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2021 ◽  
Author(s):  
Brooke Atkins ◽  
Stacey Matthews ◽  
Natalie Walton ◽  
Julie-Anne Mitchell ◽  
Garry Jennings ◽  
...  

BACKGROUND Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile applications (apps) for real-time use in clinical practice. The National Heart Foundation of Australia publish three key cardiac clinical guidelines in collaboration with the Cardiac Society of Australia and New Zealand including: 1) the Australian clinical guidelines for the prevention and detection of atrial fibrillation; 2) the Australian clinical guidelines for the detection and management of heart failure ; and 3) the Australian clinical guidelines for the management of acute coronary syndromes. To improve access and uptake for healthcare providers we developed the Smart Heart Guideline App OBJECTIVE To understand the need for, develop and evaluate the uptake of an Australian-specific mobile app to improve access and uptake of three national cardiac clinical guidelines. METHODS We used an iterative mixed methods approach, an established method in mobile app development and evaluation. First, we conducted an online survey of end-users in 2017 to determine the need and acceptability of an Australian-specific mobile app to access cardiac clinical guidelines. Second, we engaged a software developer to create the Smart Heart Guidelines App using a process of design, testing and revision, which included user testing. The app was registered with the regulatory body in Australia, the Therapeutic Goods Administration, and made freely available from October 2019 on iOS and Android operating systems and promoted using multiple methods. Third, data from the app stores was analyzed between 1 October 2019 – 1 October 2020 to evaluate the app’s uptake and performance. Fourth, data from two annual national General Practitioner (GP) surveys in 2019 and 2020 were analyzed to assess awareness and use of the clinical guidelines and the app. RESULTS Most health professionals surveyed (89%; n=447/504) reported accessing resources electronically and most (70%) reported they would use an Australian-specific cardiac guidelines app. The app was downloaded 11 313 times (66%; n=7483 from Apple App Store; 34%; n=3,830 from Google Play) during the first 20-month period. Most downloads (84%; n=6300) were a result of searching for the app in the stores. Apple App Store data indicated over 59900 impressions (the number of times the app appeared in a search) and 9000 product page views (number of times a user viewed the apps product page). Monthly downloads rates varied. Many (85%) Android users deleted the app. CONCLUSIONS Health professionals supported the development of the Smart Heart Guidelines App. The number of app store searches and total downloads indicate initial promotion of the app was effective. Further evaluation of users’ experience is needed.


2021 ◽  
Vol 18 (2) ◽  
pp. 49-51
Author(s):  
Chandra Mani Adhikari ◽  
Kiran Prasad Acharya ◽  
Amrit Bogati ◽  
Anjana Acharya ◽  
Roshani Shahi ◽  
...  

Background and Aims:  Transcatheter closure of Atrial septal defect (ASD) is one of important modality of treatment these days for ASD secundum. However, there is a paucity of data on transcatheter closure of ASDs with ³40 septal occluder. We aim to study the outcome of ASD device closure with  ³40 mm Septal Occluder in Shahid Gangalal National Heart Centre, Nepal. Methods:   It was a prospective single center study conducted at Shahid Gangalal National Heart Centre, Nepal.Among the 27 patient who underwent successful device closure with ³40 mm devices from January 2016 till December 2019, twenty-six patients could be prospectively followed up during May 2020 till December 2020. A Performa was designed to collect information about age, gender, ASD size, ASD device type and size. Right atrium(RA) and right ventricle(RV) dimension, level of tricuspid regurgitation (TR) and tricuspid regurgitation pressure gradient before the procedure and at the time of follow up were also recorded. Results: Amplatzer septal occluder (40mm) was used in 25 (96.1%) patients and Memopart device (42mm) was used in 1 (3.9%) patient.  Before the procedure all patients had dilated RA and RV, Mild TR, moderate TR and severe TR was present in 14 (53.8%), 10 (38.4%) and 2 (7.7%) patients respectively. At follow up, only one (3.9%) patient had dilated RA and RV. Mean Tricuspid regurgitation pressure gradient decreased from mean 44.4 mmHg to 18.9 mmHg. Conclusion: Transcatheter Closure of Atrial Septal Defects with ³40 mm Septal Occluder is safe and effective in short term follow up.


Author(s):  
Brian P. Delisle ◽  
Alfred L. George ◽  
Jeanne M. Nerbonne ◽  
Joseph T. Bass ◽  
Crystal M. Ripplinger ◽  
...  

Sudden cardiac death (SCD), the unexpected death due to acquired or genetic cardiovascular disease, follows distinct 24-hour patterns in occurrence. These 24-hour patterns likely reflect daily changes in arrhythmogenic triggers and the myocardial substrate caused by day/night rhythms in behavior, the environment, and endogenous circadian mechanisms. To better address fundamental questions regarding the circadian mechanisms, the National Heart, Lung, and Blood Institute convened a workshop, Understanding Circadian Mechanisms of Sudden Cardiac Death. We present a 2-part report of findings from this workshop. Part 1 summarizes the workshop and serves to identify research gaps and opportunities in the areas of basic and translational research. Among the gaps noted: a lack of standardization in animal studies for reporting environmental conditions (eg, timing of experiments relative to the light dark cycle or animal housing temperatures) that can impair rigor and reproducibility. Workshop participants also pointed to uncertainty regarding the importance of maintaining normal circadian rhythmic synchrony and the potential pathological impact of desynchrony in SCD risk. One related question raised was whether circadian mechanisms can be targeted to reduce SCD risk. Finally, the experts underscored the need for studies aimed at determining the physiological importance of circadian clocks in the many different cell types important to normal heart function and SCD. Addressing these gaps could lead to new therapeutic approaches/molecular targets that can mitigate the risk of SCD not only at certain times but over the entire 24-hour period.


Author(s):  
Brian P. Delisle ◽  
Alfred L. George ◽  
Jeanne M. Nerbonne ◽  
Joseph T. Bass ◽  
Crystal M. Ripplinger ◽  
...  

Sudden cardiac death (SCD) is the sudden, unexpected death due to abrupt loss of heart function secondary to cardiovascular disease. In certain populations living with cardiovascular disease, SCD follows a distinct 24-hour pattern in occurrence, suggesting day/night rhythms in behavior, the environment, and endogenous circadian rhythms result in daily spans of increased vulnerability. The National Heart, Lung, and Blood Institute convened a workshop, Understanding Circadian Mechanisms of Sudden Cardiac Death to identify fundamental questions regarding the role of the circadian rhythms in SCD. Part 2 summarizes research gaps and opportunities in the areas of population and clinical research identified in the workshop. Established research supports a complex interaction between circadian rhythms and physiological responses that increase the risk for SCD. Moreover, these physiological responses themselves are influenced by several biological variables, including the type of cardiovascular disease, sex, age, and genetics, as well as environmental factors. The emergence of new noninvasive biotechnological tools that continuously measure key cardiovascular variables, as well as the identification of biomarkers to assess circadian rhythms, hold promise for generating large-scale human data sets that will delineate which subsets of individuals are most vulnerable to SCD. Additionally, these data will improve our understanding of how people who suffer from circadian disruptions develop cardiovascular diseases that increase the risk for SCD. Emerging strategies to identify new biomarkers that can quantify circadian health (eg, environmental, behavioral, and internal misalignment) may lead to new interventions and therapeutic targets to prevent the progression of cardiovascular diseases that cause SCD.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nabila Mohamed Abd El Aziz Fahmy ◽  
Wael Reda Hussein ◽  
Ehab Essam Khamis Al Hanash

Abstract Background The assessment of mitral regurgitation (MR) is complex and complicated by the dynamic nature of this valvular abnormality. Intraoperative transesophageal echocardiography (TEE) is a well-established tool that is used to assess the mitral regurgitation (MR) before and after mitral valve reconstruction. Objectives This study conducted in the National Heart Institute in Cairo aimed at assessing the effect of depth of anaesthesia guided by bispectral index on the severity of mitral insufficiency as measured by transesophageal echocardiography. Patients and Methods This study was conducted in the National Heart Institute in Cairo. The study was conducted for a period of about six months after the approval from Ethical committee. Informed oral consent for every patient was obtained. Prospective observational cross-sectional study with a random sample of 20 patients at National Heart Institute. A sample size of at least 15 data pairs achieves 80% power to reject the null hypothesis of zero effect size when the population effect size is 0.80 and the significance level (alpha) is 0.05 using a two-sided paired ttest. Adult patients undergoing elective cardiac surgery in National Heart Institute. Results The MR severity decreased at a deeper anaesthesia at low BIS than at a shallower anaesthesia at high BIS in patients with organic MR. Eight patients out of twenty patients (40% with organic MR) showed a + 1 grade of improvement in MR grade, by semi-quantitively measuring maximal JA and VC width. Improvement in mitral regurge severity thought to be secondary to unloading effect of general anaesthesia on left ventricle causing a decrease in afterload, preload, and left ventricular dimensions. This study demonstrated that, a comparison between deep anaesthesia and shallow anaesthesia using BIS showed there is a significant reduction in multiple parameters of MR severity assessment secondary to unloading effect of general anaesthesia on left ventricle caused by a decrease in both afterload and preload. Conclusion This reduction in MR severity appeared to be significant enough to modify intraoperative decisions regarding valve surgery by underestimation of valve severity. Thus, strong consideration should be given to thorough preoperative assessment of MR severity, rather than relying on intraoperative findings.


Author(s):  
Emelia J. Benjamin ◽  
Sana M. Al‐Khatib ◽  
Patrice Desvigne‐Nickens ◽  
Alvaro Alonso ◽  
Luc Djoussé ◽  
...  

Abstract There has been sustained focus on the secondary prevention of coronary heart disease and heart failure; yet, apart from stroke prevention, the evidence base for the secondary prevention of atrial fibrillation (AF) recurrence, AF progression, and AF‐related complications is modest. Although there are multiple observational studies, there are few large, robust, randomized trials providing definitive effective approaches for the secondary prevention of AF. Given the increasing incidence and prevalence of AF nationally and internationally, the AF field needs transformative research and a commitment to evidenced‐based secondary prevention strategies. We report on a National Heart, Lung, and Blood Institute virtual workshop directed at identifying knowledge gaps and research opportunities in the secondary prevention of AF. Once AF has been detected, lifestyle changes and novel models of care delivery may contribute to the prevention of AF recurrence, AF progression, and AF‐related complications. Although benefits seen in small subgroups, cohort studies, and selected randomized trials are impressive, the widespread effectiveness of AF secondary prevention strategies remains unknown, calling for development of scalable interventions suitable for diverse populations and for identification of subpopulations who may particularly benefit from intensive management. We identified critical research questions for 6 topics relevant to the secondary prevention of AF: (1) weight loss; (2) alcohol intake, smoking cessation, and diet; (3) cardiac rehabilitation; (4) approaches to sleep disorders; (5) integrated, team‐based care; and (6) nonanticoagulant pharmacotherapy. Our goal is to stimulate innovative research that will accelerate the generation of the evidence to effectively pursue the secondary prevention of AF.


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