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Aims: The objective of this study was to examine associations between elevated depressive symptoms and increased risk of adverse clinical events patients with heart failure and reduced ejection fraction (HFrEF), as well as the potential contribution of health behaviours., Methods and Results: One hundred forty-two men and women with HFrEF were enrolled through heart failure (HF) clinics and followed over time. At baseline and 6 months, depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II) and HFrEF disease activity by B-type natriuretic peptide (BNP). The Self-Care of Heart Failure Index (SCHFI) was used to assess HF self-care behaviours. Proportional hazards regression models assessed the contribution of depressive symptoms and HFrEF disease biomarkers on death or cardiovascular hospitalization. Over a median follow-up period of 4 years, 42 patients (30%) died, and 84 (60%) had cardiovascular hospitalizations. A 10-point higher baseline BDI-II score was associated with a 35% greater risk of death or cardiovascular hospitalization. Higher baseline BDI-II scores were associated with poorer HF self-care maintenance behaviours (R = -0.30, P < 0.001) and fewer daily steps (R = -0.19, P = 0.04), suggesting that elevated depressive symptoms may diminish important health behaviours. Increases in plasma BNP over 6 months were associated with worse outcomes. Changes in BDI-II and plasma BNP over 6 months were positively related (R = 0.25, P = 0.004)., Conclusions: This study confirms that elevated depressive symptoms are associated with an increased likelihood of adverse clinical outcomes in patients with HFrEF. Poor health behaviours may contribute to the adverse association of elevated depressive symptoms with the increased hazard of adverse clinical outcomes., (© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: The COVID-19 pandemic catalyzed unprecedented changes to medical education, including CV fellowship programs. CV fellowship PDs offer a unique perspective regarding the impact of the pandemic on CV medical education., Objectives: The 4th annual Cardiovascular Diseases (CV) Fellowship Program Directors (PDs) Survey sought to understand the impact of the COVID-19 pandemic on CV fellows and fellowship programs., Methods: The survey contained 31 items examining the clinical, educational, and academic impact of the COVID-19 pandemic on CV fellowship programs., Results: Survey response rate was 54%. Most respondents (58%) represented university-based programs. Most PDs felt that changes to clinical practice during the COVID-19 negatively impacted fellow education in cardiac catheterization (66%), outpatient cardiology (52%), nuclear imaging (51%), and echocardiography (50%). Despite improving attendance, 75% of PDs felt that virtual educational conferences adversely impacted interaction between participants. Only 22% felt they improved fellow education. Most PDs (85%) reported a negative impact of the pandemic on fellow well-being and burnout, and 57% reported a decrease in research productivity among fellows. Even though virtual recruitment allowed programs to interview more competitive candidates, most PDs felt that virtual interviews adversely impacted interactions between their fellows and candidates (71%) and their ability to convey the culture of their program (60%)., Conclusions: Most CV fellowship PDs felt the COVID-19 pandemic brought changes that negatively impacted the clinical training, didactic learning, academic productivity, and well-being among cardiology fellows. The implications of these changes on the competency of cardiologists that trained during the COVID-19 pandemic deserve future study., Competing Interests: Dr Theriot is a paid employee of the American College of Cardiology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Pulmonary arterial hypertension (PAH) is a panvasculopathy that affects the distal pulmonary arteries and leads to restricted blood flow. This increased afterload leads to adaptive mechanisms of the right ventricle, with eventual failure once it can no longer compensate. Pulmonary hypertension from associated conditions, most importantly left heart disease, i.e. heart failure, can also lead to the same sequela. Patients often experience early vague symptoms of dyspnea and exercise intolerance, and thus PH can elude clinicians until right heart failure symptoms predominate. Evidence-based treatment options with pulmonary vasodilators are available for those with PAH and should be employed early. It is essential that patients be accurately categorized by their etiology of PH, as treatment strategies differ, and can potentially be dangerous if employed in the wrong clinical scenario.