ABSTRACT
BACKGROUND: This qualitative research explored the lived experiences of patients who experienced postponement of elective cardiac and vascular surgery due to coronavirus disease 2019 (COVID-19). We know very little about patients during the novel coronavirus pandemic. Understanding the patient voice may play an important role in prioritization of postponed cases and triage moving forward. METHODS: Utilizing a hermeneutical phenomenological qualitative design, we interviewed 47 individuals who experienced a postponement of cardiac or vascular surgery due to the COVID-19 pandemic. Data were analyzed and informed by phenomenological research methods. RESULTS: Patients in our study described 3 key issues around their postponement of elective surgery. Patients described robust narratives about the meanings of their elective surgeries as the chance to "return to normal" and alleviate symptoms that impacted everyday life. Second, because of the meanings most of our patients ascribed to their surgeries, postponement often took a toll on how patients managed physical health and emotional well-being. Finally, paradoxically, many patients in our study were demonstrative that they would "rather die from a heart attack" than be exposed to the coronavirus. CONCLUSIONS: We identified several components of the patient experience, encompassing quality of life and other desired benefits of surgery, the risks of COVID, and difficulty reconciling the 2. Our study provides significant qualitative evidence to inform providers of important considerations when rescheduling the backlog of patients. The emotional and psychological distress that patients experienced due to postponement may also require additional considerations in postoperative recovery.
Subject(s)
COVID-19/prevention & control , Cardiovascular Surgical Procedures/standards , Elective Surgical Procedures/standards , Psychological Distress , Time-to-Treatment , Adult , Aged , COVID-19/epidemiology , COVID-19/psychology , COVID-19/transmission , Cardiovascular Surgical Procedures/psychology , Elective Surgical Procedures/psychology , Female , Humans , Male , Middle Aged , Pandemics/prevention & control , Patient Preference , Qualitative Research , Time Factors , Triage/standardsABSTRACT
BACKGROUND: The coronavirus disease (COVID-19) has affected a large population across the world. Patients with cardiovascular disease have increased morbidity and mortality due to coronavirus disease. The burden over the health care system has to be reduced in this global pandemic to provide optimal care of patients with COVID-19, as well not compromising those who are in need of emergent cardiovascular care. METHODS: There is a very limited data published defining which cardiovascular procedures are to be performed or to be deferred in the COVID-19 pandemic. In this article, we have reviewed a few published guidelines regarding cardiovascular surgery in COVID-19 pandemics. CONCLUSION: After reviewing a few available guidelines regarding cardiovascular surgery in COVID-19, we conclude to perform only those surgeries which cannot be deferred to a certain period of time, to reduce the burden of the health care system of the country, provide optimal care to patients with COVID-19, and to protect health care workers and cardiovascular patients from COVID-19.
Subject(s)
Betacoronavirus , Cardiovascular Diseases/surgery , Cardiovascular Surgical Procedures/standards , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Elective Surgical Procedures/methods , Pandemics , Pneumonia, Viral/epidemiology , COVID-19 , Cardiovascular Diseases/epidemiology , Comorbidity , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/transmission , SARS-CoV-2ABSTRACT
Injection of contrast media is the foundation of invasive and interventional cardiovascular practice. Iodine-based contrast was first used in the 1920s for urologic procedures and examinations. The initially used agents had high ionic and osmolar concentrations, which led to significant side effects, namely nausea, vomiting, and hypotension. Newer contrast agents had lower ionic concentrations and lower osmolarity. Modifications to the ionic structure and iodine content led to the development of ionic low-osmolar, nonionic low-osmolar, and nonionic iso-osmolar contrast media. Contemporary contrast agents are better tolerated and produce fewer major side effects.
Subject(s)
Anaphylaxis/chemically induced , Anaphylaxis/prevention & control , Contrast Media/adverse effects , Contrast Media/chemistry , Anaphylaxis/epidemiology , Anaphylaxis/physiopathology , Cardiovascular Surgical Procedures/standards , Contrast Media/administration & dosage , Contrast Media/history , Diagnostic Techniques, Cardiovascular/standards , Female , History, 20th Century , Humans , Incidence , Male , Observational Studies as Topic , Osmolar Concentration , Risk Assessment , Urologic Surgical Procedures/standardsSubject(s)
Betacoronavirus , Cardiovascular Surgical Procedures/standards , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Surgeons/standards , Brazil , COVID-19 , Extracorporeal Membrane Oxygenation/methods , Humans , Pandemics , SARS-CoV-2 , Severe Acute Respiratory Syndrome/therapySubject(s)
Betacoronavirus/immunology , Cardiovascular Diseases/surgery , Cardiovascular Surgical Procedures/standards , Coronavirus Infections/complications , Pneumonia, Viral/complications , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , COVID-19 , Cardiovascular Diseases/complications , Cardiovascular Diseases/immunology , Clinical Decision-Making , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Infection Control/standards , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2ABSTRACT
The 2019 coronavirus disease(COVID-19) has cost a great loss to the health and economic property of Chines people. Under such a special circumstance, how to deal with such patients with acute aortic syndrome has become a serious challenge. Rapid diagnosis of concomitant COVID-19, safe and effective transportation, implementation of the interventional procedure, protection of vascular surgical team and postoperative management and follow-up of such patients have become urgent problems for us. Combined with the latest novel government documents, the literature and the experiences from Wuhan, we answered the above questions briefly and plainly. We also hope to inspire the national vascular surgeons to manage critical emergencies in vascular surgery and even routine vascular diseases with COVID-19, as a final point to limit the severe epidemic situation, and minimize the damage of COVID-19.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Betacoronavirus , Cardiovascular Surgical Procedures/standards , Coronavirus Infections/complications , Pneumonia, Viral/complications , Aortic Dissection/virology , Aortic Aneurysm/virology , COVID-19 , China , Humans , SARS-CoV-2Subject(s)
Cardiac Catheterization/instrumentation , Cardiovascular Surgical Procedures/standards , Heart Valve Prosthesis Implantation/standards , Mitral Valve/surgery , Heart Valve Prosthesis Implantation/instrumentation , Humans , Mitral Valve/pathology , Mitral Valve Annuloplasty/methods , Mitral Valve Insufficiency/complications , Standard of Care , Ventricular Dysfunction, Left/physiopathologySubject(s)
Cardiovascular Surgical Procedures/methods , Non-ST Elevated Myocardial Infarction/classification , Perioperative Care/methods , ST Elevation Myocardial Infarction/classification , Societies, Medical , Cardiovascular Surgical Procedures/standards , Electrocardiography/methods , Electrocardiography/standards , Humans , Magnetic Resonance Imaging, Cine/methods , Magnetic Resonance Imaging, Cine/standards , Myocardial Infarction/classification , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/surgery , Non-ST Elevated Myocardial Infarction/diagnostic imaging , Non-ST Elevated Myocardial Infarction/surgery , Perioperative Care/standards , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery , Societies, Medical/standardsSubject(s)
Cardiology/standards , Cardiovascular Surgical Procedures/standards , Dual Anti-Platelet Therapy/standards , Practice Guidelines as Topic/standards , ST Elevation Myocardial Infarction/therapy , Societies, Medical/standards , Coronary Artery Disease/diagnosis , Coronary Artery Disease/epidemiology , Coronary Artery Disease/therapy , Europe/epidemiology , Humans , Intersectoral Collaboration , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/epidemiologyABSTRACT
Importance: Choosing between competing treatment options is difficult for patients and clinicians when results from randomized and observational studies are discordant. Observational real-world studies yield more generalizable evidence for decision making than randomized clinical trials, but unmeasured confounding, especially in time-to-event analyses, can limit validity. Objectives: To compare long-term survival after carotid endarterectomy (CEA) and carotid artery stenting (CAS) in real-world practice using a novel instrumental variable method designed for time-to-event outcomes, and to compare the results with traditional risk-adjustment models used in observational research for survival analyses. Design, Setting, and Participants: A multicenter cohort study was performed. The Vascular Quality Initiative, an observational quality improvement registry, was used to compare long-term mortality after CEA vs CAS. The study included 86â¯017 patients who underwent CEA (n = 73â¯312) or CAS (n = 12â¯705) between January 1, 2003, and December 31, 2016. Patients were followed up for long-term mortality assessment by linking the registry data to Medicare claims. Medicare claims data were available through September 31, 2015. Exposure: Procedure type (CEA vs CAS). Main Outcomes and Measures: The hazard ratios (HRs) of all-cause mortality using unadjusted, adjusted, propensity-matched, and instrumental variable methods were examined. The instrumental variable was the proportion of CEA among the total carotid procedures (endarterectomy and stenting) performed at each hospital in the 12 months before each patient's index operation and therefore varies over the study period. Results: Participants who underwent CEA had a mean (SD) age of 70.3 (9.4) years compared with 69.1 (10.4) years for CAS, and most were men (44â¯191 [60.4%] for CEA and 8117 [63.9%] for CAS). The observed 5-year mortality was 12.8% (95% CI, 12.5%-13.2%) for CEA and 17.0% (95% CI, 16.0%-18.1%) for CAS. The unadjusted HR of mortality for CEA vs CAS was 0.67 (95% CI, 0.64-0.71), and Cox-adjusted and propensity-matched HRs were similar (0.69; 95% CI, 0.65-0.74 and 0.71; 95% CI, 0.65-0.77, respectively). These findings are comparable with published observational studies of CEA vs CAS. However, the association between CEA and mortality was more modest when estimated by instrumental variable analysis (HR, 0.83; 95% CI, 0.70-0.98), a finding similar to data reported in randomized clinical trials. Conclusions and Relevance: The study found a survival advantage associated with CEA over CAS in unadjusted and Cox-adjusted analyses. However, this finding was more modest when using an instrumental variable method designed for time-to-event outcomes for risk adjustment. The instrumental variable-based results were more similar to findings from randomized clinical trials, suggesting this method may provide less biased estimates of time-dependent outcomes in observational analyses.
Subject(s)
Cardiovascular Surgical Procedures/standards , Carotid Stenosis/surgery , Endarterectomy, Carotid/standards , Risk Assessment/methods , Stents/standards , Cardiovascular Surgical Procedures/methods , Carotid Stenosis/complications , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/statistics & numerical data , Humans , Risk Assessment/standards , Stents/adverse effects , Stents/statistics & numerical data , Survival Analysis , Time , Time and Motion StudiesABSTRACT
Objective Quality improvement in surgery has mainly been based on clinical database outcomes. This study compared variables from the patient-reported Aberdeen Varicose Vein Questionnaire with the Danish Clinical Vein Database, in order to reveal agreements and differences in symptoms and clinical findings. Methods In the period January-March 2011, 379 legs in 287 patients treated for varicose veins were registered in the Danish Clinical Vein Database and compared to the Aberdeen Varicose Vein Questionnaire. Results Patients and physicians agreed in reduction of symptoms after intervention with one or more complaints still present in 128 (93%) patients according to Aberdeen Varicose Vein Questionnaire compared to the Danish Clinical Vein Database with only 64 (47%) patients. Patients reported cosmetic complaints and teleangiectasies both before and after treatment (p < 0.001) more often than doctors. Conclusion The Aberdeen Varicose Vein Questionnaire has added valuable information to the dialogue between the doctor and patient on which symptoms expecting to improve and which not.
Subject(s)
Patient Reported Outcome Measures , Varicose Veins/physiopathology , Varicose Veins/therapy , Adult , Aged , Attitude of Health Personnel , Cardiovascular Surgical Procedures/standards , Databases, Factual , Female , Humans , Male , Middle Aged , Patient Participation , Patient Satisfaction , Quality Improvement , Quality of Life , Severity of Illness Index , Surveys and Questionnaires , Symptom Assessment , Treatment Outcome , Veins/pathologyABSTRACT
PURPOSE: The aim of this study was to build an artificial neural network (ANN) model for predicting surgery-related pressure injury (SRPI) in cardiovascular surgical patients. DESIGN: Prospective cohort study. SUBJECTS AND SETTING: One hundred forty-nine patients who had cardiovascular surgery were included in the study. This study was conducted in a 1000-bed teaching hospital in Eastern China where 250 to 350 cardiac surgeries are performed each year. METHODS: We performed a prospective cohort study among consecutive patients undergoing cardiovascular surgery between January and December 2015. The ANN model was built based on possible SRPI risk factors. The model performance was tested by a receiver operating characteristic curve and the C-index. A C-index from 0.5 to 0.7 is classified as having low accuracy, 0.7 to 0.9 as having moderate accuracy, and 0.9 to 1.0 as having high accuracy. We also compared the actual SRPI incidences based on the ANN stratification. RESULTS: Thirty-seven of 147 patients developed SRPIs, yielding an incidence rate of 24.8% (95% CI, 18.1-32.6). The C-index was 0.815, which showed the ANN model had a moderate prediction value for SRPI. According to the ANN model, the SRPI predicting incidence ranged from 6.4% to 67.7%. Surgery-related pressure injury incidences were significantly different among 3 risk groups stratified by the ANN (P < .05). CONCLUSION: We established an ANN model that provides moderate prediction of SRPI in patients undergoing cardiovascular surgical procedures. Identification and additional associated factors should be incorporated into the ANN model to increase its predictive ability.