Impact of COVID-19 infection on short-term outcome in patients referred to stress myocardial perfusion imaging.

PURPOSE: We assessed the impact of COVID-19 infection on cardiovascular events in patients with suspected or known coronary artery disease (CAD) referred to stress single-photon emission computed tomography myocardial perfusion imaging (MPS). METHODS: A total of 960 consecutive patients with suspected or known CAD were submitted by referring physicians to stress MPS for assessment of myocardial ischemia between January 2018 and June 2019. All patients underwent stress-optional rest MPS. Perfusion defects were quantitated as % of LV myocardium and expressed as total perfusion defect (TPD), representing the defect extent and severity. A TPD ≥ 5% was considered abnormal. RESULTS: During a mean follow-up of 27 months (range 4-38) 31 events occurred. Moreover, 55 (6%) patients had a COVID-19 infection. The median time from index MPS to COVID-19 infection was 16 months (range 6-24). At Cox multivariable analysis, abnormal MPS and COVID-19 infection resulted as independent predictors of events. There were no significant differences in annualized event rate in COVID-19 patients with or without abnormal MPS (p = 0.56). Differently, in patients without COVID-19, the presence of abnormal MPS was associated with higher event rate (p < .001). Patients with infection compared to those without had a higher event rate in the presence of both normal and abnormal TPD. CONCLUSION: In patients with suspected or known CAD, the presence of COVID-19 infection during a short-term follow-up was associated with a higher rate of cardiovascular events.

Implications of COVID-19 Infection on Medication Adherence with Chronic Therapies in Italy: A Proposed Observational Investigation by the Fail-to-Refill Project.

Poor medication adherence leads to worsening of clinical outcomes and increases healthcare costs, especially in the context of chronic conditions. The effects of new COVID-19 infection and the measures taken in response to the outbreak are further increasing the concerns about medication adherence. Patients with chronic diseases, many of whom are older adults, have been strongly recommended to stay at home and avoid social contacts even with family members, who often provide support for regular use of therapies. Moreover, the mobilization of health personnel to the frontline of the COVID-19 infection could limit access to healthcare services. Within the Health-DB project, the Fail-To-Refill monitoring system was designed to evaluate the lack of adherence to chronic therapies in Italian clinical practice settings. Considering the date and dose coverage of last prescription, all patients due to refill this prescription for a chronic therapy in the last month were identified, and it was verified if they had the refill. The proposed future analysis, based on the data linkage between the current administrative flows of the Italian Local Health Units involved, will be carried out on a monthly basis from the beginning of the infection, and the "post-Covid-19" results will be compared with "pre-COVID-19" results, calculated for the last three years for patients with chronic therapies. Preliminary data herein presented showed a trend of increased failed refill during the months of lockdown for lipid-lowering and biologic therapies. The pre-COVID-19 trend compared to that of post-COVID-19 in the next months will be useful to estimate the percentage of failure to refill truly related to COVID-19 and on the measures adopted. The identification of patients that do not refill their prescriptions allows healthcare professionals to put in place actions aimed to promptly correct the lack of adherence, thus reducing the associated negative outcomes.

Cardiac magnetic resonance imaging during the COVID-19 pandemic: A southern Italian single-center experience.

PURPOSE: We aimed to assess the impact of COVID-19 pandemic on cardiac magnetic resonance (CMR) imaging studies performed during the lockdown imposed by the Italian Government from March 2020 to May 2020. MATERIALS AND METHOD: We reviewed the number and the findings of CMR scans performed during the COVID-19 pandemic between March and May 2020 at University of Naples Federico II. The number and the findings of CMR studies acquired in the corresponding months of 2017, 2018 and 2019 were also assessed for direct comparison. RESULTS: A total of 117 CMR studies was considered, including the procedures performed during the pandemic (n = 18) and those performed in the corresponding months of the prior 3 years (n = 99). The number of CMR studies performed during the COVID-19 pandemic was significantly (P < .01) lower compared to the mean number (n = 33) of the procedures performed in the corresponding months of 2017-2019. The percentage of abnormal CMR studies was similar (P = 0.73) during the pandemic (67 %) compared to that found in the corresponding months of 2017-2019 (70 %) suggesting that many abnormal tests were missed due to the lockdown. CONCLUSION: The number of CMR studies was significantly reduced during the COVID-19 pandemic compared to the corresponding period of the previous three years. The lack of difference in the prevalence of abnormal CMR studies between the two study time intervals strongly suggests that many patients with potentially abnormal imaging test have been missed during the pandemic.

Management of differentiated thyroid cancer through nuclear medicine facilities during Covid-19 emergency: the telemedicine challenge.

PURPOSE: To investigate whether a telemedicine service (TMS) carried out during the Covid-19 pandemic impacted on management of patients with differentiated thyroid cancer (DTC). METHODS: We retrospectively reviewed the number and the findings of outpatient visits in DTC subjects referred between March 11, 2020, and May 31, 2020, during the Covid-19 pandemic at the Radiometabolic Unit of the University of Naples Federico II. Office visits scheduled in March and May 2020 were converted in teleconsultation reaching all patients planned for an in-ward access to advise them to use the TMS for all clinical necessity. The number and the findings of DTC patients evaluated by in-ward access in the corresponding period of 2019 were also assessed for direct comparison. RESULTS: The number of outpatient visits performed by TMS during the pandemic (n = 445) and by in-ward access in the corresponding period of 2019 (n = 525) was comparable with only 15% of outpatient evaluations missed. CONCLUSIONS: Our findings demonstrate the utility of telemedicine tools to avoid the potential negative impact of interruption or postponement of diagnostic and/or therapeutic procedures. Therefore, investments in medical network system development, including the implementation of telehealth approaches, should be encouraged at national and international levels.

Effects of the COVID-19 pandemic on myocardial perfusion imaging for ischemic heart disease.

PURPOSE: We assessed the effects of the COVID-19 pandemic on myocardial perfusion imaging (MPI) for ischemic heart disease during the lockdown imposed by the Italian Government. METHODS: We retrospectively reviewed the number and the findings of stress single-photon emission computed tomography (SPECT)-MPI performed between February and May 2020 during the COVID-19 pandemic at the University of Napoli Federico II. The number and the findings of stress SPECT-MPI studies acquired in the corresponding months of the years 2017, 2018, and 2019 were also evaluated for direct comparison. RESULTS: The number of stress SPECT-MPI studies performed during the COVID-19 pandemic (n = 123) was significantly lower (P < 0.0001) compared with the mean yearly number of procedures performed in the corresponding months of the years 2017, 2018, and 2019 (n = 413). Yet, the percentage of abnormal stress SPECT-MPI studies was similar (P = 0.65) during the pandemic (36%) compared with the mean percentage value of the corresponding period of the years 2017, 2018, and 2019 (34%). CONCLUSION: The number of stress SPECT-MPI studies was significantly reduced during the COVID-19 pandemic compared with the corresponding months of the previous 3 years. The lack of difference in the prevalence of abnormal SPECT-MPI studies between the two study periods strongly suggests that many patients with potentially abnormal imaging test have been missed during the pandemic.