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Cardiology

NCD Academy launches new Health Equity and Social … – EurekAlert

Viatris Inc. (NASDAQ: VTRS), a global healthcare company, and the American College of Cardiology (ACC) today released the latest NCD Academy course, Health Equity and Social Determinants of Health in NCDs, coinciding with World Health Day and the theme Health for All. The NCD Academy is a user-friendly, interactive online platform developed by the ACC in partnership with the NCD Alliance and the World Heart Federation and sponsored by Viatris. The program is designed to equip primary healthcare professionals with educational resources and skills to enhance their ability to prevent and treat non-communicable diseases (NCDs). The NCD Academys overarching goal is aligned with the vision to make health for all a reality, by providing continued education for skilled health workers and supporting people-centered care.

Health equity, as described by the WHO Commission on Social Determinants of Health (CSDH), is the absence of inequalities in healthcare that are avoidable by reasonable means. The new Health Equity and Social Determinants of Health in NCDs course aims to educate and increase awareness of health inequities and provide support on how to address them to achieve equitable care for all. Course topics led by leading experts in global health equity include an overview of social determinants of health; a closer look at the impact of structural discrimination; and strategies for tackling disparities in vulnerable communities, as well as low- and middle-income countries.

Health equity and broadening access to healthcare is core to Viatris mission of empowering people worldwide to live healthier at every stage of life. We are proud to collaborate with our NCD Academy partners to support the launch of the new course on Health Equity, as part of our continuing efforts to deliver access to health education on a global level, said Lobna Salem, Head of Medical Affairs, Developed Markets. NCDs account for over 70% of deaths globally, many of which are preventable. Viatris is committed to helping to reduce this number, as demonstrated through one of our initial sustainability goals announced in our 2021 Sustainability Report: to impact 100 million patients via HCP education and outreach regarding prevention, diagnosis and treatment options for cardiovascular disease, diabetes, cancer and other important chronic conditions to improve outcomes through the NCD Academy by the end of 2025.

Launched in 2020, the NCD Academy features courses on nearly all aspects of NCDs, including cardiovascular disease and cancer. More recent courses also address mental health and advocacy and their respective roles in the NCD crisis, from which no country is immune. The new Health Equity course is being rolled out throughout the month of April, available at ACC.org/NCDAcademy.

Health equity is a critical global health issue that must be addressed if we are to truly stem the tide of NCDs, said Dipti Itchhaporia, MD, MACC, former ACC president and a past chair of the Colleges Health Equity Task Force. Transforming cardiovascular care and improving heart health for all needs to start with solving for health equity. The ACC is proud to partner with Viatris, WHF and NCD Alliance to drive awareness and action around this important topic. Together we are delivering global education that inspires global action and, while there is still much work to be done, it is exciting to see how far weve come to date.

For more information about the NCD Academy and to view available courses visit ACC.org/NCDAcademy.

About the NCD Academy

NCD Academy equips healthcare professionals, such as general practitioners, internists, nurses and community health workers, with high-quality continuing education availableanytime, anywhere, and free of chargeon fundamental skills to prevent, manage and mitigate today's leading causes of death and disability. Courses address non-communicable diseases (NCDs) through an intersectional lens given shared risk factors and the tendency of NCDs to coexist with one another, as well as with infectious diseases. Courses include eLearning that emulates the experience of intensive face-to-face training through interactive knowledge application and practice in the form of patient cases and games such as trivia. The Academy has hosted 44 trainings, equipping more than 70,000 health care professionals across ten countries with the latest science, technology, resources and tools to manage and prevent NCDs. The program has reached physicians and patients across many countries including Argentina, China, Colombia, Egypt, India, Iraq, Mexico, Peru, the Philippines, Saudi Arabia, Spain and the United States.

About the American College of Cardiology

The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. Asthe preeminent source of professional medical education for the entire cardiovascular care team since 1949,ACCcredentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines.Through its world-renowned family ofJACCJournals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring aworld where science, knowledge and innovation optimize patient care and outcomes. Learn more at ACC.org or follow @ACCinTouch.

About ViatrisViatris Inc. (NASDAQ: VTRS) is a global healthcare company empowering people worldwide to live healthier at every stage of life. We provide access to medicines, advance sustainable operations, develop innovative solutions and leverage our collective expertise to connect more people to more products and services through our one-of-a-kind Global Healthcare Gateway. Formed in November 2020, Viatris brings together scientific, manufacturing and distribution expertise with proven regulatory, medical, and commercial capabilities to deliver high-quality medicines to patients in more than 165 countries and territories. Viatris' portfolio comprises more than 1,400 approved molecules across a wide range of therapeutic areas, spanning both non-communicable and infectious diseases, including globally recognized brands, complex generic and branded medicines, and a variety of over-the-counter consumer products. With approximately 37,000 colleagues globally, Viatris is headquartered in the U.S., with global centers in Pittsburgh, Shanghai and Hyderabad, India. Learn more at viatris.com and investor.viatris.com, and connect with us on Twitter at @ViatrisInc, LinkedIn and YouTube.

Contacts:

ACC:Nicole Napolinnapoli@acc.org

Viatris:Media:+1.724.514.1968Communications@viatris.com

Matt KleinMatthew.Klein@viatris.com

Investors: +1.724.514.1813InvestorRelations@viatris.com

Bill SzablewskiWilliam.Szablewski@viatris.com

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NCD Academy launches new Health Equity and Social ... - EurekAlert

Cardiology

Asymptomatic coronary atherosclerosis linked to 8-fold higher risk … – Healio

April 03, 2023

3 min read

Disclosures: Fuchs reports no relevant financial disclosures. McDermott and Newby report receiving grants and funding from the British Heart Foundation. Please see the study for all other authors' relevant financial disclosures.

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Subclinical, obstructive coronary atherosclerosis was linked to a more than 8-fold elevated risk for myocardial infarction in asymptomatic adults aged 40 years or older, according to researchers.

Andreas Fuchs, MD, PhD, of the department of cardiology at Copenhagen University HospitalRigshospitalet, and colleagues wrote that coronary atherosclerosis can develop at an early age and remain latent in the body for many years.

Coronary atherosclerosis is the key pathobiological process that is responsible for the development of myocardial infarction, and together, these conditions define ischemic heart disease, the researchers wrote. Subclinical coronary atherosclerosis comes before ischemic heart disease, and can evolve at an early age, even years before the clinical disease develops.

For more than 50 years, obstructive coronary artery disease, defined as a luminal coronary stenosis of 50% or greater, has been considered a key feature of elevated risk, they wrote. In the past decades, however, the extent of atherosclerosis in the coronary tree as well as specific morphologic features of the atherosclerotic plaque have been acknowledged as important risk factors.

Fuchs and colleagues conducted a prospective observational cohort study to define characteristics of subclinical coronary atherosclerosis linked to the development of MI in 9,533 asymptomatic participants aged at least 40 years without CVD. Their findings were recently published in Annals of Internal Medicine.

We tested the hypothesis that characteristics of subclinical coronary atherosclerosis are associated with an increased risk for MI in asymptomatic persons without known ischemic heart disease, they wrote.

The researchers used coronary computed tomography angiography to assess subclinical coronary atherosclerosis. Coronary atherosclerosis was then characterized by extent and luminal obstruction (obstructive being defined as greater than 50% luminal stenosis).

Fuchs and colleagues found that just over half 54% of the participants did not have subclinical coronary atherosclerosis, and, of the 46% who did, 10% had obstructive disease. Additionally, of those diagnosed, the condition was found more frequently in men than women (61% vs. 36%).

The researchers noted that, in the median follow-up of 3.5 years, 71 participants had an MI and 193 died. MI risk was higher in those with obstructive (adjusted relative risk [aRR] = 9.19; 95% CI, 4.49-18.11) and extensive (aRR = 7.65; 95% CI, 3.53-16.57) disease and highest in those with both extensive and obstructive subclinical coronary atherosclerosis (aRR = 12.48; 95% CI, 5.50-28.12) or obstructive-nonextensive (aRR = 8.28; 95% CI, 3.75-18.32).

Obstructive subclinical coronary atherosclerosis was associated with a more than 8-fold increased risk for MI, and the risk for either death or MI was increased 2-fold in persons with extensive subclinical coronary atherosclerosis, they wrote.

Fuchs and colleagues also wrote that, regardless of degree of obstruction, the risk for the composite end point of death or MI was increased in those with extensive disease: obstructive-extensive (aRR = 3.15; 95% CI, 2.05-4.83) and nonobstructive-extensive (aRR = 2.7 95% CI, 1.72-4.25).

Identification of luminal obstructive or extensive subclinical coronary atherosclerosis, which we have shown are associated with high risk, provides potentially clinically relevant, incremental risk assessment in patients without suspected or known ischemic heart disease undergoing cardiac CT and/or electrocardiogram-gated chest CT for other clinical indications, they wrote.

In an accompanying editorial, Michael McDermott, MBChB, a cardiology research fellow at the University of Edinburgh, and David E. Newby, DM, PhD, British Heart Foundation Duke of Edinburgh Chair of Cardiology, wrote that this exceptional and important study now provides a benchmark against which to observe the contemporary natural history of coronary artery disease.

It also provides invaluable data about event rates and prevalence of asymptomatic coronary artery disease that will inform public health prevention strategies and ongoing clinical trials of targeting preventative therapies in persons screened for occult coronary artery disease, McDermott and Newby wrote.

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Asymptomatic coronary atherosclerosis linked to 8-fold higher risk ... - Healio

Cardiology

Interpretation Accuracy of Transesophageal Echocardiograms | VHRM – Dove Medical Press

Introduction

In the recent literature, cardiology based training in different procedures and techniques has been garnering a lot of attention.13 As of 2019 over 90,000 physicians specialize in cardiac-based procedures and interpretation in the United States. One such procedure is echocardiography, and physicians who specialize in interpreting them are called primary echocardiographers, which include cardiologists and radiologists.4 22,521 active physicians practice in the field of cardiology and 28,025 active physicians practicing in radiology.5 In comparison, there are only 1667 anesthesiologists who practice cardiac anesthesia as a subspecialty.6 Subspecialization in cardiac anesthesiology requires at least 4 years of training in an anesthesiology residency program and at least 1 year of a cardiac anesthesiology fellowship.716

During their residency and fellowship years, most anesthesiologists will be trained in the use of echocardiography. One such type of echocardiography is transthoracic echocardiogram (TTE), in which a handheld transducer is held outside the heart.17,18 Although other forms of echocardiograms exist, such as intracardiac echo and stress echo, a transesophageal echocardiogram is often the approach in the perioperative setting. Compared to TTE, a transesophageal echocardiogram can be more sensitive at identifying etiologies of an embolic stroke.1921 One study suggests that TEE may be more suitable than TTE for detecting infective endocarditis.22 Transesophageal echocardiograms can assess the hearts function and detect symptoms of atherosclerosis, cardiomyopathy, heart failure, and more.23,24 This is because an ultrasound probe is guided into the esophagus, providing a closer view of the heart.2530 Interpreting TEEs have a significant impact throughout perioperative care in order to make a proper diagnosis.31 Although cardiac anesthesiologists, cardiologists, and radiologists are all trained in interpreting transesophageal echocardiography, an overwhelming majority of perioperative TEEs are performed by cardiac anesthesiologists. A study by Poterack recognized that out of 98 institutions surveyed, 54% of them have anesthesiologists in charge of TEE interpretations.32 Therefore, it is of utmost importance that cardiac anesthesiologists are well-trained in these procedures.

TEE specifically has seen major growth in terms of technology, use, and indications since its introduction to the medical community nearly half a decade ago.33 These advancements include the increase in TEE use from 29% in 2009 to 45% in 2011, and upgrades in technology such as the 3-D TEE systems.34 3-D TEE imaging has been shown to improve detecting infective endocarditis in a study by Chahine et al.35 Additional advancements include continuous TEE monitoring, strain imaging, and diastolic function assessment.36 These advancements have also increased the complexity of the procedure itself. For this reason, diagnostic evaluation of the TEE exams may vary disparately depending on who delivers the procedure and the expertise of the examiner.37 Despite the active role that cardiac anesthesiologists have in the perioperative setting, there is limited literature on the assessment of their ability to interpret intraoperative TEE. Our paper conducts a systematic literature review to assess the effectiveness with which cardiac anesthesiologists interpret TEE examinations compared to primary echocardiographers, such as cardiologists and radiologists.

The PRISMA systematic review model was used to execute this study and identify relevant literature.38 A comprehensive search was used on the MED-LINE database (PubMed) to yield articles used for our study. Step 1 included using a broad keyword search using the phrases Cardiology Anesthesiology Echocardiogram and Echocardiography Anesthesiology to produce 1114 and 684 articles, respectively, dating from 1952 to 2022. The criteria for inclusion and exclusion are shown below in Figure 1 including but not limited to articles being written in the English language.

Figure 1 Study flow chart.

From the search, a total of 363 articles were included based on the relevance of the title (Figure 1, step 1), and duplicates were then removed (Figure 1, step 2). The remaining articles were then screened based on their abstract (Figure 1, step 3). The last step executed was reading the full article to determine which publications will be used in the study (Figure 1, step 4). This process yielded a combination of quantitative and qualitative information that amounted to a total of 9 relevant articles for our topic of interest. Three researchers carried out the procedures to obtain the final sample. The investigation team agreed on the final selection of the literature (Table 1).

Table 1 Publications Included in the Systematic Review

After assembly of the 9 articles, they were divided according to whether they contained quantitative or qualitative data. There were three quantitative data containing the accuracy of cardiac anesthesiologists TEE readings. Accuracy is defined as the degree to which cardiac anesthesiologists TEE interpretation agreed with that of primary echocardiographers. The quantitative studies examined different parameters as part of the TEE procedure and also used different methods to assess accuracy. Cohens kappa coefficient and high-fidelity videotape evaluation were the methods of analysis used to evaluate the accuracy of the interpretation of these parameters. The number of correctly interpreted TEEs and the total number of TEEs were obtained from each of the three quantitative studies. These numbers were then used to calculate the mean accuracy in the interpretation of all TEEs to represent the overall accuracy of cardiac anesthesiologists (Table 2).

Table 2 Results of Transesophageal Echocardiogram Results in Systematic Review

PRISMA systematic review yielded a total of 3 quantitative studies and 6 qualitative studies for a total of 9 relevant studies. The three quantitative studies contained comparisons between cardiac anesthesiologists and radiologists, cardiac anesthesiologists and cardiologists, and cardiologists and radiologists.

Mathew et al contained the concordance rate of TEE interpretations amongst cardiac anesthesiologists, cardiologists, and radiologists. In the study, radiologists interpreted the same number of TEEs as cardiac anesthesiologists. For this reason, we decided to compare anesthesiologists to radiologists in this study. They found that anesthesiologists with less than 5 years of experience underestimated left ventricular fractional area change (FAC). On the other hand, anesthesiologists with greater experience had higher levels of concordance with radiologists, particularly in the assessment of the aorta, right atrium, pulmonary vein flow, and transmitral flow. Furthermore, cardiac anesthesiologists correctly interpreted 83% of TEEs when compared specifically to radiologists. Out of 2464 TEE exams, this comes out to a total of 2045 correctly interpreted TEEs. Nevertheless, comparisons between anesthesiologists and cardiologists (80% concordance) and cardiologists and radiologists (82% concordance) were all similar.

The study by Mishra et al contained information regarding the concordance between online interpretation by cardiac anesthesiologists and offline analysis by cardiologists. This study specifically examined left ventricle regional wall motion, valve function, and left and right ventricle function. 3620 out of 4161 TEEs were correctly interpreted by the cardiac anesthesiologists, amounting to an accuracy rating of 87%. Although this study did not state the number of anesthesiologists involved, they examined 3217 TEEs in a group of patients who underwent coronary bypass graftings and 629 TEEs in a group of patients who underwent valve procedures, yielding a total of 3846 TEEs that were interpreted.

The final quantitative study by Miller et al compared the performance of anesthesiologists to an expert cardiologist in recording and interpreting TEEs. Parameters measured in this study included size of the heart chambers, FAC, and degree of stenosis or insufficiency of heart valves. They found that their cardiac anesthesiologists correctly interpreted 1242 out of 1572 TEEs, a 79% accuracy rating. As indicated in Table 2, these three studies totaled 8197 interpreted TEEs by cardiac anesthesiologists, 84% of which were correctly interpreted.

The American Society of Echocardiography suggests that non-cardiologists such as radiologists and cardiac anesthesiologists who provide optimal TEE services should ideally undergo 6 months of full-time training in an active echocardiography training institution.39 They recommend being involved in 300 total TEE exams and performing at least 150 of those exams, and 15 h of TEE within 3 years per Continuing Medical Education (CME) standards. Thus, all physicians who were not formally trained in TEE should adhere to these standards. It may also be advisable to consider facilitating close interactions between cardiac anesthesiologists and cardiologists or radiologist echocardiographers, at least in the initial training phases.40

In our study design, we chose to compare the evaluation of TEE studies between attending anesthesiologists to primary attending echocardiographers, either cardiologists or radiologists. A prospective observational cohort study was performed between 1993 and 1997 meant to evaluate TEE as a safe and reliable technique during cardiac surgery.41 3217 TEEs were administered to 944 patients who underwent coronary artery bypass grafting (CABG) procedures, and another 629 TEES to 142 patients who underwent heart valve procedures. The attending anesthesiologists who performed the TEE had a minimum hands-on experience of performing and interpreting 500 TEE studies each. Although the study did not disclose the number of anesthesiologists included in the study, they found that there was a rather high concordance between anesthesiologists and cardiologists (87%). This suggests that anesthesiologists can interpret and perform TEE studies in a manner comparable to that of cardiologists.

Another study was done at Duke University Medical Center that assessed the concordance of TEE interpretation in a continuous quality improvement (CQI) program.4 In this study, 10 cardiac anesthesiologists conducted a total of 154 TEE studies that included the estimation of FAC using Bland-Altman methods. Fractional area change is a measure of right ventricular systolic function. It is clinically significant because it can be used to measure any impairments to right ventricle function, such as after a pulmonary valve replacement.42 All 154 of the TEE studies were reviewed by radiologists, 50 of which were also reviewed by cardiologists. Cardiac anesthesiologists were found to underestimate the FAC when compared to radiologists, especially if the anesthesiologist had less than 5 years of TEE experience. Anesthesiologists with more experience, however, were found to have higher levels of concordance with the radiologists. Ultimately, the high levels of concordance of anesthesiologists to radiologists (83%) and cardiologists (80%) suggest that anesthesiologists are proficient in TEE interpretation.

A prospective study done at the Madigan Army Medical Center evaluated the ability of anesthesiologists to perform and interpret TEE after revisions were made to their examination protocol.43 Namely, these revisions entailed going from a standard 10 view TEE examination to a 12 view in which 8 were from the original and 4 assessed with color Doppler. Eight cardiac anesthesiologists performed 135 TEE examinations, which were then compared with a final expert evaluation by a cardiologist, yielding an accuracy of 79%. Although this is considerably lower than the other studies we analyzed, this is inclusive of TEE examinations with omitted diagnoses (blanks on evaluation sheets). If these TEE examinations had not been included in the study, the rate of correct interpretation would have been 94%.

It has been shown in a study done at Aarhus University Hospital that anesthesiologists are capable of providing valuable information in interpreting TEE.44 A TEE was successfully performed on 525 children undergoing cardiac surgery and according to the results, interpretations of TEE performed by anesthesiologists resulted in a total of 184 alterations to treatment in 143 patients. Additionally, anesthesiologists were able to add 37% of new information and add 8% of decisive information out of all the TEEs interpreted.

Although our study indicates how effective anesthesiologists can be in perioperative care, there have been multiple studies that have shown experience and training is still valuable in both carrying out the TEE procedure and interpreting the results. One study compared the length of time it takes to obtain a TEE exam and how accurate the interpretation was between certified anesthesiologists and anesthesiology residents.45 Attending physicians and residents were recruited from both the Vanderbilt School of Medicine and The Icahn School of Medicine at Mount Sinai for a total of 15 residents and 11 attending physicians. Participants were required to obtain 10 standard views using TEE. The certified anesthesiologists were able to interpret 5 out of 10 images better than the residents, whereas the remaining 5 views were comparable to the residents. Results also indicated that certified anesthesiologists were able to acquire TEE images more quickly, suggesting that experience is necessary to become a proficient echocardiographer.

A study done at Mahidol University concurred with this by showing improvement in acquiring TEE images as the procedure was performed more often.46 An additional study performed at The Icahn School of Medicine at Mount Sinai suggested that more experienced anesthesiologists were able to score higher on multiple-choice questions that involved TEEs.47 Evidently, experience in echocardiography improves both the theoretical knowledge and the practical application of the skills involved in TEE.

Limitations to our study include the circumstances of assessment in our quantitative studies. Specifically, comparisons were made between on-line assessments by anesthesiologists and off-line assessments of the primary echocardiographers. It is plausible that there could have been a higher level of agreement between the two groups if they interpreted TEEs under the same circumstances. For example, there may have been higher concordance if the anesthesiologists evaluated TEE results after operation. Another limitation to our study is that most of our quantitative data were published nearly 20 years ago. If these studies were to be done today, it may be the case that we would see higher concordance between cardiac anesthesiologists and primary echocardiographers, especially because of the guidelines that were established since then.39 Another notable limitation of this study is that there were variations in the gold standard for interpreting TEEs. Some studies used expert echocardiographers as the gold standard, while others relied on the degree to which there was consensus amongst attending echocardiographers.

A possible method of improving clinical evaluation is by refining current indications for the use of echocardiography. For example, echocardiography currently plays a major role in the diagnosis and management of infective endocarditis (IE) as part of Dukes criteria. However, many patients are initially misclassified even though IE is a life-threatening emergency.4850 This is partly because a negative echocardiogram does not rule out IE and a false-positive result is not unusual with these tests. The fault here is not so much in the conductor of the test, but the test itself. Therefore, in these cases, it may be worth considering other imaging techniques. An 18F-FDG PET/CT scan has instead shown promising results with these patients.5156

Based on the studies presented, it is clear that anesthesiologists have an important role in the perioperative stages of patient care by performing and interpreting transesophageal echocardiograms. With continuous quality improvement, cardiac anesthesiologists are shown to function at a level equivalent to that of primary echocardiographers. The implementation of software programs to routinely test physician TEE skills and the implementation of standardized AI interpretation as a possible gold standard are noteworthy considerations for future investigation.

The authors declare no competing interests in this work.

1. Zhitny V, Iftekhar N, Alexander L, Ahsan C. Cardiology fellow diagnostic accuracy and data interpretation outcomes: a review of the current literature. Vasc Health Risk Manag. 2020;16:429435. PMID: 33116553; PMCID: PMC7585513. doi:10.2147/VHRM.S266510

2. Kohan LC, Nagarajan V, Millard MA, Loguidice MJ, Fauber NM, Keeley EC. Impact of around-The-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center. Vasc Health Risk Manag. 2017;13:139142. PMID: 28458558; PMCID: PMC5403126. doi:10.2147/VHRM.S132405

3. Spahillari A, McCormick I, Yang JX, Quinn GR, Manning WJ. On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists. BMC Med Educ. 2019;19(1):213. PMID: 31200721; PMCID: PMC6567532. doi:10.1186/s12909-019-1634-7

4. Mathew JP, Fontes ML, Garwood S, et al. Transesophageal echocardiography interpretation: a comparative analysis between cardiac anesthesiologists and primary echocardiographers. Anesth Analg. 2002;94(2):302309. PMID: 11812688. doi:10.1097/00000539-200202000-00013

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7. Massachusetts General Hospital. Guide to cardiac anesthesia; 2022. Available from: https://www.massgeneral.org/heart-center/treatments-and-services/cardiac-surgery/guide-to-cardiac-anesthesia#:~:text=A%20cardiac%20anesthesiologist%20is%20a,a%20cardiac%20anesthesia%20fellowship%20program. Accessed November 21, 2022.

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19. de Bruijn SF, Agema WR, Lammers GJ, et al. Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke. 2006;37(10):25312534. PMID: 16946152. doi:10.1161/01.STR.0000241064.46659.69

20. Thomsen J. To TTE or Tee? European Stroke Organisation; 2021. Available from: https://eso-stroke.org/to-tte-or-tee/#:~:text=TEE%20is%20considered%20more%20sensitive,visualization%20of%20left%20ventricular%20thrombus. Accessed October 24, 2022.

21. Kapral MK, Silver FL. Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke. Canadian Task Force on Preventive Health Care. CMAJ. 1999;161(8):989996. PMID: 10551199; PMCID: PMC1230713.

22. Noor A, Suffoletto M. An echocardiogram battle: tte vs tee in the diagnosis of infective endocarditis; 2019. Available from: https://shmabstracts.org/abstract/an-echocardiogram-battle-tte-vs-tee-in-The-diagnosis-of-infective-endocarditis/. Accessed November 10, 2022.

23. Johns Hopkins Medicine. Transesophageal echocardiogram; 2021. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transesophageal-echocardiogram. Accessed June 19, 2022.

24. UPMC. Echocardiography - purpose, types, and what to expect: UPMC in central PA. Available from: https://www.upmc.com/services/south-central-pa/heart-vascular/heart/diagnosis/screenings/echo. Accessed March 31, 2023.

25. Heart and Stroke Foundation of Canada. Transesophageal Echocardiogram (TEE); 2022. Available from: https://www.heartandstroke.ca/heart-disease/tests/transesophageal-echocardiogram-tee. Accessed June 19, 2022.

26. Stanford Health Care (SHC) - Stanford Medical Center. Transesophageal Echocardiogram (TEE); 2017. Available from: https://stanfordhealthcare.org/medical-tests/t/transesophageal-echocardiogram.html. Accessed June 19, 2022.

27. Transesophageal echocardiography (TEE); 2021. Available from: https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/transesophageal-echocardiography-tee. Accessed November 10, 2022.

28. Memorial Sloan Kettering Cancer Center. About Your Transesophageal Echocardiogram (TEE). Available from: https://www.mskcc.org/cancer-care/patient-education/patient-guide-transesophageal-echocardiogram-tee. Accessed March 31, 2023.

29. Healthline, Healthline Media. Transesophageal Echocardiogram (TEE). Available from: https://www.healthline.com/health/tee-procedure#reasons. Accessed March 31, 2023.

30. Transthoracic Echocardiography (TTE) or Transesophageal. Available from: https://mountnittany.org/wellness-article/transthoracic-echocardiography-tte-or-transesophageal-echocardiography-tee-when-------your-child-needs. Accessed March 31, 2023.

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32. Poterack KA. Who uses transesophageal echocardiography in the operating room? Anesth Analg. 1995;80(3):454458. PMID: 7864407. doi:10.1097/00000539-199503000-00004

33. Peterson GE, Brickner ME, Reimold SC. Transesophageal echocardiography. Circulation. 2003;107(19):23982402. doi:10.1161/01.cir.0000071540.97144.89

34. DAIC. Advances in transesophageal echo. DAIC; 2021. Available from: https://www.dicardiology.com/article/advances-transesophageal-echo. Accessed June 13, 2022.

35. Chahine J, Montane B, Alzubi J, et al. Improved diagnostic performance of contemporary transesophageal echocardiography with three-dimensional imaging for infective endocarditis. Circulation. 2020;142(Suppl_3):A13434A13434. doi:10.1161/circ.142.suppl_3.13434

36. Maxwell C, Konoske R, Mark J. Emerging concepts in transesophageal echocardiography. F1000Res. 2016;5:F1000Faculty Rev340. PMID: 26998250; PMCID: PMC4792209. doi:10.12688/f1000research.7169.1

37. Fatima H, Sharkey A, Qureshi N, et al. Three-dimensional transesophageal echocardiography simulator: new learning tool for advanced imaging techniques. J Cardiothorac Vasc Anesth. 2022;36(7):20902097. PMID: 34275733. doi:10.1053/j.jvca.2021.05.050

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39. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26(9):921964. PMID: 23998692. doi:10.1016/j.echo.2013.07.009

40. Rafferty T, LaMantia KR, Davis E, et al. Quality assurance for intraoperative transesophageal echocardiography monitoring: a report of 846 procedures. Anesth Analg. 1993;76(2):228232. PMID: 8424496. doi:10.1213/00000539-199302000-00005

41. Mishra M, Chauhan R, Sharma KK, et al. Real-time intraoperative transesophageal echocardiography--how useful? Experience of 5016 cases. J Cardiothorac Vasc Anesth. 1998;12(6):625632. PMID: 9854658. doi:10.1016/s1053-0770(98)90232-4

42. DiLorenzo MP, Bhatt SM, Mercer-Rosa L. How best to assess right ventricular function by echocardiography. Cardiol Young. 2015;25(8):14731481. doi:10.1017/S1047951115002255

43. Miller JP, Lambert AS, Shapiro WA, Russell IA, Schiller NB, Cahalan MK. The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologists. Anesth Analg. 2001;92(5):11031110. PMID: 11323329. doi:10.1097/00000539-200105000-00005

44. Sloth E, Pedersen J, Olsen KH, Wanscher M, Hansen OK, Srensen KE. Transoesophageal echocardiographic monitoring during paediatric cardiac surgery: obtainable information and feasibility in 532 children. Paediatr Anaesth. 2001;11(6):657662. PMID: 11696140. doi:10.1046/j.1460-9592.2001.00737.x

45. Bick JS, Jr DS, Kennedy JD, et al. Comparison of expert and novice performance of a simulated transesophageal echocardiography examination. Simul Healthc. 2013;8(5):329334. PMID: 24030477. doi:10.1097/SIH.0b013e31829068df

46. Sawasdiwipachai P, Thanasriphakdeekul S, Raksamani K, Vacharaksa K, Chaithiraphan V. Learning curve for the acquisition of 20 standard two-dimensional images in advanced perioperative transesophageal echocardiography: a prospective observational study. BMC Med Educ. 2022;22(1):412. PMID: 35637456; PMCID: PMC9153196. doi:10.1186/s12909-022-03280-3

47. Konstadt SN, Reich DL, Rafferty T. Validation of a test of competence in transesophageal echocardiography. J Cardiothorac Vasc Anesth. 1996;10(3):311313. PMID: 8725408. doi:10.1016/s1053-0770(96)80088-7

48. Sarrazin JF, Trottier M, Tessier M. Accuracy of PET/CT for detection of infective endocarditis: where are we now? J Nucl Cardiol. 2019;26(3):936938. PMID: 29143245. doi:10.1007/s12350-017-1126-2

49. Prendergast BD. Diagnostic criteria and problems in infective endocarditis. Heart. 2004;90(6):611613. PMID: 15145855; PMCID: PMC1768277. doi:10.1136/hrt.2003.029850

50. Pecoraro AJK, Herbst PG, Pienaar C, et al. Modified Duke/European Society of Cardiology 2015 clinical criteria for infective endocarditis: time for an update? Open Heart. 2022;9:e001856. doi:10.1136/openhrt-2021-001856

51. Mahmood M, Kendi AT, Ajmal S, et al. Meta-analysis of 18F-FDG PET/CT in the diagnosis of infective endocarditis. J Nucl Cardiol. 2019;26(3):922935. PMID: 29086386. doi:10.1007/s12350-017-1092-8

52. Ten HD, Slart RHJA, Sinha B, Glaudemans AWJM, Budde RPJ. 18F-FDG PET/CT in infective endocarditis: indications and approaches for standardization. Curr Cardiol Rep. 2021;23(9):130. PMID: 34363148; PMCID: PMC8346431. doi:10.1007/s11886-021-01542-y

53. Rouzet F, Iung B, Duval X, et al. 18F-FDG PET/CT in infective endocarditis. J Am Coll Cardiol. 2019;74(8):10411043. doi:10.1016/j.jacc.2019.06.049

54. Swart LE, Gomes A, Scholtens AM, et al. Improving the diagnostic performance of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography in prosthetic heart valve endocarditis. Circulation. 2018;138(14):14121427. PMID: 30018167. doi:10.1161/CIRCULATIONAHA.118.035032

55. Wang TKM, Snchez-Nadales A, Igbinomwanhia E, Cremer P, Griffin B, Xu B. Diagnosis of infective endocarditis by subtype using 18F-fluorodeoxyglucose positron emission tomography/computed tomography: a contemporary meta-analysis. Circ Cardiovasc Imaging. 2020;13(6):e010600. PMID: 32507019. doi:10.1161/CIRCIMAGING.120.010600

56. Orvin K, Goldberg E, Bernstine H, et al. The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis. Clin Microbiol Infect. 2015;21(1):6976. doi:10.1016/j.cmi.2014.08.012

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Cardiology

What the rise of outpatient cardiac OBLs and ASCs means for … – Cardiovascular Business

These outpatient treatment centers offer higher rates of both provider and patient satisfaction, Biga said, in addition to delivering high-quality outcomes in a lower-cost setting. Medicare began reimbursing for ASC basic percutaneous coronary interventions (PCI) in 2020, which accelerated the growth of these centers. Regulations in some states favor OBLs or ASCs, so there has been a concentration of these centers in some states, mainly in the band from Florida across to country to the west to Arizona.

In some cases, larger hospital systems are even partnering with private companies that manage these labs to outsource their less complex cases and make room in the hospital cath labs for more involved (and more lucrative) procedures.

Biga said the Medicare fee schedule has changed in recent years to favor these outpatient centers for lower acuity patient care because they have much lower overhead costs than large hospital systems.The shift is being made for similar financial reasons asthe shift over the past decade from private cardiology practices to cardiologists increasingly being employed by the hospitals.

"There is a financial element to that you can't ignore, and the same is true here," Biga explained.

In many cases, OBLs and ASCs have the same equipment and often they have the same cardiologists at the area hospitals performing these procedures. She said the difference is just the location, which changes how much a procedure is reimbursed and how that translates into revenue when there are not a large number of additional costs that hospitals have to cover.

"Outcomes are probably just as good, if not better, and patient satisfaction tends to be much better because it is an easier in or out. If you go to a hospital and your are registering, it is a two-hour process. If you are in a smaller setting, it is a much better patient experience," Biga said.

Her biggest concern with these centers is that they meet the same patient safety and quality metrics as hospital facilities. Biga said this can be done if OBL and ASCs become a part of the ACC National Cardiovascular Data Registry (NCDR) like larger cath labs at hospitals. She said this would provide a benchmarking capability to measure the quality of the outpatient centers as compared to traditional care for similar types of patients and procedures. The ACC is presently working on a lighter version of the registry to support OBLs and ASCs.

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Top in cardiology: Updates in hypertension research; predictors of … – Healio

March 20, 2023

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Experts at the Cardiovascular Translational Research Center at the University of South Carolina are leading research in hypertension to further advancements in CVD prevention.

Their efforts include investigations into the role of cell damage in hypertension and the relationship between changes in the vasculature and hypertension.

Healio spoke with R. Clinton Webb, PhD, director of the Cardiovascular Translational Research Center, about key topics in hypertension research. It was the top story in cardiology last week.

Another top story was about a study that found the level of inflammation better predicted future cardiovascular events or death than the level of LDL in patients at high cardiovascular risk who are already taking statin therapy. Researchers said the findings indicate that this population may need anti-inflammatory therapy just as much as cholesterol-lowering therapy to prevent cardiovascular events and death.

Read these and more top stories in cardiology below:

Hypertension research could yield advancements in CVD prevention

Hypertension is one of the most common risk factors for CVD, and despite numerous therapies existing, rates of uncontrolled hypertension have risen since the start of the COVID-19 pandemic. Read more.

Inflammatory risk better predicts events vs. cholesterol risk in statin-treated patients

In high-risk patients on statin therapy, residual inflammatory risk as assessed by high-sensitivity C-reactive protein better predicted cardiovascular events and death than residual cholesterol risk as assessed by LDL, data show. Read more.

Connections between neighbors of varying incomes tied to lower premature CV death

Increased neighborhood connectedness of people of lower and higher socioeconomic status via Facebook friendships was associated with lower county-level prevalence of cardiovascular death, a speaker reported. Read more.

Remote monitoring of cardiac devices during pandemic cut greenhouse gas emissions

Remote monitoring of more than 32,000 patients with cardiac implantable devices during the COVID-19 pandemic reduced greenhouse gas emissions by 12,596 metric tons compared with conventional monitoring, researchers reported. Read more.

Black women with genetic variant for amyloidosis face substantial CVD, mortality risk

Black female carriers of the V122I genetic variant for cardiac amyloidosis have substantially higher CVD and all-cause mortality risk, which grows with age, compared with noncarriers, researchers reported. Read more.

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Cardiology

ACC plans to focus more on cardiology’s business management … – Cardiovascular Business

Biga said ACC wants to "walk the walk" when is comes to dealing with the non-clinical business impacts of managing a cardiovascular department. The organization also hopes to take on more of the big challenges related to paying for cardiac care, moving beyond its traditional focus on clinical science, outcomes and quality.

"As our physicians leaders and CV team leaders continue to evolve, it is imperative that it is not just a clinical track, but that they also understand that business side of cardiology. Because it does impact out patients and does impact us with our compensation models, so it is really important," Biga explained.

Biga said staffing issues are the primary concern across healthcare right now amid the period of the "great resignation."

"This is really, really important because it does impact the finances. I explain to people that when we can't find our nurses, our advanced practice providers (APPs), techs, our OR teams, across the country we are closing ORs and cath labs because we just cannot get staff. It impacts all of us from a patient access prospective, but also from a compensation and a reimbursement prospective," she explained.

While to drive to leave healthcare jobs was partly fueled by burnout during the pandemic and an amplification of pre-COVID issues, the decreasing amounts seen in reimbursements are also impacting the ability for healthcare systems to retain staff. Clinical workflows and efforts to get paid for the care provided to patients have increasingly become full ofbureaucracy and obstacles, which have increased clinician burnout.

Increasing requirements to obtain prior authorizations are another contributor to both lower amounts of revenue and the increased staff burden to obtain them if physicians and hospitals want to be paid. She said this requires healthcare organizations to hire more staff to track down prior authorizations, which drives up overhead healthcare costs.

This gets more complicated and involves more staff time that is unpaid when payers require a peer-to-peer reviews of why tests or procedures are needed and the physicians have to justify their decisions to insurance companies.

"Sometimes this is also harmful to our patients because because their access to care gets decreased," Biga said. "And this is why the whole healthcare system of the United States is under scrutiny."

The American healthcare system is the most expensive, but fails to meet better outcomes of other nations, she said. She said the cost versus benefit evaluation of American healthcare shows a growing imbalance. While the U.S. spends more money per-capita on healthcare than any other country in the world, outcomes and life expectancy actually started decreasing among Americans prior to the pandemic.This lower-than-expected performance compared to costs was echoed by cardiologist and FDA Commissioner Robert Califf, MD, who presented these same statistics facing the U.S. healthcare system at theTranscatheter Cardiovascular Therapeutics (TCT) and the American Heart Association (AHA) meetings in 2022.

"Why is it that our quality or care and patient outcomes are not matching the dollar amounts that we are spending?" Biga asked. "This is a huge issue, because the fee-for-service basis that we are in uses a risk based model where we take baby steps, but we really need to be taking bigger steps to achieve something."

Biga said part of the problem is the American consumer expectation of immediate access to healthcare for everything. But she said immediate care does not mean quality care, and that is a concept the public needs to understand and accept. She said patients in some countries with socialized medicine might have to wait two months for an imaging test, but overall, the healthcare outcomes in those countries are better than in the United States.

Biga said there is a movement in Washington to pushed the healthcare system to risk-based payment models. She said the health system is already moving in that direction.

As the available funds for Medicare continue to decrease as more patients are added to the system, many patients are moving to Medicare Advantageplans.

"Call them anything you want, but Medicare Advantage are basically a risk-based model. And when you enter into a Medicare Advantage plan on our side in the office, it adds a lot more requirements," Biga said.

These additional requirements include the need for appropriate use documentation, pre-authorization, your network gets more narrow so patients may not be able to go where they want to go. She said in many places this change is subtle, but in other places it is more pronounced.

"In Chicago, our percentage Medicare Advantageto traditional Medicare patients continues to escalate and I think we are going to be seeing more of that," Biga said.

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Panacea Healthcare Solutions Hosting Webinar on Interventional … – Benzinga

Panacea Healthcare Solutions, a leading provider of strategic pricing, price transparency, chargemaster, compliance, and revenue integrity software, education, and consulting services to healthcare providers across the full continuum of care, is hosting a newly developed webinar intended to help healthcare professionals keep up with recent advances in novel treatment options in the subspecialty of interventional cardiology.

ST. PAUL, Minn., March 22, 2023 /PRNewswire-PRWeb/ -- Panacea Healthcare Solutions, a leading provider of strategic pricing, price transparency, chargemaster, compliance, and revenue integrity software, education, and consulting services to healthcare providers across the full continuum of care, is hosting a newly developed webinar intended to help healthcare professionals keep up with recent advances in novel treatment options in the subspecialty of interventional cardiology.

"Transcatheter Valvular Procedure Code Updates: New Technologies and the Codes You Should Capture" is scheduled to take place at 1 p.m. EST on Thursday, March 30, with a Continuing Education Unit (CEU) credit available through the American Academy of Professional Coders (AAPC), the Professional Association of Health Care Office Management (PAHCOM), and the Project Management Institute (PMI). Register here.

The Current Procedural Terminology (CPT) transcatheter valvular procedure code set has significantly expanded since the transcatheter aortic valve replacement (TAVR) codes were created in 2013, with new procedures for all four cardiac valves added in several areas of the code book. Additionally, many patients are enrolled in clinical trials as this area of medicine rapidly expands, creating the need for a nuanced understanding of coding, billing, and claim requirements beyond just the assignment of the correct CPT code.

"We're pleased to offer this educational session, which will help both physicians and those involved in the mid-revenue cycle process have a clearer understanding of the procedures that can be performed across all cardiac valves," said Becky Jacobsen, Director of Coding and Documentation Services at Panacea. "The material being covered will undoubtedly prove invaluable to the success and growth of any transcatheter structural heart program."

Panacea Senior Healthcare Consultant Jayna Tuominen will be the lead presenter for the 60-minute webinar, during which she will review the current state of the code set for transcatheter valvular heart interventions across all four cardiac valves and discuss how to successfully navigate clinical trial coding, billing, and claim submission for these procedures. This presentation will equip physicians, charge entry personnel, coding professionals, practice administrators, and revenue cycle staff with the information needed to perform accurate and compliant coding and claim submission.

A live Q&A will be held after the primary presentation, providing participants an opportunity to ask questions and have them answered in real time.

"I'm very excited to offer this session, as it's a topic that's both timely and relevant," Tuominen said. "I have no doubts that participants will walk away from it far better prepared to successfully manage the coding and billing of these dynamic and evolving procedures."

By the conclusion of the webinar, participants should find themselves able to:

To learn more about Panacea's tech-enabled services, or other educational sessions, visit panaceainc.com or call 888-926-5933. Register for the webinar here.

About Panacea Healthcare Solutions

Panacea (http://www.panaceainc.com) provides software and tech-enabled services that help healthcare organizations improve their revenue cycle, coding, and compliance with front-line expertise in mid-revenue cycle management. In an era where 95% of provider revenue is driven by accurate coding and defensible yet optimal pricing, clients trust Panacea to deliver unparalleled value in strategic pricing, price transparency, chargemaster, compliance, and revenue cycle solutions.

Media Contact

Catherine Short, Panacea Healthcare Solutions, LLC, 888-926-5933, contact@panaceainc.com

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Cardiology

Cardiology Stem Cells Market Revenue to Hit USD 5.1 Bn by 2031 | Transparency Market Research – Yahoo Finance

Transparency Market Research

The global cardiology stem cells market growth is driven by the increase in adoption of stem cell technology in emerging economies, surge in investment in stem cell research, and rise in number of clinical trials focused on cardiac stem cell therapies.

Wilmington, Delaware, United States, March 16, 2023 (GLOBE NEWSWIRE) -- According to Transparency Market Research study, the global cardiology stem cells market stood at US$ 2.6 Bn in 2022, and it is projected to expand at a CAGR of 7.4% from 2023 to 2031.

The rise in research to develop advanced stem cell therapies and cell delivery methods is expected to accelerate the cardiology stem cells market development. Surge in clinical trials in mesenchymal stem cells (MSCs) is ascribed to the demand for innovative cell-based therapies to treat ischemic heart disease and heart failure in the last few years.

Rapid increase in number of preclinical and clinical studies on regenerative therapy using stem cells is likely to broaden the global cardiology stem cells market outlook. Several studies in the last few years focus on exploring cardiac regeneration potential of stem cells of different origin such as induced pluripotent stem cell, mesenchymal stem cell, and mesenchymal stem cells.

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Leading players are emphasizing on the development of personalized stem cell therapies and delivery approaches using MSCs. Personalized treatment strategies aim at harnessing stem cell therapy for targeted therapeutic treatments to treat cardiovascular diseases. Effective therapies enhance angiogenesis and improve cardiac function in patients. Recent market trends underscore extensive research in evaluating novel approaches to restore damaged myocardial tissue. New modes of delivery of the stem cell therapy are expected to create new business opportunities for companies in the global cardiology stem cells market.

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Global Cardiology Stem Cells Market - Key Findings

Significant Demand for Adult Stem Cells to Treat Cardiovascular Disease (CVD): Usage of adult stem cells is expected to rise in cardiovascular medicine. Popularity of these type of stem cells is ascribed to several benefits they offer in cardiac regeneration therapy. Extensive research in the last few decades have aimed at harnessing the regenerative potential of adult stem cells. Low risk of rejection and complications are some of the advantages of adult stem cells. The adult stem cell segment accounted for leading market share in 2022.

Rise in Demand for Novel Stem Cell Therapies to Treat Heart Failure: Analysis of research on the cardiology stem cells market indicates that heart failure is a highly lucrative segment. High demand for stem cell therapies to treat heart failure could be ascribed to the need for alternative treatments to heart transplantation. Significant global burden of heart failure, including congestive heart failure, is bolstering the need for regenerative medicine to treat CVDs. Surge in R&D in stem cell therapies for patients suffering from ischemic heart disease is poised to bolster the cardiology stem cells market value. New therapeutic strategies are urgently needed to improve the quality of life of the patient population (acute and chronic ischemic heart disease). Rise in research on myocardial repair and regeneration to treat chronic heart failure is likely to open new opportunities for companies in the cardiology stem cells industry.

Cardiology Stem Cells Market - Key Drivers

High global burden of cardiovascular diseases (CVD) and significant mortality rate of CVD-related complications among populations in several countries are driving the demand for innovative therapeutic strategies. This factor is expected to drive the demand for stem cell technologies in cardiovascular medicine.

Ongoing studies on stem cell therapy have found that various adult stem cells promote cardiac tissue regeneration in myocardial ischemia and critical limb ischemia. For instance, mesenchymal stem cells (MSCs) have gathered traction in cell-based therapies to repair damaged heart.

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Global Cardiology Stem Cells Market - Regional Growth Dynamics

North America held major market share in 2021. Growth of the cardiology stem cells market in the region is likely to be propelled by increase in research spending by several prominent research centers and institutes who are focusing on regenerative medicine.

Surge in demand for advanced treatments for cardiac damage and heart failure is expected to bolster market development in Asia Pacific. The market in Asia Pacific accounted for leading market share in 2022. China, South Korea, Japan, and Singapore are witnessing a surge in R&D activities in stem cell therapies to treat CVD. The market in the region is likely to be propelled by rise in adoption of cardiac regeneration therapy. Large number of clinical trials in these countries is expected to offer lucrative opportunities for companies in the cardiology stem cells market.

Cardiology Stem Cells Market - Competition Landscape

The landscape is highly fragmented, with presence of several local and international players holding significant market share. Prominent companies focus on mergers and acquisitions and product portfolio expansion as key competitive strategies in order to consolidate their share in the market.

Key players operating in the cardiology stem cells market are Astellas Pharma Inc., STEMCELL Technologies, BioTimes Inc., TAKARA BIO INC., BrainStorm Cell Therapeutics, BioCardia, Cellular Engineering Technologies (CET), and Lisata Therapeutics.

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Cardiology Stem Cells Market Segmentation

Type of Cell

Application

Heart Failure

Myocardial Infarction

Critical Limb Ischemia

Others

Source

End-user

Regions Covered

North America

Latin America

Europe

Asia Pacific

Middle East & Africa

About Transparency Market Research

Transparency Market Research, a global market research company registered at Wilmington, Delaware, United States, provides custom research and consulting services. The firm scrutinizes factors shaping the dynamics of demand in various markets. The insights and perspectives on the markets evaluate opportunities in various segments. The opportunities in the segments based on source, application, demographics, sales channel, and end-use are analysed, which will determine growth in the markets over the next decade.

Our exclusive blend of quantitative forecasting and trends analysis provides forward-looking insights for thousands of decision-makers, made possible by experienced teams of Analysts, Researchers, and Consultants. The proprietary data sources and various tools & techniques we use always reflect the latest trends and information. With a broad research and analysis capability, Transparency Market Research employs rigorous primary and secondary research techniques in all of its business reports.

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Nikhil SawlaniTransparency Market Research Inc.CORPORATE HEADQUARTER DOWNTOWN,1000 N. West Street,Suite 1200, Wilmington, Delaware 19801 USATel: +1-518-618-1030USA Canada Toll Free: 866-552-3453Website:https://www.transparencymarketresearch.comBlog:https://tmrblog.comEmail:sales@transparencymarketresearch.com

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Cardiology

Northern Light Mercy Hospital expands cardiology services with 2 … – Press Herald

NEW HIRES

Northern Light Mercy Hospital has added two physicians to its cardiology services in Portland: Dr. Aline Iskandar and Dr. Adam Karpman.Iskandar earned her M.D. from the University of Southern Denmark, where she also did postdoctoral training at Odense University Hospital. She later completed a residency in internal medicine at the University of Connecticut Health Center, and a cardiology fellowship at University of Massachusetts Memorial Medical Center. She then joined Maine Medical Center and worked as a cardiologist with MaineHealth for almost seven years. Karpman earned his D.O. from the University of New England College of Osteopathic Medicine in Biddeford, and completed a residency in internal medicine at Newark Beth Israel Medical Center in Newark, New Jersey. He then completed a fellowship in cardiology at Oklahoma State University Center for Health Sciences in Tulsa, Oklahoma. In addition to his clinical practice, he serves as a professor at the UNE medical school.

Kristen McAuley has joined the John T. Gorman Foundation as a senior program associate. In her role, McAuley will develop investment strategies that advance the foundations goal of promoting the well-being of Maine children and their families. McAuley comes to the foundation from the Maine Department of Health and Human Services, where she served as the director of public health planning. She also served as director of prevention for the MaineHealth Center for Tobacco Independence and assistant director in the Division of Disease Prevention at the Maine Center for Disease Control and Prevention. She has a bachelors degree from Eckerd College, and a Master of Public Health degree from the University of Pittsburgh.

Jill Ward has been named a senior policy adviser in the U.S. Department of Justices Office of Juvenile Justice and Delinquency Prevention. In this part-time role, Ward, director and an adjunct professor at the University of Maine School of Laws Center for Youth Policy and Law, will provide policy guidance to the departments juvenile justice office. Prior to her time at Maine Law, she worked on youth justice issues with numerous state and national organizations, including the Maine Childrens Alliance, the Childrens Defense Fund, the Girls Scouts of the USA, the Campaign for Youth Justice and the Youth First Initiative.

PROMOTIONS

At Camden National Bank, Kathleen Bellmore has been promoted to senior vice president, talent acquisition & diversity, equity, and inclusion officer. In her new role, she will continue to lead the banks talent acquisition function while also directing DEI efforts. Bellmore has been assisting with Camden Nationals recruitment efforts for over 10 years, and holds a bachelors degree in business administration from the University of Maine and an MBA in human resources management from Thomas College. She is recognized as a senior certified professional by the Society for Human Resource Management and a professional in human resources by the Human Resource Certification Institute.

Maritime Energy has promoted Charon Curtis to senior vice president. She joined Maritime in 2007 as operations manager for the Maritime Farms convenience stores and as a member of the senior management team. Her new responsibilities include overseeing the fuel, propane, transport, customer service, branch offices and service departments. The Rockland-based company sold its 13 Maritime Farms stores in December and is now focused on its core energy business, serving Knox, Lincoln, Waldo, Hancock and Kennebec counties.

BOARD APPOINTMENTS

Marc Gosselin, executive director for sports tourism and community partnerships for the City of Auburn, has been named to the Maine Sports Commission board of directors. Gosselin, who is also a professor at Central Maine Community College, bring a variety of sports management experience to the role. In addition to his work with the city, he has served as head of corporate partnerships for the NHLs Columbus Blue Jackets. He also was vice president of corporate partnerships for the Maine Red Claws, now the Maine Celtics, in the NBA G League. He will serve a two-year term on the Maine Sports Commission board.

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