Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos / Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists

Introducción y objetivos Los programas de telemedicina entre clínico y paciente se han desarrollado con fuerza durante la pandemia de enfermedad por COVID-19, pero no hay datos de experiencias entre clínicos. Nuestro objetivo es analizar el impacto de la pandemia por COVID-19 en la actividad y resultados en salud de un programa de consulta electrónica universal (e-consulta) para todas las derivaciones de pacientes entre médicos de atención primaria y el Servicio de Cardiología de nuestra área. Métodos Analizamos mediante regresión logística a 25.121 pacientes con al menos una e-consulta entre 2018 y 2021 realizada con el Servicio de Cardiología de nuestra área sanitaria. También se realizó el análisis de regresión logística del impacto de la pandemia por COVID-19 sobre la resolución de la e-consulta y tiempo de espera de la atención, hospitalizaciones y mortalidad, tomando como referencia las consultas realizadas durante 2018. Resultados Observamos que una menor demora en la atención y resolución de la e-consulta (sin necesidad de atención presencial) se asociaba a un mejor pronóstico. Los períodos de pandemia COVID-19 presentaron similares resultados a los del 2018. Conclusiones Los resultados de nuestro estudio muestran una significativa reducción de las derivaciones a través de e-consulta durante el primer año de la pandemia por COVID-19 con recuperación posterior de la demanda asistencial sin que los períodos de pandemia se asociasen con peores resultados en salud. La reducción del tiempo de demora de resolución de la e-consulta y el grupo sin necesidad de consulta presencial se asociaron a un mejor pronóstico (AU)

Blackground and objective Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes (AU)

[Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists]. / Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos.

Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.

Impact of the COVID-19 pandemic upon a universal electronic consultation program (e-consultation) between general practitioners and cardiologists.

BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.

Manejo del paciente diabético con insuficiencia cardiaca / Management of diabetic patient with heart failure

La diabetes mellitus es una epidemia que va en aumento y frecuentementecoexiste en los pacientes con insufi ciencia cardiaca, lo que empeorasu pronóstico1. Actualmente se dispone de una gran variedad deantidiabéticos orales para el tratamiento de la diabetes tipo 2, pero lasopciones en el paciente con insufi ciencia cardiaca están limitadas, ya quela metformina y las tiazolidindionas no siempre están indicadas. Las sulfonilureas son fármacos ampliamente utilizados; sin embargo, su seguridaden los pacientes con insufi ciencia cardiaca es desconocida, debidoa los resultados controvertidos obtenidos con ellas. Los inhibidores de laalfaglucosidasa presentan niveles elevados de intolerancia gastrointestinal,pero pueden ser una buena opción en los pacientes con insufi cienciacardiaca, que requieren una moderada efi cacia para alcanzar el controlglucémico. El uso de la metformina en pacientes con insufi ciencia cardiacaes controvertido, aunque algunos estudios recientes han demostradoque puede ofrecer un efecto de protección cardiovascular. La seguridadde las tiazolidindionas es también objeto de debate. Existe una ampliaevidencia sobre el benefi cio de la inhibición del sistema renina angiotensina-aldosterona, tanto en la prevención como en el tratamiento de la insuficiencia cardiaca en el paciente con diabetes. A pesar de las dudas acerca del potencial riesgo de los betabloqueadores en pacientes condiabetes, estos fármacos han demostrado reducir la mortalidad en la insuficiencia cardiaca, por lo que todo paciente diabético con esta entidadclínica debería recibirlos, a menos que existan contraindicaciones. Losantagonistas del receptor de la aldosterona deben añadirse al tratamiento estándar en pacientes en estadios C y D(AU)

Es necesario realizar estudios prospectivos a largo plazo para establecer la seguridad y la efi cacia de los fármacos orales y poder asegurar un manejo óptimo de los pacientes diabéticos que presentan insuficiencia cardiaca(AU)

Diabetes mellitus is a growing epidemic that frequently coexists inpatients with heart failure, and worsens their prognosis. A wide varietyof oral diabetes medications are currently available for the treatmentof type 2 diabetes mellitus, but options in patients with heartfailure are limited. Alpha-glucosidase inhibitors could be a good optionin patients with heart failure requiring a modest efficacy toachieve glucose targets, especially in those with ischemic heart disease.The use of metformin in patients with heart failure is controversial,although recent studies have demonstrated a protector cardiovasculareffect. The safety of sulfonylureas and thiazolidinediones iscurrently subject of debate too. Recommendations for the treatmentof heart failure in patients with diabetes have been largely derivedfrom post hoc analyses and subgroup analyses in landmark clinicaltrials. A great evidence exists about the benefit of suppressing RAS,both in prevention and treatment of symptomatic heart failure in patientswith diabetes. Despite concerns regarding the potential risks ofbeta-blockers in patients with DM , these drugs have a clear mortalitybenefit in patients with IC, so they must be prescribed in all diabeticpatients with DM, unless contraindicated. Aldosterone receptorantagonists should be added to standard therapies in patients withstages C and D heart failure. Further studies to establish the safetyand effectiveness of oral agents are needed to ensure optimal careof patients with diabetes and heart failure(AU)