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1.
J Cardiovasc Surg (Torino) ; 65(3): 195-204, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39007553

RESUMO

BACKGROUND: In contemporary clinical practice, carotid artery stenting (CAS) is increasingly becoming a multispecialty field, joining operators of various training backgrounds, which bring forth their unique expertise, patient management philosophies, and procedural preferences. The best practices and approaches, however, are still debated. Therefore, real-world insights on different operator preferences and related outcomes are of utmost value, yet still rather scarce in the available literature. METHODS: Using the data collected in the ROADSAVER observational, European multicenter CAS study, a prespecified comparative analysis evaluating the impact of the operator's specialization was performed. We used major adverse event (MAE) rate at 30-day follow-up, defined as the cumulative incidence of any death or stroke, and its components as outcome measures. RESULTS: A total of 1965 procedures were analyzed; almost half 878 (44.7%) were performed by radiologists (interventional/neuro), 717 (36.5%) by cardiologists or angiologists, and 370 (18.8%) by surgeons (vascular/neuro). Patients treated by surgeons were the oldest (72.9±8.5), while radiologists treated most symptomatic patients (58.1%) and more often used radial access (37.2%). The 30-day MAE incidence achieved by cardiologists/angiologists was 2.0%, radiologists 2.5%, and surgeons 1.9%; the observed differences in rates were statistically not-significant (P=0.7027), even when adjusted for baseline patient/lesion and procedural disparities across groups. The corresponding incidence rates for death from any cause were 1.0%, 0.8%, and 0.3%, P=0.4880, and for any stroke: 1.4%, 2.3%, and 1.9%, P=0.4477, respectively. CONCLUSIONS: Despite the disparities in patient selection and procedural preferences, the outcomes achieved by different specialties in real-world, contemporary CAS practice remain similar when using modern devices and techniques.


Assuntos
Procedimentos Endovasculares , Radiologistas , Stents , Acidente Vascular Cerebral , Humanos , Idoso , Masculino , Feminino , Resultado do Tratamento , Europa (Continente) , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Fatores de Risco , Estenose das Carótidas/terapia , Estenose das Carótidas/mortalidade , Estenose das Carótidas/cirurgia , Cirurgiões , Padrões de Prática Médica , Cardiologistas , Idoso de 80 Anos ou mais , Disparidades em Assistência à Saúde , Especialização , Competência Clínica , Pessoa de Meia-Idade , Medição de Risco
3.
Curr Med Res Opin ; 40(7): 1077-1082, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38850517

RESUMO

BACKGROUND: In patients with atrial fibrillation (AF), direct oral anticoagulants (DOACs) have been utilized as an alternative to warfarin, which is known to have several limitations. This study aimed to clarify the selection criteria for anticoagulants, considering both individual patient factors and the differences between various drugs. METHODS: This study conducted a web-based questionnaire from September 20, 2023 to October 3, 2023, among physicians who were members of a cardiology-specific website. RESULTS: In total, 172 respondents were enrolled in this study. Edoxaban was the most frequently selected anticoagulant (39.1%), followed by apixaban (32.7%) and rivaroxaban (16.8%). Logistic regression analysis revealed that increased concern for adherence enhanced the frequency of selecting edoxaban (odds ratio [OR] = 2.42; p = 0.047), with the opposite trend observed for dabigatran (OR = 0.404; p = 0.029). The selection of apixaban is related to whether the patient is able to maintain a regular lifestyle, including adherence to medication schedules (OR = 1.874; p = 0.031). Furthermore, detailing activities from a medical representative, especially regarding a new indication, were found to influence drug selection for rivaroxaban (OR = 2.422; p = 0.047). CONCLUSION: This study revealed that edoxaban is the most frequently selected anticoagulant. Although prescribing cardiologists select drugs based on background factors, adherence to medication and information from medical representatives were also crucial factors in the selection process.


Assuntos
Anticoagulantes , Fibrilação Atrial , Cardiologistas , Piridonas , Humanos , Feminino , Masculino , Inquéritos e Questionários , Cardiologistas/estatística & dados numéricos , Japão , Anticoagulantes/uso terapêutico , Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Piridonas/uso terapêutico , Piridonas/administração & dosagem , Pessoa de Meia-Idade , Rivaroxabana/uso terapêutico , Rivaroxabana/administração & dosagem , Pirazóis/uso terapêutico , Pirazóis/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/normas , Adulto , Administração Oral , Tiazóis/uso terapêutico , Tiazóis/administração & dosagem , Dabigatrana/uso terapêutico , Dabigatrana/administração & dosagem , Piridinas/uso terapêutico , Piridinas/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Idoso , População do Leste Asiático
4.
J Assoc Physicians India ; 72(4): 68-78, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38881086

RESUMO

BACKGROUND: Coronary artery disease (CAD) management is one of the most significant facets of interventional cardiology. Evidence from several clinical trials has redefined the drug management of CAD, including optimizing the duration of antiplatelet treatment regimens in the management of CAD, which is an intricate clinical issue. The available evidence indicates that East Asians have a higher bleeding risk. However, the Indian phenotype differs from that of East Asians, making this data confounding when applied to clinical decision-making among Indian patients. There is a need for a close understanding of Indian interventional cardiologists' perceptions of complex decision-making pertaining to antiplatelet agents among Indian CAD patients in real-world clinical settings. AIM: This Indian Perspective on De-escalation from Dual Antiplatelet Therapy to Single Antiplatelet Therapy (INDEPTH) study aims to assess the perspective of Indian interventional cardiologists regarding de-escalating from dual antiplatelet therapy (DAPT) to single antiplatelet therapy (SAPT), approach to decision-making, barriers, and related challenges in CAD management. METHODS: A cross-sectional knowledge, attitude, and practice (KAP) study survey was carried out among Indian interventional cardiologists practicing across different regions of India. A total of 209 responses were received. Descriptive statistics was used to summarize all the parameters. IBM Statistical Package for the Social Sciences (SPSS) statistics was used for biostatistical analysis. RESULTS: The study indicated that >90% of CAD patients received DAPT therapy immediately after percutaneous coronary intervention (PCI) (86.1%, p < 0.001). About 115 (55%) of the respondents reported using calculator-based scoring for evaluating bleeding risk in patients on DAPT therapy for the management of acute coronary syndrome (ACS) with post-PCI (p = 0.167). Regarding the usual duration of DAPT therapy post-ACS, nearly half of the respondents, 94 (45%), said that 6-12 months is the usual duration for DAPT therapy in post-ACS patients, followed by > 12 months 94 (45%) of the respondents; 17 (8.1%) of the respondents reported it is 3-6 months, and lastly up to 3 months as per four (1.9%) of the respondents (p < 0.001). A total of 128 (61%) of the respondents strongly believe that balancing bleeding with ischemic risk influenced the choice of antiplatelet agent when treating established CAD. As per interventional cardiologists surveyed, the perfect de-escalation time frame for Indian CAD patients with high bleeding risk (HBR) is up to 3 months (35.9%, p < 0.001), 6-12 months for medium bleeding risk (48.8%, p < 0.001), and >12 months for low bleeding risk (65.6%, p < 0.001). Regarding SAPT therapy, almost one-third of the respondents, 65 (31.1%), reported that they prescribed antiplatelet therapy other than aspirin in 20-40% of their SAPT-eligible patients. Furthermore, 69 (33%) of the respondents said that they preferred to prescribe clopidogrel in 50-75% of SAPT-eligible patients. While 64 (30.5%) prescribed in 25-50%, 53 (25.4%) prescribed in <25% and 23 (11%) of the respondents prescribed the drug in >75% of the SAPT-eligible patients. (p < 0.001). "Atorvastatin + clopidogrel" is the most preferred combination of SAPT primarily for the management of CAD among the majority of interventional cardiologists [33%, 95% confidence interval (CI): 1.97-2.24, p < 0.001]. The study respondents also indicated a need for Indian-specific guidelines on de-escalating from DAPT to SAPT in CAD management. CONCLUSION: The INDEPTH study indicated that the majority of CAD patients received DAPT immediately after PCI. The perfect de-escalation time frame for Indian CAD patients with "high-bleeding" risk is up to 3 and 6-12 months for "medium-bleeding" risk and >12 months for "low-bleeding" risk. One-third of respondents used clopidogrel as an antiplatelet agent in 50-75% of SAPT-eligible patients. Atorvastatin + clopidogrel is predominantly the most preferred combination of statin + SAPT for the management of CAD. Although the current international guidelines cover the Indian perspective to some extent, there is a need for Indian-specific guidelines on de-escalating from DAPT to SAPT.


Assuntos
Cardiologistas , Doença da Artéria Coronariana , Terapia Antiplaquetária Dupla , Inibidores da Agregação Plaquetária , Humanos , Índia , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/uso terapêutico , Terapia Antiplaquetária Dupla/métodos , Doença da Artéria Coronariana/tratamento farmacológico , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Padrões de Prática Médica/estatística & dados numéricos , Intervenção Coronária Percutânea/métodos , Feminino , Masculino , Tomada de Decisão Clínica
7.
J Am Coll Cardiol ; 83(20): 1990-1998, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38749617

RESUMO

BACKGROUND: Little is known about the procedural characteristics, case volumes, and mortality rates for early- vs non-early-career interventional cardiologists in the United States. OBJECTIVES: This study examined operator-level data for patients who underwent percutaneous coronary intervention (PCI) between April 2018 and June 2022. METHODS: Data were collected from the National Cardiovascular Data Registry CathPCI Registry, American Board of Internal Medicine certification database, and National Plan and Provider Enumeration System database. Early-career operators were within 5 years of the end of training. Annual case volume, expected mortality and bleeding risk, and observed/predicted mortality and bleeding outcomes were evaluated. RESULTS: A total of 1,451 operators were early career; 1,011 changed their career status during the study; and 6,251 were non-early career. Overall, 514,540 patients were treated by early-career and 2,296,576 patients by non-early-career operators. The median annual case volume per operator was 59 (Q1-Q3: 31-97) for early-career and 57 (Q1-Q3: 28-100) for non-early-career operators. Early-career operators were more likely to treat patients presenting with ST-segment elevation myocardial infarction and urgent indications for PCI (both P < 0.001). The median predicted mortality risk was 2.0% (Q1-Q3: 1.5%-2.7%) for early-career and 1.8% (Q1-Q3: 1.2%-2.4%) for non-early-career operators. The median predicted bleeding risk was 4.9% (Q1-Q3: 4.2%-5.7%) for early-career and 4.4% (Q1-Q3: 3.7%-5.3%) for non-early-career operators. After adjustment, an increased risk of mortality (OR: 1.08; 95% CI: 1.05-1.17; P < 0.0001) and bleeding (OR: 1.08; 95% CI: 1.05-1.12; P < 0.0001) were associated with early-career status. CONCLUSIONS: Early-career operators are caring for patients with more acute presentations and higher predicted risk of mortality and bleeding compared with more experienced colleagues, with modestly worse outcomes. These data should inform institutional practices to support the development of early-career proceduralists.


Assuntos
Cardiologistas , Intervenção Coronária Percutânea , Sistema de Registros , Humanos , Estados Unidos/epidemiologia , Intervenção Coronária Percutânea/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Cardiologistas/estatística & dados numéricos , Idoso , Competência Clínica
8.
G Ital Cardiol (Rome) ; 25(6): 399-409, 2024 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-38808936

RESUMO

In patients with cardiovascular, pulmonary, muscular and neurological diseases, cardiopulmonary exercise testing (CPET) is a valuable tool providing clinically-relevant diagnostic and prognostic information by evaluation of exercise response. CPET requires to be performed in dedicated centers able to correctly carry out the examination and to carefully evaluate the results. CPET analyzes functional capacity revealing both symptomatic and asymptomatic intolerance to exercise. One of the most important advantages for clinicians derived by the use of CPET, beyond standard exercise electrocardiography testing, is the capability not only to grade the severity of the disease, but also to distinguish between different causes of dyspnea and exercise impairment. Indications for CPET use in clinical practice are increasing in the last decades, evolving beyond the routine use as a training tool in athletes. In fact, CPET represents an important step in the management of patients with heart failure or pulmonary hypertension, as suggested by international guidelines. CPET role in helping for the selection of patients candidate to heart transplantation is also well known. Beyond its clinical usefulness, scientific interest in CPET is constantly expanding, mainly due to the safety of the exam and to the huge size of the pathophysiological information that it offers. The aim of this paper is to simply explain everyday applications and potential further purposes of CPET in clinical practice. Our review is intended both for physicians approaching CPET for the first time and for clinicians with an interest in expanding their knowledge in this field.


Assuntos
Teste de Esforço , Humanos , Teste de Esforço/métodos , Cardiologistas , Tolerância ao Exercício/fisiologia , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/etiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Prognóstico , Eletrocardiografia/métodos , Transplante de Coração
11.
Br J Radiol ; 97(1158): 1191-1201, 2024 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-38711194

RESUMO

OBJECTIVES: To establish conversion coefficients (CCs), between mean absorbed dose to the brain and eye lens of the cardiologist and the air kerma-area product, PKA, for a set of projections in cardiac interventional procedures. Furthermore, by taking clinical data into account, a method to estimate the doses per procedure, or annual dose, is presented. METHODS: Thermoluminescence dosimeters were used together with anthropomorphic phantoms, simulating a cardiologist performing an interventional cardiac procedure, to estimate the CCs for the brain and eye lens dose for nine standard projections, and change in patient size and x-ray spectrum. Additionally, a single CC has been estimated, accounting for each projections fraction of use in the clinic and associated PKA using clinical data from the dose monitoring system in our hospital. RESULTS: The maximum CCs for the eye lens and segment of the brain, is 5.47 µGy/Gycm2 (left eye lens) and 1.71 µGy/Gycm2 (left brain segment). The corresponding weighted CCs: are 3.39 µGy/Gycm2 and 0.89 µGy/Gycm2, respectively. CONCLUSIONS: Conversion coefficients have been established under actual scatter conditions, showing higher doses on the left side of the operator. Using modern interventional x-ray equipment, interventional cardiac procedures will not cause high radiation dose levels to the operator when a ceiling mounted shield is used, otherwise there is a risk that the threshold dose values for cataract will be reached. ADVANCE IN KNOWLEDGE: In addition to the CCs for the different projections, methods for deriving a single CC per cardiac interventional procedure and dose per year were introduced.


Assuntos
Encéfalo , Cardiologistas , Cristalino , Exposição Ocupacional , Imagens de Fantasmas , Doses de Radiação , Humanos , Cristalino/efeitos da radiação , Encéfalo/efeitos da radiação , Encéfalo/diagnóstico por imagem , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Dosimetria Termoluminescente , Cardiologia , Radiografia Intervencionista/métodos
12.
Europace ; 26(5)2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38693772

RESUMO

AIMS: Arrhythmia-induced cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management recommendations for AiCM are lacking. The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to explore the current definitions and management of patients with AiCM among European and non-European electrophysiologists. METHODS AND RESULTS: A 25-item online questionnaire was developed and distributed among EP specialists on the EHRA SIC website and on social media between 4 September and 5 October 2023. Of the 206 respondents, 16% were female and 61% were between 30 and 49 years old. Most of the respondents were EP specialists (81%) working at university hospitals (47%). While most participants (67%) agreed that AiCM should be defined as a left ventricular ejection fraction (LVEF) impairment after new onset of an arrhythmia, only 35% identified a specific LVEF drop to diagnose AiCM with a wide range of values (5-20% LVEF drop). Most respondents considered all available therapies: catheter ablation (93%), electrical cardioversion (83%), antiarrhythmic drugs (76%), and adjuvant HF treatment (76%). A total of 83% of respondents indicated that adjuvant HF treatment should be started at first HF diagnosis prior to antiarrhythmic treatment, and 84% agreed it should be stopped within six months after LVEF normalization. Responses for the optimal time point for the first LVEF reassessment during follow-up varied markedly (1 day-6 months after antiarrhythmic treatment). CONCLUSION: This EHRA Survey reveals varying practices regarding AiCM among physicians, highlighting a lack of consensus and heterogenous care of these patients.


Assuntos
Arritmias Cardíacas , Cardiomiopatias , Humanos , Arritmias Cardíacas/terapia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Feminino , Masculino , Cardiomiopatias/terapia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Pessoa de Meia-Idade , Adulto , Europa (Continente) , Inquéritos e Questionários , Volume Sistólico , Pesquisas sobre Atenção à Saúde , Antiarrítmicos/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Função Ventricular Esquerda , Ablação por Cateter , Cardiologistas
13.
BMC Cardiovasc Disord ; 24(1): 247, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38730379

RESUMO

BACKGROUND: Despite the strong evidence supporting guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), prescription rates in clinical practice are still lacking. METHODS: A survey containing 20 clinical vignettes of patients with HFrEF was answered by a national sample of 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT and the option to make no medication changes. Survey respondents could only select one option. For analysis, responses were dichotomized to the answer of interest. RESULTS: Cardiologists were more likely to make GDMT changes than general medicine physicians (91.8% vs. 82.0%; OR 1.84 [1.07-3.19]; p = 0.020). Cardiologists were more likely to initiate beta-blockers (46.3% vs. 32.0%; OR 2.38 [1.18-4.81], p = 0.016), angiotensin receptor blocker/neprilysin inhibitor (ARNI) (63.8% vs. 48.1%; OR 1.76 [1.01-3.09], p = 0.047), and hydralazine and isosorbide dinitrate (HYD/ISDN) (38.2% vs. 23.7%; OR 2.47 [1.48-4.12], p < 0.001) compared to general medicine physicians. No differences were found in initiating angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARBs), initiating mineralocorticoid receptor antagonist (MRA), sodium-glucose transporter protein 2 (SGLT2) inhibitors, digoxin, or ivabradine. CONCLUSIONS: Our results demonstrate cardiologists were more likely to adjust GDMT than general medicine physicians. Future focus on improving GDMT prescribing should target providers other than cardiologists to improve care in patients with HFrEF.


Assuntos
Cardiologistas , Fármacos Cardiovasculares , Fidelidade a Diretrizes , Pesquisas sobre Atenção à Saúde , Insuficiência Cardíaca , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Volume Sistólico , Função Ventricular Esquerda , Humanos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Padrões de Prática Médica/normas , Volume Sistólico/efeitos dos fármacos , Fidelidade a Diretrizes/normas , Masculino , Feminino , Fármacos Cardiovasculares/uso terapêutico , Fármacos Cardiovasculares/efeitos adversos , Função Ventricular Esquerda/efeitos dos fármacos , Pessoa de Meia-Idade , Resultado do Tratamento , Tomada de Decisão Clínica , Disparidades em Assistência à Saúde , Medicina Interna , Clínicos Gerais , Idoso , Estados Unidos
15.
Curr Cardiol Rep ; 26(6): 601-622, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38625456

RESUMO

PURPOSE OF REVIEW: Invasive cardiologists are exposed to large amounts of ionizing radiation. This review aims to summarize the main occupational risks in a radiation-exposed cardiology practice. RECENT FINDINGS: We carried out a literature review on the subject. The studies reviewed allowed us to list six main health risk categories possibly associated with radiation exposure among cardiologists: deoxyribonucleic acid (DNA) and biochemical damages; cancers; ocular manifestations; olfaction, vascular, and neuropsychological alterations; musculoskeletal problems; and reproductive risks. Our descriptive analysis demonstrates higher risks of DNA damage and lens opacities among radiation-exposed cardiology staff. Surveys and questionnaires have demonstrated a higher risk of musculoskeletal disease in exposed workers. Studies reported no difference in cancer frequency between radiation-exposed workers and controls. Changes in olfactory performance, neuropsychological aspects, and vascular changes have also been reported. Limited literature supports the security of continuing radiation-exposed work during pregnancy. Therefore, there is an urgent need to increase knowledge of the occupational risks of radiation exposure and to adopt technologies to reduce them.


Assuntos
Cardiologistas , Exposição Ocupacional , Exposição à Radiação , Humanos , Exposição Ocupacional/efeitos adversos , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Doenças Profissionais/etiologia , Radiação Ionizante , Fatores de Risco , Dano ao DNA/efeitos da radiação
16.
J Am Heart Assoc ; 13(9): e032837, 2024 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-38639355

RESUMO

Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.


Assuntos
Equidade de Gênero , Cardiopatias Congênitas , Médicas , Humanos , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Feminino , Médicas/estatística & dados numéricos , Médicas/tendências , Masculino , Liderança , Cardiologia/tendências , Pediatria/tendências , Salários e Benefícios , Sexismo/tendências , Fatores Sexuais , Cardiologistas/tendências
17.
Eur Heart J ; 45(22): 1971-1987, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38591670

RESUMO

The last decade has witnessed a paradigm shift in cancer therapy, from non-specific cytotoxic chemotherapies to agents targeting specific molecular mechanisms. Nonetheless, cardiovascular toxicity of cancer therapies remains an important concern. This is particularly relevant given the significant improvement in survival of solid and haematological cancers achieved in the last decades. Cardio-oncology is a subspecialty of medicine focusing on the identification and prevention of cancer therapy-related cardiovascular toxicity (CTR-CVT). This review will examine the new definition of CTR-CVT and guiding principles for baseline cardiovascular assessment and risk stratification before cancer therapy, providing take-home messages for non-specialized cardiologists.


Assuntos
Antineoplásicos , Cardiotoxicidade , Neoplasias , Humanos , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Cardiotoxicidade/prevenção & controle , Cardiotoxicidade/etiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/induzido quimicamente , Cardiologistas , Medição de Risco
18.
Nefrologia (Engl Ed) ; 44(2): 268-275, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38609756

RESUMO

Atrial fibrillation is the most frequent chronic arrhythmia in patients with chronic kidney disease. Oral anticoagulation with vitamin K antagonists and now direct oral anticoagulants have been and are the fundamental pillars for the prevention of thromboembolic events. However, there are no randomized clinical trials on the risk-benefit profile of oral anticoagulation in patients with chronic kidney disease stage 5 on peritoneal dialysis and there is little evidence in the literature in this population. The objective of our study was to know the prevalence, treatment and professionals involved in the management of atrial fibrillation in peritoneal dialysis patients. For this purpose, we performed a descriptive analysis through a survey sent to different peritoneal dialysis units in Spain. A total of 1,403 patients on peritoneal dialysis were included in the study, of whom 186 (13.2%) had non-valvular atrial fibrillation. In addition, the assessment of the scores of thromboembolic and bleeding risks for the indication of oral anticoagulation was mainly carried out by the cardiologist (60% of the units), as well as its prescription (cardiologist 47% or in consensus with the nephrologist 43%). In summary, patients on peritoneal dialysis have a remarkable prevalence of non-valvular atrial fibrillation. Patients frequently receive oral anticoagulation with vitamin K antagonists, as well as direct oral anticoagulants. The data obtained regarding the scores used for the assessment of thromboembolic and bleeding risk, treatment and involvement by Nephrology indicates that there is a need for training and involvement of the nephrologist in this pathology.


Assuntos
Anticoagulantes , Fibrilação Atrial , Diálise Peritoneal , Humanos , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/complicações , Diálise Peritoneal/efeitos adversos , Prevalência , Masculino , Feminino , Anticoagulantes/uso terapêutico , Anticoagulantes/efeitos adversos , Espanha/epidemiologia , Idoso , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Tromboembolia/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/epidemiologia , Cardiologistas , Administração Oral
19.
Int J Cardiol ; 406: 132087, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38648917

RESUMO

BACKGROUND: In the field of academic cardiology, the assessment of an author's scholarly impact and professional progression heavily relies on publications and citations. This study investigates whether specific cardiology expertise correlates with accelerated professional growth. METHODS: Using data from the 2023 European Society of Cardiology congress, 948 faculty attendees with an h-index of 30 or higher were analyzed. Expertises were categorized into six groups, and their association with publications and citations peaks was explored. RESULTS: Interventional cardiologists exhibited the highest annual publication peak, followed by imaging and electrophysiology experts. However, no significant differences were observed in citation peaks among expertise groups. While imaging experts initially appeared to reach citation peaks faster, this effect diminished after statistical adjustments. Additionally, holding multiple expertise areas prolonged the time to reach publication and citation peaks by approximately six years. CONCLUSION: This study underscores the influence of expertise in interventional cardiology on publication peaks but suggests that citation peaks and career progression velocity remain unaffected by expertise type. Furthermore, it highlights that holding multiple areas of expertise slowers the attainment of career peak for scholarly authors.


Assuntos
Cardiologistas , Cardiologia , Humanos , Cardiologistas/normas , Bibliometria , Editoração/normas , Publicações/estatística & dados numéricos , Publicações/normas
20.
Turk Kardiyol Dern Ars ; 52(3): 199-207, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38573088

RESUMO

OBJECTIVE: The homogeneous distribution of physicians is important for ensuring patients' access to health services. To encourage physicians to work in underserved areas, policymakers create incentives. Understanding physicians' employment preferences is essential when developing these incentive packages. This study aims to quantitatively reveal the preferences of cardiologists in Türkiye using a discrete choice experiment (DCE). METHODS: A DCE questionnaire was distributed electronically to all cardiologists in Türkiye. It included 14 different pairs of hypothetical job offers based on seven parameters likely to influence their employment preferences. The data were analyzed using a conditional logit model. The coefficients (CEs) of conditional logistic regression and the willingness-to-accept (WTA) values were calculated. RESULTS: The analysis included 278 cardiologists. It revealed that the most influential parameter was location (CE: 2.86). To move to an undesirable location, the average participant would require an earnings increase of at least 123.3% relative to the average potential earnings of a cardiologist. Other parameters included availability of suitable facilities (CE: 1.07, WTA: 46.3%), harmony with co-workers (CE: 0.92, WTA: 39.61%), working conditions (CE: 0.68, WTA: 29.26%), and the number of night shifts (CE: 0.61, WTA: 26.34%). CONCLUSION: 'Location' emerged as the most important factor in the employment preferences of cardiologists in Türkiye. However, several other monetary and non-monetary factors were also influential, suggesting that policymakers should adopt a holistic approach when developing incentives for cardiologists.


Assuntos
Cardiologistas , Médicos , Humanos , Turquia , Emprego , Modelos Logísticos
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