements in the CHA2DS2-VASc score. In general, cardiologists, neurologists, and CPs had a relatively better understanding than GPs and EPs about the application of CHA2DS2-VASc score. Considering “H” and “D” components, more than 90% of respondents chose the correct answer in single-choice questions, whereas the correctness rate declined concerning detailed scoring criteria. Regarding “C”, “A2”, “S2”, and “V” components, partly correct answers were commonly observed in most multiple-choice questions. The majority of cardiologists believed themselves to be very familiar or at least familiar with the score and its components, while around 70% of EPs and GPs felt relatively unfamiliar with the CHA2DS2-VASc score. Mobile apps, AF guidelines and notebooks/handbooks were popular referencing scoring tools for respondents. Conclusions Chinese medical professionals, especially EPs and GPs, revealed a lack of knowledge and insufficient skills for CHA2DS2-VASc scores and their components. Improvements in the awareness of the CHA2DS2-VASc score and its detailed scoring criteria are urgently needed for Chinese medical professionals. Therefore, education programs concerning the introduction of stroke risk evaluation for AF patients and the development of referencing scoring tools are necessary.

Abstract 13903: Accurate Assessment of Hypertension and Belief in Clinical Readings by Cardiologists

Background: The accurate measurement of blood pressure (BP) is essential for the diagnosis & management of hypertension. In clinical practice, BP is estimated using noninvasive methods but there is significant variability in practice, despite guidelines and recommendations for accurate BP assessment. Individual clinical practices implementation of guidelines for BP assessment influence accuracy and clinical certainty of BP measurements. Hypothesis: We sought to assess how BP is assessed in clinical practice of cardiologists and to assess the clinical certainty of the BP obtained in their clinics. Methods: A survey was administered through professional societies that include predominately cardiologists & via Twitter. Assessment of adherence to guideline recommendations for BP assessment was measured and compared to belief and reliability of BP assessment in clinic. Results: 612 surveys were completed in 30 days, 364 completed by cardiologists; 49 (13%) preventive cardiologists. Majority of cardiologists based in United States. 53% routinely check BP in both arms at initial visit, 48% check BP only 1X/per visit; 64% wait 5 minutes before initial BP assessment. Automated BP assessment is used in 58% of respondents’ clinics. 83% trust their BP readings in clinic. Only 23% (85) of all cardiologist accurately measure BP as recommended by guidelines & it is more likely to be done by a preventive cardiologist (P=0.017). For those who do measure BP correctly, 80% repeat BP manually compared with 54% who do not measure BP accurately (P<0.001). For those who perform BP accurately, 86% report trusting their BP readings in clinic, similar to those who assess BP inaccurately (P=0.45). Conclusions: Accurate BP assessment by cardiologists remains suboptimal. Reliability of BP assessment in clinic requires education, implementation of recommendations and empowerment of the entire team to improve BP assessment & results in improved cardiovascular outcomes for our patients.

Exercise Training for Cardiac Patients, Why and How to Prescribe It?

AbstractThe benefits of regular physical activity whether in primary- or secondary prevention of cardiovascular disease are now irrefutable. Despite its well proven benefits, exercise training remains underused because of lack of insight and familiarity of the majority of cardiologists. This review offers cardiologists the necessary informations about the pathophysiological mechanisms, effects and limitations of the predominantly used training methods in various kardiovascular diseases.

Exploring cardiologists’ and oncologists’ exercise recommendation and referral practices

Objective: Exercise is beneficial for individuals who have been diagnosed with cardiovascular disease or cancer. Healthcare providers are well placed to discuss exercise with their patients, but their referral practices and the content of exercise recommendations remain unclear. Method: Cardiologists and oncologists completed an online survey comprising four closed-ended questions and one open-ended question to assess exercise recommendation and referral practices. Chi-square tests were used to compare the frequency of closed-ended responses, and open-ended responses were coded and analysed using qualitative content analysis. Results: Of the 154 surveys, 58 were returned ( n = 25; 43.1% cardiologists, and n = 33; 56.9% oncologists). Respondents ( Mage = 45.5 ± 11.1) were mostly men (62.1%). The majority of cardiologists (95.8%) and oncologists (78.1%) reported referring patients to hospital-based exercise programmes. In this study, the cardiologists were more likely to refer patients to certified exercise physiologists (χ2(1) = 6.140, p = .021), whereas oncologists were more likely to refer to physical therapists (χ2(1) = 11.764, p = .001). Conclusion: Findings reveal that cardiologists and oncologists discussed and recommended exercise to their patients at least some or most of the time; there were differences in the type of exercise professionals they were referred to; and exercise recommendations were variable and infrequently concurred with established guidelines.

Abstract 14226: Physicians Speak up About Heart Health Awareness and Action: A Women’s Heart Alliance Research Report

Introduction: Cardiovascular disease is the number one killer of women in the US. In November 2014, the Women’s Heart Alliance (WHA) launched a nationwide campaign to increase physician awareness and action toward women’s heart risk. Methods: Survey data collection from May 6-12, 2014 used the ERI (Research Now) Physician and Healthcare Professional Panel (HCP), an online invitation-only database based on AMA data and verified. The survey included 200 Primary Care Physicians (PCPs) and 100 cardiologists, currently in practice ≥3 yrs. Overall; ≥33% of PCPs and OB/GYN patients, and ≥21% of cardiologists’ patients were female. Results: Heart disease was a top concern for 39% PCPs. Among the AHA guideline-recommended heart risk assessment items for women, 16% of PCPs and 22% cardiologists implemented all eight. Only 22% of PCPs and 42% of cardiologists feel well prepared to assess heart disease risk in women. While a majority of cardiologists and PCPs are aware of the ASCVD Risk Assessment Calculator, current usage is below 50%s in both groups (Figure). A majority of PCPs (87%) and cardiologists (82%) were favorable towards a national campaign. Conclusions: Heart disease in women is not a top-tier concern for PCPs or cardiologists. Physician awareness and use of heart risk assessment is low, and a majority are supportive of a national campaign Strategies to improve healthcare provider awareness and action for heart risk assessment practice gaps are needed.

Optimism and interventional cardiology.

One day, a decade ago, I was trying to place a coronary stent. It wasn’t going well. I grumbled to Tammy, the cath technologist assisting me, that it looked like we were going to fail. Tammy looked me straight in the eye and said, “Dr. Blankenship, you really are a pessimistic person.” After the case ended successfully, her comment lingered. That night, somewhat defensively, I asked my wife, “I’m not a pessimistic person, am I?” She answered without hesitation: “Yes, you are.” Somewhere I had read that optimism is a choice. I swore at that moment to choose optimism. But that isn’t easy. We face pessimism every day. A 2013 survey by the Doctors Company found that 89% of physician respondents would not recommend a career in medicine to their children [1]. A 2014 Medscape survey found that only 44% of cardiologist responders are satisfied with their income, 39% would not choose a career in medicine again, and 41% would not choose cardiology as a specialty again [2]. Cardiac catheterizations and coronary interventions have decreased by 30% in the past decade, and it often seems that surgeons, payers and the media all think they should decrease further. The majority of cardiologists are now employed, and many mourn their lack of independence and chafe under the bit of hospital administrators. All of these factors might make us pessimistic. Yet I argue for optimism, for 3 reasons. First, opportunities abound in interventional cardiology. Second, optimism often proves to be right. Finally, optimism is good for you. OPPORTUNITIES IN INTERVENTIONAL CARDIOLOGY

Knowledge of guidelines for anticoagulation management of patients with atrial fibrillation

In Germany, about 1 million people are affected by atrial fibrillation (AF). Morbidity and mortality are high especially due to the risk of thromboembolic events. A valid risk stratification by the CHADS2 criteria is critical regarding the indication for anticoagulation and thus to improve prognosis. To what extent these criteria and guidelines are known and have been implemented among cardiologists and general practitioners in Germany has not been evaluated so far. A total of 558 cardiologists (46.8 %) and general practitioners (52.5 %) were surveyed during the annual meeting of the German Society of Cardiology or in writing in a representative sample of German general practitioners. Compared to 51.8 % of general practitioners, 87.6 % of cardiologists (p < 0.001) claimed to know the CHADS2 criteria. In the total cohort, CHADS2 criteria were correctly identified as risk factors by 55.6-86.9 %. Cardiologists had significantly better knowledge of these criteria (63.6-91.2 % vs. 55.6-86.9 %, p < 0.001). A previous history of cerebral stroke was known to be a risk factor in almost all physicians in contrast to heart failure (47.3 % of cardiologists vs. 36.0 % of general practitioners, p < 0.001). Physicians who had attended a training course on anticoagulation and atrial fibrillation (n = 380) in the 2 years prior to the survey performed significantly better (p = 0.007) than those without training (n = 173). While the majority of cardiologists knew the CHADS2 criteria and the related guidelines, these criteria were less known in the primary care sector. Nevertheless, even cardiologists do not always apply the guidelines for anticoagulation in AF correctly. Participants of training courses had a significantly better knowledge of these guidelines.

Italian cardiologists and tobacco smoking. A survey on the prevalence and knowledge of smoking and strategies for smoking cessation in a cohort of Italian cardiologists

Tobacco use is the single most preventable cause of death. Its cessation is the most cost-effective strategy for reducing long-term cardiovascular morbidity and mortality. Although both healthcare professionals and the general population are aware of the detrimental effects of smoking on health, more than 25% of Italians are current smokers. Recent surveys showed that almost 50% of smoker patients relapse to smoke after having been discharged for acute coronary syndrome. Physicians who smoke may be a barrier for effective cessation interventions. Thus, it is important to assess cardiologists' attitude toward smoking habits and the implementation of smoking cessation programs. The survey "Italian cardiologists and smoking habits" has been held in 2013 during the 44° National Congress of the Italian Association of Hospital Cardiologists (ANMCO) to assess cardiologists' smoking status, their level of knowledge about smoking cessation interventions and their involvement in the management of smoking cessation. Out of more than 1200 cardiologists attending the ANMCO congress, 610 subjects (aged 51 ± 11 years) answered an anonymous 35-item questionnaire; they were asked to declare their smoking status (9.5% current smokers). Among doctors who attended the survey, 58% correctly indicated smoking as an addiction and 45% regularly advised their patients to stop smoking. The majority of cardiologists (93%) reported a positive attitude toward smoking cessation strategies, 62% of them thought that cardiologists themselves should treat smoking dependence, though specific tools (70%) and education for the management of smoking cessation are lacking (66%). Two thirds of the entire sample of ANMCO cardiologists declared their willingness to participate in specialized educational programs. More than a half of Italian cardiologists are aware that smoking is an addiction. Although they feel themselves yet inadequate toward this approach, they are favorable to implement their own knowledge and skills toward smoking cessation.

One of six patients with non-ischemic heart disease exhibit provoked coronary spasms: non-ischemic heart disease associated with ischemia?

The majority of cardiologists do not perform spasm provocation tests in patients with non-ischemic heart disease (non-IHD) or non-obstructive coronary artery disease (non-ob-CAD). We herein examined the frequency of provoked spasms in non-IHD and non-ob-CAD patients, including those with atypical chest pain (Aty), valvular heart disease (Val), hypertrophic cardiomyopathy (HCM), congestive heart failure (CHF), and others (Oth). We performed acetylcholine (ACh) spasm provocation tests over a period of 22 years (1991-2012) among 1,440 patients, including 981 IHD and 459 non-IHD subjects. A total of 43 patients with significant organic stenosis were excluded, and the remaining 416 patients with non-IHD or non-ob-CAD disease were assessed. ACh was injected in incremental doses of 20/50/80 μg into the right coronary artery (RCA) and 20/50/100/(200) μg into the left coronary artery (LCA). Positive coronary spasms were defined as transient luminal narrowing of >99%. Positive coronary spasms were noted in 17.3% of the non-IHDs patients (72/416), compared to 11.4% (15/132), 19% (8/42), 16.7% (5/30), 23.9% (16/67), and 19.3% (28/145), in the patients in the Aty, Val, HCM, CHF, and Oth groups, respectively. The rate of positive provoked spasms was higher in men than women, although not significantly [20.6% (46/223) vs. 13.4% (26/193), ns], and significantly higher in the late period (2001-2012) than in the early period (1991-2000) (36.8% vs. 7.0%, p<0.001). Physicians should perform spasm provocation tests in patients with IHD as well as non-IHD with non-ob-CAD, as one of six non-IHD patients in this study exhibited provoked coronary spasms.

Abstract 174: Organization of Cardiologists in the United States - An Early View in the Era of Accountable Care Organizations

Objective: To understand the organization of cardiologists in the United States and territories with an emphasis on identifying the characteristics of practices where cardiologists practice. Data: The Healthcare Organization Services database, which provides information on the designation, specialties and business associations, or affiliations, of healthcare professionals across the US and territories. These data were updated as of September 2013. Methods: Cardiologists were defined as providers with an MD or DO, who have an active clinical practice, and either: (1) have Cardiology as primary specialty, or (2) who have Internal Medicine, Pediatrics or Family Medicine indicated as primary specialty, with Cardiology as secondary specialty. Cardiologists were linked to businesses and descriptive analyses were conducted to characterize the organization of cardiologists. Findings: We identified 33,745 cardiologists; 22,461 of these cardiologists had at least one affiliation with an ambulatory practice or independent physician association (AP/IPA), while 30,567 had at least one hospital affiliation. Approximately 57.6% (19,453 of 33,745) of cardiologists were affiliated with both the AP/IPA and hospital settings. The overwhelming majority of ambulatory practices linked to hospital-AP/IPA affiliated cardiologists are medical groups (7,839 of 9,838), while independent physician practices comprise the next largest category (1,498 of 9,838). Of the 7,839 medical groups, 3,809 are cardiology specialty, 1,316 are multispecialty group practices, and 2,060 are family practice, general practice, geriatric medicine, internal medicine, pediatric medicine or primary care. Among all non-multispecialty medical groups (n=6,523), 59.2% (3,862 of 6,523) have 1-2 affiliated cardiologists, 21.7% (1,413 of 6,523) have 3-5, 12.6% (821 of 6,523) have 6-10 and 6.5% (427 of 6,523) have more than 10 affiliated cardiologists. Focusing at the provider level, 17,639 hospital-AP/IPA cardiologists had any affiliation with a medical group (MG), with 12,840 cardiologists with any cardiology specialty MG affiliation, 3,215 with any multispecialty group practice MG affiliation, and 3,051 with any family practice, general practice, geriatric medicine, internal medicine, pediatric medicine or primary care MG affiliation. Overall, 15,476 hospital-AP/IPA cardiologists had any affiliation with at least one non-multi-specialty group practice (non-MSGP), with 4,279 affiliated with one or more non-MSGP(s) with 1-2 cardiologists, 4,378 with one or more non-MSGP(s) with 3-5 cardiologists, and 4,861 and 5,099 affiliated with one or more non-MSGP(s) with 6-10 and &gt;10 cardiologists, respectively. Conclusion: The majority of cardiologists were affiliated with both a hospital and ambulatory practice or IPA. Of this subset, most cardiologists were affiliated with at least one group practice.

Abstract 358: Factors Influencing Adoption of Radial Access for Percutaneous Coronary Intervention in the Veterans Affairs Health Care System

Background/Objective: Though the safety of transradial percutaneous coronary intervention (TRI) has been demonstrated in clinical trial and registry studies, adoption of TRI in the United States has been slow. We fielded a national survey with VA interventional cardiologists to understand factors influencing TRI use. Methods: The structured survey was developed from telephone interviews with interventional cardiologists, catheterization laboratory nurses and radiology technicians at 3 VA hospital cath labs. The survey assessed extent of interventional cardiologists’ experience with TRI, perceptions of the advantages or disadvantages of TRI relative to transfemoral PCI (TFI), and barriers to adopting and implementing TRI. We used the the Cardiovascular Assessment Reporting and Tracking (CART) registry to define our sampling frame, all VA interventional cardiologists, and to obtain cath lab TRI rates. We tested whether respondents’ opinions of the relative advantages of and barriers to TRI were associated with site-level TRI rates in a 13-month period following to the survey (January 2012 to January 2013). Results: We received responses from 78 of 235 interventional cardiologists representing 48 of 65 VA cath labs (33% response rate; 73% of cath labs). The most prevalent barriers to TRI adoption cited by cardiologists were increased radiation exposure to the cardiologist (63% cited as a major or minor barrier) or staff (51% of respondents), and the steep learning curve (44%). Other barriers such as difficulty obtaining necessary equipment (25%), lack of support from cath lab staff (23%), and lack of training opportunities (18%), were less prevalent. The majority of cardiologists rated TRI as superior for ease of post-procedure monitoring (52%), patient comfort (60%), early discharge (65%), fewer vascular access complications (69%), and less bleeding (72%). However, a majority rated TFI superior for shorter procedure duration (69%) and technical results (47% rated superior, 49% as no difference). One-year cath lab TRI rates ranged from 1.1% (3 of 270) to 90.2% (286 of 317), with a median of 7.3%. Only nine cath labs had a 1-year TRI rate greater than 50%. No barriers were correlated with TRI rates; however, all of the relative advantage measures were significantly, positively correlated. The strongest correlations were for faster procedure time (r=.59, p&lt;.0001) and ease of post-procedure monitoring (r=.52, p&lt;.0001). Conclusions: This study demonstrates that while interventional cardiologists are familiar with the advantages of TRI over TFI, there is still limited adoption of TRI on a broad scale. There were no reported barriers associated with site-level radial rates suggesting that obstacles to TRI adoption are likely multifactorial. Effective TRI training programs should focus on methods to reduce radiation exposure and manage expectations about the radial learning curve.

Are physicians underestimating the challenges of hypertension management? Results from the Supporting Hypertension Awareness and Research Europe-wide (SHARE) survey

The Supporting Hypertension Awareness and Research Europe-wide (SHARE) survey aimed to qualify the key challenges that physicians face when trying to get patients to recommended blood pressure (BP) goals. The survey was open to physicians involved in the treatment of hypertension, was anonymous, and included 45 questions covering: physicians' demographic information, familiarity with BP treatment guidelines, views on the BP targets recommended by the 2007 European Society of Hypertension and European Society of Cardiology (ESH-ESC) guidelines, and perceptions on the proportion of 'challenging patients' in hypertension management (defined as patients not achieving the BP goal, where the BP goal is at least <140/90 mm Hg, and <130/80 mm Hg for patients with co-morbidities or high CV risk). Physicians significantly underestimated the proportions of their 'challenging patients' with hypertension compared with their perceptions of the proportions achieving 2007 ESH-ESC BP targets (p < 0.0001). The majority of cardiologists (75.5%) and general/family practitioners (GPs) (81.3%) as well as internists (59.3%) (p < 0.05 for cardiologists and GPs vs internists) felt that it was a challenge to get their patients to target BP, stating that only 43.2%, 57.4% and 38.2% of their patients, respectively, achieved these targets in practice (p < 0.05 for GPs vs cardiologists and internists). Physicians may underestimate the proportion of 'challenging patients' with hypertension and there is a need to improve their BP control. Increasing physicians' awareness about the risks of uncontrolled BP and improving compliance are two possible ways to improve management of hypertension.

Sexual dysfunction and its relation to heart disease

What do cardiologists have to do with erectile dysfunction? Even though this seems far from our daily clinical routine, a closer look and interrogation among our own patients revealed that the majority of patients with underlying chronic cardiovascular disorders are suffering from erectile dysfunction. The close association of coronary artery disease and vasculogenic erectile dysfunction is a well-known phenomenon, however, it represents an example where scientific evidence did not translate into clinical practice and routine. How many cardiologists do really ask their patients about sexual problems? In addition, how many patients with ED and concomitant cardiac problems are not treated for ED because they are considered as high risk for sexual activity as well as for using drugs such as PDE-5 inhibitors. Even though the pathophysiologic mechanisms for ED are well known among urologists dealing on a daily base with ED patients, the majority of cardiologists do neither spent enough time to read about ED nor to treat ED, lacking awareness how significant sexual dysfunction impacts our patients' lives, sometimes even more than the experience of a myocardial infarction or any other cardiovascular (even life-threatening) event. Patients might not tell us cardiologists about this particular problem, and we are not asking about it.

Physician opinions on the implementation of the SIGN guideline for heart failure.

To assess physician opinion of and attitudes to, the Scottish Intercollegiate Guideline Network (SIGN) guideline for chronic heart failure (CHF) due to left ventricular systolic dysfunction. A questionnaire examining physicians' attitudes and their use of the SIGN guideline for CHF was distributed to 158 physicians in two teaching hospitals within one NHS trust. 65% of recipients responded. More cardiologists had read the guideline compared to non-cardiologists (91 vs 56%, p < 0.05). The majority of cardiologists and non-cardiologists agreed that it was applicable to their patients (92 vs 79%, p > 0.1) and that implementation may reduce hospital admissions (65 vs 59%, p > 0.5). In general, compliance was thought to be a problem in only a minority of patients in both groups for angiotensin converting enzyme inhibitors (8 vs 19%), diuretics (12 vs 29%) and digoxin (17 vs 19%, all p > 0.1). Beta-blocker compliance was identified as a problem by both groups (50 vs 53%, P > 0.5) while fewer cardiologists reported compliance as a problem with spironolactone (4 vs 25%, p < 0.05). More cardiologists felt that there was a need for a community based CHF nurse specialist (100 vs 57%, p < 0.001), and that this strategy would reduce hospital admissions (92 vs 57%, p < 0.01). Differences exist between cardiologist and non-cardiologist physicians' awareness of the SIGN guideline for CHE. Furthermore, we have shown differences in reported implementation of the guideline and perceived difficulties with specific drug therapies. This is in spite of high levels of agreement in both groups with the treatment suggested by the guideline and the anticipated benefits resulting from its implementation.

Public release of cardiac surgery outcomes data in New York: What do New York state cardiologists think of it?

Background and Objective: Since 1990, risk-adjusted outcomes for patients undergoing coronary artery bypass graft surgery in New York state have been released to the public. The purpose of this study was to assess the extent to which referring cardiologists share these data with patients and use these data to make referrals. Methods: A survey questionnaire was sent to all cardiologists in New York in the New York State Chapter of the American College of Cardiology. Results: Four hundred fifty cardiologists responded to the survey. Most (94%) found the report “easy to read.” A majority (67%) found the report to be “very accurate” or “somewhat accurate” in capturing differences in the performance of cardiac surgeons, whereas 33% found it to be “not at all accurate.” Twenty-two percent reported that they “routinely discuss the reports with their patients,” and 38% responded that the information has affected their referrals to surgeons “very much” or “somewhat.” Conclusions: A majority of cardiologists has not generally changed their well-established referral patterns as a result of the New York coronary artery bypass graft surgery reports. However, there has been a modest impact on referrals resulting from the distribution of these reports. The findings also suggest that increased dialogue between clinicians and policy makers regarding the format and structure of public releases would be a valuable undertaking. (Am Heart J 1997:134:1120-8.)

Public release of cardiac surgery outcomes data in New York: What do New York state cardiologists think of it?

Correction: In the July 1997 issue of the American Heart Journal, the following article was published with some text and a table omitted. The article is therefore being republished in its entirety. Background and Objective: Since 1990, risk-adjusted outcomes for patients undergoing coronary artery bypass graft surgery in New York state have been released to the public. The purpose of this study was to assess the extent to which referring cardiologists share these data with patients and use these data to make referrals. Methods: A survey questionnaire was sent to all cardiologists in New York in the New York State Chapter of the American College of Cardiology. Results: Four hundred fifty cardiologists responded to the survey. Most (94%) found the report “easy to read.” A majority (67%) found the report to be “very accurate” or “somewhat accurate” in capturing differences in the performance of cardiac surgeons, whereas 33% found it to be “not at all accurate.” Twenty-two percent reported that they “routinely discuss the reports with their patients,” and 38% responded that the information has affected their referrals to surgeons “very much” or “somewhat.” Conclusions: A majority of cardiologists has not generally changed their well-established referral patterns as a result of the New York coronary artery bypass graft surgery reports. However, there has been a modest impact on referrals resulting from the distribution of these reports. The findings also suggest that increased dialogue between clinicians and policy makers regarding the format and structure of public releases would be a valuable undertaking. (Am Heart J 1997:134:1120-8.)