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Background: Cardiovascular abnormalities are common in patients with rheumatologic disorders. Tachy-arrhythmias occur more frequently in these patients than the general population; however, the prevalence of bradyarrhythmias in this group is less clear. This investigation aimed to analyze the incidence and predictors of bradyarrhythmias and conduction disturbances, as well as the presence and influence of cardiologist management, in patients with rheumatologic disorders., Methods: We performed a retrospective chart review of 57 consecutive patients with rheumatologic conditions evaluated at a tertiary-care safety-net hospital. Conduction disturbances were defined by any electrocardiogram (ECG) finding indicating: bradycardia, sinoatrial block of any degree, atrioventricular nodal block of any degree, left anterior or posterior fascicular block, non-specific intraventricular conduction delay, complete or incomplete right bundle branch block, left bundle branch block, or paced rhythm. Univariate and multivariate analyses were used to assess the association of relative predictors of conduction disturbance, the primary outcome of this investigation, as well as the secondary outcome of cardiologist involvement in patient care. Statistical significance was defined as P<0.05. Variables found to be statistically significant in a univariate analysis were included in a multivariable logistic regression analysis., Results: The most common rheumatologic condition in our patient population was systemic lupus erythematous (21 patients, 36.8%) followed by gout (15 patients, 26.3%), rheumatoid arthritis (13 patients, 22.8%), sarcoidosis (6 patients, 10.5%), and two patients (3.5%) with other autoimmune diseases. A total of 31.6% of patients in this study were found to have conduction disturbances, higher than the prevalence of conduction disturbances in the general population. Multivariate logistic regression analysis showed significantly increased odds for conduction disturbances with increased age (odds ratio (OR): 1.05, 95% confidence interval (CI): 1.01-1.10, P<0.05). Similar analysis for the involvement of a cardiologist in the care of a patient with a rheumatologic disorder found increased odds for cardiologist involvement with advanced age (OR: 1.05, 95% CI: 1.002-1.09, P<0.05) and cardiovascular disease (OR: 5.0, 95% CI 1.24-21.90, P<0.05)., Conclusion: Prevalence of conduction abnormalities is greater in rheumatologic patients than the general population. Odds for conduction abnormalities increased with age; and the odds of cardiologist involvement increased with age and cardiovascular disease., Competing Interests: None., (AJCD Copyright © 2022.)

Background: Computerized electrocardiogram (EKG) interpretation technology was developed in the mid-20th century, but its use continues to be controversial. This study aims to determine clinical factors which indicate greater odds of clinical significance of an abnormal computerized EKG interpretation., Methods: The inclusion criteria for this retrospective study were patients who underwent outpatient echocardiography for the indication of an abnormal EKG and had an EKG abnormality diagnosed by the computerized EKG system. Qualifying patients had the results of their computerized EKG, echocardiogram, and charted patient characteristics collected. Computerized diagnoses and patient characteristics were assessed to determine if they were associated with increasing or decreasing the odds of an echocardiographic abnormality via logistic regression. Chi-square and t-test analyses were used for categorical and continuous variables, respectively. Odds ratios are presented as odds ratio [95% confidence interval]. A P -value of ≤ 0.05 was considered statistically significant., Results: A total of 515 patients were included in this study. The population was 59% women with an average age of 57 ± 16 years, and a mean BMI of 30.1 ± 7.3 kg/m 2 . Patients with echocardiographic abnormalities tended to have more cardiac risk factors than patients without abnormalities. In our final odds ratio model consisting of both patient characteristics and EKG diagnoses, age, coronary disease (CAD), and diabetes mellitus (DM) increased the odds of an echocardiographic abnormality (1.04 [1.02-1.06], 2.68 [1.41-5.09], and 1.75 [1.01-3.04], respectively). That model noted low QRS voltage decreased the odds of an abnormal echocardiogram (0.31 [0.10-0.91])., Conclusion: Our findings suggest that in patients with an abnormal computerized EKG reading, the specific factors of older age, CAD, and DM are associated with higher odds of abnormalities on follow-up echocardiography. These results, plus practitioner overreading, can be used to determine more appropriate management when faced with an abnormal computerized EKG diagnosis., Competing Interests: None., (AJCD Copyright © 2021.)

Introduction: Patients with chronic kidney disease (CKD) are vulnerable to adverse-drug events from cardiovascular drugs., Aim: To evaluate awareness and knowledge for appropriate dose adjustment of cardiovascular drugs in CKD patients among Internal Medicine house-staff (IMHS)., Methods: Cross-sectional convenience sample survey in Fall 2015 among 341 IMHS from multiple academic institutions in the suburban New York City metropolitan area. Awareness was whether drug dose adjustment was needed. Knowledge was correct GFR level for drug dose adjustment. Multivariate logistic regression was conducted., Results: We found overall high percentages and high odds for all cardiovascular drugs for incorrect awareness and knowledge. Postgraduate year (PGY)-1 had greater odds than PGY-3 for Carvedilol (OR: 5.56, 95% CI: 2.19-14.12, p < 0.001) and Digoxin (OR: 3.87, 95% CI: 1.37-10.95, p < 0.05), and lesser odds than PGY3 for Atenolol (OR: 0.31, 95% CI: 0.10-0.91, p < 0.05). Nephrology exposure during medical school rotation, renal clinic, or family history had lesser odds for Carvedilol (OR: 0.45, 95% CI: 0.21-0.97, p < 0.05), Simvastatin (OR: 0.40, 95% CI: 0.16-0.97, p < 0.05), and Hydralazine (OR: 0.31, 95% CI: 0.12-0.81, p < 0.05). Nephrology exposure during residency (OR: 1.96, 95% CI: 1.10-3.50, p < 0.05) and US osteopathic graduates (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05) each had greater odds for Enalapril (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05). International medical graduates had lesser odds than US graduates for Amlodipine (OR: 0.30, 95% CI: 0.11-0.82, p < 0.05)., Conclusions: IMHS had overall poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with CKD. As the majority of CKD patients are managed by their primary care providers, training programs should ensure that IMHS have adequate education in Nephrology during their residency training.