ABSTRACT
Background: The use of intermittent infusion of Levosimendan (L) demonstrated to be able to reduce hospitalisations and to improve functional capacity and quality of life in patients with advanced heart failure (HF). Purpose: To describe our preliminary experience regarding L intermittent infusions in advanced HF older outpatients. Methods: A maximum of three consecutive L infusions were carried out 14 days apart. The duration of each session was 8 hours. The starting infusion rate was 0.05 μg/Kg/min, titrated every 30/60' up to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and arrhythmias recorded during telemetry. We evaluated patients by clinical, laboratory and echocardiographic controls at baseline and two weeks after the end of treatment. Results: Since November 2020 we enrolled 17 patients with a mean age of 77 years;12% were women. HF etiology was ischemic in 64% of cases and the mean ejection fraction was 30%. A total of 41 infusions were performed, the mean dose of L administered was 5.4 mg/infusion. Three patients did not complete the expected treatment, one due to an intercurrent COVID-19 infection and two because of social issues. In 28 sessions the maximum infusion rate was reached, while in 12 a lower rate;in one case drug infusion was suspended (Figure 1). The main complication observed was marked non-symptomatic hypotension, followed by the onset of atrial fibrillation or frequently ventricular extrasystole. As shown in Figure 2, at the end of the infusion cycles, there was an improvement of clinical and hemodynamic parameters. Moreover, at the end of the infusion cycles, we observed a reduction in the mean dose of loop diuretic prescribed and an increase in the prescription of disease- modify treatment, according to HF guidelines (Figure 3). Conclusions: In our preliminary experience repeated infusions of L appear to be well tolerated in older patients with advanced HF. Although there was an improvement in congestion parameters and targeted therapy for HF, more data will be needed in the future to confirm its safety and efficacy, also in terms of guidelines-directed medical therapy. (Figure Presented).
ABSTRACT
Background: During national lockdown (LD) fear of contagion and heath care services resources redistribution to face the COVID-19 emergency, may have affected hospital access rates as well as management and inhospital outcomes for patients with acute coronary syndromes (ACS). Purpose: To describe changes in the incidence of hospital admissions for STE- and NSTE-ACS and related short term outcomes during the first pandemic wave in Tuscany, Italy. Methods: The Agenzia Regionale di Sanità (ARS) collects administrative data from 40 hospitals in Tuscany, serving 3.730.000 inhabitants. We analyzed hospitalization rates, clinical characteristics and in-hospital mortality of STE- and NSTE-ACS patients admitted during the first 2020 pandemic wave and compared them with those of an historical reference period (2018-2019) in 3 time intervals: A) pre-LD (Jan-Feb);B) LD (March- May) and C) post-LD (June-Sept). Results: A total of 1955 STE-ACS (mean age 69±13 years;69% males) and 2582 NSTE-ACS (mean age 73±13 years;65% males) admissions were recorded. Compared to the historical reference period a notable and statistically significant decrease for both STE- (-10%, p<0.0001) and NSTE-ACS (-17.9%, p=0.004) was observed (Figure). Among STE-ACS hospital admissions, the greatest reduction was observed during B (-23%, p<0.0001), particularly in the month of April (-35.2%) and persisted, just missing statistical significance (-7%, p=0.08), during C. Among NSTEACS a similar behavior could be observed with the greatest reduction during B (-34%, p<0.0001) and a peak in the month of March (-43.3%). Interestingly, a significant decrease was observed both during A (-12.4%, p=0.004) and continued during C (-7%, p<0.04). Analyzing mean age and gender as well as baseline main clinical characteristics (eg. diabetes, heart failure, Charlson comorbidity score) no differences could be observed among STE- and NSTE-ACS patients between the two observation periods (2020 vs 2018-2019). Interestingly the percentage of STE-ACS patients presenting through the Emergency Medical System increased significantly (+10%) while no change was seen for the rate of those with a FMC to catheterization lab wire crossing <120 min. In Hospital mortality rates were 7.7% and 2.7% for STE-ACS and NSTE-ACS respectively and did not differ with those observed in the historical refence period. Conclusions: We found a marked reduction in ACS hospitalizations during the first pandemic wave compared to the same period of observation in the previous two years. This decline was present for both groups of ACS, but was more pronounced for patients presenting with NSTE-ACS and persisted to some extent in the post-lockdown period. Nevertheless, our data show that the process of care was granted as usual for the management of ACS patients who gained access to the emergency network during the first pandemic wave and in-hospital mortality did not increase.
ABSTRACT
Background: Atrial fibrillation (AFib) represents the most common arrhythmia in the general population, Its prevalence is progressively increasing and currently is estimated around 3-4% and accounts for about 1.5% of all the admissions to our emergency departments (ED). Aim of the study: During the first wave of COVID 19 a significant decrease of Hospital admissions for several cardiovascular conditions was observed, The aim of the present investigation was to evaluate the incidence of new onset AFib admitted to our Regional Hospital Network during the first COVID wave. Methods: We analyzed all the Hospital admissions for AFib as major diagnosis through the data base of Agenzia Regionale di Sanità Toscana. We compared the 2020 data with those of 2018 and 2019. Results: Compared to the previous two years we observed an absolute reduction of-51% in AFIb ED accesses and Hospitalizations during the lock-down period (March-55.2%, April-54.9%, May-34.3%) (FIG 1). A reduction was also observed in the following months although to a lesser extent. Female gender, particulraly the youngest showed the greatest reduction. AFib patients admitted to the ED were more frequently admitted to the ward with respect to 2019 (15.6% vs 13.9%). We also detected a significant reduction of reported ischemic stroke that reached-24.7% on April 2020 (FIG 2). Conclusions: Our data, show a significant reduction of AFib incidence in the Regional Hospital Network during the first COVID 19 wave. The observed pattern may depend on several causes. The forced lockdown may have caused a true reduction in the AFib incidence due to a diminished exposure to favouring or predisposing factors. A second explanation may be the fear of public contacts or reluctancy to access to the Emergency wards and Hospitals seen as possible source of viral infection. The contemporary reduction of ischemic stroke occurrence or death and AFib incidence may suggest a positive effect of the lock-down on these conditions, at least over the short term. It is highly unlikely that patients with an acute condition such as AFib or stroke would not seek medical attention to such a wide extent as that observed. It appears worrisome the observed relative increase in Hospital admission of AFib patients during the lock down. Indeed, this pattern may reflect a delayed access to the necessary care with the progression to more severe complications and subsequent need of a prolonged care.