ABSTRACT
Background: Services during the pandemic were severely restricted, public reluctance to seek medical assistance rose, with a reduction of diagnostic and therapeutic modalities use in coronary artery disease (CAD). However, information about perceived barriers of care among cardiologists is limited. We aim to explore these barriers diagnostic and treatment modalities of CAD in Latin America during the pandemic. Methods: An anonymous Google form 12 closed-questions survey was conducted between November 2020 to January 2021. Latin American cardiologists members of the Imaging Society (SISIAC) of the Inter-American Society of Cardiology (SIAC) were reached by email and social media. Results: Differences were found in relation to patients' perceived reluctance to undergo testing, particularly in South America and inpatient care (p < 0.05). Respondents' perceived barriers in the use of CV tests were higher in South America (p < 0.05) and related to public practice (p < 0.01). Barriers to the treatment of myocardial infarction were present in all regions (p < 0.05), and follow-up was influenced by COVID-19 in both public and private practices (p = 0.01). Conclusions: Regardless of treatment and diagnostic approach (invasive or non-invasive) followed, according to physicians' perception, the pandemic significantly impacted the clinical management of CAD in the Latin American population, similar to the global situation.
ABSTRACT
Latin America (LATAM) children offer special insight into Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV2) due to high-risk race/ethnicity, variability in medical resources, diverse socioeconomic background, and numerous involved organ systems. This multinational study of LATAM youth examined the distinguishing features of acute or late multisystem SARS COV2 with versus without cardiac involvement. A consecutive sample of youth 0-18 years old (N = 98;50% male) presenting with multisystem SARS COV2 to 32 centers in 10 Latin American countries participating in a pediatric cardiac multi-imaging society were grouped as with versus without cardiac involvement, defined as abnormal echocardiographic findings or arrhythmia. Collected clinical data were analyzed by Student's t-test or Fisher's exact test. Cardiac (N = 48, 50% male) versus no cardiac (N = 50, 50% male) were similar in age; weight; nonrespiratory symptoms; and medical history. The cardiac group had 1 death and symptoms including coronary artery dilation, ejection fraction <50%, pericardial effusion, peripheral edema, arrhythmia, and pulmonary artery thrombus. The cardiac group had higher risk of ICU admission (77% vs 54%, p = 0.02); invasive ventilation (23% vs 4%,p = 0.007); vasoactive infusions (27% vs 4%, p = 0.002); prominent respiratory symptoms (60% vs 36%, p < 0.03); abnormal chest imaging (69% vs 34%, p = 0.001); troponin (33% vs 12%, p = 0.01); alanine aminotransferase (33% vs 12%, p = 0.02); and thrombocytopenia (46% vs 22%, p = 0.02). Receiver operating curve analysis showed that abnormal laboratories had 94% sensitivity and 98% negative predictive value on the need for ICU interventions.Conclusion: In LATAM children with multisystem SARS COV2, cardiac involvement was prevalent. Cardiac involvement was more likely to require ICU interventions, certain abnormal labs, and respiratory involvement. What is Known: ⢠SARS COV2 can be asymptomatic in children but in some cases can have serious multisystemic involvement. ⢠Hispanic ethnicity is purportedly at high risk of SARS COV2 in nations where they are often disadvantaged minority populations. What is New: ⢠Latin American children presenting with multisystem SARS COV2 frequently have cardiac involvement which was associated with ICU interventions; prominent respiratory symptoms; abnormal chest X-ray; elevated troponin, ALT, and thrombocytopenia. ⢠Elevated troponin, ALT or thrombocytopenia had high sensitivity and negative predictive value on the need for intensive care interventions.