Pathology is a discipline that provides the basis of the understanding of disease in medicine. The past decades have seen a decline in the emphasis laid on pathology teaching in medical schools and outdated pathology curricula have worsened the situation. Student opinions and thoughts are central to the questions of whether and how such curricula should be modernized. A survey was conducted among 1018 German medical students regarding their preferences in pathology teaching modalities and their satisfaction with lecture-based courses. A qualitative analysis was performed comparing a recently modernized pathology curriculum with a traditional lecture-based curriculum. The differences in modalities of teaching used were investigated. Student satisfaction with the lecture-based curriculum positively correlated with student grades (spearman’s correlation coefficient 0.24). Additionally, students with lower grades supported changing the curriculum (spearman’s correlation coefficient 0.47). The majority supported virtual microscopy, autopsies, seminars and podcasts as preferred didactic methods. The data supports the implementation of a pathology curriculum where tutorials, autopsies and supplementary computer-based learning tools play important roles.

Importance: The incidence and burden of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) are not known. Nevertheless, North American guidelines state that it is reasonable to administer 60 days of oral anticoagulation to patients with new-onset AF after CABG, a moderate-strength recommendation (class 2a) based on evidence derived from nonrandomized clinical studies. Objective: To test the hypothesis that the incidence of new-onset AF within the first year after CABG is higher than suggested in the current literature and to assess AF burden. Design, Setting, and Participants: A prospective, multicenter cohort study in 2 academic cardiac surgery centers in Germany that involved 198 patients with 3-vessel coronary artery disease or left main disease and no history of arrhythmias who received an insertable cardiac monitor during CABG for long-term continuous electrocardiographic monitoring. Patients were enrolled from November 2019 through November 2023 and were followed up for 1 year. Exposures: Atrial fibrillation detected within a year of continuous monitoring using insertable cardiac monitors implanted during CABG. Main Outcomes and Measures: Cumulative incidence of new-onset AF within a year of surgery. Secondary outcomes were AF burden and clinical outcomes. Results: A total of 1217 patients were assessed, and 1008 were excluded. Of the 198 patients enrolled (173 male [87.4%]; 25 female [12.6%]; mean age, 66 [SD, 9] years), 95 patients developed new-onset AF within the first year after CABG (cumulative incidence, 48%; 95% CI, 41%-55%). The median AF burden during the first year was 0.07% (IQR, 0.02%-0.23%) or 370 minutes. The median AF burden on days 1 through 7 was 3.65% (IQR, 0.95%-9.09%); on days 8 through 30, 0.04% (IQR, 0%-1.21%); and on days 31 through 365, 0% (IQR, 0%-0.0003%), corresponding to 368, 13, and 0 minutes, respectively. After discharge, 3 patients had an AF episode longer than 24 hours. Conclusions and Relevance: Although the incidence of new-onset AF after CABG in this study was higher than previously reported, the AF burden in these patients was very low, especially after 30 days. The very low AF burden questions the current guideline recommendations that long-term oral anticoagulation should be considered in patients with new-onset AF after CABG.

Background: New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) increases ischaemic stroke risk, yet factors influencing this risk remain unclear. We sought to identify factors associated with 1-year ischaemic stroke risk, compare the CHA₂DS₂-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes, previous Stroke/transient ischaemic attack (TIA), Vascular disease, Age 65–74 years, Sex category) and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) scores’ predictive abilities for ischaemic stroke, and assess oral anticoagulation (OAC) dispensing at discharge in patients with POAF.Methods: This nationwide cohort study used prospectively collected data from four mandatory Swedish national registries. All first-time isolated CABG patients who developed POAF during 2007–2020 were included. Multivariable logistic models were used to identify ischaemic stroke predictors and C-statistics to assess the predictive abilities of the CHA₂DS₂-VASc and ATRIA scores in patients without OAC. OAC dispensing patterns were described based on stroke-associated factors.Results: In total, 10 435 patients with POAF were identified. Out of those not receiving OAC (n=6903), 3.1% experienced an ischaemic stroke within 1 year. Advancing age (adjusted OR (aOR) 1.86 per 10-year increase, 95% CI 1.45 to 2.38), prior ischaemic stroke (aOR 18.56, 95% CI 10.05 to 34.28 at 60 years, aOR 5.95, 95% CI 3.78 to 9.37 at 80 years, interaction p2%/year, according to the CHA₂DS₂-VASc score, were not discharged on OAC.Conclusions: Prior ischaemic stroke, advancing age, history of heart failure and myocardial infarction were associated with 1-year ischaemic stroke risk in patients with POAF after CABG. CHA₂DS₂-VASc and ATRIA scores predicted stroke risk with similar accuracy as in non-surgical atrial fibrillation cohorts. OAC dispense at discharge does not seem to reflect individual stroke risk.