RESUMEN
We performed a retrospective study of cardiology telemedicine visits at a large academic pediatric center between 2016 and 2019 (pre COVID-19). Telemedicine patient visits were matched to data from their previous in-person visits, to evaluate any significant differences in total charge, insurance compensation, patient payment, percent reimbursement and zero reimbursement. Miles were measured between patient's home and the address of previous visit. We found statistically significant differences in mean charges of telemedicine versus in-person visits (2019US$) (172.95 vs 218.27, p=0.0046), patient payment for telemedicine visits versus in-person visits (2019US$) (11.13 vs 62.83, p≤0.001), insurance reimbursement (2019US$) (65.18 vs 110.85, p≤0.001) and insurance reimbursement rate (43% vs 61%, p=0.0029). Rate of zero reimbursement was not different. Mean distance from cardiology clinic was 35 miles. No adverse outcomes were detected. This small retrospective study showed cost reduction and a decrease in travel time for families participating in telemedicine visits. Future work is needed to enhance compensation for telemedicine visits.
Asunto(s)
Atención Ambulatoria , Servicio de Cardiología en Hospital , Enfermedades Cardiovasculares , Costos y Análisis de Costo , Telemedicina , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Atención Ambulatoria/organización & administración , COVID-19/epidemiología , Servicio de Cardiología en Hospital/economía , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Niño , Ahorro de Costo/métodos , Costos y Análisis de Costo/métodos , Costos y Análisis de Costo/estadística & datos numéricos , Salud de la Familia , Femenino , Accesibilidad a los Servicios de Salud/economía , Cardiopatías Congénitas/economía , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/terapia , Humanos , Masculino , Estudios Retrospectivos , SARS-CoV-2 , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Estados Unidos/epidemiologíaAsunto(s)
COVID-19 , Servicio de Cardiología en Hospital/tendencias , Infarto del Miocardio sin Elevación del ST/terapia , Admisión del Paciente/tendencias , Infarto del Miocardio con Elevación del ST/terapia , Causas de Muerte/tendencias , Registros Electrónicos de Salud , Humanos , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/mortalidad , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/mortalidad , Factores de Tiempo , Resultado del Tratamiento , TurquíaAsunto(s)
Síndrome Coronario Agudo/terapia , COVID-19 , Servicio de Cardiología en Hospital/tendencias , Infarto del Miocardio sin Elevación del ST/terapia , Admisión del Paciente/tendencias , Pautas de la Práctica en Medicina/tendencias , Infarto del Miocardio con Elevación del ST/terapia , Síndrome Coronario Agudo/diagnóstico por imagen , Anciano , Angiografía Coronaria/tendencias , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico por imagen , Readmisión del Paciente/tendencias , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Centros de Atención Terciaria/tendencias , Factores de Tiempo , Tiempo de Tratamiento/tendenciasRESUMEN
Antithrombotic drug use for acute coronary syndromes (ACS) varies considerably. The number of antithrombotic drugs (excluding oral anticoagulants) used pre- and in-hospital was recorded in ACS survivors enrolled at hospital discharge in the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry ( NCT01171404 ), a prospective cohort study. Among 10,568 patients, the number of antithrombotic drugs used early/patient ranged from 0 to 8 (interquartile range = 3-4). Overall, 250 patients (2.4%) experienced ≥ 1 in-hospital ischemic event and 343 (3.2%) ≥ 1 non-fatal bleeding event. While there was no difference in the rate of ischemic events (p = 0.75 for-trend) according to the number of antithrombotic drugs, a significantly higher incidence of non-fatal bleeds was observed (p < 0.0001 for-trend), with OR = 1.68 (95%CI = 1.51-1.88) per additional antithrombotic drug, which remained after adjustment by patient characteristics. In conclusion, careful balancing of the short-term risks for ischemic and bleeding events should be considered when adding new antithrombotic drugs.
Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico , Servicio de Cardiología en Hospital/tendencias , Servicios Médicos de Urgencia/tendencias , Fibrinolíticos/uso terapéutico , Isquemia/prevención & control , Pautas de la Práctica en Medicina/tendencias , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/epidemiología , Anciano , Revisión de la Utilización de Medicamentos , Europa (Continente)/epidemiología , Femenino , Fibrinolíticos/efectos adversos , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Incidencia , Isquemia/epidemiología , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: During coronavirus disease 2019 (COVID-19) epidemic, reducing the number of invasive procedure and choosing conservative medication strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unavoidable. Whether this relatively conservative strategy will impact in-hospital outcome for NSTEMI patients remains unclear. METHODS AND RESULTS: The current study included all consecutive NSTEMI patients who visited the emergency department in Fuwai Hospital from February 1 to March 31, 2020 and all the NSTEMI patients in the same period of 2019 as a historical control. Very-high-risk patients were defined as clinical presentation of heart failure, cardiac shock, cardiac arrest, recurrent chest pain, and life-threatening arrhythmias. The primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of all-cause death, recurrent myocardial infarction, or heart failure. A total of 115 NSTEMI patients were enrolled since the outbreak of COVID-19, and a total of 145 patients were included in the control group. There was a tendency toward higher MACE risk in 2020 compared with 2019 (18.3% vs. 11.7%, p = .14). Among very-high-risk patients, early percutaneous coronary intervention (PCI) strategy in 2019 was associated with reduced MACE risk compared with delayed PCI in 2020 (60.6% [20/33] in 2020 vs. 27.9% [12/43] in 2019, p = .01). CONCLUSIONS: COVID-19 pandemic results in a significant reduction in immediate/early PCI and a trend toward higher adverse event rate during hospitalization, particular in very-high-risk patients.
Asunto(s)
COVID-19 , Servicio de Cardiología en Hospital/tendencias , Fármacos Cardiovasculares/uso terapéutico , Puente de Arteria Coronaria/tendencias , Servicio de Urgencia en Hospital/tendencias , Infarto del Miocardio sin Elevación del ST/terapia , Intervención Coronaria Percutánea/tendencias , Salud Pública/tendencias , Anciano , Beijing , Fármacos Cardiovasculares/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Femenino , Insuficiencia Cardíaca/etiología , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/complicaciones , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/mortalidad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIMS: Limited data exist on the impact of COVID-19 on national changes in cardiac procedure activity, including patient characteristics and clinical outcomes before and during the COVID-19 pandemic. METHODS AND RESULTS: All major cardiac procedures (n = 374 899) performed between 1 January and 31 May for the years 2018, 2019, and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression was performed to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period. Overall, there was a deficit of 45 501 procedures during the COVID period compared to the monthly averages (March-May) in 2018-2019. Cardiac catheterization and device implantations were the most affected in terms of numbers (n = 19 637 and n = 10 453), whereas surgical procedures such as mitral valve replacement, other valve replacement/repair, atrioseptal defect/ventriculoseptal defect repair, and coronary artery bypass grafting were the most affected as a relative percentage difference (Δ) to previous years' averages. Transcatheter aortic valve replacement was the least affected (Δ -10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterization [OR 1.25 95% confidence interval (CI) 1.07-1.47, P = 0.006] and cardiac device implantation (OR 1.35 95% CI 1.15-1.58, P < 0.001). CONCLUSION: Cardiac procedural activity has significantly declined across England during the COVID-19 pandemic, with a deficit in excess of 45 000 procedures, without an increase in risk of mortality for most cardiac procedures performed during the pandemic. Major restructuring of cardiac services is necessary to deal with this deficit, which would inevitably impact long-term morbidity and mortality.
Asunto(s)
COVID-19 , Servicio de Cardiología en Hospital , Enfermedades Cardiovasculares , Procedimientos Quirúrgicos Cardiovasculares , Técnicas de Diagnóstico Cardiovascular , Control de Infecciones/métodos , COVID-19/epidemiología , COVID-19/prevención & control , Servicio de Cardiología en Hospital/organización & administración , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/terapia , Procedimientos Quirúrgicos Cardiovasculares/clasificación , Procedimientos Quirúrgicos Cardiovasculares/estadística & datos numéricos , Técnicas de Diagnóstico Cardiovascular/clasificación , Técnicas de Diagnóstico Cardiovascular/estadística & datos numéricos , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Innovación Organizacional , Medición de Riesgo , Factores de Riesgo , SARS-CoV-2Asunto(s)
Arritmias Cardíacas , COVID-19 , Servicio de Cardiología en Hospital , Electrocardiografía Ambulatoria , Técnicas Electrofisiológicas Cardíacas/métodos , Telemedicina , Antivirales/farmacología , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Arritmias Cardíacas/terapia , COVID-19/epidemiología , COVID-19/terapia , Servicio de Cardiología en Hospital/organización & administración , Servicio de Cardiología en Hospital/tendencias , Electrocardiografía Ambulatoria/instrumentación , Electrocardiografía Ambulatoria/métodos , Predicción , Humanos , Cooperación Internacional , Innovación Organizacional , SARS-CoV-2 , Sociedades Médicas/tendencias , Telemedicina/métodos , Telemedicina/organización & administración , Telemedicina/tendenciasRESUMEN
In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.
Asunto(s)
COVID-19 , Cateterismo Cardíaco/métodos , Servicio de Cardiología en Hospital , Unidades de Cuidados Coronarios , Cuidados Críticos , Control de Infecciones , Laboratorios de Hospital/organización & administración , Innovación Organizacional , Infarto del Miocardio con Elevación del ST , COVID-19/epidemiología , COVID-19/terapia , Servicio de Cardiología en Hospital/organización & administración , Servicio de Cardiología en Hospital/tendencias , Unidades de Cuidados Coronarios/métodos , Unidades de Cuidados Coronarios/organización & administración , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Cuidados Críticos/tendencias , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Ciudad de Nueva York/epidemiología , Grupo de Atención al Paciente/organización & administración , Atención Perioperativa/métodos , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/terapiaRESUMEN
La situación actual consecuencia de la pandemia de COVID-19 nos apremia a la reorganización de la atención ambulatoria, entre otras actividades médicas. Las medidas urgentes que se impusieron durante el periodo de confinamiento obligaron a una reestructuración de las consultas que se ha convertido en una oportunidad de cambio y una necesidad para el futuro. Es el momento de innovar con la implantación de nuevas modalidades de asistencia, apostando por la atención no presencial, con el propósito de garantizar la seguridad de los pacientes, pero también optimizar los recursos y el gasto sanitarios, evitando consultas innecesarias y repetición de actos médicos. Hay exitosas experiencias previas de la telemedicina tanto para comunicación entre profesionales como para la relación médico-paciente. El desarrollo de las tecnologlas de la información y la comunicación nos brinda multitud de oportunidades para está reorganización, que deben adaptarse a cada realidad, pero siempre primando la calidad asistencial
The current situacion caused by the COVID-19 pandemic has forced us to reorganize outpatient care, along with other healthcare activities. Urgent measures imposed during the lockdown period have necessitated the reorganization of patient consultations, which has provided an opportunity to make changes that may become essential in the future. Now is the time to innovate by implementing new modalities of care, for example by trying out remote patient care, not only to guarantee patient safety, but also to optimize the use of health-care resources and expenditure and to avoid unnecessary consultations and the duplication of medical efforts. Previously, telemedicine has been used successfully both for communications between professionals and in the doctor-patient relationship. The development of Información and communication technologies has given us a plethora of opportunities for reorganization, which must be adapted to each real-life situación while bearing in mind that care quality is a priority
Asunto(s)
Humanos , Infecciones por Coronavirus/prevención & control , Neumonía Viral/prevención & control , Pandemias , Servicio de Cardiología en Hospital/tendencias , Telecardiología , Servicio de Cardiología en Hospital/organización & administración , Servicio de Cardiología en Hospital/normas , TelemonitorizaciónRESUMEN
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. This study sought to share our experiences with in-hospital management and outcomes of acute myocardial infarction (AMI) during the COVID-19 pandemic. We retrospectively analyzed consecutive AMI patients, including those with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), from February 1, 2020, to April 15, 2020 (during the COVID-19 pandemic), and from January 1, 2019, to December 31, 2019 (before the COVID-19 pandemic), respectively. Fifty-three AMI patients (31 STEMI, 22 NSTEMI) during the COVID-19 pandemic were matched to 53 AMI patients before the pandemic. Baseline characteristics were comparable between the matched patients. STEMI patients during the COVID-19 pandemic had a longer delay time, less primary or remedial PCI and more emergency thrombolysis than those before the pandemic. Less coronary angiography and stenting were performed in AMI patients during the COVID-19 pandemic than before the pandemic. There were no statistically significant differences in the clinical outcomes between the matched patients. However, STEMI patients during the COVID-19 pandemic had a 4-fold (12.9% vs. 3.2%) increase in all-cause mortality rate compared with those before the pandemic. AMI combined with COVID-19 infection was associated with higher rates of mortality than AMI alone. This study demonstrates that the COVID-19 pandemic results in significant reperfusion delays in STEMI patients and has a marked impact on the treatment options selection in AMI patients. The mortality rate of STEMI patients exhibits an increasing trend during the pandemic of COVID-19.
Asunto(s)
Servicio de Cardiología en Hospital/tendencias , Infecciones por Coronavirus , Infarto del Miocardio sin Elevación del ST/terapia , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Pandemias , Intervención Coronaria Percutánea/tendencias , Neumonía Viral , Infarto del Miocardio con Elevación del ST/terapia , Terapia Trombolítica/tendencias , Tiempo de Tratamiento/tendencias , Anciano , COVID-19 , China , Angiografía Coronaria/tendencias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/mortalidad , Admisión del Paciente , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Estudios Retrospectivos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To monitor hospital activity for presentation, diagnosis and treatment of cardiovascular diseases during the COVID-19) pandemic to inform on indirect effects. METHODS: Retrospective serial cross-sectional study in nine UK hospitals using hospital activity data from 28 October 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown) and for the same weeks during 2018-2019. We analysed aggregate data for selected cardiovascular diseases before and during the epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. RESULTS: Across nine hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1%-58.6%) and 52.9% (52.2%-53.5%), respectively, compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown and fell by 31%-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances relative reduction (RR) 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. CONCLUSIONS: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.
Asunto(s)
COVID-19 , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/terapia , Prestación Integrada de Atención de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Evaluación de Necesidades/tendencias , Enfermedades Cardiovasculares/diagnóstico , Estudios Transversales , Servicio de Urgencia en Hospital/tendencias , Humanos , Admisión del Paciente/tendencias , Estudios Retrospectivos , Factores de Tiempo , Reino UnidoRESUMEN
BACKGROUND: The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. Concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. METHODS: We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS and ACVE before (calendar weeks 1-9, 2020) and after (calendar weeks 10-16, 2020) the first coronavirus disease (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. RESULTS: In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p = 0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p = 0.0012). Admissions due to ACS decreased by 41% (p = 0.0023 for all; Δ - 71% (p = 0.007) for unstable angina, Δ - 25% (p = 0.42) for myocardial infarction with ST-elevation and Δ - 17% (p = 0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1-9 to 62 patients in calendar weeks 10-16. ACVE decreased numerically by 20% [p = 0.25 for all; transient ischemic attack: Δ - 32% (p = 0.18), ischemic stroke: Δ - 23% (p = 0.48), intracerebral haemorrhage: Δ + 57% (p = 0.4)]. There was no significant change in ACVE per week (p = 0.7) comparing calendar weeks 1-9 (213 patients) and weeks 10-16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients (prevalence 1,54%, thereof one patient with myocardial and two with cerebral ischemia) up to calendar week 16 in 2020. CONCLUSIONS: The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.
Asunto(s)
COVID-19 , Servicio de Cardiología en Hospital/tendencias , Trastornos Cerebrovasculares/terapia , Servicio de Urgencia en Hospital/tendencias , Cardiopatías/terapia , Admisión del Paciente/tendencias , COVID-19/epidemiología , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/epidemiología , Alemania/epidemiología , Accesibilidad a los Servicios de Salud/tendencias , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Humanos , Aceptación de la Atención de Salud , Prevalencia , Factores de TiempoRESUMEN
AIMS: The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany. METHODS AND RESULTS: This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January-May 2019 (pre-COVID) to January-May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3-6.6), non-ST-segment elevation myocardial infarction (16.8-14.6), acute limb ischemia (5.1-4.6), stroke (35.0-32.5) and TIA (13.7-11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5-9.8%). CONCLUSIONS: Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients' comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients' outcomes.
Asunto(s)
COVID-19 , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/terapia , Trastornos Cerebrovasculares/terapia , Servicio de Urgencia en Hospital/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Admisión del Paciente/tendencias , Reclamos Administrativos en el Cuidado de la Salud , Anciano , COVID-19/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/epidemiología , Comorbilidad , Bases de Datos Factuales , Femenino , Alemania/epidemiología , Humanos , Masculino , Aceptación de la Atención de Salud , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. METHODS: We describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. RESULTS: From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home. CONCLUSION: Our preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Servicio de Cardiología en Hospital , Infecciones por Coronavirus , Cardiopatías Congénitas , Control de Infecciones , Pandemias , Atención Perinatal , Neumonía Viral , Betacoronavirus/aislamiento & purificación , COVID-19 , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Servicio de Cardiología en Hospital/organización & administración , Servicio de Cardiología en Hospital/tendencias , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/cirugía , Humanos , Recién Nacido , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Italia/epidemiología , Masculino , Modelos Organizacionales , Innovación Organizacional , Pandemias/prevención & control , Atención Perinatal/métodos , Atención Perinatal/organización & administración , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuidados Posoperatorios/métodos , Embarazo , SARS-CoV-2Asunto(s)
Síndrome Coronario Agudo/terapia , Angina Inestable/terapia , COVID-19/prevención & control , Servicio de Cardiología en Hospital/tendencias , Servicio de Urgencia en Hospital/tendencias , Infarto del Miocardio sin Elevación del ST/terapia , Admisión del Paciente/tendencias , Aislamiento Social , Síndrome Coronario Agudo/diagnóstico , Anciano , Anciano de 80 o más Años , Angina Inestable/diagnóstico , COVID-19/transmisión , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico , Aceptación de la Atención de Salud , Estudios Retrospectivos , Factores de TiempoAsunto(s)
COVID-19/prevención & control , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/terapia , Servicio de Urgencia en Hospital/tendencias , Admisión del Paciente/tendencias , Aislamiento Social , COVID-19/epidemiología , COVID-19/transmisión , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Europa (Continente)/epidemiología , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Aceptación de la Atención de Salud , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
AIMS: To assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients. METHODS: Data were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020. RESULTS: There was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals (p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = - 2.2-2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = - 4.9-7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = - 6.2-7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = - 3.2-4.5, p = 0.739). CONCLUSIONS: Clinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic. CLINICAL TRIAL REGISTRATION: NCT00794001.
Asunto(s)
COVID-19 , Servicio de Cardiología en Hospital/tendencias , Prestación Integrada de Atención de Salud/tendencias , Hospitalización/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Intervención Coronaria Percutánea/tendencias , Regionalización/tendencias , Infarto del Miocardio con Elevación del ST/terapia , Anciano , COVID-19/epidemiología , Estudios Transversales , Femenino , Alemania/epidemiología , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/mortalidad , Estudios Prospectivos , Indicadores de Calidad de la Atención de Salud/tendencias , Sistema de Registros , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Factores de Tiempo , Tiempo de Tratamiento/tendencias , Resultado del TratamientoAsunto(s)
COVID-19/prevención & control , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/terapia , Servicio de Urgencia en Hospital/tendencias , Admisión del Paciente/tendencias , Aislamiento Social , COVID-19/epidemiología , COVID-19/transmisión , Enfermedades Cardiovasculares/diagnóstico , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Mónaco , Aceptación de la Atención de Salud , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: In the era of the current COVID-19 health crisis, the aim of the present study was to explore population behavior as regards the visits in the Εmergency Cardiology department (ECD) of a tertiary General Hospital that does not hospitalize SARS-CoV-2 infected patients METHODS AND RESULTS: Daily number of visits at the EDC and admissions to Cardiology Wards and Intensive Care Unit of a tertiary General Hospital, in Athens, Greece, were retrieved from hospital's database (January 1st-April 30th 2018, 2019 and 2020). A highly significant reduction in the visits at ECD of the hospital during March and April 2020 was observed as compared with January and February of the same year (p for linear trend < ·001); in particular the number of visits was 41.1% lower in March 2020 and 32.7% lower in April 2020, as compared to January 2020. As the number of confirmed COVID-19 cases throughout the country increased (i.e., from February 26th to April 2nd) the number of visits at ECD decreased (p = 0.01), whereas, the opposite was observed in the period afterwards (p = 0.01).The number of acute Myocardial infarctions (MI) cases in March 2020 was the lowest compared to the entire three year period (p < 0·001); however, the number of acute MI cases in April 2020 was doubled as compared to March 2020, but still was lower than the preceding years (p < 0·001). CONCLUSIONS: It is hard to explain the mystery of the "missing" emergency hospital visits. However, if this decline in cardiovascular disease related hospital visits is "true", it is something that needs to be rigorously studied, to learn how to keep these rates down.
Asunto(s)
COVID-19/prevención & control , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/terapia , Servicio de Urgencia en Hospital/tendencias , Hospitales Generales/tendencias , Aceptación de la Atención de Salud , Admisión del Paciente/tendencias , Centros de Atención Terciaria/tendencias , COVID-19/epidemiología , COVID-19/transmisión , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Grecia/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Estudios Retrospectivos , Factores de TiempoRESUMEN
The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.