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2.
Open Heart ; 8(1)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33879506

RESUMO

BACKGROUND: The response to COVID-19 has required cancellation of all but the most urgent procedures; there is therefore a need for the reintroduction of a safe elective pathway. METHODS: This was a study of a pilot pathway performed at Barts Heart Centre for the admission of patients requiring elective coronary and structural procedures during the COVID-19 pandemic (April-June 2020). All patients on coronary and structural waiting lists were screened for procedural indications, urgency and adverse features for COVID-19 prognosis and discussed at dedicated multidisciplinary teams. Dedicated admission pathways involving preadmission isolation, additional consent, COVID-19 PCR testing and dedicated clean areas were used. RESULTS: 143 patients (101 coronary and 42 structural) underwent procedures (coronary angiography, percutaneous coronary intervention, transcatheter aortic valve intervention and MitralClip) during the study period. The average age was 68.2; 74% were male; and over 93% had one or more moderate COVID-19 risk factors. All patients were COVID-19 PCR negative on admission with (8.1%) COVID-19 antibody positive (swab negative). All procedures were performed successfully with low rates of procedural complications (9.8%). At 2-week follow-up, no patients had symptoms or confirmed COVID-19 infection with significant improvements in quality if life and symptoms. CONCLUSION: We demonstrated that patients undergoing coronary and structural procedures can be safely admitted during the COVID-19 pandemic, with no patients contracting COVID-19 during their admission. Reassuringly, patients reflective of typical practice, that is, those at moderate or higher risk, were treated successfully. This pilot provides important information applicable to other settings, specialties and areas to reintroduce services safely.


Assuntos
Serviço Hospitalar de Cardiologia/organização & administração , Angiografia Coronária/métodos , Procedimentos Cirúrgicos Eletivos , Implante de Prótese de Valva Cardíaca/métodos , Controle de Infecções , Intervenção Coronária Percutânea/métodos , Idoso , /prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Risco Ajustado/métodos , Gestão da Segurança/organização & administração , Reino Unido/epidemiologia
4.
J Invasive Cardiol ; 33(2): E71-E76, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33348314

RESUMO

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.


Assuntos
Cateterismo Cardíaco/métodos , Serviço Hospitalar de Cardiologia , Unidades de Cuidados Coronarianos , Cuidados Críticos , Controle de Infecções , Laboratórios Hospitalares/organização & administração , Inovação Organizacional , Infarto do Miocárdio com Supradesnível do Segmento ST , /epidemiologia , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/tendências , Unidades de Cuidados Coronarianos/métodos , Unidades de Cuidados Coronarianos/organização & administração , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cuidados Críticos/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Cidade de Nova Iorque/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Assistência Perioperatória/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
5.
Rev. esp. cardiol. Supl. (Ed. impresa) ; 20(supl.E): 21-26, dic. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195343

RESUMO

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


Assuntos
Humanos , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias , Serviço Hospitalar de Cardiologia/tendências , Telecardiologia , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/normas , Telemonitoramento
7.
Rev. esp. cardiol. (Ed. impr.) ; 73(10): 804-811, oct. 2020. tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-199624

RESUMO

INTRODUCCIÓN Y OBJETIVOS: Analizar la estructura asistencial y las características clínicas de las cardiopatías congénitas del adulto en España. MÉTODOS: En 2014 se realizó una encuesta entre 32 centros que se clasificaron como nivel 1 o 2 en función de su estructura asistencial. En 2017 se realizó un registro clínico de todos los pacientes asistidos consecutivamente en cada centro durante un periodo de 2 meses. RESULTADOS: Un total de 31 centros (97%) respondieron la encuesta. Se excluyó a 7 por no disponer de consulta especializada. Hasta el año 2005 solo había 5 centros con dedicación específica, pero en 2014 había 10 centros de nivel 1 y 14 de nivel 2 con un total de 19.373 pacientes en seguimiento. La estructura institucional era completa en la mayoría de los centros, pero solo el 33% disponía de enfermería propia y el 29%, de unidad de transición estructurada. La actividad terapéutica específica supuso el 99 y el 91% de la publicada en los registros nacionales de cirugía y cateterismo terapéutico. Del total, el 44% de los pacientes tenían cardiopatía de complejidad moderada y el 24%, de gran complejidad. Aunque el 46% de los pacientes atendidos en centros de nivel 2 tenían cardiopatías simples, el 17% eran cardiopatías de gran complejidad. CONCLUSIONES: La estructura y la actividad de los centros españoles cumplen las recomendaciones internacionales y son comparables a las de otros países desarrollados. El espectro de cardiopatías en seguimiento muestra una concentración de lesiones de complejidad moderada y gran complejidad incluso en centros de nivel 2. Sería aconsejable reordenar el seguimiento de los pacientes en función de las recomendaciones internacionales


INTRODUCTION AND OBJECTIVES: To assess the structure of health care delivery and the clinical characteristics of adults with congenital heart disease (ACHD) attending specialized centers in Spain. METHODS: A survey was conducted among 32 Spanish centers in 2014. The centers were classified into 2 levels based on their resources. In 2017, a clinical dataset was collected of all consecutive patients attended for a 2-month period at these centers. RESULTS: A total of 31 centers (97%) completed the survey. Seven centers without specialized ACHD clinics were excluded from the analysis. In 2005, only 5 centers met the requirements for specific care. In 2014, there were 10 level 1 and 14 level 2 centers, with a total of 19 373 patients under follow-up. Health care structure was complete in most centers but only 33% had ACHD nurse specialists on staff and 29% had structured transition programs. Therapeutic procedures accounted for 99% and 91% of those reported by National Registries of Cardiac Surgery and Cardiac Catheterization, respectively. Among attended patients, 48% had moderately complex lesions and 24% had highly complex lesions. Although 46% of patients attending level 2 centers had simple lesions, 17% had complex lesions. CONCLUSIONS: The structure for ACHD health care delivery in Spain complies with international recommendations and is similar to that of other developed countries. Congenital heart diseases under specialized care consist mostly of moderately and highly complex lesions, even in level 2 centers. It would be desirable to reorganize patient follow-up according to international recommendations in clinical practice


Assuntos
Humanos , Adulto , Cardiopatias Congênitas/epidemiologia , Serviço Hospitalar de Cardiologia/organização & administração , Especialização/tendências , Infraestrutura Sanitária/tendências , Espanha/epidemiologia , Sobreviventes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Padrão de Cuidado/tendências
8.
Intern Med J ; 50(8): 1000-1003, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32881225

RESUMO

An increase in coronavirus disease (COVID-19) infections prompted Level 4 lockdown throughout New Zealand from 25 March 2020. We have investigated trends in coronary and electrophysiology (EP) procedures before and during this lockdown. The number of acute procedures for ST elevation myocardial infarction remained stable. In contrast, the number of in-patient angiograms and percutaneous intervention procedures fell by 53% compared with the previous 4 weeks in 2020 and by 56% compared with the corresponding period in 2019. Further study is required to determine the reasons for these trends.


Assuntos
Serviço Hospitalar de Cardiologia , Infecções por Coronavirus , Controle de Infecções/estatística & dados numéricos , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral , Infarto do Miocárdio com Supradesnível do Segmento ST , Betacoronavirus , Eletrofisiologia Cardíaca/métodos , Eletrofisiologia Cardíaca/tendências , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Angiografia Coronária/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Pandemias/prevenção & controle , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Carga de Trabalho/estatística & dados numéricos
9.
J Cardiovasc Med (Hagerstown) ; 21(9): 654-659, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32740498

RESUMO

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.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Serviço Hospitalar de Cardiologia , Infecções por Coronavirus , Cardiopatias Congênitas , Controle de Infecções , Pandemias , Assistência Perinatal , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Masculino , Modelos Organizacionais , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/métodos , Gravidez
10.
Hell J Nucl Med ; 23 Suppl: 26-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32860393

RESUMO

The Coronavirus Disease 2019 (COVID-19) pandemic is the biggest shock in decades to the well developed healthcare system and resources worldwide. Although there was a wide variation in the level of preparedness, the transition was tough even for the most renowned healthcare systems. Increasing the capacity and adapting healthcare for the needs of COVID-19 patients is described by the WHO as a fundamental outbreak response measure. However, while the system is preoccupied with a pandemic infection, patients suffering from other illnesses are in high risk to get infected, also being compromised by the imperative shift in medical resources and significant restrictions on routine medical care. For example patients with cardiovascular disease and others referred for nuclear cardiology procedures are frequently greater than 60 years of age and have other comorbidities (e.g. hypertension, diabetes, chronic lung disease, and chronic renal disease) that place them at a high-risk for adverse outcomes with COVID-19, providing unique challenges for their management in healthcare facilities, as well as for the care of health care personnel. Numerous medical specialty societies and governmental agencies issued guidelines aiming at the specification of preventive measures and amendments in everyday clinical practice during the escalation and peak of the pandemic. In accordance, the American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI), issued a common statement in late March 2020, which was provided as an initial response to this pandemic, offering specific recommendations for adapting nuclear cardiology practices at each step in a patient's journey through the lab-for inpatients, outpatients and emergency department patients. One of the main recommendations was cancelling or delaying of all non-urgent nuclear cardiology studies. As COVID-19 follows a different time course in different geographic regions and lockdowns begin to lift in many countries, the issue of re-establishment of non-emergent care, in nuclear cardiology laboratories amongst others, has to be addressed in a watchful and balanced way, keeping in mind that the COVID-19 crisis is far from over. Furthermore measuring what is happening in the current crisis is essential to ensuring preparedness for a possible next wave of the pandemic. Recently the ASNC, SNMMI, the International Atomic Energy Agency (IAEA) and the Infectious Disease Society of America (IDSA), issued an information statement which describes a careful approach to reestablishment of non-emergent care in nuclear cardiology laboratories reflecting diverse settings from the United States and worldwide. In the same spirit it is also the reintroduction guidance issued by North American Cardiovascular Societies. In this paper we provide a synopsis of the basic steps of adapting nuclear cardiology practice in the era of COVID-19 in order to balance between the risk of viral transmission while also providing crucial cardiovascular assessments for our patients.


Assuntos
Serviço Hospitalar de Cardiologia/normas , Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Serviço Hospitalar de Cardiologia/organização & administração , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Prioridades em Saúde , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologia
17.
Can J Cardiol ; 36(8): 1313-1316, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32505633

RESUMO

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.


Assuntos
Serviço Hospitalar de Cardiologia , Doenças Cardiovasculares , Infecções por Coronavirus , Ética Institucional , Controle de Infecções/métodos , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Canadá/epidemiologia , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/tendências , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Modelos Organizacionais , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
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