RESUMEN
BACKGROUND: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). AIM: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. DESIGN: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. RESULTS: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. CONCLUSIONS: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.
Asunto(s)
Síndrome Coronario Agudo , COVID-19 , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Adolescente , Hospitalización , Humanos , Pandemias , Estudios Retrospectivos , SARS-CoV-2RESUMEN
A pesar de que la insuficiencia cardiaca es uno de los síndromes clínicos más frecuentes en medicina y de su elevada mortalidad, pocos son los pacientes que se benefician del acceso a unos cuidados paliativos adecuados a su situación clínica. Recientemente se han publicado varios ensayos para comprobar la utilidad de iniciar tratamiento paliativo junto con el tratamiento cardiológico en pacientes con insuficiencia cardiaca avanzada. En la presente revisión se analizan aspectos sobre el diagnóstico y el control de síntomas de pacientes con insuficiencia cardiaca avanzada, y se ofrece una recopilación de ensayos clínicos que analizan la eficacia de una intervención paliativa en este grupo de pacientes. Es preciso dotar al médico de estrategias para reconocer la necesidad de este tipo de intervenciones sin que ello implique descuidar el tratamiento activo de su insuficiencia cardiaca
Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure
Asunto(s)
Humanos , Insuficiencia Cardíaca/terapia , Cuidados Paliativos al Final de la Vida/métodos , Enfermedad Crítica , Ajuste de Riesgo/métodos , Índice de Severidad de la Enfermedad , Insuficiencia Cardíaca/complicaciones , PronósticoRESUMEN
Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure.
