This article spotlights the relationship between likes and comments and the content of tourism photographs on Instagram with the aim of understanding users’ behavior and, thus, helping destination management organizations. Based on the stimulus-organism-response model, a content analysis was conducted of 1,094 pictures that received 131,116,800 likes and 2,859,448 comments. By combining content analysis and regression analysis, the results show that Instagrammers’ responses are influenced differently by different picture attributes, resulting in dissimilar behavior with regard to likes and comments. Specifically, likes, as immediate reactions, tend to be driven by content featuring people, views, or common habits. In contrast, comments, which require greater effort on the part of the Instagrammer, are elicited by the topic of festivals or hotels, colors such as cream, green, orange, or yellow, images of water or animals, and images featuring tourist activities, mostly at night. Multi-image or fake pictures negatively impact likes. By analyzing the content of the information provided by the uploaded photographs, a typology of photographic attributes is developed to offer clues for destination management organizations to enhance engagement with potential customers and Instagram users.

(1) Background: Hyperkalemia is a common finding in patients with heart failure and reduced ejection fraction (HFrEF), though its prognostic significance is controversial. There is no consensus on optimal potassium levels in these patients. The primary endpoint of this study was to determine the 5-year incidence of hyperkalemia in a cohort of patients with HFrEF. Secondary endpoints were to determine predictors of hyperkalemia and its impact on overall 5-year mortality; (2) Methods: retrospective, longitudinal, single-center observational study of patients with HFrEF followed-up in a specialized unit between 2011 and 2019. Hyperkalemia was considered as potassium concentration > 5.5 mEq/L; (3) Results: Hyperkalemia was observed in 170 (16.8%) of the 1013 patients. The 5-year hyperkalemia-free survival rate was 82.1%. Hyperkalemia was more frequent at the beginning of follow-up. Factors associated with hyperkalemia in the multivariate analysis were baseline potassium (HR 3.13, 95%CI 2.15–4.60; p < 0.001), creatinine clearance (HR 0.99, 95%CI 0.98–0.99; p = 0.013), right ventricular function (HR 0.95, 95%CI 0.91–0.99; p = 0.016) and diabetes mellitus (HR 1.40, 95%CI 1.01–1.96; p = 0.047). The overall survival rate at 5 years was 76.4%. Normal–high potassium levels (5–5.5 mEq/L) were inversely associated with mortality (HR 0.60, 95%CI 0.38–0.94; p = 0.025); (4) Conclusions: Hyperkalemia is a common finding in patients with HFrEF with an impact on the optimization of neurohormonal treatment. In our retrospective study, potassium levels in the normal–high range seem to be safe and are not associated with increased mortality.

We aimed to describe the clinical characteristics, underlying causes and outcomes of syncope in patients with transthyretin amyloid cardiomyopathy (ATTR-CM).The clinical profile and underlying caus...