AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Aurelie Merlo, MD Assistant Professor 3040 Burnett Womack 1 Dental Circle Drive Chapel Hill, NC 27514.
Citation: Panagiotis Tasoudis, William Mostertz, Mirnela Byku, Aurelie Merlo (2024), Substance Use is Associated with Increased Readmissions, but not in-hospital morbidity or long-term survival after left ventricular assist device implantation, J Clinical Cardiology and Cardiovascular Interventions, 7(7); DOI: 10.31579/2641-0419/383
Copyright: © 2024, Aurelie Merlo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 30 May 2024 | Accepted: 17 June 2024 | Published: 25 June 2024
Keywords: LVAD; substance use; transplant
Aim: Patients with active substance use are not eligible for heart transplantation and often undergo left ventricular assist device (LVAD) implantation. We define substance use as use of a substance that precludes transplant such as tobacco products, marijuana, illicit drug use, and excessive alcohol use. The purpose of this study is to describe and compare outcomes in patients with active or recent substance use undergoing LVAD implantation to those who do not use substances.
Materials and Methods: We performed a single-center retrospective cohort study of all patients undergoing HeartMate3 implantation during the period from 2017 to 2023. The patients were divided into those who have a current or recent history of substance use (SUD) and those who do not. The primary outcome was survival. And the secondary outcome measures included in-hospital outcomes and readmission rate. The Kaplan Meier method was used to calculate overall survival. An unadjusted multivariate cox proportion hazards model was used to assess differences in survival. Adjusted Poisson regression models were used to determine differences in readmission rates.
Results: 177 patients were included, with 55 (31%) of patients using substances at the time of implantation (mainly tobacco products and marijuana). Patients using substances were younger (p<0.001) and had a higher body mass index (p=0.012). Survival (HR 1.51, CI (0.84-2.71)) and in-hospital outcomes were not significantly different between groups (stroke, bleeding, renal failure, days in intensive care, length of stay, mortality). When adjusting for age and INTERMACS score, patients with SUD had significantly higher rates of readmissions compared to those without SUD (IRR: 1.23, 95% CI:1.02-1.50, p=0.035).
Conclusions: In conclusion, in a large single-center retrospective cohort study, patients who are using substances at the time of LVAD implantation have the same survival and in-hospital complication rates as patients who are not using substances. When adjusting for age and INTERMACS score, patients who use substances have a higher readmission rate than patients who are not using substances.
Active and recent substance use precludes patients from being listed for heart transplantation. The International Society of Heart and Lung Transplant recommends six months of abstinence from tobacco products and other substances such as marijuana, heroin, heavy alcohol use, and cocaine before being listed [1]. These recommendations are based on data showing that patients who are actively using substances have worse survival after heat transplant [2] and ongoing substance use is associated with non-adherence with medical therapy after transplantation [3]. To maximize survival after transplantation and to promote organ stewardship, transplant centers help patients who use substances demonstrate six months of abstinence prior to being listed, as this duration of pre-transplant abstinence is associated with staying substance free post-transplant [3]. Unfortunately, many patients are too sick to wait six months to demonstrate abstinence and need advanced therapies sooner. These patients often undergo left ventricular assist device (LVAD) implantation.
While, up until recently, survival after LVAD implantation did not compare to that of a heart transplant, more recent data is promising. Five-year survival (survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation for pump exchange) in the MOMENTUM 3 trial was 54% [4]. Five-year survival for heart transplant recipients is approximately 70% [5]. As patients who use substances undergo LVAD implantation live longer with their LVAD, the focus shifts towards improving outcomes other than survival, such as the ability to achieve abstinence, readmissions, the incidence of driveline infections, etc. As we continue to learn what we can achieve in terms of outcomes for all LVAD patients, so too are we learning how sub-groups of patients fare. The purpose of this study is to retrospectively describe and compare outcomes in patients who use substances undergoing LVAD implantation to those undergoing LVAD implantation who do not use substances.
This study is a single-center retrospective cohort study that includes all HeartMate3 implantations at our institution from January 2017 to June 2023. We excluded patients who underwent LVAD implantation and were listed for transplant at the time of implantation (bridge to transplant). The patients were divided into two groups – those with an active or recent history of substance use (SUD group) and those without (no SUD group).
Substance use was defined as the use of a substance precluding listing for transplantation based on our transplant centre listing criteria. This includes tobacco products, marijuana, other illicit drugs, and substantial alcohol use within six months of implantation. The primary outcome measure was overall survival. Secondary outcome measures included implant hospitalization outcomes such as survival at index hospitalization, incidence of bleeding, stroke, renal failure, days spent in the intensive care unit, and length of stay, but also longer-term outcomes such as number of readmissions and ongoing substance use at one year. Readmissions were defined as readmissions at the implanting hospital system. Median follow-up for this study was 616 [IQR 302, 1366] days. This study was conducted following our institution’s IRB (IRB # 20-0642).
Statistical analysis
Patient baseline characteristics and clinical outcomes data are expressed as frequencies with corresponding percentages for categorical variables and as median [first quartile, third quartile] for continuous data. The baseline patient characteristics were compared among the two groups using the χ2 test for categorical and the t-test for continuous variables.
The Kaplan–Meier method calculates and plots the overall survival (OS). An unadjusted multivariate Cox proportional hazards model was utilized to assess if there is any difference in OS between the SUD and no SUD groups. We used adjusted Poisson regression models to determine our readmission and reoperation outcomes. We adjusted our models accounting for the patient’s age and INTERMACS score. We used the incidence rate ratio (IRR) to express the differences in the mean number of outcomes observed in two comparative groups. An IRR >1 means that the SUD group's outcome result is most observed. Data was analysed using STATA IC 17.0 (StataCorp LLC, College Station, Texas).
A total of 199 patients underwent HeartMate3 insertion at our institution, and 177 were not listed for transplant at the time of implantation (implanted as “destination therapy”). Of those patients, 55 (31%) of them were using substances at the time of implantation (SUD group). Of the patients using substances, 33 (60%) of them were unable to be listed for transplantation solely based on substance use. Figure 1 depicts the breakdown of substance type in this study’s cohort. The majority of patients were using tobacco products and marijuana. 19 (35%) patients were using more than one substance and 16 of those patients were using either a tobacco product or marijuana. Baseline characteristics between groups are depicted in Table 1. Patients who were using substances were younger, with a median age of 54 years [45, 60] compared to 63 [56, 62] (p<0 p=0.012). >Table 1. Baseline Demographics All patients No substance use Substance Use N = 177 N= 122 N=55 N or median % or IQR N or median % or IQR N or median % or IQR p-value Age (years) 60 51-68 63 56-62 54 45-60 <0> Female Sex 43 24.3 30 24.6 13 23.6 0.526 Race African American 87 49.2 57 46.7 30 54.6 0.54 White 83 46.9 60 49.2 23 41.8 Other 7 3.9 5 4.1 2 3.6 BMI (kg/m2) 28 24-33 27 22-30 28 25-35 0.012 INTERMACS 1-2 54 31 32 26 22 40 0.262 INTERMACS 3 97 55 72 59 25 46 INTERMACS 4-6 24 14 17 14 7 13 Ischemic CM 73 41 53 43 20 36 0.467 CPB time (min) 70 50-93 70.5 48-97 66 51-90 0.1 Abbreviations. BMI, body mass index; CM, cardiomyopathy; CPB, cardiopulmonary bypass time; IQR, interquartile range; std. dev, standard deviation
Table 1. Baseline Demographics and Clinical Characteristics of 177 Patients Undergoing LVAD Implantation as Destination Therapy Divided by Those Who Use Substances and Those Who Do Not
Figure 1: Pie Chart Illustrating Which Substances Were Being Used in a Cohort of 177 Patients Being Evaluated for LVAD Insertion as Destination Therapy
Figure 2 shows the Kaplan–Meier curves depicting overall survival for both groups. Overall survival was not significantly different between patients who use substances and those who do not (HR 1.51, CI (0.84-2.71). In terms of secondary outcomes, in-hospital mortality did not differ between groups and neither did incidence of in-hospital complications (Table 2).
Figure 2. Overall Survival Curves Using Kaplan Meier Method of Patients who Underwent LVAD Implantation as Destination Therapy By Those Who Use Substances and Those Who Do Not
| Table 2. Postoperative Complications | |||||||
| All patients | No substance use Substance use | p-value | |||||
| N=177 | N=122 | N=55 | |||||
| N or mean | % or IQR | N or mean | % or IQR | N or mean | % or IQR | ||
| Stroke | 4 | 2.26 | 4 | 3.28 | 0 | 0 | 0.312 |
| Bleeding | 15 | 8.47 | 9 | 7.38 | 6 | 10.91 | 0.56 |
| Renal failure | 39 | 22.03 | 32 | 26.23 | 7 | 12.73 | 0.051 |
| Hours in ICU | 281.5 | 191, 413 | 234 | 175, 392 | 287 | 199, 451 | 0.396 |
| Length of Hospital Stay | 30 | 18, 42 | 31 | 17, 45 | 27 | 20, 39 | 0.677 |
| Death during implant hospitalization | 22 | 12.43 | 19 | 15.57 | 3 | 5.45 | 0.083 |
| Abbreviations. ICU, intensive care unit; IQR, interquartile range | |||||||
Table 2. Postoperative Outcomes of 177 Patients Undergoing LVAD Implantation as Destination Therapy Divided by Those Who Use Substances and Those Who Do Not
In our unadjusted model, no differences were noted between SUD and no SUD groups regarding readmissions (IRR: 1.04, 95% CI:0.87-1.26, p=0.648). However, when our model was adjusted for patients’ age and INTERMACS score, patients with SUD were found to have significantly higher rates of readmissions compared to those with no SUD (IRR: 1.23, 95% CI:1.02-1.50, p=0.035). Of note, of the 47 patients in the SUD group who were alive at one year, the majority were continuing to use substances (N = 31, 66%).
In this retrospective single-center cohort study, we show that patients with active or recent use of substances that preclude them from immediate transplant listing at the time of LVAD implantation have similar survival compared to patients who do not. However, we observed a higher hospital readmission rate in this group when adjusted for age and INTERMACS score. This study provides hope for patients who are not able to receive transplant therapy promptly, showing that LVAD implantation is an acceptable, indeed the only, alternative, so long as attention is paid to long-term and programmatic support to help with the increased burden of readmissions. The findings of this study are in keeping with recent data from the Interagency Registry for Mechanically Assisted Circulatory Support [6], which also showed no mortality differences in patients who use illicit drugs or have a history of alcohol abuse. However, that study did show that after adjusting for other covariates, a history of alcohol abuse or illicit drug use was significantly associated with the combined end point of increased device malfunction, device-related infection, or all-cause hospitalization. They also noted that the postoperative quality of life in patients with a history of alcohol abuse or illicit drug use after LVAD implantation was lower than in patients who did not use those substances at 12 and 18 months. Our data has shown no difference in mortality in these patients, but did study a different population as it also included patients using tobacco products. A subgroup analysis may show similar findings to the INTERMACS study. In contrast, our results differ, from similar studies conducted a decade ago that came from case series [7] and for a long time served as the basis for not offering LVAD therapy to these patients. Our study expands upon the more recent results by underlying readmission rates and ongoing substance use rates.
This study does not answer the question of why patients who use substances at the time of implantation are more likely to be readmitted. One hypothesis is that readmissions may be driven by infectious complications such as driveline infections. However, this was not fully captured in our study and will be the source of future research for our group. Additionally, this study does not fully capture social determinants of health and psychosocial risk factors. It is likely not to detect factors that contribute to ongoing substance use, social distress, and readmissions. Race, sex, and specific social determinants of health can influence disparities with completing an advanced therapies evaluation and undergoing LVAD implantation [8], as well as affecting outcomes following surgery [9]. What we can derive from this study is that for a centre to adequately care for these patients in the long term, a solid multidisciplinary care team, including social workers, psychologists, psychiatrists, and LVAD coordinators, is essential for success.
It was disappointing to see the high rate of ongoing substance use at one year (66%), suggesting, even more, can be done with counselling and support for these patients. It is possible that for some patients, six months of substance abstinence before heart transplantation alone is unrealistic or insufficient. That decision likely needs to be individualized for each patient [10]. This study does show that LVAD implantation is an acceptable, indeed the only, alternative for patients who are having difficulty achieving the six-month abstinence period.
While this isn’t the central topic of our study, it is essential to acknowledge the shifting landscape of marijuana use and transplantation. Marijuana is legal in several states now, suggesting its use is more acceptable, similar to alcohol and tobacco, rather than an illegal substance. ISHLT task forces encourage the development of guidelines based on data and not subjective judgement [11]. 2023 Guidelines reference studies showing marijuana is linked to decreased adherence, increased rate of infections, and problems with drug interference, and they currently recommend continuing to use a six-month period of abstinence from cannabis prior to listing for transplantation [11]. With only data from a single center, it was not possible to evaluate differences in outcomes by substance type. Still, it would be interesting to see how outcomes may differ based on substance use, especially with the majority of patients using either tobacco or marijuana. We are currently working on creating a multi-institutional registry to answer this question.
The limitations of this study are those inherent to a single-center retrospective study. The results of this study might not be generalizable to other centers due to specifics inherent to our LVAD patient population. In addition, due to the small sample size, further sub-analysis was not able to be performed, and we cannot say if a particular substance type or substance use with a specific comorbidity was associated with worse outcomes. Finally, the definition of substance use, especially for alcohol use was subjective. However, these patients were evaluated by a multidisciplinary team, including social workers and therapists who were trained in psychosocial risk assessment of patients undergoing evaluation for advanced therapies. Only one patient was excluded from listing for transplantation solely based on the use of alcohol. The remainder of patients had substance use documented by drug screen or nicotine test, in addition to patient interviews with our social work team. This analysis grouped all substances that precluded listing for transplant together. It may be true that demographic and clinical characteristics are different between patients who use illegal substances compared to legal substances such as tobacco. Nonetheless, we grouped these patient populations as we felt it to be helpful to evaluate patients who are excluded from transplant candidacy. Furthermore, subdividing into smaller groups would limit our interpretation of differences observed.
In conclusion, in a large single-center retrospective cohort study, patients using substances at the time of LVAD implantation had the same survival rates but higher hospital readmission rates compared to patients who were not using substances. With the right resources, centers can provide the benefits of LVAD therapy to these patients and expect similar outcomes to patients not using substances.
CI – confidence interval
INTERMACS - The Interagency Registry for Mechanically Assisted Circulatory Support
LVAD – left ventricular assist device
OS – overall survival
SUD – substance use
All authors declare that they have no conflicts of interest regarding the content in this manuscript.
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
