Zoom and its Discontents: Group Decision Making in Pediatric Cardiology in the Time of COVID (and Beyond) : Aurthors.

The emergence of Covid-19 has led to change within hospital-based healthcare. An example, has been to reconfigure clinical decision making meetings from traditional in-person (Face-to-face, FtF) to online video-conferencing (VC) format inorder to decrease contagion risk. Despite its widespread uptake, there is minimal empirical data evaluating this format. This narrative review considers the implications on medical decision-making when clinicians communicate remotely via Microsoft Teams. The discussion is informed by the psychological literature and by commentary obtained from a survey of paediatric cardiac clinicians who participated in clinical meetings when video-conferencing was first introduced. Whist video-conferencing can optimize clinician presence, this is potentially offset by compromises in current imaging quality, the group discussion, information sharing and decision quality. Implementing a shift from face-to-face to VC within the group decision-making process requires an appreciation of the changed environment, appropriate adaptations and the implemention of new technology solutions. Meanwhile, healthcare should carefully consider the potential implications of clinical decision making using online video conferencing, be prepared to adapt and evaluate prior to a shift away from face-to-face formats.

A Longitudinal Study of Individual Radiation Responses in Pediatric Patients Treated with Proton and Photon Radiotherapy, and Interventional Cardiology: Rationale and Research Protocol of the HARMONIC Project.

The Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy (photon and proton) in Pediatrics (HARMONIC) is a five-year project funded by the European Commission that aimed to improve the understanding of the long-term ionizing radiation (IR) risks for pediatric patients. In this paper, we provide a detailed overview of the rationale, design, and methods for the biological aspect of the project with objectives to provide a mechanistic understanding of the molecular pathways involved in the IR response and to identify potential predictive biomarkers of individual response involved in long-term health risks. Biological samples will be collected at three time points: before the first exposure, at the end of the exposure, and one year after the exposure. The average whole-body dose, the dose to the target organ, and the dose to some important out-of-field organs will be estimated. State-of-the-art analytical methods will be used to assess the levels of a set of known biomarkers and also explore high-resolution approaches of proteomics and miRNA transcriptomes to provide an integrated assessment. By using bioinformatics and systems biology, biological pathways and novel pathways involved in the response to IR exposure will be deciphered.

Cardiology Care and Loss to Follow-Up Among Adults With Congenital Heart Defects in CH STRONG.

Many of the estimated 1.4 million adults with congenital heart defects (CHDs) in the United States are lost to follow-up (LTF) despite recommendations for ongoing cardiology care. Using 2016 to 2019 CH STRONG (Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG) data, we describe cardiac care among community-based adults with CHD, born in 1980 to 1997, identified through state birth defects registries. Our estimates of LTF were standardized to the CH STRONG eligible population and likely more generalizable to adults with CHD than clinic-based data. Half of our sample were LTF and more than 45% had not received cardiology care in over 5 years. Of those who received care, only 1 in 3 saw an adult CHD physician at their last encounter. Not knowing they needed to see a cardiologist, being told they no longer needed cardiology care, and feeling "well" were the top reasons for LTF, and only half of respondents report doctors discussing the need for cardiac follow-up.

Occluded Coronary Artery among Non-ST Elevation Myocardial Infarction Patients in Department of Cardiology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomplete blockage of the culprit artery, whereas ST elevation myocardial infarction is frequently thought to be caused by total occlusion of the culprit artery. The objective of the study was to find out the prevalence of occluded coronary arteries among non-ST elevation myocardial infarction patients department of cardiology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among non-ST elevation myocardial infarction patients in a tertiary care centre from 22 June 2020 to 21 June 2021 after taking ethical approval from the Institutional Review Committee [Reference number: 4271 (6-11) E2 076/077]. A total of 196 patients were included in the study by simple randomized sampling. Data on the patient's clinical profile, angiographic findings, and in-hospital complications were recorded. Point estimate and 95% Confidence Interval were calculated. Results: Among 126 non-ST elevation myocardial infarction patients included in the study, the prevalence of occluded coronary artery was 41 (32.54%) (24.36-40.72, 95% Confidence Interval). Conclusions: The prevalence of occluded coronary arteries was similar to the studies done in similar settings. Keywords: coronary angiography; MINOCA; Non-ST elevation myocardial infarction.

Clinical Features and Management of Patients Assessed by Cardiology Teleconsultation in the Brazilian Region with the Highest Number of Isolated Cities. / Características Clínicas e Manejo de Pacientes Avaliados por Teleconsulta Cardiológica na Região Brasileira com Maior Número de Cidades Isoladas.

BACKGROUND: Cardiovascular diseases are the leading cause of adult mortality. Geographically remote and low-income Brazilian regions lack specialized consultations. The telemedicine management of this population by cardiologists is not fully known. OBJECTIVES: To analyze cardiology teleconsultation in the Brazilian region with the highest number of isolated cities. METHODS: From February 2020 to October 2021, patients from the North Region of Brazil evaluated by local general practitioners were referred for cardiological evaluation by telemedicine. Referral reasons, demographics, clinical history, physical examinations, tests, medications, and prescriptions pre- and post-telemedicine were analyzed (p<0.05 was considered statistically significant). RESULTS: We analyzed 653 patients. The attendance rate was 85.7% (53.1% female, mean age: 54.2±6.5 years). The main reasons for referral were cardiovascular symptoms (58.1%) and risk factors among asymptomatic patients (13.3%). Only 12.6% had a diagnosed disease. Most patients had regular physical examinations and electrocardiograms. Few had recent complementary tests. The prescription of angiotensin receptor blockers (ARBs), calcium channel blockers and statins was significantly increased, while that of digoxin, noncardiac beta-blockers and acetylsalicylic acid (ASA) was decreased at the first teleconsultation. Most of the tests requested were of low complexity and cost: electrocardiogram (28.2%), chest X-ray (14%), echocardiogram (64.5%) and blood tests (71.8%). For 2.1% of patients, interventions were indicated, and 8% were discharged after the first consultation. CONCLUSION: On-demand cardiology teleconsultation contributes to heart disease treatment optimization. Most patients were referred with syndromic diagnoses without previous complementary tests. The specialist workup requested was usually available locally and at a low cost but precluded early discharge. Local training could optimize the referral.

FUNDAMENTO: As doenças cardiovasculares são a principal causa de morte no mundo. Regiões brasileiras geograficamente remotas e de baixa renda carecem de consultas especializadas. Não se tem conhecimento total acerca do manejo por telemedicina dessa população por parte de cardiologistas. OBJETIVOS: Analisar a teleconsulta cardiológica na região brasileira com maior número de municípios isolados. MÉTODOS: Entre fevereiro de 2020 e outubro de 2021, pacientes da Região Norte do Brasil avaliados por médicos generalistas locais foram encaminhados para avaliação cardiológica por telemedicina. Foram analisados os motivos do encaminhamento, dados demográficos, histórico clínico, exames físicos, exames complementares, medicamentos e prescrições pré e pós-telemedicina (considerou-se p<0,05 como estatisticamente significativo). RESULTADOS: Analisamos 653 pacientes. A taxa de frequência foi de 85,7% (53,1% do sexo feminino, idade média: 54,2±6,5 anos). Os principais motivos de encaminhamento foram sintomas cardiovasculares (58,1%) e fatores de risco entre pacientes assintomáticos (13,3%). Apenas 12,6% apresentava alguma doença diagnosticada. A maioria dos pacientes havia passado por exame físico e eletrocardiogramas regulares. Poucos tinham exames complementares recentes. A prescrição de bloqueadores dos receptores da angiotensina (BRA), bloqueadores dos canais de cálcio e estatinas aumentou significativamente, enquanto a de digoxina, betabloqueadores não cardíacos e ácido acetilsalicílico (AAS) diminuiu na primeira teleconsulta. A maioria dos exames complementares solicitados era de baixa complexidade e custo: eletrocardiograma (28,2%), radiografia de tórax (14%), ecocardiograma (64,5%) e exames de sangue (71,8%). Para 2,1% dos pacientes, foram indicadas intervenções, e 8% recebeu alta após a primeira consulta. CONCLUSÃO: A teleconsulta cardiológica sob demanda contribui para a otimização do tratamento das doenças cardíacas. A maioria dos pacientes foi encaminhada com diagnósticos sindrômicos sem exames complementares prévios. A avaliação especializada solicitada geralmente estava disponível localmente e com baixo custo, mas impedia a alta precoce. Capacitação local poderia otimizar o encaminhamento.

[living with our dead]. / Vivre avec nos morts.

As a young cardiologist, Dr. Guillaume Bonnet was confronted with the end of life during a significant death that occurred during a shift in cardiological intensive care. Through his testimony, we can see the importance of freeing up speech, as well as ways of thinking about preparing physicians for such situations, particularly by highlighting the role of simulation.

Systematic basic and advanced resuscitation training in medical students and fellows: a proposal from the Working Group on Cardiovascular Urgences and Emergencies of the Italian Society of Cardiology.

Sudden cardiac arrest is a leading cause of death in Europe. High-quality cardiopulmonary resuscitation (CPR) and guidelines compliance of rescuers have been associated with better outcomes after cardiac arrest. However, wide variability in attempting bystander CPR manoeuvres has been reported. Educational programmes for teaching CPR to medical students and fellows are highly advisable in this context. However, there is no homogeneity regarding the CPR education offered by academic institutions. We surveyed 208 Italian medical students and 162 fellows in cardiology regarding the educational offer and needs in CPR. Among the 11 medical schools surveyed, 8 (73%) offer basic (BLS) courses but only 3 (38%) with formal certification of 'BLS provider', while none offers advanced (ACLS/ALS) courses. Among the 30 specialization schools in cardiology surveyed, 10 (33%) offer a BLS course (6 with formal certification of 'BLS provider'), and 8 (27%) offer an ACLS/ALS course (5 with formal certification). Only a minority of students and fellows perceive themselves as highly proficient either in BLS or ACLS/ALS, although most of the fellows were involved at least once in rescuing a cardiac arrest. The present position paper analyses and suggests the strategies that should be adopted by Italian medical and specialization schools to spread the CPR culture and increase the long-standing retention of CPR-related technical and nontechnical skills.

Cardiovascular prevention in women: an update by the Italian Society of Cardiology working group on 'Prevention, hypertension and peripheral disease'.

The recent pandemic has substantially changed the approach to the prevention of cardiovascular diseases in women. Women have been significantly impacted by the changes that occurred during the pandemic and the quarantine adopted to prevent the spread of the disease. Changes involved prevention both through the reduction of visits and preventive screening and through social and economic changes. It is necessary to adopt new cardiovascular prevention approaches focused on returning to healthy lifestyles, reducing stress and depression also using modern tools such as telemedicine, mobile phone applications and the web. These tools convey messages in a persuasive way especially in young and adult women. There is less impact of these new tools on older women towards whom it is important to adopt a more traditional approach. This review focuses on the new approach to cardiovascular prevention in women in light of the lifestyle changes recorded during the pandemic and which led to an increase in obesity examines the effects on the cardiovascular system induced by stress and depression and analyses the new high blood pressure guidelines and indications that are specific to women.

The Italian Society of Cardiology and Working Group on Telecardiology and Informatics 2023 updated position paper on telemedicine and artificial intelligence in cardiovascular disease.

In 2015, the Italian Society of Cardiology and its Working Group on Telemedicine and Informatics issued a position paper on Telecardiology, resuming the most eminent evidence supporting the use of information and communication technology in principal areas of cardiovascular care, ranked by level of evidence. More than 5 years later and after the global shock inflicted by the SARS-CoV-2 pandemic, an update on the topic is warranted. Recent evidence and studies on principal areas of cardiovascular disease will be therefore reported and discussed, with particular focus on telemedicine for cardiovascular care in the COVID-19 context. Novel perspectives and opportunities disclosed by artificial intelligence and its applications in cardiovascular disease will also be discussed. Finally, modalities by which machine learning have realized remote patient monitoring and long-term care in recent years, mainly filtering critical clinical data requiring selective hospital admission, will be provided.

[Heart Diseases by Professor Dmitry D. Pletnev (for the reprint of D.D. Pletnev's monograph "Heart Diseases", 1936)].

The article presents a brief review of Heart Diseases (1936), the monograph by one of the founders of domestic and world cardiology Dmitry Dmitrievich Pletnev. In the monograph, he summarized his clinical and experimental approach to the issues of heart diseases, addressed several fundamental problems of modern physiology and healthcare, introduced the concept of "functional unit" and "functional unity of the whole body", the concept of the extracardiac genesis of the chest frog, differential diagnosis of left and right ventricle myocardial infarction, semiotics and treatment of chronic heart failure, functional diagnosis of heart arrhythmias. All these approaches and concepts have long been included in the classics of world cardiology.

OncoCardioDB: a public and curated database of molecular information in onco-cardiology/cardio-oncology.

Numerous studies have been published which, separately, investigate the influence of molecular features on oncological and cardiac pathologies. Nevertheless, the relationship between both families of diseases at the molecular level is an emerging area within onco-cardiology/cardio-oncology. This paper presents a new open-source database that aims to organize the curated information concerning the molecular features validated in patients involved in both cancer and cardiovascular diseases. Entities like gene, variation, drug, study and others are modelled as objects of a database which is populated with curated information from 83 papers identified by systematic literature searched for up to 2021. Researchers will discover new connections among them to validate hypotheses or suggest new ones. Special care has been taken to use standard nomenclature for genes, pathologies and all the objects for which accepted conventions exist. The database can be consulted via the web with a system of simplified queries, but it also accepts any query. It will be updated and refined with the incorporation of new studies as they become available. Database URL http://biodb.uv.es/oncocardio/.

Conduction system pacing in France in 2022: A snapshot survey from the Working Group of Pacing and Electrophysiology of the French Society of Cardiology.

BACKGROUND: Conduction system pacing (CSP) is an emerging and promising approach for physiological ventricular pacing. While data from randomized controlled trials are scarce, use of His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP) has increased in France. AIM: To perform a national snapshot survey for cardiac electrophysiologists to evaluate adoption of CSP in France. METHODS: An online survey, distributed to every senior cardiac electrophysiologist in France, was conducted in November 2022. RESULTS: A total of 120 electrophysiologists completed the survey. Eighty-three (69%) respondents reported experience in undertaking CSP procedures and 27 (23%) were planning to start performing CSP in the coming 2 years. The implantation techniques and criteria used for successful implantation differed significantly among operators. The most frequent indications for HBP and LBBAP were high-degree atrioventricular block with left ventricular ejection fraction (LVEF) < 40% (24 and 82%, respectively) or with LVEF ≥ 40% (27 and 74%, respectively), and after failure of a coronary sinus left ventricular lead (27 and 71%, respectively). The limitations respondents most frequently perceived when performing HBP were bad sensing/pacing parameters (45%), increased procedure duration (41%) and risk of lead dislodgement (30%). The most frequently perceived limitations to performing LBBAP were absence of guidelines or consensus (31%), lack of medical training (23%) and increased procedure duration (23%). CONCLUSIONS: Our national survey-based study supports wide adoption of CSP in France. CSP is currently used as a second-line approach for both antibradycardia and resynchronization indications, with important variations regarding implantation techniques and criteria for measuring success.