Background: Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients. Aims: To compare functional and structural improvement, as well as long-term outcome, between diabetic and non-diabetic HF patients treated with cardiac resynchronization therapy (CRT). Methods: We compared response to CRT in 141 diabetic and 214 non-diabetic consecutive patients. Major events were; death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Frequencies of hospitalisation and defibrillator (CRT-D) discharges were also analyzed. Results: CRT was able to significantly improve functional capacity, ventricular geometry and neurohumoral imbalance in both diabetic and nondiabetic patients over a median follow-up time of 34 months. Overall event-free survival was similar in diabetic and non-diabetic patients (HR 1.23, p = 0.363), as was survival free from CRT-D interventions (HR 1.72; p = 0.115) and hospitalisations (HR 1.12; p = 0.500). On multivariable analysis, NYHA class IV (p = 0.002), low LV ejection fraction (p = 0.002), absence of beta-blocker therapy (p b 0.001), impaired renal function (p = 0.003), presence of an epicardial lead (p = 0.025), but not diabetes (p = 0.821) were associated with a poor outcome after CRT. Conclusions: Diabetic HF patients treated with CRT had a very favourable functional and survival outcome, which was comparable to nondiabetic patients.
Background: The use of technology in the medical field has been rising rapidly and offering, in many cases, an alternative to traditional ways of practicing medicine, especially when remote medical services are required. This background has laid the foundation for telemedicine to play a role in controlling the current coronavirus disease 2019 (COVID-19) pandemic. Telemedicine has the potential to allow the facilitation of providing the necessary medical care to patients without exposing them to contact with other patients or the general population. Objective: The aim of this study was to investigate the utilization of telemedicine by the Lebanese physicians during the COVID-19 pandemic. Methods: This cross-sectional online study was conducted using LimeSurvey Ò through an e-mail-based questionnaire sent to physicians currently enrolled in both Beirut and Tripoli Lebanese Order of Physicians.Results: Four hundred one physicians completed the survey resulting in a response rate of 5.85%. Most of the respondents (N = 401, 75.8%) reported using telemedicine to provide health care services to patients without in-person visits during the pandemic. Among those using telemedicine (N = 304), around 40% reported that they started using it during COVID-19 pandemic. Discussion: Literature states that the average time of an inperson clinic consultation is more than 15 min. This implies that telemedicine can play a role in saving physicians' time; this conclusion is supported by other studies that consider telemedicine a time-saving method of providing health care services. Conclusions: Our study indicated that telemedicine is used by the majority of Lebanese physicians and that this use has been accelerated by the COVID-19 pandemic. Our results showed that telemedicine does have a potential that can allow it to be integrated in the health care system and implemented on a national organized level.
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