BACKGROUND:Characterizations of cardiology's professional climate often focus on negative experiences. OBJECTIVES:The study's primary objective was to broadly characterize cardiology climate. METHODS:The American College of Cardiology surveyed 1805 cardiologists online in 2022. Agreement with cardiology 7 workforce statements could be categorized into 4 attitudinal profiles (A-D) in 1513 (84%), using a 2-step cluster analysis maximizing log-likelihood measures of agreement. Multivariable modeling described respondents' alignment with profiles. ORs compared perceptions across profiles. RESULTS:Most respondents were men (n = 1,095, 72%), heterosexual/cisgender (n = 1,380, >90%), and identified as White (n = 800, 53%). Profile A (441, 29%) perceived cardiology's climate as empowering/inclusive/no change needed. Profile D (n = 278; 18%) felt climate was stifling/exclusionary/change needed. Intermediate were B: inclusive/change needed (n = 501; 33%) and C: stifling/uncertain about change (293; 19%). Profile A was independently associated with male sex, White race, late career, and no mistreatment, C-statistic = 0.73 (95% CI: 0.70-0.75). Profile D was associated with female sex, Black, Asian, Hispanic or other race individuals, early/mid-career, and experience of mistreatment, C-statistic = 0.80 (95% CI: 0.77-0.83). Men were respected by most (93%; range across profiles 90%-96%) with less agreement about people identifying as Black, Asian, Hispanic, or other (68%; 27%-90%); women (68%; 25%-95%); people with a disability (54%; 22%-77%); and nonheterosexual (48%; 19%-69%) or transgender/sex nonconforming people (23%; 5%-36%). Primary workplace culture was perceived more positively, while organizations were seen as ineffective in improving climate. CONCLUSIONS:Cardiologists' perceptions of professional climate differ widely with 37% viewing it as stifling/exclusionary and 51% desiring change. These findings, plus perceived organizational ineffectiveness, support efforts to improve the cardiology workplace climate.

BACKGROUND Discrimination and harassment are common in cardiology but data on its impact are limited. OBJECTIVES This study sought to identify the prevalence and impact of workplace mistreatment among U.S. cardiologists overall and when engaged in clinical and academic work. METHODS The American College of Cardiology conducted an online survey of 1,583 U.S. cardiologists in 2022. Demographics, types of mistreatment, professional experiences, and impact were self-reported. Multivariable logistic regression analyses were used to determine the predictors of "negative professional impact" defined as a composite of any of the following outcomes: being less productive, taking sick time, leaving a position, leaving cardiology, or leaving medicine. RESULTS Three-quarters of cardiologists experienced workplace mistreatment, including incivility (34%), discrimination (62%), emotional or physical harassment (32%), and sexual harassment (13%). Unfair treatment was reported by 54% working in any clinical setting, including issues related to professional advancement (31%), clinical work expectations (27%), and compensation (23%). Unfair treatment was reported by 58% during academic work. Consequently, 20% avoided training, employment, or promotion opportunities, 20% felt silenced, and 16% reported social avoidance; 11% considered leaving medicine. Predictors of negative professional impact included type of mistreatment (harassment [OR: 10.01; 95% CI: 5.25-19.10], discrimination [OR: 3.03; 95% CI: 1.56-5.80]), identification as homosexual (OR: 5.60; 95% CI: 1.87-16.78), and woman gender (OR: 1.57; 95% CI: 1.19-2.07). CONCLUSIONS Three of 4 U.S. cardiologists report workplace mistreatment, including two-thirds reporting discrimination and/or harassment. Mistreatment negatively impacts professional lives, career trajectory, well-being, productivity, workforce retention, and ultimately impacts the delivery of patient care. These data highlight the need to improve the climate within cardiology. (JACC Adv. 2025;4:101666) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND Mental illness among physicians is an increasingly recognized concern. Global data on mental health conditions (MHCs) among cardiologists are limited. OBJECTIVES The purpose of this study was to investigate the global prevalence of MHCs among cardiologists and its relationships to professional life. METHODS The American College of Cardiology conducted an online survey with 5,931 cardiologists globally in 2019. Data on demographics, practice, MHC, and association with professional activities were analyzed. The P values were calculated using the chi-square, Fischer exact, and Mann-Whitney Utests. Univariate and multivariate logistic regression analysis determined the association of characteristics with MHC. RESULTS Globally, 1 in 4 cardiologists experience any self-reported MHC, including psychological distress, or major or other psychiatric disorder. There is significant geographic variation in MHCs, with highest and lowest prevalences in South America (39.3%) and Asia (20.1%) (P < 0.001). Predictors of MHCs included experiencing emotional harassment (OR: 2.81; 95% CI: 2.46-3.20), discrimination (OR: 1.85; 95% CI: 1.61-2.12), being divorced (OR: 1.85; 95% CI: 1.27-2.36), and age <55 years (OR: 1.43; 95% CI: 1.24-1.66). Women were more likely to consider suicide within the past 12 months (3.8% vs 2.3%), but were also more likely to seek help (42.3% vs 31.1%) as compared with men (all P < 0.001). Nearly one-half of cardiologists reporting MHCs (44%) felt dissatisfied on at least one professional metric including feeling valued, treated fairly, and adequate compensation. CONCLUSIONS More than 1 in 4 cardiologists experience self-reported MHCs globally, and the association with adverse experiences in professional life is substantial. Dedicated efforts toward prevention and treatment are needed to maximize the contributions of affected cardiologists. (J Am Coll Cardiol 2023;81:574-586) (c) 2023 by the American College of Cardiology Foundation.

Abstract Aims Length of hospital stay for colorectal patients can be prolonged by stoma training. This study explores the impact of 2 variables on time to stoma competency; day of the week that surgery is performed and whether stoma education was available at the weekends. Methods Retrospective review of a prospectively maintained stoma database identified all patients who had a GI tract stoma formed between 1st January and 31st December 2020. Demographics, operative details and time to stoma competence data was collated. Results 158 patients had a stoma formed. Mean age was 59 years (range 13 – 94). Conclusions Time to stoma competence was shorter when stoma education was available at the weekends, despite similar numbers of reviews being provided. This suggests that length of hospital stay could be reduced for this cohort by providing stoma education 7 days a week. The day that surgery was performed did not have a clear impact on time to stoma competence.

Abstract Aims Abdominal VAC dressings are part of the surgical armamentarium in the management of the open abdomen. This study examined the number, indication and outcomes of patients with VAC dressings in a tertiary surgical unit. Methods Retrospective review of the operating theatre database identified all patients with abdominal VAC dressing between February 2016 and July 2021. Medical records were reviewed for demographics, operative, outcome and discharge data. Results 76 patients had abdominal VAC dressings. 40 (53%) were female and 57 (75%) were aged >50 years. For 54 (72%) the primary surgery was an emergency. Major indications for VAC included intra-abdominal sepsis 41 (53.9%) and wound dehiscence 16 (21.1%). Mean VAC changes under GA 2.07 (range 0–10). Mean VAC changes on the ward 2.1 (range 0–11). Mean length of hospital stay 48.6 days (range 4–258). 49 (70%) had the VAC removed in hospital, in this cohort mean duration of VAC therapy was 22 days. 11 (15%) were discharged to community hospitals and 56 (77%) directly home. 4 (5.3%) patients developed entero-atmospheric fistulae, 1 (1.3%) bleeding and 1 (1.3%) wound infection. Conclusions Abdominal VAC therapy is safe. However, it comes with significant immediate and medium-term burdens, in terms of hospital bed days, theatre time and specialist staff input, all of which are costly. Longer term, incisional hernias are associated with morbidity for patients and a financial cost for the Trust. The authors therefore advocate an attempt at early fascial closure where possible, through techniques such as mesh mediated fascial closure.

Abstract Introduction: Cardiovascular disease is the leading cause of death, in Uruguay it corresponds to 30%. To the known risk factors, the use of QT and RT are added. The improvement in response and overall survival of hematologic patients allow a longer time to develop cardiovascular complications. Cardiotoxicity has been extensively studied in the context of breast cancer and the use of anthracyclines; however, there are very few data on hematopoietic stem cell transplantation (HSCT). Objective: Assess subclinical myocardial damage by measuring biomarkers and echocardiography and identify patients at high risk of developing cardiotoxicity after HSCT. Methods: This is a prospective, single-center study between April 2017 and November 2020. Population: adult patients admitted in the British Hospital Transplant Unit, Montevideo Uruguay to receive either an autologous or allogeneic HSCT. Measurement: cardiac biomarkers (pro-BNP, Troponin T, Troponin I and CPK) at admission, D1, D14 and D30. Echocardiograms were performed on admission and at D30 by the same team of 3 echocardiographers with the same machine. It was repeated at D100 if some alteration was seen. Results: We included 158 transplants: 148 autologous and 10 allogeneic. The characteristics of the population and results are shown in Table 1. 126 raised some biomarker during the first 100 days (79.7%). Pro-BNP is the biomarker that most frequently rises after admission until day 100: 125/158 (79.1%). The kinetics of the biomarkers are shown in Figure 1. Regarding echocardiograms, there were no patients with a cardiotoxicity criterion defined by: a decrease in LVEF of more than 10% to a value less than 53%. Regarding myocardial deformability, there was a reduction in strain between the initial echocardiogram and D30 in 76 patients of 116 patients with both determinations (65.5%). A reduction of 15% or more was evidenced in 18 (11.3%). Of them, 13 (72.2%) had elevated biomarkers in the first 100 days. Of the patients who did not have strain changes, 78.6% had elevated biomarkers. No statistically significant relationship was found between strain reduction and the presence or absence of elevated biomarkers in the first 100 days. With a median follow-up of 23.3 months (0.89-48.62), 11 (7%) developed clinical cardiotoxicity: hypertension 6, arrhythmia 4, pulmonary embolism 1, sudden death 1. We have strain data of 6/11 patients, and there was no reduction of 15%. Of the 11, 90.9% raised some biomarker during the 100 days. Median development time of cardiotoxicity: 10.3 months (0.03-36.6). 133 had one year follow up so, the incidence of clinical cardiotoxicity at 1 year is 4.5%. There were no differences in elevated biomarkers in the first 100 days and use of Melphalan (p = 0.096) however, there was a difference with BEAM versus other plans, p = 0.035. The reduction in strain at day 30 was not influenced by Melphalan or BEAM. Patients with subclinical myocardial damage were older than those without it: mean age: 56.7 +/- 11.2 versus 44.1 +/- 13.1, p = 0.0001. There was no statistically significant difference between patients who had elevated biomarkers in the first 100 days versus those who did not in relation to a history of diabetes, hypertension, dyslipidemia, heart disease or previous use of anthracyclines. Either in patients with a 15% reduction in strain versus those without. This is one of the first studies worldwide that comprehensively evaluates cardiovascular function during HSCT. Given the small number of observed cardiac complications, greater follow-up of this subpopulation with elements of subclinical cardiotoxicity is required to determine if they are indeed predictive parameters of cardiovascular complications in the future in the transplant setting. Conclusions: Subclinical cardiotoxicity is common in transplantation: Pro-BNP is the biomarker that most frequently rises after admission until day 100: 79.1%. Strain reduction of 15% or more occurs in 11,3%. Subclinical myocardial damage parameters were not associated with type of conditioning, previous use of anthracyclines, comorbidities and clinical cardiotoxicity at 1 year. Clinical cardiotoxicity post HSCT is low, 4,5% at 1 year. We must do a longer-term follow-up in order to evaluate whether the combination of pro-BNP associated with strain reduction can be predictive factors of clinical cardiotoxicity. Figure 1 Figure 1. Disclosures Oliver: Roche: Other: conference support and fees ; Abbvie: Other: conference support and fees .

OBJECTIVES:This report aimed to determine whether transitional care management (TCM) services, provided by Inspira Care Connect, LLC (ICC), a Track 1 Medicare Shared Savings Program accountable care organization, were effective in reducing 30-day readmission rates, observation stay days, and emergency department visits, along with mortality rates, total costs, and frequency of primary care physician (PCP) visits among Medicare beneficiaries served by ICC.STUDY DESIGN:In accordance with TCM programming, ICC contacted the majority of patients telephonically within 48 business hours after discharge from an inpatient setting and scheduled a face-to-face visit with the patient's PCP within 1 to 14 days after discharge from an inpatient setting. The patients were provided with non-face-to-face services as needed throughout the 30-day period.METHODS:The effectiveness of the TCM model was measured using a retrospective propensity score matching design, which allowed for an accurate comparison between those who received TCM and similar ICC Medicare beneficiaries who did not. The analysis utilized Medicare parts A and B claims from January 1, 2016, to December 31, 2017.RESULTS:Patients who received TCM had lower 30-day readmission rates than those who did not (P < .05).CONCLUSIONS:The services provided to ICC Medicare patients through the TCM model may have enhanced the ability to identify problems at an earlier stage, resulting in the prevention of complications and unnecessary utilization of costly health care services.

Introduction: Cardiovascular disease is the first cause of death worldwide; in Uruguay it corresponds to 30%. Classical risk factors are: age, smoking, male gender, diabetes, hypertension, hyperuricemia and dyslipidemia. In the last decades, the increasing use of chemotherapy and radiotherapy in oncology have augmented cardiovascular side effects. The improvement in response and overall survival of hematologic patients allow a longer time to develop cardiovascular complications. Cardiotoxicity has been studied extensively in the setting of breast cancer and anthracyclines use.However, within Hematopoietic Stem Cell Transplantation (HSCT) this is still being in research. The estimated incidence is 5-10 % but the data is little and unsystematic. The primary objective of this trial is to assess subclinical myocardial damage using biomarkers and echocardiography and identify patients at high risk of developing cardiotoxicity after HSCT. Methods: This is a prospective, single center trial that started on April 2017. Population: adult patients admitted in the British Hospital Transplant Unit, Montevideo Uruguay to receive either an autologous or allogeneic HSCT. Inclusion criteria: 18 years old or older, Eastern Cooperative Oncology Group performance status 0-1. Patients who signed informed consent. Exclusion criteria: baseline left ventricular ejection fraction (LVEF) <50%, systemic amyloidosis. We have performed serial measurements of cardiac biomarkers (pro-BNP, Troponin T, Troponin I and CPK) at the admission, day 1, day 14 and day 30 after HSCT. Echocardiograms at admission and at day 30 were performed by the same physicians. Biomarkers and echocardiogram were repeated at day 100 if there were alterations in normal values of biomarkers or myocardial dysfunction measured by the echocardiography in day 30. Results: Between May 2017 and April 2019 we have perform 96 HSCT, of those, all 96 consented to enter into the study. Male gender 57 (60%). Median age 56 years old (18-74). Diseases: Multiple myeloma: 42, Non Hodgkin Lymphoma 27, Hodgkin Lymphoma 12, Acute Myeloid Leukemia 11, Solid tumors 2, Aplasia 1, Renal Amyloidosis 1. Type of transplant: Autologous were 85 and Related Allogenic 11 patients. 82 patients (85,5%) have been studied with the 4 biomarkers determinations and the 2 echocardiograms proposed by the study. Causes for which patients were not studied: 3 because they died before the time points, and 11 because violation of protocol. Forty nine (51%) patients had one biomarker elevated at Day 30, so they would have to be studied at Day 100. Of them 49% performed the echocardiogram studies at D100 and 45% the biomarkers. Biomarkers: The evolution of the biomarkers during transplant is shown in figure 1. Pro-BNP is the biomarker that has more significant changes: 71% of transplanted patients has pro-BNP elevated at day 14; at day 30 53% persists with this biomarker elevated. At day 100, Troponin T and I 0% elevated, CPK 4% and pro-BNP 75% elevated. Echocardiogram: no one patient reached the definition of cardiotoxicity in terms of a decrease in LVEF of more than 10% to a value of less than 53%. However, 12 patients (12,5%) had a reduction of the Global Longitudinal Strain (GLS) of more than 15%. Currently, the deformation index strain is an echocardiographic way to detect early cardiac involvement. The decline in rates of deformation precedes the decline in LVEF and persists during subsequent cancer treatment. A relative reduction of 15% or more of GLS has the greatest specificity in predicting subclinical left ventricular dysfunction. In 74 patients we were able to measure the strain at the admission and 81 at day 30. At day 100 there were no significant reduction of LVEF and 3 patients had a relative reduction of GLS more than 15%. Conclusions: This is a prospective and systematic analysis of biomarker and echocardiographic changes during HSCT. We found changes in biomarkers and echocardiographic measures during HSCT: pro-BNP is the biomarker that raises during transplant, and it is persistently elevated at day 30 in 53%. GLS has a significant reduction in 12,5% of patients. We hypothesized that this changes can be predictive of clinical cardiotoxicity in the future, therefore, we are planning to enroll 100 more patients to confirm this results and after that, correlate this changes with comorbidities, conditioning regimens and study the development of clinical cardiotoxicity after 1-year post HSCT. Disclosures Galeano: Szabo SA: Other: (Equity interest).

![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] Each year, the American College of Cardiology’s (ACC’s) State of the States report summarizes the many accomplishments of the College’s state chapters, while also addressing the challenges and opportunities

![Figure][1] ![Figure][1] ![Figure][1] As cardiovascular care continues to undergo dramatic change, the American College of Cardiology (ACC) is acutely aware of the myriad challenges and opportunities facing its members, both now and in the years to come. Given this, 1 of the

ISS Fro pa no Th ins vis Ma The detection of spontaneous coronary artery dissection (SCAD) causing myocardial infarction is integral in pursuing the appropriate management. Our case posed a diagnostic challenge, with Takotsubo cardiomyopathy and coronary embolism among the potential differential diagnoses upon the initial presentation. Extensive propagation of spontaneous coronary artery dissection subsequently resulted in a significant challenge to management requiring surgical revascularization. (Level of Difficulty: Intermediate.) (J Am Coll Cardiol Case Rep 2020;2:1437–42) © 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] Being patient-centered is a core value of the American College of Cardiology (ACC)—the safety and needs of cardiovascular patients are central to everything we do. When policies and procedures hinder the ability of

Equine grass sickness (EGS) is a frequently fatal disease of horses, responsible for the death of 1 to 2% of the U.K. horse population annually. The etiology of this disease is currently uncharacterized, although there is evidence it is associated with Clostridium botulinum neurotoxin in the gut. Prevention is currently not possible, and ileal biopsy diagnosis is invasive. The aim of this study was to characterize the fecal microbiota and biofluid metabolic profiles of EGS horses, to further understand the mechanisms underlying this disease, and to identify metabolic biomarkers to aid in diagnosis. Urine, plasma, and feces were collected from horses with EGS, matched controls, and hospital controls. Sequencing the16S rRNA gene of the fecal bacterial population of the study horses found a severe dysbiosis in EGS horses, with an increase in Bacteroidetes and a decrease in Firmicutes bacteria. Metabolic profiling by 1H nuclear magnetic resonance spectroscopy found EGS to be associated with the lower urinary excretion of hippurate and 4-cresyl sulfate and higher excretion of O-acetyl carnitine and trimethylamine-N-oxide. The predictive ability of the complete urinary metabolic signature and using the four discriminatory urinary metabolites to classify horses by disease status was assessed using a second (test) set of horses. The urinary metabolome and a combination of the four candidate biomarkers showed promise in aiding the identification of horses with EGS. Characterization of the metabolic shifts associated with EGS offers the potential of a noninvasive test to aid premortem diagnosis.

![Figure][1] As we are challenged to meet a growing demand for cardiovascular (CV) services and to provide the right care at the right time in the right place in value-based CV enterprises, defining optimal team-based care is a professional

Introduction: Autologous stem cell transplant (ASCT) plays a central role in the treatment of diverse diseases. Infection is one of the major causes of morbidity and costs of the procedure, representing the 2ndcause of death (24%) after primary disease (69%). Thus, preventing infections is a major goal.1There are no publications concerning infections in ASCT in our country.

![Figure][1] ![Figure][1] ![Figure][1] As we are challenged to meet a growing demand for cardiovascular (CV) services and to provide the right care at the right time in the right place in value-based CV enterprises, defining optimal team-based care is a professional

SummaryA 10‐year‐old Thoroughbred mare was referred to Tennessee Equine Hospital for evaluation and treatment of a subepiglottic mass. Physical and laboratory examinations revealed no other abnormalities. The tumour was excised through a laryngotomy site using transendoscopic laser and sharp excision. Histological evaluation revealed a poorly differentiated sarcoma with features of a leiomyosarcoma, a rarely identified neoplasm in the oropharynx of the horse. The mare developed intermittent dorsal displacement of the soft palate (iDDSP) after surgery but was able to resume full training. There was no evidence of regrowth 8 months post‐operatively.