ABSTRACT
Since the SARS-CoV-2 pandemic began, numerous studies have reported a concerning drop in the number of acute myocardial infarction (AMI) admissions. In the present systematic review and meta-analysis, we aimed to compare the rate of AMI admissions and major complication during the pandemic, in comparison with pre-pandemic periods. Three major databases (PubMed, Scopus, and Web of Science Core Collection) were searched. Out of 314 articles, 41 were entered into the study. Patients hospitalized for AMI were 35% less in the COVID-19 era compared with pre-pandemic periods, which was statistically significantly (OR = 0.65; 95% CI: 0.56-0.74; I2 = 99%; p < 0.001; 28 studies). Patients hospitalized for STEMI and NSTEMI were 29% and 34% respectively less in the COVID-19 era compared with periods before COVID-19, which was statistically significantly (OR = 0.71; 95% CI: 0.65 -0.78; I2 = 93%; p < 0.001; 22 studies, OR = 0.66; 95% CI: 0.58-0.73; I2 = 95%; p < 0.001; 14 studies). The overall rate of in-hospital mortality in AMI patients increased by 26% in the COVID-19 era, which was not statistically significant (OR = 1.26; 95% CI: 1.0-1.59; I2 = 22%; p < 0.001; six studies). The rate of in-hospital mortality in STEMI and NSTEMI patients increased by 15% and 26% respectively in the COVID-19 era, which was not statistically significant (OR = 1.15; 95% CI: 0.85-1.57; I2 = 48%; p = 0.035; 11 studies, OR = 1.35; 95% CI: 0.64-2.86; I2 = 45%; p = 0.157; 3 articles). These observations highlight the challenges in the adaptation of health-care systems with the impact of the COVID-19 pandemic.
ABSTRACT
Hospitals all around the world play an essential role in response to the COVID-19 pandemic. During an epidemic event, hospital leaders frequently face new challenges requiring them to perform unaccustomed tasks, which might be well beyond the scope of their previous practice and experience. While no absolute set of characteristics is necessary in all leadership situations, certain traits, skills and competencies tend to be more critical than others in crisis management times. We will discuss some of the most important ones in this manuscript. To strengthen those managerial competencies needed to face outbreaks, healthcare leaders should be better supported by competency-based training courses as it is more and more clear that traditional training courses are not as effective as they were supposed to be. It seems we should look at the COVID-19 pandemic as a learning opportunity to re-frame what we expect from hospital leaders and to re-think the way we train, assess and evaluate them.