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The impact of COVID-19 on the management of heart failure: a United Kingdom patient questionnaire study.

Identifieur interne : 000082 ( Main/Exploration ); précédent : 000081; suivant : 000083

The impact of COVID-19 on the management of heart failure: a United Kingdom patient questionnaire study.

Auteurs : Rajiv Sankaranarayanan [Royaume-Uni] ; Nick Hartshorne-Evans [Royaume-Uni] ; Sam Redmond-Lyon [Royaume-Uni] ; Jill Wilson [Royaume-Uni] ; Hani Essa [Royaume-Uni] ; Alastair Gray [Royaume-Uni] ; Louise Clayton [Royaume-Uni] ; Carys Barton [Royaume-Uni] ; Fozia Z. Ahmed [Royaume-Uni] ; Colin Cunnington [Royaume-Uni] ; Duwarakan K. Satchithananda [Royaume-Uni] ; Clare L. Murphy [Royaume-Uni]

Source :

RBID : pubmed:33463044

Abstract

AIMS

The coronavirus disease 2019 (COVID-19) pandemic has created significant challenges to healthcare globally, necessitating rapid restructuring of service provision. This questionnaire survey was conducted amongst adult heart failure (HF) patients in the United Kingdom (UK), to understand the impact of COVID-19 upon HF services.

METHODS AND RESULTS

The survey was conducted by the Pumping Marvellous Foundation, a UK HF patient charity. 'Survey Monkey' was used to disseminate the questionnaire in the Pumping Marvellous Foundation 's online patient group and in 10 UK hospitals (outpatient hospital and community HF clinics). There were 1050 responses collected (693/1050-66% women); 55% (579/1050) were aged over 60 years. Anxiety level was significantly higher regarding COVID-19 (mean 7 ± 2.5 on anxiety scale of 0 to 10) compared with anxiety regarding HF (6.1 ± 2.4; P < 0.001). Anxiety was higher amongst patients aged ≤60 years about HF (6.3 ± 2.2 vs. 5.9 ± 2.5 in those aged >60 years; P = 0.005) and COVID-19 (7.3 ± 2.3 vs. 6.7 ± 2.6 those aged >60 years; P < 0.001). Sixty-five per cent of respondents (686/1050) reported disruption to HF appointments (cancellation or postponement) during the lockdown period. Thirty-seven per cent reported disruption to medication prescription services, and Thirty-four per cent reported inability to access their HF teams promptly. Thirty-two per cent expressed reluctance to attend hospital (25% stated they would only attend hospital if there was no alternative, and 7% stated that they would not attend hospital at all).

CONCLUSIONS

The COVID-19 pandemic has caused significant anxiety amongst HF patients regarding COVID-19 and HF. Cancellation or postponement of scheduled clinic appointments, investigations, procedures, prescription, and monitoring services were implicated as sources of anxiety.


DOI: 10.1002/ehf2.13209
PubMed: 33463044


Affiliations:


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Le document en format XML

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<name sortKey="Murphy, Clare L" sort="Murphy, Clare L" uniqKey="Murphy C" first="Clare L" last="Murphy">Clare L. Murphy</name>
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<name sortKey="Gray, Alastair" sort="Gray, Alastair" uniqKey="Gray A" first="Alastair" last="Gray">Alastair Gray</name>
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<name sortKey="Clayton, Louise" sort="Clayton, Louise" uniqKey="Clayton L" first="Louise" last="Clayton">Louise Clayton</name>
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<nlm:affiliation>Alliance for Heart Failure, London, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Alliance for Heart Failure, London</wicri:regionArea>
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<nlm:affiliation>Department of Cardiology, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK.</nlm:affiliation>
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<name sortKey="Barton, Carys" sort="Barton, Carys" uniqKey="Barton C" first="Carys" last="Barton">Carys Barton</name>
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<nlm:affiliation>Department of Cardiology, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London, W2 1NY, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Cardiology, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London, W2 1NY</wicri:regionArea>
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<author>
<name sortKey="Ahmed, Fozia Z" sort="Ahmed, Fozia Z" uniqKey="Ahmed F" first="Fozia Z" last="Ahmed">Fozia Z. Ahmed</name>
<affiliation wicri:level="1">
<nlm:affiliation>Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL</wicri:regionArea>
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<affiliation wicri:level="4">
<nlm:affiliation>School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL</wicri:regionArea>
<orgName type="university">Université de Manchester</orgName>
<placeName>
<settlement type="city">Manchester</settlement>
<region type="nation">Angleterre</region>
<region nuts="2" type="region">Grand Manchester</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Cunnington, Colin" sort="Cunnington, Colin" uniqKey="Cunnington C" first="Colin" last="Cunnington">Colin Cunnington</name>
<affiliation wicri:level="1">
<nlm:affiliation>Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL</wicri:regionArea>
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</affiliation>
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<nlm:affiliation>School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL</wicri:regionArea>
<orgName type="university">Université de Manchester</orgName>
<placeName>
<settlement type="city">Manchester</settlement>
<region type="nation">Angleterre</region>
<region nuts="2" type="region">Grand Manchester</region>
</placeName>
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<author>
<name sortKey="Satchithananda, Duwarakan K" sort="Satchithananda, Duwarakan K" uniqKey="Satchithananda D" first="Duwarakan K" last="Satchithananda">Duwarakan K. Satchithananda</name>
<affiliation wicri:level="1">
<nlm:affiliation>Department of Cardiology, University Hospital North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Cardiology, University Hospital North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG</wicri:regionArea>
<wicri:noRegion>ST4 6QG</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Murphy, Clare L" sort="Murphy, Clare L" uniqKey="Murphy C" first="Clare L" last="Murphy">Clare L. Murphy</name>
<affiliation wicri:level="1">
<nlm:affiliation>NHS Greater Glasgow and Clyde Heart MCN Heart Failure subgroup, Scotland, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>NHS Greater Glasgow and Clyde Heart MCN Heart Failure subgroup, Scotland</wicri:regionArea>
<wicri:noRegion>Scotland</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1">
<nlm:affiliation>Heart Failure Hub, Scotland, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Heart Failure Hub, Scotland</wicri:regionArea>
<wicri:noRegion>Scotland</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1">
<nlm:affiliation>Department of Cardiology, Royal Alexandra and Vale of Leven Hospitals, Castlehead, Paisley, PA2 9PJ, Scotland, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Cardiology, Royal Alexandra and Vale of Leven Hospitals, Castlehead, Paisley, PA2 9PJ, Scotland</wicri:regionArea>
<wicri:noRegion>Scotland</wicri:noRegion>
</affiliation>
</author>
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<series>
<title level="j">ESC heart failure</title>
<idno type="eISSN">2055-5822</idno>
<imprint>
<date when="2021" type="published">2021</date>
</imprint>
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<div type="abstract" xml:lang="en">
<p>
<b>AIMS</b>
</p>
<p>The coronavirus disease 2019 (COVID-19) pandemic has created significant challenges to healthcare globally, necessitating rapid restructuring of service provision. This questionnaire survey was conducted amongst adult heart failure (HF) patients in the United Kingdom (UK), to understand the impact of COVID-19 upon HF services.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS AND RESULTS</b>
</p>
<p>The survey was conducted by the Pumping Marvellous Foundation, a UK HF patient charity. 'Survey Monkey' was used to disseminate the questionnaire in the Pumping Marvellous Foundation 's online patient group and in 10 UK hospitals (outpatient hospital and community HF clinics). There were 1050 responses collected (693/1050-66% women); 55% (579/1050) were aged over 60 years. Anxiety level was significantly higher regarding COVID-19 (mean 7 ± 2.5 on anxiety scale of 0 to 10) compared with anxiety regarding HF (6.1 ± 2.4; P < 0.001). Anxiety was higher amongst patients aged ≤60 years about HF (6.3 ± 2.2 vs. 5.9 ± 2.5 in those aged >60 years; P = 0.005) and COVID-19 (7.3 ± 2.3 vs. 6.7 ± 2.6 those aged >60 years; P < 0.001). Sixty-five per cent of respondents (686/1050) reported disruption to HF appointments (cancellation or postponement) during the lockdown period. Thirty-seven per cent reported disruption to medication prescription services, and Thirty-four per cent reported inability to access their HF teams promptly. Thirty-two per cent expressed reluctance to attend hospital (25% stated they would only attend hospital if there was no alternative, and 7% stated that they would not attend hospital at all).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>The COVID-19 pandemic has caused significant anxiety amongst HF patients regarding COVID-19 and HF. Cancellation or postponement of scheduled clinic appointments, investigations, procedures, prescription, and monitoring services were implicated as sources of anxiety.</p>
</div>
</front>
</TEI>
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<DateRevised>
<Year>2021</Year>
<Month>01</Month>
<Day>19</Day>
</DateRevised>
<Article PubModel="Print-Electronic">
<Journal>
<ISSN IssnType="Electronic">2055-5822</ISSN>
<JournalIssue CitedMedium="Internet">
<PubDate>
<Year>2021</Year>
<Month>Jan</Month>
<Day>18</Day>
</PubDate>
</JournalIssue>
<Title>ESC heart failure</Title>
<ISOAbbreviation>ESC Heart Fail</ISOAbbreviation>
</Journal>
<ArticleTitle>The impact of COVID-19 on the management of heart failure: a United Kingdom patient questionnaire study.</ArticleTitle>
<ELocationID EIdType="doi" ValidYN="Y">10.1002/ehf2.13209</ELocationID>
<Abstract>
<AbstractText Label="AIMS" NlmCategory="OBJECTIVE">The coronavirus disease 2019 (COVID-19) pandemic has created significant challenges to healthcare globally, necessitating rapid restructuring of service provision. This questionnaire survey was conducted amongst adult heart failure (HF) patients in the United Kingdom (UK), to understand the impact of COVID-19 upon HF services.</AbstractText>
<AbstractText Label="METHODS AND RESULTS" NlmCategory="RESULTS">The survey was conducted by the Pumping Marvellous Foundation, a UK HF patient charity. 'Survey Monkey' was used to disseminate the questionnaire in the Pumping Marvellous Foundation 's online patient group and in 10 UK hospitals (outpatient hospital and community HF clinics). There were 1050 responses collected (693/1050-66% women); 55% (579/1050) were aged over 60 years. Anxiety level was significantly higher regarding COVID-19 (mean 7 ± 2.5 on anxiety scale of 0 to 10) compared with anxiety regarding HF (6.1 ± 2.4; P < 0.001). Anxiety was higher amongst patients aged ≤60 years about HF (6.3 ± 2.2 vs. 5.9 ± 2.5 in those aged >60 years; P = 0.005) and COVID-19 (7.3 ± 2.3 vs. 6.7 ± 2.6 those aged >60 years; P < 0.001). Sixty-five per cent of respondents (686/1050) reported disruption to HF appointments (cancellation or postponement) during the lockdown period. Thirty-seven per cent reported disruption to medication prescription services, and Thirty-four per cent reported inability to access their HF teams promptly. Thirty-two per cent expressed reluctance to attend hospital (25% stated they would only attend hospital if there was no alternative, and 7% stated that they would not attend hospital at all).</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">The COVID-19 pandemic has caused significant anxiety amongst HF patients regarding COVID-19 and HF. Cancellation or postponement of scheduled clinic appointments, investigations, procedures, prescription, and monitoring services were implicated as sources of anxiety.</AbstractText>
<CopyrightInformation>© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y">
<Author ValidYN="Y">
<LastName>Sankaranarayanan</LastName>
<ForeName>Rajiv</ForeName>
<Initials>R</Initials>
<Identifier Source="ORCID">https://orcid.org/0000-0003-2355-2011</Identifier>
<AffiliationInfo>
<Affiliation>Liverpool University Hospitals NHS Foundation Trust, Department of Cardiology, Aintree University Hospital, Liverpool, L9 7AL, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L69 3BX, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>National Institute for Health Research Clinical Research Network (NIHR CRN), NIHR Clinical Research Network, North West Coast, iC1 Liverpool Science Park, 131 Mount Pleasant, Liverpool, L3 5TF, UK.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Hartshorne-Evans</LastName>
<ForeName>Nick</ForeName>
<Initials>N</Initials>
<AffiliationInfo>
<Affiliation>The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK.</Affiliation>
</AffiliationInfo>
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<LastName>Redmond-Lyon</LastName>
<ForeName>Sam</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Wilson</LastName>
<ForeName>Jill</ForeName>
<Initials>J</Initials>
<AffiliationInfo>
<Affiliation>The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Essa</LastName>
<ForeName>Hani</ForeName>
<Initials>H</Initials>
<AffiliationInfo>
<Affiliation>Liverpool University Hospitals NHS Foundation Trust, Department of Cardiology, Aintree University Hospital, Liverpool, L9 7AL, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L69 3BX, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>National Institute for Health Research Clinical Research Network (NIHR CRN), NIHR Clinical Research Network, North West Coast, iC1 Liverpool Science Park, 131 Mount Pleasant, Liverpool, L3 5TF, UK.</Affiliation>
</AffiliationInfo>
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<LastName>Gray</LastName>
<ForeName>Alastair</ForeName>
<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>Craigavon Area Hospital, Department of Cardiology, 68 Lurgan Rd, Portadown, Craigavon, BT63 5QQ, Northern Ireland, UK.</Affiliation>
</AffiliationInfo>
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<LastName>Clayton</LastName>
<ForeName>Louise</ForeName>
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<Affiliation>British Society for Heart Failure, 33 Cavendish Square, London, W1G 0PW, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Alliance for Heart Failure, London, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Cardiology, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Barton</LastName>
<ForeName>Carys</ForeName>
<Initials>C</Initials>
<AffiliationInfo>
<Affiliation>British Society for Heart Failure, 33 Cavendish Square, London, W1G 0PW, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Cardiology, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London, W2 1NY, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Ahmed</LastName>
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<AffiliationInfo>
<Affiliation>Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y">
<LastName>Cunnington</LastName>
<ForeName>Colin</ForeName>
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<AffiliationInfo>
<Affiliation>Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.</Affiliation>
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<LastName>Satchithananda</LastName>
<ForeName>Duwarakan K</ForeName>
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<AffiliationInfo>
<Affiliation>Department of Cardiology, University Hospital North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK.</Affiliation>
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<LastName>Murphy</LastName>
<ForeName>Clare L</ForeName>
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<AffiliationInfo>
<Affiliation>NHS Greater Glasgow and Clyde Heart MCN Heart Failure subgroup, Scotland, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Heart Failure Hub, Scotland, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Cardiology, Royal Alexandra and Vale of Leven Hospitals, Castlehead, Paisley, PA2 9PJ, Scotland, UK.</Affiliation>
</AffiliationInfo>
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<name sortKey="Sankaranarayanan, Rajiv" sort="Sankaranarayanan, Rajiv" uniqKey="Sankaranarayanan R" first="Rajiv" last="Sankaranarayanan">Rajiv Sankaranarayanan</name>
</noRegion>
<name sortKey="Ahmed, Fozia Z" sort="Ahmed, Fozia Z" uniqKey="Ahmed F" first="Fozia Z" last="Ahmed">Fozia Z. Ahmed</name>
<name sortKey="Ahmed, Fozia Z" sort="Ahmed, Fozia Z" uniqKey="Ahmed F" first="Fozia Z" last="Ahmed">Fozia Z. Ahmed</name>
<name sortKey="Barton, Carys" sort="Barton, Carys" uniqKey="Barton C" first="Carys" last="Barton">Carys Barton</name>
<name sortKey="Barton, Carys" sort="Barton, Carys" uniqKey="Barton C" first="Carys" last="Barton">Carys Barton</name>
<name sortKey="Clayton, Louise" sort="Clayton, Louise" uniqKey="Clayton L" first="Louise" last="Clayton">Louise Clayton</name>
<name sortKey="Clayton, Louise" sort="Clayton, Louise" uniqKey="Clayton L" first="Louise" last="Clayton">Louise Clayton</name>
<name sortKey="Clayton, Louise" sort="Clayton, Louise" uniqKey="Clayton L" first="Louise" last="Clayton">Louise Clayton</name>
<name sortKey="Cunnington, Colin" sort="Cunnington, Colin" uniqKey="Cunnington C" first="Colin" last="Cunnington">Colin Cunnington</name>
<name sortKey="Cunnington, Colin" sort="Cunnington, Colin" uniqKey="Cunnington C" first="Colin" last="Cunnington">Colin Cunnington</name>
<name sortKey="Essa, Hani" sort="Essa, Hani" uniqKey="Essa H" first="Hani" last="Essa">Hani Essa</name>
<name sortKey="Essa, Hani" sort="Essa, Hani" uniqKey="Essa H" first="Hani" last="Essa">Hani Essa</name>
<name sortKey="Essa, Hani" sort="Essa, Hani" uniqKey="Essa H" first="Hani" last="Essa">Hani Essa</name>
<name sortKey="Gray, Alastair" sort="Gray, Alastair" uniqKey="Gray A" first="Alastair" last="Gray">Alastair Gray</name>
<name sortKey="Hartshorne Evans, Nick" sort="Hartshorne Evans, Nick" uniqKey="Hartshorne Evans N" first="Nick" last="Hartshorne-Evans">Nick Hartshorne-Evans</name>
<name sortKey="Murphy, Clare L" sort="Murphy, Clare L" uniqKey="Murphy C" first="Clare L" last="Murphy">Clare L. Murphy</name>
<name sortKey="Murphy, Clare L" sort="Murphy, Clare L" uniqKey="Murphy C" first="Clare L" last="Murphy">Clare L. Murphy</name>
<name sortKey="Murphy, Clare L" sort="Murphy, Clare L" uniqKey="Murphy C" first="Clare L" last="Murphy">Clare L. Murphy</name>
<name sortKey="Redmond Lyon, Sam" sort="Redmond Lyon, Sam" uniqKey="Redmond Lyon S" first="Sam" last="Redmond-Lyon">Sam Redmond-Lyon</name>
<name sortKey="Sankaranarayanan, Rajiv" sort="Sankaranarayanan, Rajiv" uniqKey="Sankaranarayanan R" first="Rajiv" last="Sankaranarayanan">Rajiv Sankaranarayanan</name>
<name sortKey="Sankaranarayanan, Rajiv" sort="Sankaranarayanan, Rajiv" uniqKey="Sankaranarayanan R" first="Rajiv" last="Sankaranarayanan">Rajiv Sankaranarayanan</name>
<name sortKey="Satchithananda, Duwarakan K" sort="Satchithananda, Duwarakan K" uniqKey="Satchithananda D" first="Duwarakan K" last="Satchithananda">Duwarakan K. Satchithananda</name>
<name sortKey="Wilson, Jill" sort="Wilson, Jill" uniqKey="Wilson J" first="Jill" last="Wilson">Jill Wilson</name>
</country>
</tree>
</affiliations>
</record>

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