AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2641-0419/070
*Corresponding Author: Martin Mumuni Danaah Malick, Tamale Teaching Hospital, Department of Pharmacy,
Citation: Danaah Malick MM., Adjei S., (2020) Statin therapy Prescribing patterns for primary prevention of Cardiovascular disease in patients with type 2 Diabetes Mellitus receiving primary care at the Tamale Teaching Hospital (TTH) in Northern Ghana. J. Clinical Cardiology and Cardiovascular Interventions, 3(7);Doi:10.31579/2641-0419/070
Copyright: © 2020 Martin Mumuni Danaah Malick, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 10 June 2020 | Accepted: 03 July 2020 | Published: 10 July 2020
Keywords: Pleiotropic properties; Statin therapy; Primary prevention; CVD; T2DM
Background: One of the leading causes of morbidity and mortality amongst type 2 diabetic (T2DM) patients is Cardiovascular disease (CVD). Patients with T2DM are at a higher risk of developing CVD than non-diabetic patients. Statin therapy has been proven to be effective for the primary prevention of CVD amongst T2DM patients. The objective of this study was to determine the extent of statin therapy use for primary prevention of CVD in T2DM patients at TTH.
Methods: A retrospective review of prescription records of T2DM patients who attended the Diabetes Clinic between January 1 2019 to March 31 2019 was conducted. Patient-specific data, evidence of T2DM Diagnosis and prescribed statin therapy were retrieved. Data was collected using a pre-structured tool and analyzed with STATA 15.0.
Results: A total of 171 patients were included in this study. Of these, only 49% (84) patients received a statin. Atorvastatin 20mg was prescribed for 76% (64) patients, followed by atorvastatin 10mg for 22% (19) patients. Atorvastatin 40mg and simvastatin 20mg was the least prescribed at 1% (1) patient each. A total of 76% of statin therapies were of moderate-intensity dose, 23% were of low-intensity dose and only 1% was of high-intensity dose.
Conclusion: Despite the overwhelming evidence supporting the cardiovascular benefits of statins in T2DM patients, these therapeutic agents are under-prescribed for T2DM patients at TTH with atorvastatin being the most frequently prescribed statin therapy
Diabetes is a chronic condition caused by a total lack of insulin or decreased insulin because of impaired insulin secretion and action. It is characterized by symptomatic glucose intolerance resulting in hyperglycemia and alterations in lipid and protein metabolism [1]. Diabetes is a global public health concern as it has been recognized as an important cause of premature death and disability with more than 400 million people living with the disease [2]. Long term complications that may arise from diabetes mellitus include cardiovascular disease (CVD), retinopathy, nephropathy, and neuropathy, and a higher risk of cancer [3]. Type 2 diabetes predisposes patients to an increased prevalence of lipid abnormalities which contributes to their high risk of developing ASCVD [4]. Studies indicate that in T2DM, there is a three-to-fourfold elevated risk for myocardial infarction (MI) and cardiovascular death compared to non-diabetic people [5]. Diabetic dyslipidemia is characterized by hypertriglyceridemia, low high-density lipoprotein (HDL) and LDL that is minimally elevated. Patients with type 2 diabetes are at risk of increased cardiovascular morbidity and mortality. This arises from the high prevalence of cardiovascular risk factors such as hypertension, dyslipidemia, obesity, poor glycemic control and albuminuria than non-diabetic patients [6]. Adequate control of these modifiable risk factors helps to reduce the frequency and outcomes of such cardiovascular events in patients.
Studies have shown that controlling these cardiovascular risk factors helps in preventing and slowing cardiovascular events in diabetes [7]. Management of cardiovascular risks in type 2 diabetics is usually grouped into two categories: primary prevention and secondary prevention. Primary prevention refers to those patients without documented atherosclerotic cardiovascular disease (ASCVD) whilst secondary prevention refers to those with documented ASCVD [8]. Statins inhibit the enzyme 3-hydroxy-3-methyl-glutaryl coenzyme A reductase, which is the rate-limiting step in cholesterol synthesis in the body. Statins reduce levels of both total cholesterol and low-density cholesterol and to an appreciable extent, the triglycerides [9]. The beneficial cardiovascular effects of statins are associated with their pleiotropic properties [10]. These pleiotropic properties include: improvement of endothelial dysfunction, increased nitric oxide availability, antioxidant properties, inhibition of inflammatory responses, stabilization of plaques, reduction of vascular cell adhesion molecules, stimulation of endothelial progenitor cell recruitment and immunomodulation [11].
Pleiotropic effects of a drug are described as those effects that are completely different from those for which the drug was specifically designed. These unique properties may be related or unrelated to the mode of action of the drug and are usually not readily predictable [12]. These effects act in concert with LDL-cholesterol reduction to provide the overall cardioprotective effects of statin. A thorough understanding of the pleiotropic effects of statins will greatly help practicing clinicians to optimize their use in the treatment and prevention of cardiovascular disease, especially those with concomitant diabetes mellitus [13].T2DM patients also have elevated CVD risks prompting the need for primary prevention in such patients [14].
The focus of primary prevention is aimed at reducing or delaying the onset of cardiovascular events and improve quality of life. The incidence of CVD related deaths is on the increase in many developed countries and it is currently the leading cause of death globally [15]. Blacks (including Ghanaians) are at higher risk of developing coronary heart diseases (CHD) than other ethnic groups [16].
There are two main statin dosing intensities that are recommended in clinical practice [17]. These are the high-intensity statin therapy and moderate-intensity statin therapy. A low – intensity statin therapy is generally not recommended in patients with T2DM but in some cases, it may be the only dose the patient can tolerate. The high-intensity statin therapy achieves about 50% reduction in LDL cholesterol while the moderate-intensity therapy achieves between 30 – 50% reductions in LDL cholesterol [18].
Recommendations for use of statins in patients with diabetes with atherosclerosis regardless of their age are high-intensity statin therapy complemented with lifestyle modifications. For patients less than 40 years with additional ASCVD factors, moderate-intensity therapy is considered whilst lifestyle modifications are recommended for those who do not have ASCVD factors (19).However, for the primary prevention of cardiovascular events in Type 2 diabetes patients, moderate-intensity statin therapy is initiated in patients between the ages of 40 to 75 years and above 75 years without additional cardiovascular disease risk factors [20].
Underutilization of statins in patients who are at risk for CVDs such as type 2 diabetic patients aged over 40 years has been reported in many forms such as inappropriate dosing, issues with adherence, and discontinuation of medication therapy [21]. It is really difficult to apply entirely the recommendation of clinical Practice guidelines on statins in diabetes in real-world practice [22]. The main objective of this study is to determine the extent of statins used for primary prevention of cardiovascular diseases in Type 2 Diabetes at Tamale Teaching Hospital.
Materials and Methods
This was a retrospective study conducted at the outpatient diabetic clinic of the TTH between January 1st, 2019 to March 31st, 2019. The Tamale Teaching Hospital is an 800-bed capacity teaching hospital located in the Northern Region of Ghana. It has over 1000 registered diabetic patients who attend the clinic on a biweekly basis and attends to an average of 300 diabetic patients in a month with the majority of them been sponsored by the National Health Insurance Scheme. A purposive sampling technique was used in this study. A data collection tool was structured to enable all relevant data to be obtained from the needed patient records. Data was recorded for one visit during the data collection period. Any follow up visit was not recorded as additional data. Secondary data were obtained from patient records at the Out-Patient Department of TTH. Quantitative data derived from the review of the patients’ records were entered into excel and exported to STATA version 15 for statistical analysis. Descriptive analysis (pie charts, frequency tables etc.) was used to summarize and present data on socio-demographic findings of participants. The analysis consisted of the use of the chi-square test to determine the association between the dependent and independent variables and the strength of associations will be affirmed using logistic regression analysis. The level of significance for the chi-square test was accepted where the p-value was p<0.05 at 95% confidence level. Permission was obtained from the management of the Tamale Teaching Hospital to allow the principal researcher to collect secondary data.
Exclusion and Inclusion criteria
All T2DM patients between 40 to 75 years, with no documented diagnosis of cardiovascular diseases, were included in the study. All T2DM patients below the age of 40 years and or with a documented diagnosis of cardiovascular diseases were all excluded from this study.
Several factors have been ascribed to affect adherence to prescription and use of statins as recommended by guidelines. These include the knowledge of base of the clinicians and familiarity of the newer clinical practice guidelines on statins use primary prevention, a specialty of the prescriber, underestimation of patient’s risk by physicians, presence of guidelines disagreement, practice setting limit (Figure. 1) [23].
From the results depicted in Table 2, we can ascertain that about 122(71.35%) were females while 49(28.65%) were males. Most of the patients above 60 years 78(45.61%). The majority of the patients have had the condition for less than or 5 years 88(51.46%) while those who have had the condition for more than 5 years were 83(48.54%). Only 66(38.60%) have had their lipids being tested. However, 105(61.40%) have not had their lipid tested. Lastly, more of the patients 87(50.88%) do not use statin while 84(49.12%) use a statin. while those who have had the condition for more than 5 years were 83(48.54%). Only 66(38.60%) have had their lipids being tested. However, 105(61.40%) have not had their lipid tested. Lastly, more of the patients 87(50.88%) do not use statin while 84(49.12%) use a statin.
From figure 2. The majority of patients (65.45%) were hypertensive. About 15.45% had hypertension with peripheral neuropathy whereas only 14.45 of patients had only neuropathy. Lastly, 4.55 % of the patients had other concomitant diseases
The results from Figure 3 demonstrates that the most commonly prescribed statin for the primary prevention of cardiovascular disease is Atorvastatin 20 mg which falls into the category of moderate-intensity dosing strategy as shown in Table.1; followed by Atorvastatin 10 mg. Atorvastatin 40mg and Simvastatin 20mg were the least prescribed statin for primary prevention of cardiovascular disease.
Data from Table.3 was used to perform a bivariate analysis to test whether there were any possible associations between the socio-demographic factors and statin use. However, none of the socio-demographic variables was associated with statin use since there was none that had a p-value to be less than 0.05.
From table 4, an analysis was done to test the association between the various conditions and statin use. However, there was no association.
n A total of one hundred and seventy-one folders of patients between the ages of 40 to 75 years with T2DM were used in this study with 29% being male and 71% being female (Table 3). About 46% of the study population was above 61 years while 20% were between 40 to 50 years (Table 3). It was observed that 51.46% of patients had been diagnosed with T2DM for more than 5 years while the remaining patients (48.54%) had the condition for less than 5 years (Table 2). Some of these patients had other commodities in addition to T2DM with about 65% having hypertension, 14.5% having neuropathy and 15.5% having both hypertension and neuropathy (Table 2). About 89% of the study population had high recorded glycated hemoglobin (above 7%) while approximately 11% normal recorded glycated hemoglobin (≤7) (Table 4/Figure 2). Approximately 49% of the study population received a statin for primary prevention whilst the other 51% of the study population were not prescribed a statin (Table 2).
According to the results of the study, about 49% of respondents who attended the Tamale Teaching Hospital Diabetes Clinic between January to March 2019 were prescribed a statin. These results were considerably higher than other studies conducted in Germany, the United States of America, Denmark and China which reported the percentage of statin
prescription for primary prevention in T2DM as 33.2%, 40%, 47% and 33.8% respectively [25-28]. In countries such as India, Ethiopia, and Malaysia, the use of statins for primary prevention in T2DM was reported to be 55.2%, 55.7% and 65% respectively [29.30.31], which are moderately higher than the findings from this study. Against the backdrop of the clearly established benefits of statin for primary prevention among the population in this study, the results purport underutilization of statins among the patient’s population who would otherwise benefit from statin use and optimization. The guidelines for medication utilization review in this present study highly recommend statin use among all the participants in this study unless contraindicated [32]. There was no demonstrable or documented contraindication in any of the participants in this study which suggested all the participants should have received a statin.
Among the patients who were prescribed statin therapy, 1% and 76% received high intensity and moderate-intensity statin respectively; which is the recommended statin dose for T2DM patients aged 40 years and above with high risk of cardiovascular events [33]. The reason for the underdosing in the other 23% was not apparently known however, some studies suggest that underutilization of statins for primary prevention in T2DM patients over 40 years may be associated with inappropriate dosing, issues with adherence and discontinuation by patients and argue that some clinicians may decide to go for low dose for safety reasons even when treatment goals are not met [34].. Also, the prescribing of low doses of statins for primary prevention than those recommended by guidelines affect the desired benefits to a patient in the real-world [35]).
Only 39%( 66) patients out of the 171 had their lipid panel performed and quite a significant number of 32% (55) patients had elevated low density (LDL) lipoprotein levels. Furthermore, only 19 participants out of the 55 had ever been prescribed a statin (Table 3). This is far below the recommendation from clinical practice guidelines for the management of dyslipidemia and primary prevention in the population under this study [36].
From the study conducted, the most commonly prescribed statin in TTH between January TO March 2019 was Atorvastatin 20mg (76%), Atorvastatin 10mg (22%), Atorvastatin 40mg (1%) and Simvastatin 20mg (1%) (Figure 2). Generally, Atorvastatin constituted about 99% of all statin therapy prescriptions for primary prevention in T2DM patients who attended the diabetes clinic between January 2019 to March 2019. This is comparable to a study in India where the most commonly prescribed statin for primary prevention in T2DM was Atorvastatin (74.1%) followed by Rosuvastatin (29.2%) [37]. Another study in Ethiopia revealed a contrary pattern of simvastatin being the most commonly prescribed statins (37.2%), followed by Atorvastatin (32.8%) and Rosuvastatin (15.6%) [38].
The greatest limitation of this study is that the design was not good enough to give the researchers the opportunity to determine the impact of Statin therapy underutilization for primary prevention of CVD in T2DM on the overall cardiovascular morbidity and mortality of these patients. Missing information and information bias from stored records due to differences in manual recording and digital recording. The facility employs both digital and manual patient records keeping. During data collection, it was discovered that the paper-based patient medical records contained more detailed more information than the one on the Health Administration Management System (HAMS) which lead to relying solely on the paper-based medical records for patient-specific data extraction. However, it was highly possible that some prescribers might have imputed some vital patient information on the HAMS but not in the paper-based patient medical record and vice versa. The retrospective nature of the study did not afford the investigators with the opportunity to obtain some relevant answers to questions associated with patient-specific information that could have only been answered by the patients whose medical records were selected for this study. More parameters could have been used to ascertain more utilization of statins for primary prevention in totality, however, the allotted time for the research was very limited.
Despite the overwhelming evidence supporting the cardiovascular benefits of statin therapy for primary prevention of CVD in T2DM patients, these therapeutic agents are under-prescribed for T2DM patients at TTH; with atorvastatin being the most frequently prescribed statin therapy. Clinicians caring for T2DM patients at TTH, generally utilize the moderate-intensity Statin therapy as their preferred dosing strategy for primary prevention of CVD.
Declaration of the source of funding for this research
We the researchers do not have any conflict of interest to declare because we have not received any form of financial support from any private or public institutions for the conduct of this research. The activities of this research were conducted using monies from the annual Book and research allowances allocated by the Government of the Republic of Ghana to every researcher within the public research institutions
Declaration of conflicting interests
No
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
