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Akingbade O, Cabrera E, Subashchandran V, Yang R, Shah N, Patel H, Slivnick JA. Sociodemographic Disparities in Obtaining Cardiac MRI: Black, White, and Shades of Gray. Curr Cardiol Rep 2025; 27:62. [PMID: 40014229 DOI: 10.1007/s11886-025-02219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2025] [Indexed: 02/28/2025]
Abstract
PURPOSE OF REVIEW Despite growing recommendations for CMR utilization in heart disease evaluation, access remains limited by geography and socioeconomic status. In this review we discuss the role of CMR in addressing health disparities, review barriers to CMR access, and finally propose solutions to increasing CMR testing globally and in the U.S. RECENT FINDINGS CMR testing is higher prevalence in academic and urban centers in the Northeast and Midwest and remains sparser in Southern and rural areas which face a high burden of cardiovascular mortality. Globally, CMR is also limited in low- and middle-income countries. Barriers to CMR access include bias in physician referrals based on race, patient income, insurance status, language barriers, health literacy, and disparities in the multimodal cardiovascular imaging workforce. A multimodal approach involving policy makers, hospital systems, cardiologists, and health care personnel is essential to improving national and global barriers to accessing CMR.
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Affiliation(s)
- Ololade Akingbade
- University of Chicago Medicine, 5758 S. Maryland Ave M.C. 9067, Chicago, IL, 60637, USA
| | - Elizabeth Cabrera
- University of Chicago Medicine, 5758 S. Maryland Ave M.C. 9067, Chicago, IL, 60637, USA
| | - Varun Subashchandran
- University of Chicago Medicine, 5758 S. Maryland Ave M.C. 9067, Chicago, IL, 60637, USA
| | - Ryan Yang
- University of Chicago Medicine, 5758 S. Maryland Ave M.C. 9067, Chicago, IL, 60637, USA
| | - Neal Shah
- University of Chicago Medicine, 5758 S. Maryland Ave M.C. 9067, Chicago, IL, 60637, USA
| | - Hena Patel
- University of Chicago Medicine, 5758 S. Maryland Ave M.C. 9067, Chicago, IL, 60637, USA
| | - Jeremy A Slivnick
- University of Chicago Medicine, 5758 S. Maryland Ave M.C. 9067, Chicago, IL, 60637, USA.
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Yamano T, Kotani K, Kitano N, Morimoto J, Emori H, Takahata M, Fujita S, Wada T, Ota S, Satogami K, Kashiwagi M, Shiono Y, Kuroi A, Tanimoto T, Tanaka A. Telecardiology in Rural Practice: Global Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074335. [PMID: 35410012 PMCID: PMC8998494 DOI: 10.3390/ijerph19074335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
Abstract
The management of cardiovascular diseases in rural areas is plagued by the limited access of rural residents to medical facilities and specialists. The development of telecardiology using information and communication technology may overcome such limitation. To shed light on the global trend of telecardiology, we summarized the available literature on rural telecardiology. Using PubMed databases, we conducted a literature review of articles published from January 2010 to December 2020. The contents and focus of each paper were then classified. Our search yielded nineteen original papers from various countries: nine in Asia, seven in Europe, two in North America, and one in Africa. The papers were divided into classified fields as follows: seven in tele-consultation, four in the telemedical system, four in the monitoring system, two in prehospital triage, and two in tele-training. Six of the seven tele-consultation papers reported the consultation from rural doctors to urban specialists. More reports of tele-consultations might be a characteristic of telecardiology specific to rural practice. Further work is necessary to clarify the improvement of cardiovascular outcomes for rural residents.
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Affiliation(s)
- Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
- Correspondence:
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan;
| | - Naomi Kitano
- Health Administration Center, Wakayama Medical University, Wakayama 641-0012, Japan;
| | - Junko Morimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Keisuke Satogami
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
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Zhu X, Merchant KAS, Mohr NM, Wittrock AJ, Bell AL, Ward MM. Real-Time Learning Through Telemedicine Enhances Professional Training in Rural Emergency Departments. Telemed J E Health 2020; 27:441-447. [PMID: 32552479 DOI: 10.1089/tmj.2020.0042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The low volume and the intermittent nature of serious emergencies presenting to rural emergency departments (EDs) make it difficult to plan and deliver pertinent professional training. Telemedicine provides multiple avenues for training rural ED clinicians. This study examines how telemedicine contributes to professional training in rural EDs through both structured and unstructured approaches. Methods: This qualitative study examined training experiences in 18 hospitals located in 6 Midwest states in the United States, which participated in a single hub-and-spoke telemedicine network. Twenty-eight interviews were conducted with 7 physicians, 10 advanced practice providers, and 11 nurses. Standard, inductive qualitative analysis was used to identify key themes related to experiences with telemedicine-based training and its impact on rural ED practice. Results: For structured formal training, rural ED clinicians used asynchronous sessions more often than live sessions. It was reported that the formal training program may not have been fully utilized due to time and workload constraints. Rural clinicians strongly valued unstructured real-time training during telemedicine consultations. It was perceived consistently across professional groups that real-time training occurred frequently and its spontaneous nature was beneficial. Hub providers offering suggestions respectfully and explaining the rationale behind recommendations facilitated real-time learning. Rural providers and nurses perceived several effects of real-time training, including keeping rural practice up to date, instilling confidence, and improving performance. Discussion: Our research shows that telemedicine provided rural ED providers and nurses both formal training and real-time training opportunities. Real-time training occurred frequently, complemented formal training, and was perceived to have many advantages.
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Affiliation(s)
- Xi Zhu
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Kimberly A S Merchant
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Nicholas M Mohr
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA.,Department of Emergency Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA.,Division of Critical Care, Department of Anesthesia, College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Marcia M Ward
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
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Muehlberg F, Arnhold K, Fritschi S, Funk S, Prothmann M, Kermer J, Zange L, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy - a prospective clinical cardiovascular magnetic resonance trial. J Cardiovasc Magn Reson 2018; 20:13. [PMID: 29458430 PMCID: PMC5819178 DOI: 10.1186/s12968-018-0434-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/05/2018] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Segmented phase-sensitive inversion recovery (PSIR) cardiovascular magnetic resonance (CMR) sequences are reference standard for non-invasive evaluation of myocardial fibrosis using late gadolinium enhancement (LGE). Several multi-slice LGE sequences have been introduced for faster acquisition in patients with arrhythmia and insufficient breathhold capability. The aim of this study was to assess the accuracy of several multi-slice LGE sequences to detect and quantify myocardial fibrosis in patients with ischemic and non-ischemic myocardial disease. METHODS Patients with known or suspected LGE due to chronic infarction, inflammatory myocardial disease and hypertrophic cardiomyopathy (HCM) were prospectively recruited. LGE images were acquired 10-20 min after administration of 0.2 mmol/kg gadolinium-based contrast agent. Three different LGE sequences were acquired: a segmented, single-slice/single-breath-hold fast low angle shot PSIR sequence (FLASH-PSIR), a multi-slice balanced steady-state free precession inversion recovery sequence (bSSFP-IR) and a multi-slice bSSFP-PSIR sequence during breathhold and free breathing. Image quality was evaluated with a 4-point scoring system. Contrast-to-noise ratios (CNR) and acquisition time were evaluated. LGE was quantitatively assessed using a semi-automated threshold method. Differences in size of fibrosis were analyzed using Bland-Altman analysis. RESULTS Three hundred twelve patients were enrolled (n = 212 chronic infarction, n = 47 inflammatory myocardial disease, n = 53 HCM) Of which 201 patients (67,4%) had detectable LGE (n = 143 with chronic infarction, n = 27 with inflammatory heart disease and n = 31 with HCM). Image quality and CNR were best on multi-slice bSSFP-PSIR. Acquisition times were significantly shorter for all multi-slice sequences (bSSFP-IR: 23.4 ± 7.2 s; bSSFP-PSIR: 21.9 ± 6.4 s) as compared to FLASH-PSIR (361.5 ± 95.33 s). There was no significant difference of mean LGE size for all sequences in all study groups (FLASH-PSIR: 8.96 ± 10.64 g; bSSFP-IR: 8.69 ± 10.75 g; bSSFP-PSIR: 9.05 ± 10.84 g; bSSFP-PSIR free breathing: 8.85 ± 10.71 g, p > 0.05). LGE size was not affected by arrhythmia or absence of breathhold on multi-slice LGE sequences. CONCLUSIONS Fast multi-slice and standard segmented LGE sequences are equivalent techniques for the assessment of myocardial fibrosis, independent of an ischemic or non-ischemic etiology. Even in patients with arrhythmia and insufficient breathhold capability, multi-slice sequences yield excellent image quality at significantly reduced scan time and may be used as standard LGE approach. TRIAL REGISTRATION ISRCTN48802295 (retrospectively registered).
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Affiliation(s)
- Fabian Muehlberg
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Kristin Arnhold
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Simone Fritschi
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Stephanie Funk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Marcel Prothmann
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Josephine Kermer
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Leonora Zange
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | | | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
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Eskandari M, Kramer CM, Hecht HS, Jaber WA, Marwick TH. Evidence Base for Quality Control Activities in Cardiovascular Imaging. JACC Cardiovasc Imaging 2016; 9:294-305. [DOI: 10.1016/j.jcmg.2015.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/06/2015] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
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von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Role of cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology. J Cardiovasc Magn Reson 2016; 18:6. [PMID: 26800662 PMCID: PMC4724113 DOI: 10.1186/s12968-016-0225-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/11/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite common enthusiasm for cardiovascular magnetic resonance (CMR), its application in Europe is quite diverse. Restrictions are attributed to a number of factors, like limited access, deficits in training, and incomplete reimbursement. Aim of this study is to perform a systematic summary of the representation of CMR in the guidelines of the European Society of Cardiology (ESC). METHODS Twenty-nine ESC guidelines were screened for the terms "magnetic", "MRI", "CMR", "MR" and "imaging". As 3 topics were published twice (endocarditis, pulmonary hypertension, NSTEMI), 26 guidelines were finally included. MRI in the context of non-cardiovascular examinations was not recognized. The main CMR-related conclusions and, if available, the level of evidence and the class of recommendation were extracted. RESULTS Fourteen of the 26 guidelines (53.8%) contain specific recommendations regarding the use of CMR. Nine guidelines (34.6%) mention CMR in the text, and 3 (11.5%) do not mention CMR. The 14 guidelines with recommendations regarding the use of CMR contain 39 class-I recommendations, 12 class-IIa recommendations, 10 class-IIb recommendations and 2 class-III recommendations. Most of the recommendations have evidence level C (41/63; 65.1%), followed by level B (16/63; 25.4%) and level A (6/63; 9.5%). The four guidelines, which absolutely contained most recommendations for CMR, were stable coronary artery disease (n = 14), aortic diseases (n = 9), HCM (n = 7) and myocardial revascularization (n = 7). CONCLUSIONS CMR is represented in the majority of the ESC guidelines. They contain many recommendations in favour of the use of CMR in specific scenarios. Issues regarding access, training and reimbursement have to be solved to offer CMR to patients in accordance with the ESC guidelines.
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Affiliation(s)
- Florian von Knobelsdorff-Brenkenhoff
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.
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