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RESEARCH ARTICLE
In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample
Ashraf Abugroun, Osama Hallak, Ahmed Taha, Awadalla Sanchez-Nadales, Saria Awadalla, Hussein Daoud, Efehi Igbinomwanhia, Lloyd W Klein
, Available online  , doi: 10.11909/j.issn.1671-5411.2021.09.005
Abstract:
 Objective  To compare the outcomes of transapical transcatheter aortic valve replacement (TA-TAVR) and surgical aortic valve replacement (SAVR) using a large US population sample.  Methods  The U.S. National Inpatient Sample was queried for all patients who underwent TA-TAVR or SAVR during the years 2016−2017. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were in-hospital stroke, pericardiocentesis, pacemaker insertion, mechanical ventilation, vascular complications, major bleeding, acute kidney injury, length of stay, and cost of hospitalization. Outcomes were modeled using multi-variable logistic regression for binary outcomes and generalized linear models for continuous outcomes.  Results  A total of 1560 TA-TAVR and 44,280 SAVR patients were included. Patients who underwent TA-TAVR were older and frailer. Compared to SAVR, TA-TAVR correlated with a higher mortality (4.5% vs. 2.7%, effect size (SMD) = 0.1) and higher periprocedural complications. Following multivariable analysis, both TA-TAVR and SAVR had a similar adjusted risk for in-hospital mortality. TA-TAVR correlated with lower odds of bleeding with (adjusted OR (a-OR) = 0.26; 95% CI: 0.18–0.38; P < 0.001), and a shorter length of stay (adjusted mean ratio (a-MR) = 0.77; 95% CI: 0.69−0.84; P < 0.001), but higher cost (a-MR = 1.18; 95% CI: 1.10−1.28; P < 0.001). No significant differences in other study outcomes. In subgroup analysis, TA-TAVR in patients with chronic lung disease had higher odds for mortality a-OR = 3.11 (95%CI: 1.37−7.08; P = 0.007).  Conclusion  The risk-adjusted analysis showed that TA-TAVR has no advantage over SAVR except for patients with chronic lung disease where TA-TAVR has higher mortality.
Digital literacy as a potential barrier to implementation of cardiology tele-visits after COVID-19 pandemic: the INFO-COVID survey
Giuseppe Boriani, Anna Maisano, Niccolò Bonini, Alessandro Albini, Jacopo Francesco Imberti, Andrea Venturelli, Matteo Menozzi, Valentina Ziveri, Vernizia Morgante, Giovanni Camaioni, Matteo Passiatore, Gerardo De Mitri, Giulia Nanni, Denise Girolami, Riccardo Fontanesi, Valerio Siena, Daria Sgreccia, Vincenzo Livio Malavasi, Anna Chiara Valenti, Marco Vitolo
, Available online  , doi: 10.11909/j.issn.1671-5411.2021.09.003
Abstract:
 Background  During the COVID-19 pandemic, the implementation of telemedicine has represented a new potential option for outpatient care. The aim of our study was to evaluate digital literacy among cardiology outpatients.  Methods  From March to June 2020, a survey on telehealth among cardiology outpatients was performed. Digital literacy was investigated through six main domains: age; sex; educational level; Internet access; availability of Internet sources; knowledge and use of teleconference software programs.  Results  The study included 1067 patients, median age 70 years, 41.3% females. The majority of the patients (58.0%) had a secondary school degree, but among patients aged ≥ 75 years old the most represented educational level was primary school or none. Overall, for internet access, there was a splitting between “never” (42.1%) and “every day” (41.0%), while only 2.7% answered “at least 1/month” and 14.2% “at least 1/week”. In the total population, the most used devices for Internet access were smartphones (59.0%), and WhatsApp represented the most used app (57.3%). Internet users were younger compared to non-Internet users (63 vs. 78 years old, respectively) and with a higher educational level. Age and educational level were associated with non-use of Internet (age-per 10-year increase odds ratio (OR) = 3.07, 95% CI: 2.54−3.71, secondary school OR = 0.18, 95% CI: 0.12−0.26, university OR = 0.05, 95% CI: 0.02−0.10).  Conclusions  Telemedicine represents an appealing option to implement medical practice, and for its development it is important to address the gaps in patients’ digital skills, with age and educational level being key factors in this setting.
REVIEW
Advances in telemedicine for the management of the elderly cardiac patient
Nadim El Jamal, Bernard Abi-Saleh, Hussain Isma’eel
, Available online  , doi: 10.11909/j.issn.1671-5411.2021.09.004
Abstract:
Telemedicine is the use of information and communication technology to deliver healthcare at a distance. It has been resorted to during the COVID-19 pandemic to lessen the need for in-person patient care decreasing the risk of transmission, and it can be of benefit afterward in the management of cardiac disease. The elderly population has unique challenges concerning the use of telehealth technologies. We thus review the advances in telemedicine technologies in treating elderly cardiac patients including in our discussion only studies with a mean age of participants above 60. Remote monitoring of blood pressure, weight, and symptoms, along with home ECG recording has been found to be superior to usual in-clinic follow up. Combining remote monitoring with video conferencing with physicians, patient education websites, and applications is also of benefit. Remote monitoring of Implantable Cardioverter Defibrillators (ICD) and Cardiac Resynchronization Therapy Defibrillators (CRT-D) is also beneficial but can be at the cost of an increase in both appropriate and inappropriate interventions. Implantable sensing devices compatible with remote monitoring have been developed and have been shown to improve care and cost-effectiveness. New smartphone software can detect arrhythmias using home ECG recordings and can detect atrial fibrillation using smartphone cameras. Remote monitoring of implanted pacemakers has shown non-inferiority to in clinic follow up. On the other hand, small-scale questionnaire-based studies demonstrated the willingness of the elderly cardiac patients to use such technologies, and their satisfaction with their use and ease of use. Large-scale studies should further investigate useability in samples more representative of the general elderly population with more diverse socioeconomic and educational backgrounds. Accordingly, it seems that studying integrating multiple technologies into telehealth programs is of great value. Further efforts should also be put in validating the technologies for specific diseases along with the legal and reimbursement aspects of the use of telehealth.
LETTER TO THE EDITOR
Orthostatic hypertension and adverse clinical outcomes in adults and older people: a systematic review
Sarah Damanti, Paolo D Rossi, Matteo Cesari
, Available online  , doi: 10.11909/j.issn.1671-5411.2021.09.001
Abstract: