Vernakalant: Perception of state of health in patients with a recent-onset atrial fibrillation

Background: Vernakalant is a new, safe and effective drug used intravenously, which has proved to be more rapid in converting recent onset atrial fibrillation (AF) to sinus rhythm compared to placebo, amiodarone, propafenone, and flecainide in clinical studies. Until now no study has been conducted comparing the perception of state of health in patients who received vernakalant versus propafenone or flecainide for conversion of recent-onset AF. The aim of ourstudy is to compare the change of perception of state of health from screening to hour 2 in patients treated with vernakalant and propafenone or flecainide for conversion of recent-onset AF.Methods: Eighty hemodynamically stable patients with recent onset AF without structural heart disease were prospectively included. A single oral dose of propafenone 600 mg was administered to 30 patients, 30 patients received intravenous vernakalant and the remaining 20 patients received a single oral dose of flecainide 300 mg. Clinical, laboratory variables and perception of state of health from screening to hour 2 treated with these drugs measured by the EQ-5 D quality-of-life assessments visual analog scale were recorded.Results: Baseline characteristics were similar in the three groups. Treatment with vernakalant resulted in a significantly greater improvement in patient perception of state of health athour 2 compared with propafenone and flecainide. In the vernakalant group, a mean increase (from baseline) of 12.1 points was seen compared with a mean increase of 5.4 points in the propafenone group or 5.2 points in flecainide group (p < 0.01).Conclusions: The change of perception of state of health from screening to hour 2 treated with vernakalant had a significantly statistical improvement compared with propafenone or flecainide for conversion recent-onset AF.

Cardiovascular disease in times of COVID-19

Existen crecientes informes sobre una drástica caída en consultas y realización de procedimientoscardiovasculares (incluyendo urgencias y emergencias) en regiones afectadas por la pandemia deCOVID-19, con el consecuente incremento marcado de la mortalidad total que no se explica totalmente por las defunciones atribuidas a COVID-19. En Argentina, la enfermedad cardiovascular lidera el ranking de muertes en adultos con 280 muertes por día, y en las últimas décadas hemos reducido su mortalidad entre 20 y 30% mediante diversas intervenciones basadas en la evidencia. En el presente trabajo realizamos análisis predictivos para entender cuáles podrían ser las consecuencias de una peor implementación de dichas intervenciones. Estimamos que un menor control de los factores de riesgo cardiovascular de abril a octubre de 2020 podría causar hasta 10 500 nuevos casos prevenibles de enfermedad cardiovascular. En términos de infarto de miocardio, una caída del 40% al 60% del tratamiento de reperfusión podría incrementar la mortalidad del 3% al 5%. Un incremento marginal de riesgo relativo de 10% a 15% de muerte cardiovascular equivaldría a un exceso de 6000 a 9000 muertes evitables. En conclusión, dada la alta prevalencia y fatalidad de la enfermedad cardiovascular, incluso un pequeño impacto negativo en la eficacia de su cuidado se traducirá en grandes cantidades de afectados en Argentina. Es necesario informar a las autoridades y educar al público para que sigan controlando enfermedades cardiovasculares y sus factores de riesgo, siempre que existan recursos y minimizando el riesgo de contagio y propagación del virus.There are increasing reports of a drastic drop in consultations and cardiovascular procedures (including urgencies and emergencies) in regions affected by the COVID-19 pandemic, with a consequent marked increase in total mortality that is not fully explained by COVID-19. Cardiovascular disease leads the ranking in deaths in adults in Argentina with 280 deaths per day, and in recent decades we have reduced its mortality by 20-30% through various evidence-based interventions. Herein we conducted predictive analyses to understand what could be the consequences of a worse implementation of those interventions. We estimate that less control of cardiovascular risk factors from April to October 2020 could cause up to 10 500 new preventable cases of cardiovascular disease. In terms of myocardial infarction, a drop from 40% to 60% of the reperfusion treatment could increase mortality by 3% to 5%. A marginal 10% to 15% increase in relative risk of cardiovascular death would be equivalent to an excess of 6000 to 9000 preventable deaths. In conclusion, given the high prevalence and fatality of cardiovascular disease, even a small negative impact on the efficacy of its care will translate into large numbers of people affected in Argentina. It is necessary to inform the authorities and educate the public so cardiovascular diseases and their risk factors remain a health priority, as long as resources exist and minimizing the risk of contagion and spread of the virus.Fil: Lamelas, Pablo. Instituto Cardiovascular de Buenos Aires; Argentina. McMaster University. Department of Health Research Methods, Evidence, and Impact; Estados UnidosFil: Botto, Fernando. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Pedernera, Gustavo. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Alves de Lima, Alberto Enrique. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Costabel, Juan Pablo. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Belardi, Jorge. Instituto Cardiovascular de Buenos Aires; Argentin

Burnout syndrome in cardiology fellows and residents: The role of resilience

El síndrome de burnout es un estado de desgaste mental y físico muy prevalente en el ambiente médico. Está asociado a serios detrimentos físicos y emocionales de los profesionales de la salud, y se produce generalmente en un clima de trabajo adverso. Varios trabajos han demostrado que la resiliencia, definida como la capacidad de reponerse frente a las adversidades, puede ser un factor protector del síndrome de burnout. En este estudio se evaluaron los niveles de resiliencia por medio de un cuestionario validado en residentes de cardiología y cardiólogos realizando subespecialidades, y se relacionaron con los criterios de burnout. Se comprobó que un tercio de los encuestados presentaban niveles bajos de resiliencia y criterios positivos de burnout, y se encontró una asociación estadísticamente significativa entre ambas variables. Por su parte, la resiliencia se asoció negativamente con el cansancio y positivamente con la percepción de la realización personal. Es importante incorporar técnicas de detección de niveles bajos de resiliencia en residentes para intentar modificarlos y disminuir así el riesgo de burnout.Burnout syndrome is a very prevalent condition of physical and mental wear in the medical profession. It is associated with serious physical and emotional consequences in health professionals, and is generally produced by an adverse working environment. Several research papers have proven that resilience, defined as the capacity to overcome adversity, can be a protective factor against burnout. In this study, levels of resilience were evaluated through a validated questionnaire in cardiology fellows and residents, and a relationship with burnout syndrome was established. One third of participants showed low resilience levels and a similar amount had positive criteria for burnout syndrome. A statistically significant association was found between these two conditions. Resilience was also negatively associated with tiredness, and positively with the perception of personal realization. Therefore, it is important to incorporate procedures for detecting low resilience levels in residents in order to attempt to improve them and thus diminish the risk of experiencing burnout.Fil: Sigal, Alan. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Costabel, Juan Pablo. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Alves de Lima, Alberto Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Burgos, Lucrecia María. Instituto Cardiovascular de Buenos Aires; Argentin

Evaluación del síndrome de burnout en residentes luego de implementar el “descanso postguardia”

Background: The burnout syndrome generates a negative impact on professional performance, patient´s safety and resident´s life. Despite this problem has become important in the residency programs in Argentina, effective measures to prevent burnout among residents have not been evaluated yet. Objective: The aim of this study was to evaluate the prevalence of the burnout syndrome before and after the implementation of rest after shift in cardiology residents. Methods: An analytic and prospective study was conducted using the Maslach burnout questionnaire in cardiology residents of an institution in the city of Buenos Aires, before and after the implementation of a day of rest (DOR) after a 24-hour shift. Results: The survey was responded by 42 residents (2014: 19; 2015: 23). There was a trend towards lower prevalence of burnout in the DOR group (26.1% vs. 47.4% p=0.152) and better outcomes in the depersonalization scale [19 (11-21) vs. 10 (1-17) p=0.023]. Women and residents who had moved to Buenos Aires presented lower degrees of exhaustion and depersonalization. Conclusions: The implementation of DOR after a 24-hour shift was associated with a reduction in the depersonalization scale, particularly among women. We emphasize the importance of creating prevention strategies aimed at improving residents’ working conditions and quality of life.Introducción: El síndrome de burnout genera impacto negativo en la actuación profesional, la seguridad del paciente y la vida del residente. Esta problemática ha tomado vigencia en las residencias argentinas; sin embargo, no se han evaluado medidas efectivas para prevenir su aparición. Objetivo: Evaluar la prevalencia del síndrome de burnout antes y después de la implementación del descanso postguardia en médicos residentes de cardiología. Material y métodos: Estudio analítico, prospectivo. Se implementó el cuestionario de Maslach en residentes de cardiología de una institución de la Ciudad de Buenos Aires, antes y después de la implementación de un período de descanso de 24 horas (DPG) luego de una guardia de 24h. Hubo una tendencia a menor prevalencia de burnout en el grupo con DPG (26,1% vs. 47,4% p =0,152) y mejores resultados en la escala de despersonalización (19 [11-21] vs. 10 [1-17] p = 0,023). Presentaron menor agotamiento y despersonalización las mujeres y los mudados a Buenos Aires. Conclusiones: La implementación del DPG se asoció a la reducción de la escala de despersonalización, principalmente en mujeres. Se remarca la importancia de crear estrategias de prevención que mejoren las condiciones de trabajo y la calidad de vida del residente.Fil: Burgos, Lucrecia María. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Battioni, Luciano. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Costabel, Juan Pablo. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Alves de Lima, Alberto Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Cardiovascular de Buenos Aires; Argentin

Reliability and acceptability of the multiple mini-interview for selection of residents in cardiology

Introduction: The multiple mini-interview (MMI) model can be useful to evaluate non-cognitive domains and guide the selection process in medical residency programs. The aim of this study was to evaluate the reliability and acceptability of the MMI model for the selection of residents in a cardiology residency program. Methods: We conducted an observational and prospective study. It was performed in a tertiary-care center specialized in cardiology and included candidates for the cardiology residency program in March 2018. Ten stations were developed to evaluate different non-cognitive domains. Reliability was evaluated by the generalizability G coefficient. Candidates and interviewers were surveyed to evaluate the acceptability of the MMI model. Results: Nine faculty members were trained and 22 candidates were evaluated. The G study showed a relative G coefficient between 0.56 and 0.73, according to the design. 91% of the candidates stated that they preferred MMI over other types of interviews as a selection method for admission to the residency program, and all the interviewers considered they had enough time to evaluate the candidates and their strengths as future residents. Conclusion: The MMI is a reliable model to evaluate candidates for a residency program in cardiology with high acceptability among residents and observers.Fil: Burgos, Lucrecia María. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Alves de Lima, Alberto Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Parodi, Maria Josefina. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Costabel, Juan Pablo. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Ganiele, María de Las Nieves. Instituto Universidad Escuela de Medicina del Hospital Italiano; ArgentinaFil: Durante, Eduardo Héctor. Instituto Universidad Escuela de Medicina del Hospital Italiano; ArgentinaFil: Arceo, Maria Dolores. Instituto Universidad Escuela de Medicina del Hospital Italiano; ArgentinaFil: Gelpi, Ricardo Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentin

Perception of success of cardiopulmonary resucitation and the influence of television: Miracle or reality

En las salas generales, de emergencias y en unidades críticas, los médicos, pacientes y familiares se enfrentan con situaciones en las cuales hay que decidir si iniciar o no reanimación cardiopulmonar (RCP). Para que los pacientes y familiares puedan participar de las decisiones médicas en su plenitud deben estar informados acerca de lo que implica la RCP, la tasa de éxito y sus posibles riesgos y efectos adversos. Las preferencias de los pacientes para iniciar RCP se relacionan con la percepción de la probabilidad de éxito del procedimient que probablemente cambiarían si supieran la tasa real de éxito. Múltiples estudios han demostrado que el público en general tiene un escaso conocimiento de los resultados de la resucitación cardiopulmonar y sobreestiman el éxito. Y esto se basa en gran medida en la experiencia de la representación de la RCP en los medios televisivos. En esta presentación se realiza una revisión actual acerca de la percepción de éxito de la RCP, y la influencia de la representación del paro cardiorrespiratorio en la ficción televisiva.In general wards, emergency rooms and critical units, doctors, patients and families are faced with situations in which we must decide whether or not to initiate cardiopulmonary resuscitation (CPR). For patients and families to be able to participate in medical decisions they should be fully informed about what CPR involves, the success rate and possible risks and side effects. The patients’ preferences to initiate CPR relate to the perception of the likelihood of success of the procedure; if they understand the real rate of success they are far less likely to request it. Multiple studies have shown that the lay public has little knowledge of the results of CPR and overestimate success. And this is based largely on the experience of the depiction of CPR in the media. The aim is to make a current review about the perceived success of CPR, and the influence of the representation of cardiorespiratory arrest in television fiction.Fil: Burgos, Lucrecia María. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Costabel, Juan Pablo. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Alves de Lima, Alberto Enrique. Instituto Cardiovascular de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin