Cardiology in 280 characters

European Heart Journal, vol. 43, pp. 1186–1188

Abstract

Communication is truth; communication is happiness. To share is our duty Virginia Woolf—The common reader Once upon a time, there were doctors receiving printed medical journals, fellows searching in libraries for updates or clinical cases related to their field of interest, researchers sending handwriting letters to the authors of the published studies with the purpose of sharing clinical cases, ideas, and maybe starting collaborations. Then, Internet arrived. Little by little, post boxes had less printed medical journals, libraries have been replaced by online databases such as PubMed, GoogleScholar, and WebofScience, and handwritten letters have been substituted by the incredibly faster e-mails facilitating connection and communication as never before (Figure 1). The evolution of communications and Twitter's vocabulary explanation. The evolution of communications and Twitter's vocabulary explanation. This was up to when social media showed up. Although Facebook is the worldwide dominant social media platform, Twitter has become the most attractive platform for doctors. Scientific news is condensed to 280 characters. Senior doctors were looking sideways at Twitter, but tweet by tweet, the little bluebird has continued to grow up and spread across all ages. Even the most prominent medical journals and scientific societies had to surrender to the power of Twitter for sharing their news and research. And in the sky of the bluebird, the #CardioTwitter sign was born (being the Twitter term ‘hashtag’) and under it, the cardiologists' community has become one of the most active. If you are still wondering, ‘why that?’ the answer is just one ‘Twitter is dynamic’. Twitter is a microblogging service that defines itself as ‘what’s happening and what people are talking about right now […] with the purpose to serve the public conversation’. It has changed medical communication from the unidirectional feature of paper journals and websites to the bidirectional nature of a platform where information can be shared readily, one can see what is the matter of discussion at a country level and globally, and interact with healthcare providers and scientists to share experiences and opinions. Twitter has changed the research and education in cardiology. ‘I like the sharing of science, the ability to discuss treatment and controversies and finding out about the people in the #CardioTwitter world’, said Dr Gulati (handle: @DrMarthaGulati), one of the most popular twitter cardiologists when we asked her what she likes more of Twitter. To the same question, Dr Mamas (@mamasmamas), another popular twitter cardiologist, replied ‘I like networking with colleagues and the opportunity for collaborations, I feel that Twitter is probably the most effective continuing professional development for me, in that it highlights interesting work that I can read about. It’s like having a personal search engine that finds all the interesting studies for you’. Thanks to the use of the hashtag, Twitter creates a digital database for you. The hashtag (the use of the ‘#’ in front of a term) archives the term within Twitter: in this way, the posts are grouped and can be searched by topic. In cardiology, several hashtag have been created, some of them are listed in the Cardiology Hashtag Ontology, but the list increases day by day. The terms can be general (i.e. #CardioTwitter, #cvImaging, #cvPrevention, #CVD), related to a sub-speciality (i.e. #radialfirst, #echofirst, #whyMRI, #sportscardiology), disease specific (i.e. #LQTS, #AFib, #HFpEF, #STEMI) or therapy specific (i.e. #statin, #NOAC). The hashtag can also be used as crowd-sourcing: i.e. #WIC (women in cardiology) has grouped a great community of female cardiologists with the aim to strengthen their professional support system and skills.1,2 Twitter has not only bridged distances, by spreading contents and news globally, it has done it in a unique way: through quotes, re-tweets, and likes (Figure 1), it multiplies the sources, amplifies the messages, and disseminates important healthcare information in a very short time. This has been well received by many societies and journals that have opened their official accounts in the last years (i.e. @escardio, @ESC_journals, @ACCinTouch, @JACCJournals, @CircAHA). Clinical cases, quizzes, journal’s club and Twittorial (collected by hashtags such as #CardioEd, #clinicalcases, #ECGchallenge) are among the most used ways to spread cardiology knowledge, guidelines, papers, and experience by all the users. The importance of Twitter for educational purposes has become even more evident after the Covid-19 pandemic. The cancellation of scientific meetings during the pandemic has led to the creation of virtual meetings with a timely dissemination of their contents on Twitter (#ESCCongress, #ACC20, #AHACongress) through the Societies’ official accounts and also the so-called ‘twitter Ambassadors’, highly popular experts on Twitter, selected to spread the contents of the conferences. Furthermore, Twitter does not wait for you, rather it works for you: thanks to the possibility of activating specific notifications, the user is updated in real-time, at any time and place. Considering the new educational role of Twitter, not only the Altimetric score is increasing its importance in the journalś ratings, but also a discussion has been opened about the translation of the educational content of Twitter into formal CME.3 Most cardiologists use it also for self-promotion. A study in the field of interventional cardiology shows that even young non-academic cardiologists may be popular on Twitter: your title is not as important as what you do on Twitter.4 And not surprisingly the most twitted papers are also the ones most likely cited.5 Flattening all the hierarchies, Twitter provides everyone with a democratic opportunity to comment. However, this has its downface. The limit of characters may result in distortion of the contents. Therefore, it is always important that the reader verifies the information and the trust of the user by going deeper and reading the original paper, not just the message promoted in the tweet. There are also concerns about patients’ privacy and the criticisms of papers and trials that sometimes may be nasty and impolite.6 Nevertheless, Twitter represents a useful platform also for patients who want to have more information on their conditions or share their experience with other patients. The great interaction has often given birth to research collaborations: some papers have been written by cardiologists that have become friends and collaborators on Twitter.7,8 The possibility of running polls increases the interaction, and it may be useful for new little data collection: some of us have used polls’ results for talks, and the results in some cases have generated new research and papers. An example? To write this paper, a tweet was posted: ‘#CardioTwitter I need your help: I’m writing a paper on #Twitter in #Cardiology: write me a word to define Twitter for you’. In half an hour, there were more than 10 replies. The answers have then grown very quickly. What did the #CardioTwitter people say? Very similar key words: ‘Connection, knowledge, innovation, support’ (@drmilicaa; @SineadHughes19); ‘collective intelligence, knowledge spreading, scientific community’s indexing and cross-talking’ (@CAmarelli74); ‘a never-ending textbook, full of inspiration’ (@NMerke); ‘Knowledge’ (@rafavidalperez; @DavidNiederseer); ‘opportunity’ (@MamasMamas); ‘global community’ (@DrMarthaGulati; @ola_alani; @mmonaghan07); ‘Networking, mentorship, keeping up to date with literature, following conferences… there are so many more!’ (@DeveshRaiMD; @jakshatcardio); ‘immediacy’ (@ConcienciaMini); ‘connecting to share knowledge and meet friends/colleagues’ (@AliElzieny); ‘learning and network’ (@CianMcDermott); ‘Knowledge & collaboration, friends, advocacy’ (@biljana_parapid); ‘connected’ (@KevinShahMD; @gavin_mcclean; @stephanie2453; @EkateriniL); ‘collaboration’ (@cardioPCImom); ‘Learning Sharing’ (@djc795; @ZainabDakhil2); ‘new papers at an early stage’ (@ag_stuart); ‘Collaboration Learning Debate!’ (@dr_benoy_n_shah); ‘Quick update’ (@chiari_1990); ‘informative’ (@GabbGenevieve); ‘All, here & now’ (@JuanBenezet); ‘Critical appraisal; keeping up with literature; new and best techniques; networking’ (@doconmoney); ‘collaboration Sharing Critical appraisal’ (@pomyers); ‘information’ (@gina_lundberg); ‘Staying connected; rapid access, new perspectives, friends, opportunities, mentorship, sponsorship… more than 1 word! Oops’ (@ShelleyZieroth); ‘Keeping up to date’ (@JGrapsa); ‘Great minds’ (@Obisht); ‘ educational’ (@richardbogle); ‘Uninterrupted passionate dialogue’ (@jeanlucvachiery); ‘Didactic engagement, bridge across fields (helps to get out of own “cocoons”; burnout/fun/learn)’ (@KTamirisaMD); ‘Networking, fun, knowledge’ (@AlexFrogoudaki); ‘our podium for sharing our Middle Eastern cardiovascular studies’ (@AcademyCardio); ‘all the above, would add breaking the hierarchy and giving a voice to trainee’ (@PSatishMD); ‘all the above, but also a huge Distraction’ (by @dcscant); and ‘Distraction came to mind but in all honesty a plethora of information’ (@PatriceMcKay9). So, why not joining Twitter? ‘The main reason to join is to network with colleagues across the globe and have interesting educational resources at your fingertips 24-hour a day, 365 days a year’, said Dr Mamas; ‘to expand your network in cardiology and beyond, to find collaborators, colleagues, mentors, supporters and even friends!’ said Dr Gulati. So, have we convinced you that a 280-character cardiology world is not so bad? If so, create your own account and join our #CardioTwitter world. We are waiting for you! We would like to thank Manuel Garofalo for his graphical support. Conflict of interest: none declared. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Authors 3

1. Silvia Castelletti corresponding

   IRCCS Istituto Auxologico Italiano

   Affiliation as printed

   IRCCS Istituto Auxologico Italiano, Cardiomyopathy Unit and Center for the Cardiac Arrhythmias of Genetic Origin, Department of Cardiovascular, Neural and Metabolic Sciences, Piazzale Brescia, 20, Milan 20149, Italy

2. Carlos Aguíar

   Hospital de Santa Cruz · Hospital de Egas Moniz · Centro Hospitalar de Lisboa Ocidental

   Affiliation as printed

   Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Centro Hospitalar Lisboa Ocidental, Avenida Prof Dr Reinaldo dos Santos 2790-134 Carnaxide, Lisbon, Portugal

3. Victoria Delgado Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC Leiden, The Netherlands