Impact of the COVID-19 pandemic on emergency department visits: experience of a Brazilian reference center.

OBJECTIVE: To analyze the impact of COVID-19 on emergency department metrics at a large tertiary reference hospital in Brazil. METHODS: A retrospective analysis of consecutive emergency department visits, from January 1, 2020, to November 21, 2020, was performed and compared to the corresponding time frame in 2018 and 2019. The volume of visits and patients' demographic and clinic characteristics were compared. All medical conditions were included, except confirmed cases of COVID-19. RESULTS: A total of 138,138 emergency department visits occurred during the study period, with a statistically significant (p<0.01) reduction by 52% compared to both 2018 and 2019. This decrease was more pronounced for pediatric visits - a drop by 71% in comparison to previous years. Regarding clinical presentation, there was a decrease of severe cases by 34.7% and 37.6%, whereas mild cases decreased by 55.2% and 56.2% when comparing 2020 to 2018 and 2019, respectively. A 30% fall in the total volume of hospital admission from emergency department patients was observed during the study period, but accompanied by a proportional increase in monthly admission rates since April 2020. CONCLUSION: The COVID-19 pandemic led to a 52% fall in attendance at our emergency department for other conditions, along with a proportional increase in hospital admission rates of COVID-19 patients. Healthcare providers should raise patient awareness not to delay seeking medical treatment of severe conditions that require care at the emergency department.

Impact of the COVID-19 pandemic on emergency department visits: experience of a Brazilian reference center / Impacto da pandemia da COVID-19 no volume de atendimentos no pronto atendimento: experiência de um centro de referência no Brasil

ABSTRACT Objective To analyze the impact of COVID-19 on emergency department metrics at a large tertiary reference hospital in Brazil. Methods A retrospective analysis of consecutive emergency department visits, from January 1, 2020, to November 21, 2020, was performed and compared to the corresponding time frame in 2018 and 2019. The volume of visits and patients' demographic and clinic characteristics were compared. All medical conditions were included, except confirmed cases of COVID-19. Results A total of 138,138 emergency department visits occurred during the study period, with a statistically significant (p<0.01) reduction by 52% compared to both 2018 and 2019. This decrease was more pronounced for pediatric visits - a drop by 71% in comparison to previous years. Regarding clinical presentation, there was a decrease of severe cases by 34.7% and 37.6%, whereas mild cases decreased by 55.2% and 56.2% when comparing 2020 to 2018 and 2019, respectively. A 30% fall in the total volume of hospital admission from emergency department patients was observed during the study period, but accompanied by a proportional increase in monthly admission rates since April 2020. Conclusion The COVID-19 pandemic led to a 52% fall in attendance at our emergency department for other conditions, along with a proportional increase in hospital admission rates of COVID-19 patients. Healthcare providers should raise patient awareness not to delay seeking medical treatment of severe conditions that require care at the emergency department.

RESUMO Objetivo Analisar o impacto da pandemia da COVID-19 nas métricas do pronto atendimento de um hospital terciário de referência no Brasil. Métodos Uma análise retrospectiva das visitas consecutivas ao pronto atendimento, de 1o de janeiro de 2020 a 21 de novembro de 2020, foi realizada e comparada ao mesmo intervalo nos anos de 2018 e 2019. O volume de atendimentos e as características clínicas e demográficas dos pacientes foram comparados. Todos os diagnósticos foram incluídos, exceto os casos confirmados de COVID-19. Resultados Um total de 138.138 visitas ao pronto atendimento ocorreu durante o período do estudo, com redução estatisticamente significativa (p<0,01) de 52% do volume comparado tanto a 2018 como a 2019. Essa queda foi mais pronunciada nos atendimentos de pediatria, com redução de 71% se comparada aos números de anos anteriores. Em relação ao quadro clínico, houve redução dos casos graves em 34,7% e 37,6%, enquanto os casos leves caíram 55,2% e 56,2%, quando comparado 2020 a 2018 e a 2019, respectivamente. Uma queda de 30% foi vista no volume de admissões hospitalares originadas dessas visitas, porém houve aumento percentual da taxa de admissão mensal em relação ao volume desde abril de 2020. Conclusão O impacto da pandemia da COVID-19 gerou redução de 52% no volume de atendimento do pronto atendimento por outras condições clínicas, bem como aumento proporcional na taxa de admissão hospitalar de pacientes com COVID-19. Os profissionais de saúde devem orientar seus pacientes a não atrasar a procura por atendimento médico de condições graves que precisem de cuidados no pronto atendimento.

Limitações da terapêutica da insuficiência cardíaca com fração de ejeção preservada / Limitations of therapy heart failure with preserved ejection fraction

Insuficiência cardíaca com função sistólica preservada (ICFEP) apresenta elevada incidência, prevalência, morbidade e mortalidade. Diferentemente, a insuficiência cardíaca com disfunção sistólica, na qual o bloqueio farmacológico neurohormonal reduziu significativamente mortalidade e morbidade, na ICFEP, até o presente momento, não há tratamento específico suportado por evidências. Entretanto, ensaios clínicos com desfechos clinicamente significativos que testam medicamentos especificamente para ICFEP estão em andamento. O tratamento da ICFEP, portanto, deve ser norteado pelo alívio da hipervolemia preferencialmente por diuréticos de alça, controle da frequência cardíaca e anticoagulação, principalmente nos portadores de fibrilação atrial, rigorosos controle da hipertensão com vasodilatadores e alívios da isquemia com revascularização miocárdica nos coronariopatas.

Heart failure with preserved ejection fraction (HFPEF) presents high incidence, prevalence, morbidity e mortality. Unlike the heart failure with systolic dysfunction, where the neurohormonal and autonomic pharmacologic block significantly reduced mortality and morbidity, in the HFPEF, up to this point, there is no specific treatment supported by evidence. However, clinical trials with clinically significant outcomes that test drugs specifically for HFPEF are in progress. The treatment of HFPEF, therefore, must be guided by hypervolemia relief preferably by diuretics, heart rate control and anticoagulation in atrial fibrillation carriers, rigorous control of hypertension with vasoldilators and ischemia relief in the people with coronary ischemic disease.