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Nuclear cardiology in a managed care environment.

Health maintenance organizations (HMO) and nuclear cardiology represent mutual threats and mutual opportunities for each other. On the one hand, nuclear cardiology represents a cost center with HMOs exerting tremendous financial pressure on nuclear cardiology programs. On the other hand, nuclear cardiology can act as a sage gatekeeper to the cardiac catheterization laboratory and help HMOs effectively control the health care of an increasing percentage of the population. Through the process of negotiation, of determining each other's needs, an accommodation can take place between the two. The ability to correlate scan results with coronary angiography provides individual nuclear cardiology programs with the opportunity to demonstrate their accuracy. A Nuclear Cardiology Report Card based on these data can be developed for use, with HMOs creating the opportunity to compete not only on price but also on value. Carved out capitation rates for nuclear cardiology can be estimated on the basis of actual experience with an HMO population and by extrapolation from test frequency of the U.S. population. The financial disincentives of capitation and of managed care challenge the physician-patient relationship. Advocacy of the role of nuclear cardiology and an understanding of negotiation strategies can aid nuclear cardiologists in their attempts to provide quality care with commensurate compensation.

Capitation Fee↗

History of German pediatric cardiology.

Due to the isolation of German medicine in World War II accompanied by the destruction of many hospitals, German pediatricians did not show any serious interest in the treatment of children with congenital heart diseases, nor did they take notice of the progress achieved by Helen Taussig, Alfred Blalock and other cardiologists and surgeons in the western world. This problem was even worse in East Germany. Only a few German internists and forward-looking surgeons were able and ready to take care of this group of principally operable children in places like Bonn/Düsseldorf, Marburg/Munich, Berlin, and Hamburg. However, in the early 1950s some directors of pediatrics at university hospitals--largely motivated by the cardiac surgeons--allowed or even encouraged younger colleagues to concentrate on pediatric cardiology and to begin application of heart catheterization and angiocardiography. In 1960 a group of colleagues interested in pediatric cardiology met for the first time in Frankfurt and became the nucleus of the future "working group" (1969) and finally the "German Society of Pediatric Cardiology" (1974). By 1972 pediatric cardiology had been approved as an independent (sub)specialty. Colleagues and friends from surrounding countries (Austria, Great Britain, Sweden, Switzerland, and the Netherlands) and also from the US and some eastern countries were either members or regular guests during or between the meetings. Pediatric cardiology is now represented in Germany by specialized practitioners, trainees and assistants who work in both community and university hospitals, and in specialized departments. Due to the foresightedness of the Chief of Pediatrics, Prof. G. Joppich, the first Chair of Pediatric Cardiology was founded in Göttingen in 1960 under the direction of A. Beuren. Another model of interdisciplinary cooperation between pediatric cardiologists, bioengineers, mathematicians and computer scientists was established in Kiel in 1966. In other places pediatric and adult cardiologists were brought together in "Heart Centers" with cardiovascular surgeons. The first of these Heart Centers was founded in 1974 in Munich under the directorship of K. Bühlmeyer and comparable centers were later established in Bad Oeynhausen (1985) and Berlin (1986). Following reunification in 1990, pediatric cardiologists from the east and west came together. Thus, within the last three to four decades German pediatric cardiology gradually caught up with international standards and in some fields of cardiovascular research even assumed a leading role. The care of the growing numbers of surviving patients with congenital heart disease has become a new challenge that has to be met by experienced cardiologists. To maintain the level of competence, future activities should however, not only concentrate on the optimal care of patients with congenital heart disease but also be responsible for cardiovascular research.

Cardiology↗

Preventive cardiology: a progress report.

The progress to the current era of preventive cardiology covers a period of more than 40 years, beginning with epidemiological studies on coronary heart disease and other forms of atherosclerotic disease and related factors and progressing through prevention trials and community demonstration projects to the actual implementation of preventive measures by combined population and high-risk strategies. The scientists of the United States have played a leading role in the data collection which forms the scientific basis for preventive cardiology and the fruitful collaboration in the United States between the scientists and governmental, as well as nongovernmental, organizations in the implementation of preventive cardiology has served as a good example for other countries. The Section on Epidemiology and Prevention of the International Society and Federation of Cardiology and the Cardiovascular Diseases Unit of the World Health Organization, working in close liaison, have had key roles in the worldwide promotion of preventive cardiology. The rapid progress in preventive cardiology during the past 4 years, since the 1st International Conference of Preventive Cardiology, has been dominated by a "snowballing" movement toward more intensive application of cholesterol-lowering measures at both the population and the individual level. Promising progress has also been made in the field of nonpharmacological control of elevated blood pressure.

Adult↗

Variations in adult congenital heart disease training in adult and pediatric cardiology fellowship programs.

OBJECTIVES: The purpose of this study was to evaluate adult congenital heart disease (CHD) training among U.S. cardiology fellowship programs. BACKGROUND: Although training recommendations for caring for adults with CHD exist, the educational patterns and numbers of specialists remain unknown. METHODS: We surveyed U.S. directors of 170 adult cardiology and 45 pediatric cardiology (PC) fellowship programs. Adult program surveys contained 1 single-response and 10 multiple-choice questions; pediatric program surveys contained 1 single-response and 13 multiple-choice questions. RESULTS: Ninety-four adult cardiology fellowship directors (55%) and 34 PC directors (76%) responded. Of adult programs, 70% were in university hospitals and 40% were associated with PC groups. Those with PC-affiliation had more adult CHD clinics (p < 0.02) and more adult CHD inpatient (p < 0.02) and outpatient (p < 0.002) visits than those without PC affiliation. Most PC programs were in children's hospitals (38%) or children's hospitals within adult hospitals (50%). Eighty-two percent had associated adult cardiology programs. Pediatric programs followed adult CHD patients in various care settings. Over one-third of adult and pediatric programs had < or = 3 lectures annually regarding adult CHD. Nine adult and 2 pediatric programs offered adult CHD fellowships, and only 31 adult and 11 pediatric fellows pursued advanced CHD training in the last 10 years. CONCLUSIONS: Adult CHD didactic and clinical experiences for cardiology fellows vary widely. Few programs offer advanced CHD training, and the number of specially trained physicians is unlikely to meet projected workforce requirements. Adult cardiology programs with PC affiliation have increased CHD experience and might provide good educational models.

Adult↗

[The Spanish registry of organization, resources and activities in pediatric cardiology].

INTRODUCTION: We present the findings of the registry of activities and resources of the Spanish Society of Pediatric Cardiology in 2002, with the objective of providing a national reference for professionals and entities involved in the study and treatment of congenital heart defects. METHODS: Data were retrospectively collected through questionnaires sent from the Spanish Society of Pediatric Cardiology to the heads of pediatric cardiology units with medical and surgical activities, as well as to all the members of the Society and those of the Pediatric Cardiology Section of the Spanish Society of Cardiology. RESULTS: Thirty-eight centers, including 17 national centers with medical and surgical activities, completed the questionnaire. Human resources consisted of 110 cardiologists, 43 surgeons and 12 residents in training. All the centers had the elementary tools for diagnosis and all except one had Echo-2D-Doppler. There were eight catheterization laboratories exclusively used for pediatric activities and nine further laboratories that combined adult and pediatric activities. A total of 83,061 patients were attended in outpatient clinics and there were 6,938 hospital admissions in 22 centres. A total of 279 ablation procedures were performed in 12 electrophysiology laboratories. The seventeen centres with surgical activities performed 2,498 cardiac catheterisms (968 interventional) and 2,292 cardiac surgical interventions. CONCLUSIONS: Given the large number of participating centers, the present report provides exhaustive information on the organization, resources and activities of pediatric cardiology in Spain. Pediatric cardiology should be granted official recognition of its work so that teaching hospitals, organization, resources and activities can be regulated.

Cardiac Care Facilities↗

Differences in treatment and outcome of patients with acute myocardial infarction admitted to hospitals with compared to without departments of cardiology; results from the pooled data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA 1+2) Registries and the Myocardial Infarction Registry (MIR).

AIMS: The specialty of the admitting physician may influence treatment and outcome in patients with acute myocardial infarction. METHODS AND RESULTS: The pooled data of three German acute myocardial infarction registries: the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) 1+2 studies and the Myocardial Infarction Registry (MIR) were analysed. Patients admitted to hospitals with departments of cardiology were compared to hospitals without such departments. A total of 24 814 acute myocardial infarction patients were included, 9020 (36%) patients at 91 (29.8%) hospitals with departments of cardiology and 15 794 (64%) at 214 (70.2%) hospitals without cardiology departments. There were only minor differences in patient characteristics and prevalence of concomitant diseases between the two types of hospital. The first electrocardiogram was more often diagnostic at hospitals with cardiology departments (71.8% vs 66.5%, P<0.001). Reperfusion therapy and adjunctive medical therapy, such as aspirin, beta-blockers and ACE-inhibitors were used more often at cardiology departments (all P -values <0.001), even after adjustment for confounding parameters. Treatment improved at both types of hospital over time. Admission to a hospital with a department of cardiology was independently associated with a lower hospital mortality (14.2% vs 15.4%, adjusted OR=0.91; 95%CI: 0.83-0.99). Additional logistic regression models showed that the higher use of reperfusion therapy and recommended concomitant medical therapy was responsible for most of the survival benefit at such hospitals. CONCLUSION: Treatment of acute myocardial infarction patients at hospitals with departments of cardiology was independently associated with a higher use of recommended therapy and a lower hospital mortality compared to hospitals without such departments.

Aged↗

The changing face of twentieth-century American cardiology.

The meaning of American cardiology has been transformed over the past century. During that time, cardiology has been defined by several organizations: by the American Board of Internal Medicine through subspecialty certifications; by the two major American cardiology societies, the American Heart Association and the American College of Cardiology; and by the four major cardiology journals. These organizations have sometimes cooperated, sometimes competed. Cardiology has also had to negotiate relationships with several external interest groups, including pediatrics, surgery, hospitals, and internal medicine. Throughout the 20th century, the word cardiology has had no meaning save its definition within a larger web of organizations, relationships, and ideas. The meaning, like the meaning of all specialties and subspecialties, is historically mediated and constantly changing.

American Heart Association↗

Access to an outpatient cardiology consultation in southwestern Ontario.

OBJECTIVE: To determine whether there were differences in waiting time for a consultation for a nonurgent cardiology problem among specialists in an academic centre compared with those in community practice. DESIGN: Cross-sectional telephone survey. SETTING: Southwestern Ontario. PARTICIPANTS: Academically affiliated and community-based specialists in cardiology or internal medicine with an interest in cardiology. OUTCOME MEASURE: Waiting period in weeks for outpatient consultation. RESULTS: Among community specialists, those with cardiology training had significantly longer waiting times than those without for nonurgent cardiology consultation (median 8.6 versus 3.8 weeks, P=0.0077). Waiting times for consultation were significantly longer for academic specialists than for those in community practice (median 9.1 versus 4.1 weeks, P=0.0013). Significantly longer waiting times exist in communities with a population greater than 100,000 (median 9.1 versus 4.0 weeks, P=0.0005). CONCLUSIONS: Waiting times for consultation for a nonurgent cardiology problem are long. Waiting times are longer for physicians with certification in cardiology, in the academic medical centre and in larger communities.

Academic Medical Centers↗

Tele-cardiology.

After defining tele-medicine, we describe its situation in the public health service of South Africa and its application to cardiology. Methods of communication relevant to tele-cardiology are outlined, together with their bearing on primary healthcare. The range of tele-cardiological applications to electrocardiology, echocardiology, auscultation, imaging and pathology are indicated. Tele-cardiology's contributions to a range of cardiological problems and types of management are described briefly. Finally, a mention is made of the relevance of tele-medicine to education and the costs related to cardiology, with an indication of some future needs for tele-cardiology.

Cardiology↗

Evaluation of cardiology consultations sought from the anaesthesia clinic.

OBJECTIVE: To evaluate the criteria for cardiology referrals and to assess the perioperative relevance of the cardiology advice given in patients evaluated for non-cardiac surgery. DESIGN: Single center, observational study. PLACE AND DURATION OF STUDY: Outpatient Anaesthesia Clinic at The Aga Khan University Hospital (AKUH), between January 2001- August 2001 and February 2002- August 2002. MATERIALS AND METHODS: A review of case files of 70 patients, scheduled for non-cardiac surgery, who were referred for cardiology consultations from the anaesthesia clinic at AKUH during the study period. The clinical criteria for seeking cardiology advice, the cardiology advice given, its influence on patient management, as well as number of adverse cardiac events in the perioperative period were documented. RESULTS: A history of hypertension, ischemic heart disease, and ECG abnormalities were the major criteria for seeking opinion on cardiac status. Cardiology advice frequently resulted in the ordering of extensive cardiac investigations. Among the patients identified for further tests by the cardiologists, 75% had no evidence of ischemic heart disease or myocardial dysfunction; none of them were monitored invasively intraoperatively or had adverse cardiac events in the perioperative period requiring intensive care or prolonged hospital stay. CONCLUSION: No definite criteria or pattern for referrals was identified. Most of the referrals did not fall within the AHA guidelines. Cardiology advice given had very little influence on the perioperative management.

Adult↗

Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intraobserver and interobserver reproducibility among experienced nuclear cardiologists and cardiology trainees.

BACKGROUND: Stress electrocardiography (ECG)-gated single photon emission computed tomography (SPECT) for assessment of left ventricular perfusion and function improves the confidence of interpretation and enhances specificity for detection of coronary artery disease. The reproducibility of visual interpretation of ECG-gated SPECT images and the significance of training and experience have not been reported previously in a large series of consecutive patients. We evaluated both intraobserver and interobserver agreement of interpretation of ECG-gated SPECT images among 3 cardiology trainees and 3 experienced nuclear cardiologists from 3 institutions. METHODS AND RESULTS: Three nuclear cardiologists and 3 cardiology trainees who had fulfilled American College of Cardiology/American Society of Nuclear Cardiology Core Cardiology Training Symposium (ACC/ASNC COCATS) guidelines for level II training in nuclear cardiology independently evaluated 106 consecutive technetium 99m sestamibi SPECT images with ECG gating of either the stress or rest images. All cases were interpreted blindly, twice in random sequence, without clinical data. We assessed intraobserver and interobserver agreement for myocardial perfusion, left ventricular regional and global systolic function, and overall clinical impression, by means of percent agreement and Cohen's kappa statistic. Intraobserver agreement was good (82%-92%, kappa = 0.54-0.84) for assessment of myocardial perfusion, systolic function, and overall impression. Interobserver agreement was also good, ranging from 65% to 90% (kappa = 0.32-0.76), with better agreement found for assessment of function (77%-85%, kappa = 0.52-0.7) than for perfusion (65%-80%, kappa = 0.32-0.6). For all measures, there were no significant differences in reproducibility between nuclear cardiologists and cardiology trainees. CONCLUSIONS: Interpretation of ECG-gated SPECT images has high reproducibility and agreement among both nuclear cardiologists and cardiology trainees.

Electrocardiography↗

[Interventional cardiology in Lithuania: current status and perspectives].

The objective of the article is to evaluate current status of interventional cardiology in Lithuania, to compare these data with the results of interventional cardiology of other European countries and to discuss about perspectives of interventional cardiology in Lithuania. A detailed questionnaire of interventional cardiology of European Society of Cardiology was used for analysis of Lithuanian interventional cardiology data of 2000-2002. Lithuanian interventional cardiologists in 2000-2002 annually performed respectively 1535, 1666 and 2085 coronary angiographies, 500, 532 and 632 PTCA, 120, 133 and 193 stenting procedures per 1000000 inhabitants. According to morbidity of heart diseases in Lithuania and the rate of interventional procedures in Europe, in 2004 more than 9000 coronary angiographies should be performed, 3000 percutaneous transluminal coronary angioplast procedures, and 2000 coronary stent implantations in Lithuania. Achievement of such results would be possible, if the State Sickness Fund and the Ministry of Health would pay more attention to financial problems of interventional cardiology in Lithuania. In conclusion, it can be stated that there are good perspectives for Lithuanian cardiologists to achieve mean European level of interventional procedures in the nearest future.

Angioplasty, Balloon, Coronary↗

[Cardiologic rehabilitation. An orienting overview].

The European Society of Cardiology has dealt in detail with concepts of cardiological rehabilitation in 1992 and has published guidelines. According to the opinion of this society, the organization of cardiological rehabilitation can differ among the European countries considering the socio-economic structures, legal and insurance regulations as well as national traditions. Guidelines for the standards of cardiological rehabilitation have to be flexible and adaptable to the organization of each European country. According to the opinion of Müller-Fahrnow, the beginning of modern medical rehabilitation in the Federal Republic of Germany is clearly linked to the development of concepts for cardiological rehabilitation at the end of the sixties and beginning of the seventies with a holistic approach under consideration of a kinetotherapeutic and psychosocial focus. A countrywide introduction of the concept of the following curative treatment at the end of the seventies by the insurances contributed to a significant stabilization of the new qualities of rehabilitation and, again the cardiological rehabilitation played an important role (Müller-Fahrnow W., 1994). This paper demonstrates basic elements and structures of the cardiological rehabilitation in an orientating manner and contains conclusions about the future development.

Combined Modality Therapy↗

Provision of services for the diagnosis and treatment of heart disease. Fourth report of a Joint Cardiology Committee of the Royal College of Physicians of London and the Royal College of Surgeons of England.

The principal conclusions of the fourth report of the Joint Cardiology Committee are: 1 Cardiovascular disease remains a major cause of death and morbidity in the population and of utilisation of medical services. 2 Reduction in the risk of cardiovascular disease is feasible, and better co-ordination is required of strategies most likely to be effective. 3 Pre-hospital care of cardiac emergencies, in particular the provision of facilities for defibrillation, should continue to be developed. 4 There remains a large shortfall in provision of cardiological services with almost one in five district hospitals in England and Wales having no physician with the appropriate training. Few of the larger districts have two cardiologists to meet the recommendation for populations of over 250,000. One hundred and fifty extra consultant posts (in both district and regional centres) together with adequate supporting staff and facilities are urgently needed to provide modest cover for existing requirements. 5 The provision of coronary bypass grafting has expanded since 1985, but few regions have fulfilled the unambitious objectives stated in the Third Joint Cardiology Report. 6 The development of coronary angioplasty has been slow and haphazard. All regional centres should have at least two cardiologists trained in coronary angioplasty and there should be a designated budget. Surgical cover is still required for most procedures and is best provided on site. 7 Advances in the management of arrhythmias, including the use of specialised pacemakers, implantable defibrillators, and percutaneous or surgical ablation of parts of the cardiac conducting system have resulted in great benefit to patients. Planned development of the emerging sub-specialty of arrhythmology is required. 8 Strategies must be developed to limit the increased exposure of cardiologists to ionising radiation which will result from the expansion and increasing complexity of interventional procedures. 9 Supra-regional funding for infant cardiac surgery and transplantation has been successful and should be continued. 10 Despite advances in non-invasive diagnosis of congenital heart disease the amount of cardiac catheterisation of children has risen due to the increase in number of interventional procedures. Vacant consultant posts in paediatric cardiology and the need for an increase in the number of such posts cannot be filled from existing senior registrar posts. All paediatric cardiac units should have a senior registrar and in the meantime it may be necessary to make proleptic appointments to consultant posts with arrangements for the appointees to complete their training. 11 Provision of care for the increasing number of adolescent and adult survivors of complex congenital heart disease is urgently required. The management of these patients is specialised, and the committee recommends that it should ultimately be undertaken by either adult or pediatric cardiologists with appropriate additional training working in supra-regionally funded centers alongside specially trained surgeons. 12 Cardiac rehabilitation should be available to all patients in the United Kingdom. 13 New recommendations for training in cardiology are for a total of at least five years in the specialty after general professional training, plus a year as senior registrar in general medicine. An additional year may be required for those wishing to work in interventional cardiology and adequate provision must be made for those with an academic interest. 14 It is essential that both basic and clinical research is carried out in cardiac centres but these activities are becoming increasingly limited by the lack of properly funded posts in the basic sciences and restriction in the number of honorary posts for clinical research workers. 15 A joint audit committee of the Royal College of Physicians and the British Cardiac Society has been established to coordinate audit in the specialty. All district and regional cardiac centres should cooperate with the work of the committee, in addition to their participation in local audit activities.

Cardiac Surgical Procedures↗

Core curriculum for the training of pediatric invasive/interventional cardiologists: report of the Society for Cardiac Angiography and Interventions Committee on Pediatric Cardiology Training Standards.

Within the field of pediatric cardiology, a number of subspecialty fields are generally recognized. Some of these overlap. For example, most electrophysiologists also would consider themselves to be clinical cardiologists. Some fields, however, are relatively mutually exclusive. For example, most clinical pediatric cardiologists would not consider themselves to be electrophysiologists and would admit that there is a different knowledge, skill, and experience base that separates an electrophysiologist from other specialists within the broader field of pediatric cardiology. Likewise, it is our opinion that a separate knowledge, skill, and experience base exists among pediatric Invasive/Interventional cardiologists. The purpose of this report is to define the unique knowledge and skill base required for the training of an invasive pediatric cardiologist. The scope of this report is limited to the training of Invasive/Interventional cardiologists dealing with the treatment of pediatric patients and the cardiac diseases most often encountered in these patients. This report describes in detail the core curriculum suggested for the training of an invasive pediatric cardiologist. For these purposes, invasive pediatric cardiology encompasses all aspects of pediatric diagnostic cardiac catheterization, whether congenital or acquired. Additional curriculum regarding training for therapeutic or interventional procedures is also addressed because of today's needs: most pediatric cardiac catheterizations are performed to acquire specific data that cannot be obtained otherwise by non-invasive technologies and are required for the best medical or surgical management. However, more and more frequently the need for a cardiac catheterization entertains the possibility of having to proceed with an interventional procedure, and therefore, to conserve the vessels of pediatric patients as well as to consider costs, any invasive pediatric cardiologist should be well trained in most of the accepted interventional pediatric cardiology procedures. The curricula is divided here into five major sections followed by a bibliography keyed to those sections. Also included is a suggested format for the objective evaluation and documentation of the progress of invasive pediatric cardiology fellows. It is intended to complement the core curriculum and provide a means for standardizing the evaluation of invasive pediatric cardiology fellows.

Angiography↗

Nuclear cardiology in the UK: activity and practice 1997.

A questionnaire was sent to 251 nuclear medicine centres asking for details of nuclear medicine activity, and nuclear cardiology activity and practice in 1997. One hundred and seventy-one (68%) centres replied. Nuclear medicine activity was estimated at 11.8 studies/1,000 population/year, and 9.5% of these studies were within cardiology (1.12 studies/1,000/year). Myocardial perfusion imaging (MPI) studies accounted for 77% and radionuclide ventriculography (RNV) for 22% of all nuclear cardiology. On a national basis this represents activity levels of 0.86 and 0.25 studies/1,000/year for MPI and RNV, respectively. Of the 171 responding centres, 102 (60%) performed MPI studies and 81 (79%) of these reported that activity was increasing. However, MPI activity was unevenly distributed between hospitals. Two centres accounted for 13% of total MPI; others had far lower activity rates, and 51/102 (50%) centres performed less than 200 MPI studies/year. Comparison with previous surveys showed that nuclear medicine activity had almost doubled since 1990 (it was 6.0 studies/1,000 population in 1990, 9.3 studies/1,000 in 1994 and 11.8 studies/1,000 in 1997). Over the same period, nuclear cardiology activity had also risen, the greatest increase being seen for the last 3 years (it was 0.7 studies/1,000 population in 1990, 0.82 studies/1,000 in 1994 and 1.12 studies/1,000 in 1997). Despite these encouraging figures, MPI activity for 1997 remained well below that recommended by the British Cardiac Society in 1994 (2.6 studies/1,000/year) as adequate to serve the needs of patients with cardiac disease in the UK; it was also below the European average activity for the same year (2.2 studies/1,000/year). The anticipated increased workload for nuclear cardiology is encouraging despite the wide and varied practice of nuclear cardiology around the UK. The nuclear medicine community now needs to address the issues that will prevent it keeping up with demand, such as restricted camera time, excessive waiting lists and outdated equipment, but also to standardise acquisition and reporting techniques so that all studies, wherever performed, will be of a uniformly high standard.

Cardiology↗

Activity and practice of nuclear cardiology in the Czech Republic, 2001.

Radionuclide myocardial perfusion imaging (MPI) has been on the rise in Europe and the USA. Details on nuclear cardiology in the Czech Republic are not available as yet, as it is impossible to obtain comprehensive data from official registers owing to different methods of reporting and data evaluation. A questionnaire concerning nuclear cardiology activity and practice in 2001 was sent to all nuclear medicine departments in the Czech Republic. All 48 departments completed the questionnaire. In 2001, 50 planar and 54 tomographic (SPET) scintillation cameras were used. The average age of the SPET cameras was 5 years (13% of SPET cameras were >8 years old). Out of the 48 centres, 39 (81%) provided a nuclear cardiology service; the total number of cardiological studies was 15,740 in 2001 (1.5 studies/1,000 population/year). The most frequently employed method was MPI (81.7%), the frequency of which had increased by 10% compared with 2000; 26 of the 39 (67%) departments reported that MPI activity was increasing. Nevertheless, the Czech Republic nuclear cardiology activity remained below the European average (2.2/1,000 population in 1994) and, particularly, below activity in the USA (15/1,000 in 1997). The activity was rather unevenly spread. Whereas two centres with >1,000 studies/year accounted for 20% of the total MPI studies, 16 of 39 (41%) departments exhibited low activity (<200 studies/year) and accounted for only 15% of the total MPI studies. The use of SPET increased from 91% in 2000 to 94% in 2001 (only three institutes performed planar examinations). The most widely used tracer was (99m)Tc-MIBI (60% of total MPI), followed by (201)Tl (21%) and (99m)Tc-tetrofosmin (19%). ECG-gated SPET was employed by 20/39 (51%) centres, of which 11 (28%) performed it as a standard examination; 39% of the total MPI studies included this technique. Thirteen percent (5/39) of the departments used attenuation correction, and 69% (27/39) of the departments used a prone projection. Equilibrium radionuclide ventriculography, with 2,317 examinations (14.7%), ranked second among all nuclear cardiology methods, followed by first-pass angiocardiography (406 studies, 2.6%) and (18)F-FDG (163 studies, 1%).

Cardiology Service, Hospital↗

Comparison of 7 English-language cardiology journals for 1983.

This article analyzes and compares 7 English-language cardiology journals for the year 1983 in terms of numbers of pages, articles, types of articles, figures and tables published and numbers of authors per article. The 7 journals included the 4 major USA cardiology journals--The American Journal of Cardiology (AJC), Circulation, Journal of the American College of Cardiology (JACC) and American Heart Journal (AHJ)--and 3 non-USA English-language cardiology journals: British Heart Journal (BHJ), European Heart Journal (EHJ) and the International Journal of Cardiology (IJC). Although Circulation published the most total pages (because of its huge abstract issue), the AJC published more total pages for articles, the most articles (in its regular issues, 44% more than Circulation, 48% more than the JACC and 39% more than the AHJ) and the AJC provided the most words per page (its maximal number being 20% higher than the maximal number in Circulation, 16% higher than in the JACC and 26% higher than in the AHJ). Each of the 3 non-USA journals was much smaller in terms of pages and articles published than were any of the 4 USA journals. In types of articles published, several differences among the 7 journals were apparent. Of the articles in Circulation, 24% concerned experimental (nonhuman) studies; this percent was 14 in the JACC, 12 in the AHJ, 8 in the AJC and none or nearly none in the BHJ, EHJ and IJC. Brief reports accounted for 27% of the 392 articles in the AHJ and 13% of the 643 articles in the AJC.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiology↗