ABSTRACT
BACKGROUND: The East Timor Hearts Fund has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. AIM: To develop collaborative telehealth services between Australia and Timor-Leste in the context of international border closures due to the COVID-19 pandemic. METHODS: Scoping discussions identified major challenges (structural, patient related and medical system related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared with an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. RESULTS: Twenty-three patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared with an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients; 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23; 73.9%) and Dili based (18/23; 78.3%), with a mean age of 25.9 ± 7.2 years. The majority (12/23; 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-min walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. Eleven (47.8%) patients were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at the current inability to provide interventional services was highlighted. CONCLUSION: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.
ABSTRACT
The global COVID-19 pandemic remains challenging with efforts for community vaccination the primary strategy to control transmission and disease sequalae in the mid to long term. While several candidate vaccines have been approved for use, there is an ongoing discussion regarding potential vaccine-related adverse events. Notably, thrombotic thrombocytopaenia has been reported following ChAdOx1 nCov-19 (AstraZeneca) vaccination. We report the first known case of takotsubo (stress) cardiomyopathy 4 days after administration of the ChAdOx1 nCoV-19 vaccine in a 72-year-old man. While this condition remains one primarily seen in females, our case represents a new trigger that warrants careful consideration when assessing patients presenting with acute coronary syndromes following ChAdOx1 nCoV-19 vaccination.