Chile's public healthcare sector hypertension control rates before and during the pandemic and HEARTS implementation.

Hypertension (arterial blood pressure ≥ 140/90 mmHg) is a risk factor for cardiovascular diseases, with the greatest burden of attributable deaths in Chile, having a national prevalence of 27.6%. In 2018, the implementation of HEARTS begun in primary health care centers of the Public Health System, with the aim of achieving increase in control rates, by raising the proportion of hypertensive individuals who meet blood pressure goals (< 140/90 mmHg for individuals 15-79 years old and of 150/90 mmHg for individuals 80 years and older), and thus contributing to reduce cardiovascular morbidity and mortality associated with this condition. This is a descriptive study that follows average treatment and control rates from the Public Health System between 2017-2021 obtained from health centers statistics reports during HEARTS implementation. Treatment and control rates remained at 57% and 39% respectively between 2017-2019. Between 2020 and 2021, in the context of the SARS-CoV-2 pandemic, treatment and control rates decreased very significantly, reaching 46% and 26%, respectively, in December 2021, even though the number of centers reporting the implementation of HEARTS increased from 227 to 387 in this same period. Prior to the pandemic, during the last quarter of 2019, a decrease in cardiovascular health controls was already observed as a result of social protests. In light of the results, the technical pillars of the HEARTS Initiative have an important role in helping to recover the population control rates reached in 2019 and increasing the speed to achieve better hypertension control rates.

La hipertensión arterial (presión arterial ≥ 140/90 mmHg) es un factor de riesgo para las enfermedades cardiovasculares, que tienen la mayor carga de muertes atribuibles en Chile. En este país, la hipertensión tiene una prevalencia nacional del 27,6%. En el 2018 se inició la aplicación del paquete técnico HEARTS en los centros de atención primaria de salud del sistema público de salud de Chile, con el objetivo de lograr un aumento de las tasas de control, al elevar la proporción de personas hipertensas que cumplen con las metas de presión arterial (< 140/90 mmHg para personas de 15 a 79 años y de 150/90 mmHg para personas de 80 años o más) y así contribuir a reducir la morbilidad y la mortalidad cardiovascular asociadas a esta enfermedad. En este estudio descriptivo se realiza un seguimiento de las tasas promedio de tratamiento y control del sistema público de salud entre el 2017 y el 2021 obtenidas de los informes estadísticos de los centros de salud durante la aplicación de la iniciativa HEARTS. Las tasas de tratamiento y control se mantuvieron en 57% y 39%, respectivamente, en el período entre el 2017 y el 2019. Entre el 2020 y el 2021, en el contexto de la pandemia de SARS-CoV-2, las tasas de tratamiento y control disminuyeron de manera muy significativa, y se ubicaron en 46% y 26%, respectivamente, en diciembre del 2021, a pesar de que el número de centros que notificaron la aplicación de HEARTS aumentó de 227 a 387 en el mismo período. Antes de la pandemia, en el último trimestre del 2019, ya se había observado una disminución en los controles de salud cardiovascular debido a las protestas sociales. En vista de estos resultados, los pilares técnicos de la iniciativa HEARTS desempeñan un papel importante para ayudar a recuperar las tasas de control que se habían alcanzado en el 2019 y acelerar la consecución de mejores tasas de control de la hipertensión.

A hipertensão (pressão arterial ≥ 140/90 mmHg) é um fator de risco para doenças cardiovasculares, com a maior carga de mortes atribuíveis no Chile, onde a prevalência nacional é de 27,6%. Em 2018, teve início a implementação da iniciativa HEARTS em centros de atenção primária à saúde do sistema de saúde pública, com o objetivo de elevar as taxas de controle, pelo aumento da proporção de indivíduos hipertensos que alcançam as metas de pressão arterial (< 140/90 mmHg para pessoas de 15-79 anos e de 150/90 mmHg para pessoas a partir de 80 anos), e, assim, contribuir para a redução da morbimortalidade cardiovascular associada a essa condição. Este é um estudo descritivo que acompanha as taxas médias de tratamento e controle no sistema de saúde pública entre 2017 e 2021, obtidas de relatórios estatísticos dos centros de saúde durante a implementação da iniciativa HEARTS. Entre 2017 e 2019, as taxas de tratamento e de controle foram, respectivamente, de 57% e 39%. Entre 2020 e 2021, no contexto da pandemia causada pelo SARS-CoV-2, houve uma diminuição muito significativa das taxas de tratamento e de controle, que chegaram, respectivamente, a 46% e 26% em dezembro de 2021, embora o número de centros que informaram ter implementado o pacote HEARTS tenha aumentado de 227 para 387 no mesmo período. Antes da pandemia, durante o último trimestre de 2019, já se observava uma diminuição dos controles da saúde cardiovascular em consequência de uma onda de protestos sociais. Os resultados mostram que os pilares técnicos da iniciativa HEARTS são importantes para ajudar a recuperar as taxas de controle na população alcançadas em 2019 e aumentar a velocidade para atingir melhores taxas de controle da hipertensão.

Development of a Novel Care Rehabilitation Pathway for Post-COVID Conditions (Long COVID) in a Provincial Health System in Alberta, Canada.

OBJECTIVE: The purpose of this study was to describe the development and composition of a codesigned, multidisciplinary, integrated, systematic rehabilitation framework for post-COVID conditions (PCC) that spans the care continuum to streamline and standardize rehabilitation services to support persons with PCC in Alberta, Canada. METHODS: A collaborative, consensus-based approach was used involving 2 iterative provincial taskforces in a Canadian provincial health system. The first taskforce (59 multidisciplinary stakeholders) sought to clarify the requisite facets of a sustainable, provincially coordinated rehabilitation approach for post-COVID rehabilitation needs based on available research evidence. The second taskforce (129 multidisciplinary stakeholders) translated that strategy and criteria into an operational framework for provincial implementation. Both taskforces sought to align with operational realities of the provincial health system. RESULTS: The summation of this collaborative consensus approach resulted in the Provincial Post COVID-19 Rehabilitation Response Framework (PCRF). The PCRF includes 3 care pathways across the care continuum specifically targeting in-hospital care, continuing care, and community-based care with 3 key elements: (1) the use of specific symptom screening and assessment tools to systematically identify PCC symptoms and functional impairments, (2) pathways to determine patients' rehabilitation trajectory and guide their transition between care settings, and (3) self-management and education resources for patients and providers. CONCLUSION: The PCRF aligns with international mandates for novel, codesigned, multidisciplinary approaches to systematically address PCC and its myriad manifestations across the care continuum. The PCRF allows for local adaptation and highlights equity considerations, allowing for further spread and scale provincially, nationally, and internationally. IMPACT: The PCRF is a framework for health systems to ensure consistent identification, assessment, and management of the rehabilitation needs of postacute and chronic PCC. Rehabilitation providers and health systems can build from the PCRF for their local communities to reduce unmet needs and advance the standardization of access to rehabilitation services for persons with PCC.

What is the current practice for managing patients with chronic limb-threatening ischaemia in vascular surgery services? A survey of UK vascular surgeons.

INTRODUCTION: The Vascular Society of Great Britain and Ireland (VSGBI) Peripheral Arterial Disease Quality Improvement Framework (PAD QIF) stipulates targets for managing patients with chronic limb-threatening ischaemia (CLTI); however, it is unknown whether these are achievable. This survey aims to evaluate contemporary practice for managing CLTI in the UK. METHODS: A questionnaire was developed in conjunction with the VSGBI to survey the management of CLTI and canvass opinions on the PAD QIF. The survey was distributed to all consultant members of the VSGBI and through a targeted social media campaign. RESULTS: Forty-seven consultant vascular surgeons based at 36 arterial centres across the UK responded (response rate from arterial centres = 46%). Only 14.3% of centres provided outpatient consultation within the target of seven days from referral, with only one centre providing revascularisation within the target of seven days from consultation. For inpatient management, 31.6% provided surgical and 23.8% endovascular revascularisation within the target of three days from assessment. While 60% of participants believe the PAD QIF's 5-day 'admitted care' pathway is achievable, only 28.6% thought the 14-day 'non-admitted care' pathway was feasible. Challenges to meeting these targets include the availability of theatre space and angiography lists, and availability of outpatient appointments for patient assessment. CONCLUSIONS: The opinion of UK vascular surgeons indicates that achieving the targets of the PAD QIF represents a major challenge based upon current services. Adapting existing services with a greater focus on providing an 'urgent' model of care may help to potentially overcome these challenges.

Clinical Pathway for Emergency Brain Surgery during COVID-19 Pandemic and Its Impact on Clinical Outcomes.

BACKGROUND: One of the challenges neurosurgeons are facing in the global public health crisis caused by the coronavirus disease 2019 (COVID-19) pandemic is to balance COVID-19 screening with timely surgery. We described a clinical pathway for patients who needed emergency brain surgery and determined whether differences in the surgery preparation process caused by COVID-19 screening affected clinical outcomes. METHODS: During the COVID-19 period, patients in need of emergency brain surgery in our institution were managed using a novel standardized pathway designed for COVID-19 screening. We conducted a retrospective review of patients who were hospitalized through the emergency room and underwent emergency brain surgery. A total of 32 patients who underwent emergency brain surgery from February 1 to June 30, 2020 were included in the COVID-19 group, and 65 patients who underwent surgery from February 1 to June 30, 2019 were included in the pre-COVID-19 group. The baseline characteristics, disease severity indicators, time intervals of emergency processes, and clinical outcomes of the two groups were compared. Subgroup analysis was performed between the immediate surgery group and the semi-elective surgery group during the COVID-19 period. RESULTS: There were no significant differences in baseline characteristics and severity indicators between the pre-COVID-19 group and COVID-19 group. The time interval to skin incision was significantly increased in the COVID-19 group (P = 0.027). However, there were no significant differences in the clinical outcomes between the two groups. In subgroup comparison, the time interval to skin incision was shorter in the immediate surgery group during the COVID-19 period compared with the pre-COVID-19 group (P = 0.040). The screening process did not significantly increase the time interval to classification and admission for immediate surgery. The time interval to surgery initiation was longer in the COVID-19 period due to the increased time interval in the semi-elective surgery group (P < 0.001). CONCLUSION: We proposed a clinical pathway for the preoperative screening of COVID-19 in patients requiring emergency brain surgery. No significant differences were observed in the clinical outcomes before and after the COVID-19 pandemic. The protocol we described showed acceptable results during this pandemic.

Role of Rehabilitation Department for Adult Individuals With COVID-19: The Experience of the San Raffaele Hospital of Milan.

The rapid evolution of the health emergency linked to the spread of severe acute respiratory syndrome coronavirus 2 requires specifications for the rehabilitative management of patients with coronavirus disease 2019 (COVID-19). The symptomatic evolution of patients with COVID-19 is characterized by 2 phases: an acute phase in which respiratory symptoms prevail and a postacute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions, and to cognitive and emotional disorders. Thus, there is the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan and recommends the setup of specialized clinical pathways for the rehabilitation of patients with COVID-19. In this hospital, between February 1 and March 2, 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (intensive care/infectious diseases). In the following 30 days, from March 2 to mid-April, despite the presence of 60 daily arrivals to the emergency department, the organization of patient flow between different wards was modified, and several different units were created based on a more accurate integration of patients' needs. According to this new organization, patients were admitted first to acute care COVID-19 units and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units, and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, and nutritionists.