Cardiac papillary fibroelastomas (CPFs) are benign endocardial tumours with embolic potential. This article is a systematic review to identify the clinical profile, diagnosis, tumour characteristics, and treatment modalities in patients with CPF presenting with stroke or transient ischemic attack (TIA).
Methods
This systematic review was conducted using the PubMed and Embase databases, including case reports and/or series and observational studies (for a search period of up until April 2022). A descriptive summary of case reports and/or series, and a narrative summary of observational studies, were completed.
Results
A total of 161 cases were identified from 133 case reports and 11 case series. The mean age of patients was 54.8 years, and 46.6% were male. TIA and stroke were reported in 32.3% and 67.8%, respectively. The most common stroke territory was multiple brain sites (36.6%). The mean tumour size was 11.8 mm. Most of the tumours were left-sided (98.7%). The mitral valve was the most involved valve (38.9%), with the anterior leaflet being the commonest site (61.3%). A total of 91.4% of tumours were independently mobile; 10.6% of tumours missed by transthoracic echocardiography were identified on transesophageal echocardiography. Antiplatelet and anticoagulation treatment were used in 87.9% and 12.1% of cases, respectively. Simple excision, valve repair, and valve replacement were performed in 66.7%, 16.7%, and 16.7%, respectively. The logistic regression model revealed that age was the only significant predictor; an increase in the log-odds of recurrent cerebrovascular events occurred with increasing age.
Conclusions
CPFs are a differential diagnosis of cryptogenic stroke, especially if the initial workup for stroke is negative. Transesophageal echocardiography serves as a better imaging tool, compared to transthoracic echocardiography, in identifying CPF. Although the consensus for CPF management remains controversial, surgical excision is the primary approach for left-sided CPF presenting as stroke or TIA.
{"title":"Cardiac Papillary Fibroelastoma and Cerebrovascular Events: A Systematic Review","authors":"Gagan Neupane MD , Raksha Sharma MD , Rabindra Parajuli PhD , Adithya Mathews MD, FACC, MBA , Houman Khalili MD, FACC, FSCAI","doi":"10.1016/j.cjco.2024.07.008","DOIUrl":"10.1016/j.cjco.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac papillary fibroelastomas (CPFs) are benign endocardial tumours with embolic potential. This article is a systematic review to identify the clinical profile, diagnosis, tumour characteristics, and treatment modalities in patients with CPF presenting with stroke or transient ischemic attack (TIA).</div></div><div><h3>Methods</h3><div>This systematic review was conducted using the PubMed and Embase databases, including case reports and/or series and observational studies (for a search period of up until April 2022). A descriptive summary of case reports and/or series, and a narrative summary of observational studies, were completed.</div></div><div><h3>Results</h3><div>A total of 161 cases were identified from 133 case reports and 11 case series. The mean age of patients was 54.8 years, and 46.6% were male. TIA and stroke were reported in 32.3% and 67.8%, respectively. The most common stroke territory was multiple brain sites (36.6%). The mean tumour size was 11.8 mm. Most of the tumours were left-sided (98.7%). The mitral valve was the most involved valve (38.9%), with the anterior leaflet being the commonest site (61.3%). A total of 91.4% of tumours were independently mobile; 10.6% of tumours missed by transthoracic echocardiography were identified on transesophageal echocardiography. Antiplatelet and anticoagulation treatment were used in 87.9% and 12.1% of cases, respectively. Simple excision, valve repair, and valve replacement were performed in 66.7%, 16.7%, and 16.7%, respectively. The logistic regression model revealed that age was the only significant predictor; an increase in the log-odds of recurrent cerebrovascular events occurred with increasing age.</div></div><div><h3>Conclusions</h3><div>CPFs are a differential diagnosis of cryptogenic stroke, especially if the initial workup for stroke is negative. Transesophageal echocardiography serves as a better imaging tool, compared to transthoracic echocardiography, in identifying CPF. Although the consensus for CPF management remains controversial, surgical excision is the primary approach for left-sided CPF presenting as stroke or TIA.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1259-1273"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cjco.2024.07.010
Razi Khan MD, MSc , Shanjot Brar MD , Farshad Hosseini MD , Nazmul Karim MBBS, MPH, PhD , Natasha Kohli RN , Robert Yao MD , Albert Chan MD , Jahangir Charania MD , Roger Philipp MD , Minh Vo MD , Tycho Vuurmans MD, PhD
Background
Repatriation of ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is common in regional health care programs. We examined the short- and long-term safety of early repatriation after PPCI in stable STEMI patients.
Methods
Consecutive stable STEMI patients undergoing PPCI between 2016 to 2018 in the Fraser Health Authority were included. Outcomes were compared between early and nonrepatriated cohorts. Co-primary outcomes were a composite of death, myocardial infarction, congestive heart failure, and stroke at 30 days and 1 year. Logistic regression analyses were performed to determine association between early repatriation and outcomes, and to assess impact of transfer to cardiologist- vs internist-based care centres.
Results
A total of 788 patients were included, with 62% being repatriated early. Primary composite and individual outcomes rates were similar between both cohorts. Early repatriation was not an independent predictor of 30-day (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.50-1.72; P = 0.82) or 1-year (OR 1.05, 95% CI 0.67-1.65; P = 0.8) primary outcome, or of 30-day (OR 1.35, 95% CI 0.41-4.47, P = 0.63) or 1-year (OR 1.03, 95% CI 0.44-2.40; P = 0.95) mortality. Among early repatriated patients, transfer to cardiologist- vs internist-based care centres was not an independent factor for 30-day (OR 1.07, 95% CI 0.45-2.54; P = 0.87) or 1-year (OR 1.17, 95% 0.55-2.50, P = 0.69) primary outcome.
Conclusions
Early repatriation of stable STEMI patients after PPCI appears to be safe based on short- and long-term outcomes, and transfer to internist- vs cardiology-based centres did not affect outcomes. After PPCI, early repatriation allows for redistribution of stable STEMI patients to lower-acuity settings across regional hospitals.
{"title":"Assessing the Safety of Early Repatriation for Stable ST-Segment Elevation Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention","authors":"Razi Khan MD, MSc , Shanjot Brar MD , Farshad Hosseini MD , Nazmul Karim MBBS, MPH, PhD , Natasha Kohli RN , Robert Yao MD , Albert Chan MD , Jahangir Charania MD , Roger Philipp MD , Minh Vo MD , Tycho Vuurmans MD, PhD","doi":"10.1016/j.cjco.2024.07.010","DOIUrl":"10.1016/j.cjco.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Repatriation of ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is common in regional health care programs. We examined the short- and long-term safety of early repatriation after PPCI in stable STEMI patients.</div></div><div><h3>Methods</h3><div>Consecutive stable STEMI patients undergoing PPCI between 2016 to 2018 in the Fraser Health Authority were included. Outcomes were compared between early and nonrepatriated cohorts. Co-primary outcomes were a composite of death, myocardial infarction, congestive heart failure, and stroke at 30 days and 1 year. Logistic regression analyses were performed to determine association between early repatriation and outcomes, and to assess impact of transfer to cardiologist- vs internist-based care centres.</div></div><div><h3>Results</h3><div>A total of 788 patients were included, with 62% being repatriated early. Primary composite and individual outcomes rates were similar between both cohorts. Early repatriation was not an independent predictor of 30-day (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.50-1.72; <em>P</em> = 0.82) or 1-year (OR 1.05, 95% CI 0.67-1.65; <em>P</em> = 0.8) primary outcome, or of 30-day (OR 1.35, 95% CI 0.41-4.47, <em>P</em> = 0.63) or 1-year (OR 1.03, 95% CI 0.44-2.40; <em>P</em> = 0.95) mortality. Among early repatriated patients, transfer to cardiologist- vs internist-based care centres was not an independent factor for 30-day (OR 1.07, 95% CI 0.45-2.54; <em>P</em> = 0.87) or 1-year (OR 1.17, 95% 0.55-2.50, <em>P</em> = 0.69) primary outcome.</div></div><div><h3>Conclusions</h3><div>Early repatriation of stable STEMI patients after PPCI appears to be safe based on short- and long-term outcomes, and transfer to internist- vs cardiology-based centres did not affect outcomes. After PPCI, early repatriation allows for redistribution of stable STEMI patients to lower-acuity settings across regional hospitals.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1289-1298"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cjco.2024.08.003
Michael Ke Wang MD , P.J. Devereaux MD, PhD , Maura Marcucci MD, MSc , Vladimir Lomivorotov MD, PhD , Daniel I. Sessler MD , Matthew T.V. Chan MBBS, MMed, PhD , Flavia K. Borges MD, PhD , Sandra N. Ofori MBBS, PhD , Pilar Paniagua MD, PhD , James D. Douketis MD , Alben Sigamani MD , Joel L. Parlow MD, FRCPC, MSc , Chew Y. Wang MBChB , Juan Carlos Villar MD, PhD , Sadeesh K. Srinathan MD, MSc, FRCSC, FRCS C-Th , Wojciech Szczeklik MD, PhD , María José Martínez-Zapata MD, PhD , German Malaga MD, MSc , Soori Sivakumaran MD, FRCPC , William F. McIntyre MD, PhD, FRCPC , David Conen MD, MPH
Background
Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time.
Methods
We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression.
Results
Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3—16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11).
Conclusions
Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population.
背景具有临床意义的围手术期心房颤动（POAF）是非心脏手术后常见的心脏并发症。我们对 2002 年至 2021 年期间参加围手术期缺血评估 (POISE)-1、2 和 3 试验的 POAF 患者进行了观察性子研究，这些患者心血管风险较高。POAF 被定义为术后 30 天内发生的新的、有临床意义的心房颤动。我们评估了出院时和术后 30 天内针对 POAF 使用心律控制和抗凝治疗的情况。结果 在纳入的 27,896 例患者中，有 545 例（1.9%）出现了具有临床意义的 POAF。48.6%的患者接受了节律控制治疗。使用节律控制治疗的比例在试验过程中有所增加（POISE-1 vs POISE-2 vs POISE-3；40.9% vs 49.5% vs 59.1%）。随机日期越晚，使用节律控制治疗的比例越高（几率比为每年 1.05；95% 置信区间为 1.01-1.09）。21%的 POAF 病例接受了抗凝治疗。与之前的两项试验相比，POISE-3 的抗凝治疗使用率更高（POISE-1 vs POISE-2 vs POISE-3-16.4% vs 16.5% vs 33.6%）。结论尽管缺乏随机对照试验，但针对 POAF 的节律控制和抗凝治疗的使用水平正在上升。迫切需要进行高质量的试验，以确定这些干预措施在这一人群中是否安全有效。
{"title":"Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery","authors":"Michael Ke Wang MD , P.J. Devereaux MD, PhD , Maura Marcucci MD, MSc , Vladimir Lomivorotov MD, PhD , Daniel I. Sessler MD , Matthew T.V. Chan MBBS, MMed, PhD , Flavia K. Borges MD, PhD , Sandra N. Ofori MBBS, PhD , Pilar Paniagua MD, PhD , James D. Douketis MD , Alben Sigamani MD , Joel L. Parlow MD, FRCPC, MSc , Chew Y. Wang MBChB , Juan Carlos Villar MD, PhD , Sadeesh K. Srinathan MD, MSc, FRCSC, FRCS C-Th , Wojciech Szczeklik MD, PhD , María José Martínez-Zapata MD, PhD , German Malaga MD, MSc , Soori Sivakumaran MD, FRCPC , William F. McIntyre MD, PhD, FRCPC , David Conen MD, MPH","doi":"10.1016/j.cjco.2024.08.003","DOIUrl":"10.1016/j.cjco.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time.</div></div><div><h3>Methods</h3><div>We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3—16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11).</div></div><div><h3>Conclusions</h3><div>Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1363-1371"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cjco.2024.08.006
Alexander C. Egbe MD, MPH, Barry A. Borlaug MD, William R. Miranda MD, Snigdha Karnakoti MBBS, Ahmed E. Ali MBBS, Ahmed Younis MBBS, Heidi M. Connolly MD
Background
Aortic valve disease is common in adults with coarctation of aorta. However, no systematic comparative analyses have been performed of the clinical course of aortic valve disease for male vs female patients in this population. The purpose of this study was to compare cardiac remodelling, onset of symptoms, and incidence of aortic valve replacement (AVR) for male vs female patients.
Methods
A retrospective study was conducted of adults with repaired coarctation of aorta and ≥ moderate aortic stenosis and/or aortic regurgitation. Cardiac remodelling (left ventricular [LV], left atrial, right ventricular [RV], and right atrial structure and function) and symptomatic and/or functional class were determined at the baseline encounter. Development of new-onset symptoms and the incidence of AVR were ascertained for the period from baseline to last encounter.
Results
We identified 214 patients (121 male [57%], 93 female [43%]). Although both groups had a similar aortic valve gradient, aortic valve area indexed to body surface area, aortic regurgitation severity, and functional status at baseline, female patients had more LV concentric hypertrophy and remodelling, left atrial hypertension and dysfunction, elevated RV systolic pressure, and RV systolic dysfunction. Of 151 patients without symptoms at baseline,102 (72%) developed symptoms. Female sex was independently associated with new-onset symptoms (adjusted hazard ratio 1.14, [95% confidence interval 1.05-1.23]). Of 214 patients, 191 (89%) underwent AVR. Female sex was not associated with AVR upon multivariable analysis. However, LV concentric hypertrophy and remodelling (both of which were more common in female patients) were associated with new-onset symptoms and AVR.
Conclusions
Female patients, compared to male patients, had more-advanced cardiac remodelling, and more-rapid onset of symptoms, but a similar risk of AVR.
{"title":"Sex Differences in Outcomes of Adults with Repaired Coarctation of Aorta and Concomitant Aortic Valve Disease","authors":"Alexander C. Egbe MD, MPH, Barry A. Borlaug MD, William R. Miranda MD, Snigdha Karnakoti MBBS, Ahmed E. Ali MBBS, Ahmed Younis MBBS, Heidi M. Connolly MD","doi":"10.1016/j.cjco.2024.08.006","DOIUrl":"10.1016/j.cjco.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Aortic valve disease is common in adults with coarctation of aorta. However, no systematic comparative analyses have been performed of the clinical course of aortic valve disease for male vs female patients in this population. The purpose of this study was to compare cardiac remodelling, onset of symptoms, and incidence of aortic valve replacement (AVR) for male vs female patients.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted of adults with repaired coarctation of aorta and ≥ moderate aortic stenosis and/or aortic regurgitation. Cardiac remodelling (left ventricular [LV], left atrial, right ventricular [RV], and right atrial structure and function) and symptomatic and/or functional class were determined at the baseline encounter. Development of new-onset symptoms and the incidence of AVR were ascertained for the period from baseline to last encounter.</div></div><div><h3>Results</h3><div>We identified 214 patients (121 male [57%], 93 female [43%]). Although both groups had a similar aortic valve gradient, aortic valve area indexed to body surface area, aortic regurgitation severity, and functional status at baseline, female patients had more LV concentric hypertrophy and remodelling, left atrial hypertension and dysfunction, elevated RV systolic pressure, and RV systolic dysfunction. Of 151 patients without symptoms at baseline,102 (72%) developed symptoms. Female sex was independently associated with new-onset symptoms (adjusted hazard ratio 1.14, [95% confidence interval 1.05-1.23]). Of 214 patients, 191 (89%) underwent AVR. Female sex was not associated with AVR upon multivariable analysis. However, LV concentric hypertrophy and remodelling (both of which were more common in female patients) were associated with new-onset symptoms and AVR.</div></div><div><h3>Conclusions</h3><div>Female patients, compared to male patients, had more-advanced cardiac remodelling, and more-rapid onset of symptoms, but a similar risk of AVR.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1386-1394"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cjco.2024.07.013
Kate M. Bourne BSc , Robert S. Sheldon MD, PhD , Derek V. Exner MD, MPH , Mary Runte PhD , Satish R. Raj MD, MSCI
Background
Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance that primarily affects female patients. Despite the severity of POTS, there are no approved medications for use in patients with this disorder. Compression garments are a commonly prescribed nonpharmacological treatment, but little is known about the patient experience with compression. In this study we aimed to evaluate the patient experience with compression garments using a structured survey and semistructured telephone interviews.
Methods
A focused survey was designed as a component of a larger clinical trial on compression garment use in patients diagnosed with POTS. Building on the survey, semistructured telephone interviews were conducted with POTS patients. Recorded interviews were transcribed and coded in a thematic analysis using a descriptive-interpretive approach.
Results
A total of 27 participants completed the survey, and 20 participants completed the telephone interview. Patient experiences with compression were variable, with some participants experiencing significant benefits, and others reporting minimal to no benefits. Six themes that influenced garment use were identified: the potential benefit of the garment to improve symptoms, specific activities patients will be undertaking, environmental conditions, garment attributes, psychological and cognitive aspects, and financial considerations.
Conclusions
Participants engage in a daily cost-benefit analysis when making decisions to use a compression garment. Clinicians should be aware of the benefits of and factors that limit use of compression garments as a treatment for POTS.
{"title":"One Size Does Not Fit All: An Exploration of Compression Garment Use in Patients With Postural Orthostatic Tachycardia Syndrome","authors":"Kate M. Bourne BSc , Robert S. Sheldon MD, PhD , Derek V. Exner MD, MPH , Mary Runte PhD , Satish R. Raj MD, MSCI","doi":"10.1016/j.cjco.2024.07.013","DOIUrl":"10.1016/j.cjco.2024.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance that primarily affects female patients. Despite the severity of POTS, there are no approved medications for use in patients with this disorder. Compression garments are a commonly prescribed nonpharmacological treatment, but little is known about the patient experience with compression. In this study we aimed to evaluate the patient experience with compression garments using a structured survey and semistructured telephone interviews.</div></div><div><h3>Methods</h3><div>A focused survey was designed as a component of a larger clinical trial on compression garment use in patients diagnosed with POTS. Building on the survey, semistructured telephone interviews were conducted with POTS patients. Recorded interviews were transcribed and coded in a thematic analysis using a descriptive-interpretive approach.</div></div><div><h3>Results</h3><div>A total of 27 participants completed the survey, and 20 participants completed the telephone interview. Patient experiences with compression were variable, with some participants experiencing significant benefits, and others reporting minimal to no benefits. Six themes that influenced garment use were identified: the potential benefit of the garment to improve symptoms, specific activities patients will be undertaking, environmental conditions, garment attributes, psychological and cognitive aspects, and financial considerations.</div></div><div><h3>Conclusions</h3><div>Participants engage in a daily cost-benefit analysis when making decisions to use a compression garment. Clinicians should be aware of the benefits of and factors that limit use of compression garments as a treatment for POTS.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1324-1333"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cjco.2024.07.014
Taylor Petropoulos MD , Anita Shah HBSc , Andrew Dueck MD , Christine Hawkes MD , Sheldon W. Tobe MD , William Kingston MD , Mina Madan MD, MHS
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes. Fibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic, and noninflammatory arterial disease that affects small- to medium-sized arteries that can result in multifocal aneurysms, stenosis, tortuosity, and dissections. Extracoronary FMD has been identified in approximately 70% of SCAD patients and it is recommended that all SCAD patients undergo screening for FMD once in their lifetime using computed tomography angiography from head to pelvis. This focused review for cardiologists outlines current approaches to diagnosis and management of patients with FMD.
{"title":"Fibromuscular Dysplasia: A Focused Review for the Cardiologist","authors":"Taylor Petropoulos MD , Anita Shah HBSc , Andrew Dueck MD , Christine Hawkes MD , Sheldon W. Tobe MD , William Kingston MD , Mina Madan MD, MHS","doi":"10.1016/j.cjco.2024.07.014","DOIUrl":"10.1016/j.cjco.2024.07.014","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes. Fibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic, and noninflammatory arterial disease that affects small- to medium-sized arteries that can result in multifocal aneurysms, stenosis, tortuosity, and dissections. Extracoronary FMD has been identified in approximately 70% of SCAD patients and it is recommended that all SCAD patients undergo screening for FMD once in their lifetime using computed tomography angiography from head to pelvis. This focused review for cardiologists outlines current approaches to diagnosis and management of patients with FMD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1274-1288"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cjco.2024.07.012
Christine Fahim PhD, MSc , Ayaat T. Hassan MSc , Elikem Togo MPH , Heather Ross , Sharon E. Straus MD, Msc , Douglas S. Lee MD, PhD
Background
The Comparison of Outcomes and Access to Care for Heart Failure (COACH) trial demonstrated that use of a point-of-care risk assessment tool and a rapid ambulatory transitional heart failure clinic led to significant reductions in death and cardiovascular hospitalisation among patients with acute heart failure. We report a process evaluation of COACH intervention and strategy implementation.
Methods
We conducted longitudinal interviews with staff to assess barriers and facilitators to COACH implementation. Factors were coded according to the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Intervention mapping was conducted to identify theory-rooted strategies to address barriers and influence facilitators toward implementation. We used interviews, document reviews, and check-in calls with implementation teams to describe uptake of these strategies and their impact on implementation success over time.
Results
A total of 29 interviews were conducted across 10 sites. We identified 10 factors that affected COACH implementation, which corresponded to 6 TDF and 5 CFIR domains. Some barriers were resolved within the study period, but others persisted over time. Seven implementation strategies were recommended to sites. Participants identified ample preparation time, site-specific personnel support, structural and social characteristics conducive to the intervention needs, and implementation experience as factors that facilitated implementation success.
Conclusions
We supported implementation of the COACH intervention in 10 acute care hospital sites and describe the factors impacting implementation. We recommend a rapid implementation assessment to sites wishing to implement COACH, and suggest strategies that can be used to mitigate barriers and aid facilitators to improve implementation success.
{"title":"Implementation of the Comparison of Outcomes and Access to Care for Heart Failure (COACH) Trial","authors":"Christine Fahim PhD, MSc , Ayaat T. Hassan MSc , Elikem Togo MPH , Heather Ross , Sharon E. Straus MD, Msc , Douglas S. Lee MD, PhD","doi":"10.1016/j.cjco.2024.07.012","DOIUrl":"10.1016/j.cjco.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>The Comparison of Outcomes and Access to Care for Heart Failure (COACH) trial demonstrated that use of a point-of-care risk assessment tool and a rapid ambulatory transitional heart failure clinic led to significant reductions in death and cardiovascular hospitalisation among patients with acute heart failure. We report a process evaluation of COACH intervention and strategy implementation.</div></div><div><h3>Methods</h3><div>We conducted longitudinal interviews with staff to assess barriers and facilitators to COACH implementation. Factors were coded according to the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Intervention mapping was conducted to identify theory-rooted strategies to address barriers and influence facilitators toward implementation. We used interviews, document reviews, and check-in calls with implementation teams to describe uptake of these strategies and their impact on implementation success over time.</div></div><div><h3>Results</h3><div>A total of 29 interviews were conducted across 10 sites. We identified 10 factors that affected COACH implementation, which corresponded to 6 TDF and 5 CFIR domains. Some barriers were resolved within the study period, but others persisted over time. Seven implementation strategies were recommended to sites. Participants identified ample preparation time, site-specific personnel support, structural and social characteristics conducive to the intervention needs, and implementation experience as factors that facilitated implementation success.</div></div><div><h3>Conclusions</h3><div>We supported implementation of the COACH intervention in 10 acute care hospital sites and describe the factors impacting implementation. We recommend a rapid implementation assessment to sites wishing to implement COACH, and suggest strategies that can be used to mitigate barriers and aid facilitators to improve implementation success.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1307-1319"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.cjco.2024.08.002
Arjun K. Aggarwal MHSc , Ayana Nanthakumar , Bonnie Daba , Arulalan Veluppillai MSc , Kumaraswamy Nanthakumar MD, FHRS , Melanie R. Burg MD, MSc
{"title":"Paced QRS Interval Duration and Pacing-Induced Cardiomyopathy - Time to Display","authors":"Arjun K. Aggarwal MHSc , Ayana Nanthakumar , Bonnie Daba , Arulalan Veluppillai MSc , Kumaraswamy Nanthakumar MD, FHRS , Melanie R. Burg MD, MSc","doi":"10.1016/j.cjco.2024.08.002","DOIUrl":"10.1016/j.cjco.2024.08.002","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 11","pages":"Pages 1320-1323"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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