Survey Of Cardiologists Research Articles

Differences in the Approach to Guideline-Directed Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction: A Survey of Cardiologists, Internists, and Pharmacists.

Guideline-directed medical therapy (GDMT) has significantly improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, GDMT prescribing remains suboptimal. The purpose of this study was to survey cardiologists, internists, and pharmacists on their approach to GDMT prescribing. A survey containing 20 clinical vignettes of patients with HFrEF was answered by 127 cardiologists, 68 internists, and 89 pharmacists. Each vignette presented options for adjusting GDMT. Responses were dichotomized to the answer of interest. A mixed-effect model was used to calculate the odds of changing GDMT between pharmacists and physicians. Pharmacists were more likely to make changes to GDMT compared with internists (92.1% vs 82%; odds ratio [OR] 3.02 [1.50-6.06]; p=0.002). In medically-naïve patients, pharmacists were more likely to initiate beta-blockers than internists (45.4% vs 32.0%; OR 2.19 [1.00-4.79], p=0.049). Pharmacists were more likely than both internists and cardiologists to initiate mineralocorticoid receptor antagonists (34.4% vs 11.5%; OR 4.95 [2.41-10.18]; p<0.001 and 34.4% vs 13.9%; OR 3.95 [2.16-7.21]; p<0.001). Pharmacists were more likely than both internists and cardiologists to titrate beta-blockers (30.9% vs 16.4%; OR 3.15 [1.92-5.19]; p<0.001 and 30.9% vs 22.0%; OR 1.88 [0.18-2.87]; p=0.0030). Pharmacists were more likely than internists to titrate angiotensin receptor-neprilysin inhibitors (ARNI) (61.8% vs 34.1%; OR 3.54 [1.50-8.39]; p=0.004). The survey results show pharmacists were more likely to make any adjustments to GDMT than internists and cardiologists. Pharmacists prefer adding spironolactone and titrating beta-blockers compared with cardiologists and internists. Compared with only internists, pharmacists were more likely to initiate beta-blockers and titrate the dose of ARNI.

Effects of the Japanese medical office system on innovation creation among medical doctors: A survey of cardiologists in acute care settings

ABSTRACT In the Japanese medical office system, medical doctors are dispatched from university medical offices to affiliated hospitals. In the present study, the effects of Japan’s unique medical office system on innovation creation among medical doctors were examined. A questionnaire survey was administered to 150 cardiologists between 7 and 30 June 2023; results showed that 109 (73.0%) participants were affiliated with the medical office system and 41 (27.0%) were not. From the literature, the following categories of elements of creativity were extracted: personality, cognitive processes, competence/intelligence, motivation, work environment/management, social networks and entrepreneurial orientation. Analysis of these categories identified five types of factors influencing creativity: knowledge-seeking attitude, challenging work environment, intrinsic motivation promotion, diversity preference and self-help. Linear regression analysis showed that creativity increased with age (beta, 0.274 [95% confidence interval, 0.084–0.464]; p = 0.005) but was unaffected by all other factors. Thus, the study found that the medical office system did not have a negative impact on the creativity (i.e. innovation creation) of individual medical doctors; however, this system may delay the age at which these doctors can demonstrate their creativity.

Effect of the Japanese medical office system on job satisfaction, loyalty, engagement, and organizational commitment of medical practitioners: a survey of cardiologists in the acute care setting

BackgroundIn Japan, medical doctors have traditionally been assigned from university medical offices, under the medical office system. The present study examined the effects of the medical office system on job satisfaction, engagement, loyalty, and organizational commitment among cardiologists.MethodsIn this study, a survey of 156 cardiologists was conducted, from April 22, 2023, to May 21, 2023, to examine the effect of the medical office system on employee job satisfaction, employee engagement, and organizational commitment.ResultsCompared with the group that belonged to a medical office system (affiliated group, n = 117), the group that did not belong to a medical office system (non-affiliated group, n = 39) was affiliated to hospitals with a smaller number of beds. The results of the factor analysis showed that four types of hospital management styles were generated, namely, environment-, loyalty-building-, treatment-, and philosophy-oriented hospitals. There is an indication that the philosophy-oriented management style was adopted at the workplaces of the non-affiliated group. The treatment-oriented style also tended to be higher in the non-affiliated group than in the affiliated group. Furthermore, the non-affiliated group had higher organizational commitment, indicating that they were more likely to agree with the management philosophy set forth by hospital executives.ConclusionAlthough the medical office system did not affect job satisfaction, compared with medical doctors with the affiliated group, those with the non-affiliated group tended to work in hospitals that emphasized philosophy-oriented management, and they received moderate compensation while practicing in an environment suitable for their specialty. These results suggest that the medical office system makes it difficult for medical doctors to have high workplace loyalty, engagement, and commitment to the hospital to which they are dispatched.

Knowledge of Direct Oral Anticoagulants (DOACS) and Limits of Their Prescription: Survey of Cardiologists, Intensivists, Neurologists and Pulmonologists in Senegal

Knowledge of Direct Oral Anticoagulants (DOACS) and Limits of Their Prescription: Survey of Cardiologists, Intensivists, Neurologists and Pulmonologists in Senegal

The role of seasonal influenza immunisation in cardiovascular care: a survey of cardiologists

Abstract Background Seasonal influenza immunisation reduces cardiovascular events by 30% in those with atherosclerotic cardiovascular disease (ASCVD) and up to 50% in those with recent acute coronary syndrome. However, uptake in high-risk patients remains poor. Clinician recommendation has been shown to increase adoption of influenza immunisation in the general population; thus, cardiologists are well-placed to promote uptake in patients with cardiovascular disease. Purpose To describe the attitudes and behaviours of Australian cardiologists regarding seasonal influenza immunisation. Methods We used an exploratory sequential mixed methods design. Semi-structured interviews of 10 cardiologists were performed to identify themes for quantitative evaluation in an online survey. Multiple choice and Likert scale questions explored (a) attitudes and behaviours regarding influenza immunisation, (b) engagement with colleagues and professional bodies and (c) preventative care in cardiology. The survey was administered to 63 cardiologists between November 2020 and January 2021 and respondents received an honorarium for their time. Results The majority of respondents were general cardiologists (50/63) – compared with subspecialist cardiologists, and had spent an average of 21 years in practice. Less than half of the cardiologists surveyed asked patients about their vaccination status always or most of the time (46%, 29/63). Only one quarter (25.4%, 16/63) of cardiologists recommended influenza immunisation to all of their patients while higher proportions recommended it among patients with ASCVD (49.2%, 31/63), heart failure (69.8%, 44/63) and those over the age of 65 years (68.3%, 44/63). Just over half of the cardiologists (57.1%, 36/63) agreed that influenza immunisation was important/very important for prevention of cardiac events, however this was of lower priority compared with other components of preventive care including smoking cessation (100% agreed important, 63/63), anti-hypertensives (96.8%, 61/63), statins (94.3%, 60/63), exercise (80.9%, 51/63), anticoagulants (74.6%, 47/63), SGLT2 inhibitors (69.8%, 44/63) and diet (68.2%, 43/63). Three quarters of cardiologists (76.2%, 48/63) believed that the clinician predominantly responsible for ensuring that patients received the immunisation was the general practitioner, with only a minority (12.7%, 8/63) reporting that it was the role of the cardiologist. Conclusions Despite a relative risk reduction exceeding that of statins and antihypertensives for patients with CVD, influenza immunisation is not prioritized or recommended by many cardiologists. Efforts at increasing awareness and advocacy among cardiologists may assist in broadening uptake among high-risk patients with cardiovascular disease.

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]

Understanding Source-Related Influences on Physicians’ Translating Comparative Effectiveness Research into Patient Care: Results from a Study of Cardiologists

Comparative effectiveness research (CER), which refers to an evaluation of the clinical effectiveness of two or more medical interventions that are used to treat the same condition, has the potential to inform decision-making in both policy circles and physicians’ exam rooms. The ability of stakeholders to translate that research into practice has important implications for health outcomes, but the impact of information sources on physicians in translating CER remains understudied. This project examines the source-related influences on and motivations of cardiologists with respect to willingness to make changes in their practice based on emerging CER results. The results from this survey of cardiologists (N = 42) indicate that the source of information (including perceived credibility of those sources) matters greatly to cardiologists when deciding whether to make a change in practice. These findings suggest data-based implications for researchers and practitioners that are engaged in closing the CER translation gap.

Antiarrhythmic Medication for Atrial Fibrillation (AIM-AF) study: A physician survey of sotalol use and patient monitoring in the EU and USA

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Sanofi Introduction In the recent 2020 European Society of Cardiology (ESC) guidelines, sotalol was downgraded from a Class IA to a llbA recommendation and advised not to be prescribed in patients with specific co-morbidities. All patients given sotalol should also be closely monitored for proarrhythmic risk factors. To date, American guidelines have not changed. Our study sought to understand the use of sotalol in AF patients and monitoring compliance across the USA and in the EU, with regards to the recent ESC guideline change. Method An online physician survey of cardiologists, cardiac electrophysiologists (EPs) and interventional EPs (N = 569) was conducted in the USA, Germany, Italy and the UK. All respondents were actively treating ≥10 AF patients who received drug therapy and/or who had received or were referred for ablation. This survey included topics on AF types and antiarrhythmic drug (AAD) treatment practices in those with AF +/- co-morbidities (including left ventricular hypertrophy [LVH], LV heart failure, and sinus node dysfunction or renal impairment). Results Sotalol was prescribed across all patient sub-groups, with high use in those with hypertension (49% of physicians) and revascularised coronary artery disease (44%). Sotalol use was consistently higher among US respondents than EU clinicians across co-morbidity categories (heart failure with reduced ejection fraction: 25% vs 14% [guideline deviation]; hypertension: 53% vs 44%; valve disease: 33% vs 23%; recent myocardial infarction [MI]: 44% vs 22%; old MI: 52% vs 31%, respectively). Use was also generally higher among EPs compared with cardiologists, but remained low in patients with minimal or no structural heart disease across all groups. Many respondents prescribed sotalol in those with LVH (35%) or renal impairment (22%), despite guidelines advising against this due to proarrhythmia risk. This contrasts with expressed respondent concerns, as 43% cited ventricular proarrythmia risk as a reason for not using sotalol. Although respondents noted concern over such risks, as per the new guidelines, routine monitoring for these factors was not performed as follows: electrocardiograms (ECG) (19% [US: 23%; EU: 15%]), renal function assessment (42% [US: 36%; EU: 50%]) or electrolyte monitoring (48% [US: 49%; EU: 46%]). Respondents reported sotalol is typically initiated in hospital (45% of patients) or in outpatients with intensive ECG monitoring (37%), but is also being started in non-monitored outpatients (19%). Conclusions Although sotalol use among EU clinicians was lower compared with the USA, which may reflect recent ESC guideline changes, the extent of monitoring practices that would indicate avoidance in those with proarrhythmic risk factors was insufficient. The lack of routine monitoring for specific factors, such as renal impairment or electrolytes, and unmonitored outpatient initiation highlights an ongoing need for further education on maximising safety when using AADs. Abstract Figure.

Antiarrhythmic Medication for Atrial Fibrillation (AIM-AF) study: A physician survey of antiarrhythmic drug (AAD) treatment practices and guideline adherence in the EU and USA

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Sanofi Introduction The 2020 European Society of Cardiology and the 2019 USA (AHA/ACC/HRS) guidelines recommend the use of AADs for rhythm control in patients with symptomatic AF. This study sought to understand AAD treatment practices and adherence to guidelines across the EU and the USA. Method An online physician survey of cardiologists, cardiac electrophysiologists and interventional electrophysiologists (N = 569) was conducted in the USA, Germany, Italy and the UK. All respondents were actively treating ≥10 AF patients who received drug therapy and/or who had received or were referred for ablation. This extensively detailed survey explored questions on physician demographics, AF types, and drug treatment and ablation practices. Results: Of the responses obtained (1) Amiodarone was used frequently across co-morbidity categories (highest use in those with heart failure with reduced left ventricular ejection fraction [LVEF] [80%]), including in those in which it is not indicated for initial therapy (minimal or no structural heart disease: 26%). Other deviations from guideline recommendations, include: class 1C drugs were used with structural heart disease, including coronary artery disease (CAD) (average class 1C use in CAD-related comorbidities: 6%); sotalol was used with renal dysfunction (22%); and drugs such as sotalol and dofetilide were initiated out of hospital (56% and 17% of respondents, respectively). (2) Nonetheless, a majority of respondents (53%) considered guidelines as the most important non-patient factor in influencing their choice of AF management. (3) Rhythm control was selected more frequently as primary therapy for paroxysmal AF (PAF) (59% of patients) while rate control was used more often for persistent AF (53%). (4) For PAF, AADs were preferred as 1st line more often than ablation, especially if PAF was infrequent and mildly symptomatic (59% of respondents) while ablation was preferred more if frequent symptomatic PAF and for recurrent persistent AF. (5) Rhythm control (AAD or ablation) was chosen in notable numbers for asymptomatic AF and subclinical AF (AADs: 36% and 37%, respectively; ablation: 9% and 14%, respectively). (6) AAD use for those with a first or recurrent episodes of symptomatic AF was 60% or 47%, respectively. (7) Efficacy and safety were chosen as the most important considerations for choice of specific rhythm control therapy (49% and 33%, respectively), and reduction of mortality and cardiovascular hospitalisation (23%) were as important as maintaining sinus rhythm (26%) for rhythm therapy goals. Conclusions Although surveyed clinicians consider guidelines important, deviations in patient types and treatments chosen that compromise safety or were not indicated were common. Findings suggest a lack of understanding of the pharmacology and safe use of AADs, highlighting an important need for further education. Abstract Figure.

Best Practices in Specialized Amyloidosis Centers in the United States: A Survey of Cardiologists, Nurses, Patients, and Patient Advocates.

Background:Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group.Methods:A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups.Results:Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research.Conclusions:Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.

PDG47 Periprocedural Percutaneous Coronary Intervention (PCI) Management in Clinical Practice in Europe

Percutaneous coronary intervention (PCIs) are widely practiced in Europe but clinical practice may differ across countries. For this reason, identifying current PCI burden and clinical practice, especially the use of P2Y12 inhibitors, is necessary to understand PCI clinical impact from a health system perspective. A survey of cardiologists and interventional cardiologists from different European countries regarding PCI management practices at their centers was conducted in February 2020. 38 questionnaires were completed (Belgium (n=1), Germany (n=3), Netherlands (n=8), Portugal (n=6), Spain (n=14) and 6 declined to specify). The reported duration of hospital stays (mainly in ICU and cardiovascular units, for 1 - 7 days) following PCI and the occurrence of thrombotic and bleeding events (<1% to 10% and <1% to 20%, respectively) were somewhat variable. Between 8% and 50% of PCIs were described as complex and between 10% and 60% were in high risk patients, mainly due to diabetes. In terms of medication, pre-loading patients with oral P2Y12 inhibitors was considered a good strategy, however between up to 30% of patients didn´t receive any and up to 30% were thought not to be suitable candidates. For bail-out treatment of periprocedural thrombotic events, the GPI tirofiban was the most commonly cited option and often used in pre-loaded patients with oral P2Y12 inhibitors (61%). 29% of respondents reported previous experience using the intravenous P2Y12 inhibitor cangrelor (mostly in STEMI patients) and said they would choose it in up to 50% of complex PCI patients, with fast onset (2 min) and offset of action (duration of effect: 1-2 h) its most-cited added value in the adjunctive treatment in PCI. PCIs have a significant clinical burden in Europe and their clinical management differs across centers and countries. Further studies may be advisable to reveal their economic impact on the health system.

Best Practices In Amyloidosis Programs: A Survey of Cardiologists, Nurses, Patients, and Patient Advocates

Introduction Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is a progressive, life-threatening condition that is underdiagnosed and frequently recognized at a late stage. ATTR-CM poses unique diagnostic and therapeutic challenges that often require referral to an Amyloidosis Program (AP). APs have developed strategic practices to provide multidisciplinary comprehensive care, and their best practices have not yet been studied as a group. Hypothesis Gaining insight on AP best practices may help provide guidance to health care providers who see patients with heart failure about early ATTR-CM diagnosis, comprehensive patient care, improved disease management, and apt timing/consideration of referral to an AP. Methods A qualitative survey was conducted by telephone or e-mail from Oct 14, 2019 to Feb 3, 2020. Interviewees were 15 cardiologists and 9 nurses with ATTR-CM expertise from 15 US APs; 16 patients with ATTR-CM (mean age, 69 y; range, 45-81 y) treated in APs; and 4 patient advocates from amyloidosis support groups. Results The majority of APs included in the survey have been in existence for ≥5 years. Best practices most often cited by cardiologists were diagnostic capability and staff expertise (Figure). The greatest priorities for establishing an AP were building a multidisciplinary approach, ensuring expertise and quality of diagnostic techniques, and allocating time for patient education. Most APs have group meetings to discuss cases, and many include genetic counselors and specialty pharmacists plus a range of clinician/nurse specialists on their teams. Most patients were referred to APs by their physicians, and many travel ≥3 hours to visit APs. Patients described the ‘ideal’ AP as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials (Figure). The majority of APs host patient support group meetings, and patient advocacy groups provide support for APs with physician/patient education and research. Conclusions APs offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient education. Raising awareness of AP best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.

PROBLEMS AND WAYS TO IMPROVE THE ORGANIZATION OF CARDIOLOGICAL CARE TO THE RURAL POPULATION, IN THE CARDIOLOGISTS OPINION

The aim: to study the state, problems and ways of improving the organization of cardialogical care for the rural population in Ukraine based on the materials of a sociological survey of cardiologists.&#x0D; Material and methods The sociological research was carried out according to a specially developed program and covered 352 cardiologists from all regions of Ukraine.&#x0D; Results The main directions for improving the organization of cardialogical care, according to cardiologists opinion, are to increase funding for health care institutions (91,5±1,5%), increase wages (87,2±1,8%), introduce social medical insurance (81,8±2,1%) and mechanisms for economic motivation of personnel (89,8±1,6%); equipping health care institutions with modern medical and diagnostic equipment (73,9±2,3%); improving the quality of postgraduate training of cardiologists (78,2±1,9%); introduction of a health care qua-lity monitoring system (66,9±4,9%); an increase in the economic and legal independence of health care institutions (78,1±2,2); introduction of public-private partnership mechanisms with preservation of health care institutions in state ownership (79,3±2,2%).&#x0D; Conclusions The sociological study found that the main parameters of the organization of cardialogical care for the rural population of Ukraine do not correspond to the economic realities of the time and require modernization.

Medical Malpractice in Interventional Cardiology: Identifying Patterns and Areas for Improvement

Introduction: The feared possibility of involvement in a medical malpractice lawsuit ultimately becomes reality for many physicians in high-risk specialties including cardiology. In a survey of cardiologists and fellows, 15.9% of those from the United States and 13.5% from China stated they were influenced by the fear of malpractice litigation in at least half of all cases they managed daily. A study of 40,916 physicians covered by a large nationwide professional liability insurer from 1991 to 2005 found that the percentage of cardiologists facing a malpractice claim each year is between 7.5%-10%, above the average across all physicians. This study analyzes interventional cardiology malpractice claims by specific procedure and allegation types. Methods: Seventy-nine cardiology malpractice claims involving procedures were identified in a major nationwide legal database (over 200,000 cases) called VerdictSearch. An exemption was obtained from the Yale University Institutional Review Board. Baseline patient characteristics, reasons for lawsuit, and case outcomes were recorded. Statistical analysis included percentage distributions and Fisher’s exact test. Results: A defendant verdict was reached in 64.6% of cases; plaintiƒ verdict, 21.5% (with average payout $5,212,719.79); and settlement, 13.9%. Death was the injury in 48.1% of cases and did not influence the likelihood of a plaintiƒ verdict. Of the 53.2% of cases involving cardiac catheterization, angioplasty, or stenting, periprocedural injury was alleged in 83.3%, lack of informed consent in 7.1%, failure to perform the correct procedure in a timely manner or at all in 14.3%, and performance of an unnecessary procedure in 7.1% (Figure 1). The most common injury type was arterial (non-coronary), including injury to the catheterization site, followed by coronary artery dissection or tamponade (Figure 2). Electrophysiology procedures were the next most common category, and receiving a defendant verdict was significantly less likely for these cases than any other type. A cardiothoracic or vascular surgeon was named as a co-defendant in 25.3% of cases. In 12.6% of cases, cardiologist failure to obtain timely surgical consultation or ensure backup surgeon availability during procedure performance was alleged. Discussion: Comprehensively reviewing interventional cardiology malpractice claims can elucidate common contributory factors to adverse outcomes and practice improvement opportunities. This study ’ s results suggest, for instance, that securing appropriate cardiothoracic surgical backup prior to a catheterization, angioplasty, or stent procedure would significantly decrease the number of lawsuits. Diligence in the informed consent process should also be prioritized, as this area generated allegations in 7.1% of cases. Though VerdictSearch is a large, nationwide legal database, its content is limited to those attorneys, courts, and states who choose to report cases. However, any selection biases may be bidirectional and ultimately cancel each other out, since the attorney on the prevailing side of every case theoretically has equal incentive to report it to a public database so the verdict can be used as a marketing tool for that attorney. By uniquely stratifying cardiology malpractice claims within a large nationwide database by specific procedure types and allegations, this study points to factors that commonly contribute to adverse patient outcomes and enables cardiologists to reflect upon opportunities for clinical practice improvement.

A056 Managing and Monitoring Long-term Oral Corticosteroids – How Good Are We and Do We Follow Best Practice Guidelines?

Background: Long-term (defined as >1 month) oral corticosteroids are widely used for chronic inflammatory and autoimmune conditions. In cardiology, the primary indications are transplantation, cardiac sarcoidosis and large vessel vasculitis. Minimising organ-based complications including infection (Pneumocystis jiroveci pneumonia (PJP)), gastro-intestinal (GI) bleeding and osteoporosis warrant consideration but guidelines vary between specialties and co-existing treatments. The aim of this study was to assess prescribing patterns between specialties at Auckland, Waitemata and Counties Manukau District Health Boards. Method: An anonymised survey of cardiologists, respiratory, oncology, haematology, endocrinology, infectious diseases and rheumatologists with questions regarding prescribing and monitoring practices for: i) PJP prophylaxis, ii) proton pump inhibitor (PPI) for GI protection, iii) baseline bone mineral density (BMD) and iv) bisphosphonate use. Results: In total 44 responders; cardiology n=16 vs. other n=28. PJP prophylaxis was prescribed n= 5 (31%) of cardiologists compared to n=23 (96%) of other specialties. Cardiologists were less likely to prescribe bisphosphonates n=1 (6%) than other specialists n=10 (36%, p value = 0.01) but with similar prescription of PPI and baseline BMD (Figure 1). Conclusion: Prescription of PJP prophylaxis, bisphosphonates and PPIs are lower amongst cardiologists. PPI and bisphosphonates use were high particularly amongst non-cardiologists increasing the patient pill burden but may be unnecessary in the absence of previous GI complications or co-existing NSAID use and moderate-high risk of fracture on BMD. Consensus guidelines for cardiologists aimed at standardising pre-treatment assessment and prevention of prove patient care and prevent unnecessary therapy. [Formula presented]

Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging-Part 1: Standardized Protocol.

Cardiac magnetic resonance (CMR) imaging is widely used in many areas of cardiovascular disease assessment. This is a practical, standard CMR protocol for beginners that is designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines and includes sequence terminology used by vendors, essential MR physics, imaging planes, field strength considerations, MRI-conditional devices, drugs for stress tests, various CMR modules, and disease/symptom-based protocols based on a survey of cardiologists and various appropriate-use criteria. It will be of considerable help in planning and implementing tests. In addressing CMR usage and creating this protocol guideline, we particularly tried to include useful tips to overcome various practical issues and improve CMR imaging. We hope that this document will continue to standardize and simplify a patient-based approach to clinical CMR and contribute to the promotion of public health.

Hypertension Attitude PersPEctives and Needs (HAPPEN): A Real-World Survey of Physicians and Patients With Hypertension in China.

The Hypertension Attitude PersPEctives and Needs (HAPPEN) survey was a real‐world survey of cardiologists, nephrologists, and patients with treated hypertension at level 3 hospitals in China. It aimed to characterize the attitudes and behavior of physicians and patients and to identify possible causes of poor blood pressure (BP) control. Randomly selected participants (100 cardiologists, 30 nephrologists, 400 patients) completed face‐to‐face interviews investigating BP control rates, consulting behavior, prescribing patterns, and attitudes toward hypertension management. Perceived levels of BP control were high; 70% of physicians and 85% of patients believed that BP targets were achieved, despite only 31% of patients achieving targets. Physician satisfaction with control rates and patient satisfaction with treatment were high. Differences in perceived and actual levels of BP control may be driving therapeutic inertia. In combination with inadequate patient evaluation and support services, therapeutic inertia may contribute to poor BP control among patients with treated hypertension in China.

REAL-WORLD PRACTICE PATTERNS OF DOFETILIDE AND SOTALOL UTILIZATION FOR ATRIAL FIBRILLATION: A MULTI-NATIONAL SURVEY

To evaluate the real-world practice patterns of utilization of dofetilide for treating Atrial Fibrillation (AF). We performed an online survey of cardiologists and cardiac electrophysiologists in US and Europe. Participation was voluntary. 31 specific questions were included in the study, primarily

Use of a heart team in decision-making for patients with complex coronary disease at hospitals in Michigan prior to guideline endorsement.

BackgroundRevascularization decisions can profoundly impact patient survival, quality of life, and procedural risk. Although use of Heart Teams to make revascularization decisions is growing, data on their implementation in the real-world are limited. Our objective was to assess the prevalence of Heart Teams and their association with collaboration in routine practice.MethodsA survey of cardiologists and cardiac surgeons at 31 hospitals in Michigan was performed in May, 2011 – prior to the recommendation for using Heart Teams in national guidelines. This survey included all percutaneous coronary intervention-performing hospitals in Michigan participating in the Blue Cross/Blue Shield of Michigan Cardiovascular Consortium and Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. It targeted both the use of Heart Teams and multidisciplinary Case Conferences.ResultsThere were 53 physician survey respondents from 27 hospitals with 4 hospitals not responding. Among respondents, 11 (40.7%) hospitals reported no Heart Teams or Case Conferences while 7 (25.9%) hospitals reported either a Heart Team or Case Conference. However, there was disagreement about the presence of a Heart Team at seven hospitals, and about Case Conferences at nine hospitals. Hospitals with definite Heart Teams reported significantly greater levels of collaboration between cardiologists and cardiac surgeons.ConclusionThe overall presence of Heart Teams prior to their recommendation in national guidelines was limited. Even among hospitals with a potential Heart Team, there was substantial disagreement between respondents about their presence. Further refinement of the definition of a Heart Team and measures of successful implementation are needed.

Collaborative Practice Model Between Cardiologists and Clinical Pharmacists for Management of Patients With Cardiovascular Disease in an Outpatient Clinic

The increasing prevalence of cardiovascular disease (CVD) has prompted leading cardiovascular organizations to advocate utilization of a team approach to patient care that includes nonphysician providers. In spite of that, the American College of Cardiology reported that nonphysician providers are underutilized in the management of patients with CVD. A survey of cardiologists revealed that the underutilization is a result of lack of understanding of how best to involve nonphysician providers in the health care team. Clinical pharmacists are one category of nonphysician providers that have recognized effectiveness in managing patients with CVD. No example of a comprehensive model of collaboration between cardiologists and clinical pharmacists is described in the literature that could serve to close this gap in understanding. The objective of this report is to describe a model of cardiologist-clinical pharmacist collaboration in the longitudinal management of patients with CVD that has been successfully implemented in 2 diverse settings. The implementation, evolution, scope of practice, required pharmacist training, logistical elements needed for success, and implementation barriers are reviewed. A summary of the patients referred to the clinic are examined as well.