Explore the vast range of titles available.

Heterogeneity is observed in the care of patients with chest pain. We investigate the association of physician specialty and diagnostic testing among patients admitted for suspected acute coronary syndrome (ACS). This is a secondary analysis of the CMR-IMPACT multicenter randomized controlled trial in which patients with suspected ACS were admitted and randomized to undergo invasive angiography or non-invasive CMR stress imaging. Admitting physician was dichotomized to interventional cardiologist (IC) or not (e.g. hospitalist). We describe adherence to protocol and angiography during the index visit by treatment arm and admitting physician specialty. A generalized estimating equation accounting for clustering within physician was used to evaluate significance and adjusted for randomization arm. The 258 enrolled patients from 2013 to 2018 had a mean age of 60.7 (SD ± 10.9) years, 40.3 % (104/258 were female), and 64.7 % (167/258) were white race. ICs were the admitting physicians for 50.4 % (130/258) of the patients. Index angiography was performed more often among patients admitted by IC versus other physicians, 65.4 % (85/130) versus 53.1 % (68/128), respectively; aOR 1.75 (95 % CI 1.14–2.68). Among patients randomized to an invasive strategy, higher protocol adherence was observed in those admitted by IC [85.3 % (58/68)] versus other physicians [64.5 % (40/62)]; OR 2.82 (95 % CI 1.08–7.38). For patients randomized to the CMR-based strategy, adherence to protocol was similar for IC [67.7 % (42/62)] and other physicians [66.7 % (44/66)]; OR 0.82 (95 % CI 0.35–1.94). Invasive angiography was more frequent among patients admitted by interventional cardiologists compared to other physicians.

Although the heart team approach is recommended in revascularization guidelines, the frequency with which heart team decisions differ from those of the original treating interventional cardiologist is unknown. To examine the difference in decisions between the heart team and the original treating interventional cardiologist for the treatment of patients with multivessel coronary artery disease. In this cross-sectional study, 245 consecutive patients with multivessel coronary artery disease were recruited from 1 high-volume tertiary care referral center (185 patients were enrolled through a screening process, and 60 patients were retrospectively enrolled from the center's database). A total of 237 patients were included in the final virtual heart team analysis. Treatment decisions (which comprised coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy) were made by the original treating interventional cardiologists between March 15, 2012, and October 20, 2014. These decisions were then compared with pooled-majority treatment decisions made by 8 blinded heart teams using structured online case presentations between October 1, 2017, and October 15, 2018. The randomized members of the heart teams comprised experts from 3 domains, with each team containing 1 noninvasive cardiologist, 1 interventional cardiologist, and 1 cardiovascular surgeon. Cases in which all 3 of the heart team members disagreed and cases in which procedural discordance occurred (eg, 2 members chose coronary artery bypass grafting and 1 member chose percutaneous coronary intervention) were discussed in a face-to-face heart team review in October 2018 to obtain pooled-majority decisions. Data were analyzed from May 6, 2019, to April 22, 2020. The Cohen κ coefficient between the treatment recommendation from the heart team and the treatment recommendation from the original treating interventional cardiologist. Among 234 of 237 patients (98.7%) in the analysis for whom complete data were available, the mean (SD) age was 67.8 (10.9) years; 176 patients (75.2%) were male, and 191 patients (81.4%) had stenosis in 3 epicardial coronary vessels. A total of 71 differences (30.3%; 95% CI, 24.5%-36.7%) in treatment decisions between the heart team and the original treating interventional cardiologist occurred, with a Cohen κ of 0.478 (95% CI, 0.336-0.540; P = .006). The heart team decision was more frequently unanimous when it was concordant with the decision of the original treating interventional cardiologist (109 of 163 cases [66.9%]) compared with when it was discordant (28 of 71 cases [39.4%]; P < .001). When the heart team agreed with the original treatment decision, there was more agreement between the heart team interventional cardiologist and the original treating interventional cardiologist (138 of 163 cases [84.7%]) compared with when the heart team disagreed with the original treatment decision (14 of 71 cases [19.7%]); P < .001). Those with an original treatment of coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy, 32 of 148 patients [22.3%], 32 of 71 patients [45.1%], and 6 of 15 patients [40.0%], respectively, received a different treatment recommendation from the heart team than the original treating interventional cardiologist; the difference across the 3 groups was statistically significant (P = .002). The heart team's recommended treatment for patients with multivessel coronary artery disease differed from that of the original treating interventional cardiologist in up to 30% of cases. This subset of cases was associated with a lower frequency of unanimous decisions within the heart team and less concordance between the interventional cardiologists; discordance was more frequent when percutaneous coronary intervention or medication therapy were considered. Further research is needed to evaluate whether heart team decisions are associated with improvements in outcomes and, if so, how to identify patients for whom the heart team approach would be beneficial.

ObjectiveCardiac guidelines recommend that the decision to perform coronary angiography (CA) in patients with Non-ST-Elevation Acute Coronary Syndrome (NST-ACS) is based on multiple factors. It is, however, unknown how cardiologists weigh these factors in their decision-making. The aim was to investigate the importance of different clinical characteristics, including information derived from risk scores, in the decision-making of Dutch cardiologists regarding performing CA in patients with suspected NST-ACS.DesignA web-based survey containing clinical vignettes.Setting and participantsRegistered Dutch cardiologists were approached to complete the survey, in which they were asked to indicate whether they would perform CA for 8 vignettes describing 7 clinical factors: age, renal function, known coronary artery disease, persistent chest pain, presence of risk factors, ECG findings and troponin levels. Cardiologists were divided into two groups: group 1 received vignettes ‘without’ a risk score present, while group 2 completed vignettes ‘with’ a risk score present.Results129 (of 946) cardiologists responded. In both groups, elevated troponin levels and typical ischaemic changes (p<0.001) made cardiologists decide more often to perform CA. Severe renal dysfunction (p<0.001) made cardiologists more hesitant to decide on CA. Age and risk score could not be assessed independently, as these factors were strongly associated. Inspecting the factors together showed, for example, that cardiologists were more hesitant to perform CA in elderly patients with high-risk scores than in younger patients with intermediate risk scores.ConclusionsWhen deciding to perform in-hospital CA (≤72 hours after patient admission) in patients with suspected NST-ACS, cardiologists tend to rely mostly on troponin levels, ECG changes and renal function. Future research should focus on why CA is less often recommended in patients with severe renal dysfunction, and in elderly patients with high-risk scores. In addition, the impact of age and risk score on decision-making should be further investigated.

Colchicine has emerged as an effective agent for reducing ASCVD based on recent large cardiovascular outcome trials and exerts its benefit through targeting inflammation. In light of the robust body of data and FDA approval of low-dose colchicine for ASCVD prevention, this paper aimed to use the National Prescription Audit to quantify the volume and trends of colchicine prescriptions dispensed through U.S. retail pharmacies between March 2018 and February 2024. Despite a 6% increase in total monthly prescriptions since 2020, which was driven primarily by cardiologists, this specialty still represents only 2.8%-4% of the national monthly precription totals with small absolute numbers (ie estimated ∼4000 incremental prescriptions/month since 2020), suggesting limited cardiologist adoption of colchicine for ASCVD prevention despite favorable clinical trial data. [Display omitted]

Cardiac rehabilitation (CR) is an effective secondary prevention intervention, yet it is globally underutilized. Physicians play a key role in CR uptake by eligible patients through encouragement and referral to the program. This study assessed the knowledge, attitudes, and practices concerning CR among cardiologists in the Kingdom of Saudi Arabia (KSA), identified barriers to patient referrals to CR programs, and proposed strategies to increase service adoption. We conducted an observational cross-sectional study in which an online questionnaire was distributed via email to cardiologists and cardiology fellows during the Saudi Heart Association's annual conference in October 2023 and through social media platforms. Participants were required to have at least six months of clinical practice in managing patients, including those with coronary heart disease (CHD) following percutaneous coronary intervention (PCI). Of the 140 cardiologists surveyed, 106 completed more than 95% of the questionnaires. The cohort, which was primarily male (88.7%), included 67% consulting cardiologists, 15.1% fellows, and 17.9% specialists in areas such as general cardiology (29.2%), interventional cardiology (21.7%), and echocardiography (20.8%). Major barriers included a lack of local CR services (72.6%) and inadequate referral systems (41.5%). Despite the challenges and mixed views on the effectiveness of CR in KSA, attitudes toward CR were largely positive. The knowledge scores averaged 7.97, indicating a moderate to high understanding of CR services and benefits. Referral practices vary widely and are influenced by demographic and workplace factors, mainly geographic location. While cardiologists in KSA generally have reasonable knowledge of CR and its benefits, substantial barriers hinder its broader implementation. There is enthusiasm for adopting diverse CR models; thus, further research is necessary to explore and evaluate alternative CR approaches, including home-based CR and telerehabilitation, to enhance patient care.

To quantify the current state of the cardiology specialist workforce in Health New Zealand - Te Whatu Ora. The Cardiac Society of Australia and New Zealand sent a survey to all Health New Zealand - Te Whatu Ora cardiology departments in 2024, requesting information on specialist cardiac staff. Population information was obtained from Health New Zealand - Te Whatu Ora. International comparisons were obtained by website search. Of 154 Health New Zealand - Te Whatu Ora-employed cardiologists, 119 (77%) were male, and 113 (73%) received cardiology training in New Zealand. Over half were aged >50, 35% >55, including 18% >60 years. Time in current position was 12±9 years and the vacancy rate was 14%. The current ratio of persons per cardiologist is 35,000. In the five districts with the highest proportion of Māori and Pacific peoples, this ratio exceeds the national average: Tairāwhiti 54,000; Counties Manukau 38,000; Lakes 61,000; Northland 52,000; Hawke's Bay 47,000. For cities with cardiac surgery the ratio is 32,000 and without is 46,000. International ratios include: United States of America (USA) 15,000; Canada 25,000; United Kingdom (UK) 40,000 and Australia 25,000 persons per cardiologist. Health New Zealand - Te Whatu Ora has an experienced but ageing cardiologist workforce, with many vacancies. Districts with higher Māori/Pacific populations have fewer cardiologists per capita than the national average of 1:35,000, which is similar to the UK, but less than the USA, Australia and Canada.

Creation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients. The algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance. Based on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.

ObjectivesThis study aimed to determine doctors’ level of adherence to the natriuretic peptide testing guideline and to identify the factors influencing their adherence.DesignCross-sectional study.SettingWeb-based survey.ParticipantsFull-time doctors involved in heart failure (HF) treatment in Vietnam.Primary and secondary outcome measuresDoctors using natriuretic peptide testing for diagnosis, differential diagnosis, treatment assessment and prognosis of patients with HF were classified as adhering to the guidelines. We assessed the practice of natriuretic peptide testing and stratified the doctors based on their professional qualifications. Univariate and multivariate logistic regression analyses were used to estimate the Odds Ratio (ORs) and 95% CIs for associations between guideline adherence and selected covariates.ResultsOver half of the participants adhered to the natriuretic peptide testing guidelines (57.4%). Cardiologists adhered more closely to the guidelines than other professionals; they had approximately four times higher odds of adherence than other doctors (univariate model, OR: 3.88, 95% CI: 2.56 to 5.89, p<0.001; multivariate model, OR: 4.24, 95% CI: 2.64 to 6.82, p<0.001). Cardiologists also had significantly higher rates of using natriuretic peptide testing for diagnosis (93.8% vs 84.1%, p<0.002), differential diagnosis (71.4% vs 53.5%, p<0.001), treatment assessment (87% vs 64.2%, p<0.001) and prognosis (68.2% vs 50.4%, p<0.001) than other professionals. More years of professional experience correlated with higher guideline adherence (<2 years was used as a reference point; >5 to <10 years, OR: 2.59, 95% CI: 1.45 to 4.60, p<0.001; ≥10 years, OR: 2.30, 95% CI: 1.30 to 4.09, p<0.004).ConclusionThe level of adherence to natriuretic peptide testing guidelines among doctors treating patients with HF varies across Vietnam. Targeted interventions are needed to enhance understanding and proficiency, especially among non-cardiologists and those with limited experience. A dedicated fact sheet focusing on natriuretic peptide testing in HF management, separate from the existing guidelines, could bridge this gap.

The COVID-19 pandemic disproportionately affects females in the home and workplace. This study aimed to acquire information regarding the gender-specific effects of the COVID-19 lockdown on aspects of professional and personal lives of a subset of pediatric cardiologists. We sent an online multiple-choice survey to a listserv of Pediatric Cardiologists. Data collected included demographics, dependent care details, work hours, leave from work, salary cut, childcare hours before and after the COVID-19 peak lockdown/stay at home mandate and partner involvement. Two hundred forty-two pediatric cardiologists with dependent care responsibilities responded (response rate of 20.2%). A significantly higher proportion of females reported a salary cut (29.1% of females vs 17.6% of males, p = 0.04) and scaled back or discontinued work (14% vs 5.3%; p = 0.03). Prior to the COVID-19 lockdown phase, females provided more hours of dependent care. Females also reported a significantly greater increase in childcare hours overall per week (45 hours post/30 hours pre vs 30 hours post/20 hours pre for men; p < 0.001).  Male cardiologists were much more likely to have partners who reduced work hours (67% vs 28%; p < 0.001) and reported that their partners took a salary cut compared with partners of female cardiologists (51% vs 22%; p < 0.001). In conclusion, gender disparity in caregiver responsibilities existed among highly skilled pediatric cardiologists even before the COVID-19 pandemic. The pandemic has disproportionately affected female pediatric cardiologists with respect to dependent care responsibilities, time at work, and financial compensation.

Mobile health (mHealth) apps provide innovative solutions for improving treatment adherence, facilitating lifestyle modifications, and optimizing blood pressure control in patients with hypertension. Despite their potential benefits, the adoption and recommendation of mHealth apps by physicians in Germany remain limited. This reluctance may be due to a lack of understanding of the factors influencing physicians' willingness to incorporate these digital tools into routine clinical practice. Understanding these factors is crucial for fostering greater integration of mHealth apps in hypertension care. The aim of this study was to explore the relationship between physicians' information needs and acceptance factors, and how these elements can support the effective integration of mHealth apps into daily medical routines. We conducted a qualitative study involving 24 semistructured telephone interviews with physicians, including 14 cardiologists and 10 general practitioners, who are involved in the treatment of hypertensive patients. Participants were selected through purposive sampling to ensure a diverse range of perspectives. Thematic analysis was conducted using MAXQDA software (Verbi GmbH) to identify key themes and subthemes related to the acceptance and use of mHealth apps. The analysis revealed significant variability in physicians' information needs regarding mHealth apps, particularly concerning their functionalities, clinical benefits, and potential impact on patient outcomes. These informational gaps play a critical role in determining whether physicians are willing to recommend mHealth apps to their patients. Key determinants influencing acceptance were identified, including the availability of robust knowledge about the apps, high-quality and reliable data, generational shifts within the medical profession, solid evidence supporting the effectiveness of the mHealth apps, and clearly defined areas of application and responsibilities within the physician-patient relationship. The study found that acceptance of mHealth apps could be significantly increased through targeted educational initiatives, enhanced data quality, and better integration of these tools into existing clinical workflows. Furthermore, younger physicians, more familiar with digital technologies, demonstrated greater openness to using mHealth apps, suggesting that generational changes may drive future increases in adoption. The successful integration of mHealth apps into hypertension management requires a multifaceted approach that addresses both the informational and practical concerns of physicians. By disseminating comprehensive knowledge about the variety, functionality, and proven efficacy of hypertension-related mHealth apps, health care providers can be better equipped to use these tools effectively. This approach necessitates the implementation of various knowledge transfer strategies, such as targeted training programs, peer learning opportunities, and active engagement with digital health technologies. As physicians become more informed and confident in the use of mHealth apps, their acceptance and recommendation of these tools are likely to increase, leading to more widespread adoption. Overcoming current barriers related to information deficits and data quality is essential for ensuring that mHealth apps are optimally used in routine hypertension care, ultimately improving patient outcomes and enhancing the overall quality of care. German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761. RR2-10.3389/fcvm.2022.1089968.