Bergeron, Nicholas

Background Patients with atrial fibrillation (AF) often complain of dyspnea, raising the question that symptoms could be related to unrecognized heart failure (HF) with preserved ejection fraction (HFpEF). Methods We used the HFpEF‐age, body mass index and history of AF algorithm to estimate the probability of undiagnosed HFpEF in CABANA (Catheter Ablation vs. Antiarrhythmic Drug Therapy), and its interaction with catheter ablation on quality of life (QOL). Probable HFpEF was defined as patient‐reported dyspnea with HFpEF‐age, body mass index and history of AF probability≥75%. Absence of dyspnea or HFpEF‐age, body mass index and history of AF probability<75% was considered to reflect patients without HFpEF. The effect of randomization to catheter ablation on QOL (Mayo Atrial Fibrillation‐Specific Symptom Inventory questionnaire and EuroQol‐5 Dimension‐3 Level score) was assessed using mixed models. Results Of participants without known HF, 70% (n=1225) had probable HFpEF and the remaining 30% (n=522) did not. Those with probable HFpEF had worse New York Heart Association class, EuroQol‐5 Dimension‐3 Level score, Mayo Atrial Fibrillation‐Specific Symptom Inventory severity, and Mayo Atrial Fibrillation‐Specific Symptom Inventory frequency scores ( P <0.0001 for all), with higher risk of HF hospitalization (hazard ratio [HR], 2.19 [95% CI, 1.11–4.31], P =0.01). Ablation resulted in greater improvement in EuroQol‐5 Dimension‐3 Level and Mayo Atrial Fibrillation‐Specific Symptom Inventory severity/frequency scores in probable HFpEF (interactions P =0.005, P =0.05, and P =0.04 respectively). In probable HFpEF, catheter ablation was associated with lower risk of cardiovascular hospitalization (HR, 0.78 [95% CI, 0.66–0.92], P =0.003, interaction P =0.03) but not HF hospitalization (HR, 0.94 [95% CI, 0.55–1.64], P =0.84). Conclusions Nearly three quarters of CABANA participants had potentially undiagnosed HFpEF, with worse QOL and risk of HF hospitalization. Catheter ablation in probable HFpEF resulted in greater improvement in QOL, but residual QOL impairment and HF risk remained elevated despite ablation. These data reinforce the importance of diligent consideration of HFpEF among patients with symptomatic AF to ensure optimal use of foundational treatments for HF.

Background: The American opioid use disorder (OUD) and overdose epidemic require physicians and advanced care providers to be prepared to care for patients with this life-threatening condition. Learning to identify, engage, and treat patients with OUD with medications is an essential skill for providers, as is developing requisite confidence and therapeutic attitudes regarding the care of patients with OUD (CP-OUD). To address the need for improved OUD treatment education, our team built and implemented a 12-module asynchronous course entitled, “Care of Patients with Opioid Use Disorder”, in 3 Doctor of Medicine (MD) programs and a Graduate School of Nursing (GSN) program. Methods: Students self-reported their attitudes and confidence regarding the CP-OUD before and after each module. Twelve questions assessed confidence, and 12 questions assessed attitude. Students’ change in confidence and attitudes before and after training was calculated. Results: Responses were collected between January 2021 and November 2024. The number of students completing each module ranged from 552 to 967 MD students and 81 to 149 GSN students. Students reported improved confidence after completing each of the 12 modules (<0.0001). Students reported improved attitudes after completing 10 of the 12 modules (<0.0001). Differences ranging from small to medium size were observed between MD and GSN student’s baseline confidence for 4 modules, and baseline attitudes for 6 modules. Conclusions: Asynchronous learning modules can be effectively implemented in medical and nursing education to improve confidence and attitudes regarding the CP-OUD. The use of asynchronous training modules allows for flexible deployment, as evidenced by their use in 3 MD programs and a GSN program. Future research should investigate whether improved confidence and attitudes during medical and nursing education result in more graduates caring for patients with OUD post-training.