ABSTRACT
Background: Advanced heart failure (HF) is a complex clinical syndrome with scarce therapeutic options. Despite growing body of research in the field, no alternative end-stage solution is available for those individuals who are not eligible for heart transplant and mechanical circulatory support. The efficacy of implantable hemodynamic monitoring is currently being tested. Clinical manifestations of congestive HF appear late in the progression to acute decompensation, whereas intracardiac pressures rise gradually and can anticipate, even by weeks, the symptoms onset, thus offering a sweet spot to timely face an incipient acute decompensation. To date, the only implantable monitoring systems which received the regulatory agencies approval is a PAP sensor allowing PAP-guided management in symptomatic patients with reduced left ventricular ejection fraction (LVEF <35%). Although right-sided pressures data have proved their usefulness, they do not always correlate with left heart chambers pressures, so that PAP indirect estimation of left ventricular filling pressure can be misleading in some clinical contexts. Purpose. The V-LAP system is the latest-generation device, capable of monitoring the left atrial pressure (LAP) directly, by an intracardiac leadless sensor, transmitting LAP data wirelessly to an external reader. It is designed to offer a continuously updated status of the left-sided hemodynamics in order to improve the outcomes of advanced chronic HF-patient by reducing HF-related hospitalizations. Methods: In our center, V-LAP was implanted in five NYHA class III HF patients, not eligible for heart transplant, with a history of frequent hospital readmission and recurrently elevated proBNP levels. After confirmation of the device reliability, LAP trends have been remotely monitored over time in order to guide therapy optimization. Results: Over a median follow-up time of 18 months, LAP - driven therapy adjustments succeeded in noticeably reducing LAP and no HF-related hospitalization occurred in all patients considered. Morover, functional capacity improved in three out of five patients (NYHA class from III to II), and this was paralleled by an increase in the perceived quality of life as indicated by the KCCQ summary score (67.01±15.95 at baseline vs 83.21±11.94 at latest follow-up). The overall compliance of our patients to daily LAP measurements was > 90%, attesting a remarkable patient usability and acceptance. Conclusion: Preliminary data from V-LAP application at our institution expressed optimistic efficacy, along with remarkable reliability and ease of use, encouraging patients to adhere with a high compliance rate. In covid-19 era, VLAP revealed to be an excellent tool to control HF patients avoiding medical contacts and in-hospital exposure. While further study is needed, heart failure patient management guided by the V-LAP system may have the potential to significantly improve clinical outcomes.
ABSTRACT
Introduction: The study of seasonal influences on the COVID-19 pandemic can take advantage of the unique position of Chile and its different climatic profiles in the north-south extension. The purpose is to verify the influence of seasonal climate changes on the COVID-19 in the temperate and sub-arctic areas of Chile. Methods: We monitored the evolution of CFR in temperate versus sub-boreal regions, reporting from the John Hopkins University COVID-19 Center on the CFR in each province in midwinter, spring, and early summer. Results: CFR worsened from mid-winter to mid-spring in the temperate zone of Chile, while in the sub-boreal area the CFR improves in the same period, (Kruskal Wallis Test, p=0.004). In the temperate zone after the increase in late winter-early spring, CRF tends to stabilize;on the contrary in the sub-boreal zone, there is a more marked tendency to worsen the CFR at the same time (Kruskal Wallis Test, p=0.010). The temperate zone of Chile shows a CFR increasing until spring-like temperate Europe, unlike Europe CFR does not decrease in summer, but the mean minimum temperature in temperate Chile is lower in summer than in temperate Europe. In Patagonian, CFR remains stable or drops from winter to spring but increases in early summer. Conclusion: The temperate and sub-boreal zones of Chile have a markedly different CFR variation profile during the COVID-19 pandemic.
ABSTRACT
Introduction. The COVID-19 pandemic affected the lives of millions of patients worldwide, both directly, with its insidious infection, and by means of collateral damages that severely hindered the health system. However, COVID-19 era has also become the testing ground for alternative ways to deliver healthcare avoiding in-hospital contacts, thus affirming the validity of telemedicine as a key tool to improve the patient journey. In our center, video consults have been integrated to follow chronic coronary syndrome (CCS) patients, not only preventing the risk of contagion but laying the groundwork for a shift in clinical care course. Methods. Since July 2020, the Lazio Region offered to its inhabitants free of charge teleconsulting for both primary care and specialist referral. At the cardiovascular department of Fondazione Policlinico A. Gemelli IRCCS, this opportunity has been applied to optimize the CCS patient's care pathway, both replacing the in-person first visit to the clinic and to assess follow-up consult after percutaneous myocardial revascularization. Results. In our experience, 110 patients have been examined with virtual visits. 37 patients (33.6%) have been referred to coronary angiography. Being CCS a context in which the transition to higher level-tests is mainly led by symptoms, these video consultations worked as well as in-hospital visits in ruling out which patients needed ischaemia testing or coronary angiography, and to probe the relative urgency criteria. Moreover, the implementation of this parallel virtual pathway for these patients allowed us to decrease the waiting times for in-person visits at our CCS clinic, with an estimated time reduction of almost 3 months. Conclusion. COVID-19 accclcratcd the rise of tclchcalth to empower primary and specialty health care. The adoption of a remote pathway for chronic illness patients may also provide more opportunities for treatment of severe cases at in-person clinic that is often overcrowded. CCS seems the perfect setting for an integrated physical and virtual health system.
ABSTRACT
The objective of our study is, therefore, to verify whether the trend of the pandemic regarding the lethality of the virus is similar in Argentina and Chile to that which emerged in the temperate countries of Europe and Oceania. The CFRs were derived from the John Hopkins University database. To check the trend of the Case Fatality Ratio and Argentina, Chile we calculated this index on the same dates in which it was calculated for comparison in European countries and in Australia and New Zealand: i.e., May 6th and from May 6th to the September 21st. We continued comparing the other countries of the southern hemisphere, recalculating the CFR as of 11th November. For comparing a period of year homogeneous, late spring, we calculate the change if CFR from 20th March to 15th April in the North Hemisphere. Our study's results seem to confirm in Latin America a possible influence of the climate and the changing of the seasons in the lethality of the virus. For the same exceptions, it is evident that the study shows that this factor is not the only one nor probably the most important. The obvious exception concerns Argentina, which does not show any summer improvement of the CFR, unfortunately;for this, nation-specific data are not available to verify if the trend is homogeneous in the different climates that the vast territory presents. Other very important factors come into play, among which the diffusivity of the virus also seems to play a role. © 2020 by the authors.
ABSTRACT
Climate could influence the COVID-19 pandemic, but while no evidence has been advanced on the influence of colder climates, some studies have provided data to support a possible heat-related protective factor. The objective is to verify whether areas with a Cold Temperate Climate (TC) have a higher Case Fatality Ratio (CFR) for COVID-19 than areas with a Cold Climate (CC) or with a Mediterranean Climate (MC) in the European Union and the Enlarged European Region. Countries or regions were subdivided into 3 groups according to the Koppen climate classification system: TC (Cfa, Cfb and Cfc in the Koppen system);MC (Csa, Csb);CC (D and E in the Koppen system). The total number of cases and the total number of deaths were detected on 13 August 2020 on the COVID-19 Map-Johns Hopkins Coronavirus Resource Center-the CFR was thus calculated by area. Living in TC areas is strongly associated with risk of a high Case Fatality Ratio for COVID-19, OR for MC=0.42, IC 95% 0.41-0.43;OR for CC=0.33, IC 95% 0.33-0.35. The results are confirmed in the EU, OR per MC=0.85, CI 95% 0.84-0.87;OR per CC=0.63, IC 95% 0.61-0.65.The study found that the IC in a humid temperate climate is associated with higher CFR with respect to the coldest and warmest temperate climates in Europe. This does not appear to be the only determinant of the pandemic.
ABSTRACT
The climate has an influence on the COVID-19 virus lethality. The aim of this study is to verify if the summer weather coincided with the decrease of the Case Fatality Ratio (CFR) in Europe and if, on the contrary, an inverse trend was observed in Australia and New Zealand. To verify our hypothesis, we considered the largest European countries (Germany, UK, France, Italy, and Spain), plus Belgium and the Netherlands. Furthermore, we compared these countries with Australia and New Zealand. For each country considered, we have calculated the CFR from the beginning of the pandemic to May 6th and from May 6th to September 21st (late summer in Europe, late winter in the southern hemisphere). The CFRs were calculated from the John Hopkins University database. According to the results, in all European countries, a progressive decrease in CFR is observed. A diametrically opposite result is found in Australia where, on the contrary, the CFR is much higher at the end of September (at the end of winter) than on May 6th (mid-autumn), and the risk of dying if we count the infection is higher in September. In New Zealand, there are no statistically significant differences between the two surveys. The present study was based on public access macro data. © 2020 by the authors.