Cardiologist honoured for rural service

A/Prof Kevin Alford

NSW cardiologist Associate Professor Kevin Alford has been recognised for his contributions to the specialty over more than four decades at the RACP 2022 congress .

Professor Alford, who has practiced in Port Macquarie on the NSW mid north coast since 1977 was granted the RACP Medal for Clinical Service in Rural and Remote Areas in a ceremony at the congress last week.

“Over that time, he has touched the lives of many patients, staff and students,” the RACP citation said.

“He was the first physician in the Port Macquarie area and has worked to expand the medical services.”

“He instituted rotational terms for interns, residents and physician trainees and has provided strong mentorship.”

A mentor to multiple generations of doctors, he began training the city’s first ever advanced trainee in cardiology training in 1982, the college said.

“Any physician trainee who has trained in Port Macquarie will undoubtedly have a story from working with Kevin.”

“He has pioneered several services for the area.”

Cardiac surgery patients risk DKA with SGLT2i therapy

Vigilance is needed in identifying SGLT2i use in cardiac surgery patients, according to WA clinicians who found that one in seven of their diabetes patients taking the agents experienced perioperative diabetic ketoacidosis (DKA).

A review of outcomes for 685 patients with diabetes who underwent cardiac surgery identified 55 patients as taking a SGLT2i in the perioperative period. Of the 39 patients who were still taking SGLT2is at the time of the operation, 15% developed DKA post-operatively in the ICU, compared to a DKA rate of 0.5% in non-SGLT2i-treated patients.

Reporting their findings in the Internal Medicine Journal, Dr Michael McCann and colleagues noted that intravenous insulin in the first 24 hours after surgery was associated with a significantly lower risk of DKA in SGLT2i patients.

They drew attention to current guidelines which advise that elective cardiac surgery patients should cease SGLT2i medications at least 48 hours before the day of surgery.

“In patients who are critically ill and unable to cease these medications due to urgent surgery, routine prophylactic insulin administration should be considered to reduce the risk of DKA,” they advised.

Cardiovascular acronyms confuse patients

As more patients are accessing their electronic medical records, many fail to comprehend basic abbreviations and acronyms for cardiovascular conditions such as myocardial infraction and heart failure, a study has found.

Comprehension of common abbreviations such as ‘HTN’ (hypertension) and ‘MI’ (myocardial infarction) remained below 40%, much lower than clinicians estimated, a survey conducted at three US hospitals found.

The survey of 60 patients found that most understood terms such as BP (blood pressure) but only two thirds knew what ED meant and only about 20% comprehended terms such as HF (heart failure) and HTN.

Researchers at the Department of Biomedical Informatics, Columbia University, New York, said clinicians should not assume that patients will understand even the most basic medical abbreviations. Automated text programs that convert and spell out acronyms in notes may help overcome misunderstanding of some medical abbreviations, they suggested.

The findings are published in JAMA Network Open.