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1.
JMIR Form Res ; 6(10): e33769, 2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2079960

ABSTRACT

BACKGROUND: Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients' readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users' expectations. OBJECTIVE: This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases. METHODS: We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants. RESULTS: Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication. CONCLUSIONS: During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions.

2.
American Journal of Transplantation ; 22(Supplement 3):1051, 2022.
Article in English | EMBASE | ID: covidwho-2063478

ABSTRACT

Purpose: Although, much has been written about COVID risk and immunization efficacy in transplant recipients, there is little data on the impact of COVID on transplant professionalism. Method(s): A survey about the impact of COVID on professional development was sent to transplant providers. There were 138 responses (10% response rate) with equal representation from transplant nephrologists, pulmonologists, surgeons, cardiologists and advanced practice providers. Responses were evenly divided between gender and across regions of the US. Result(s): 75% of respondents reported that COVID has had a negative impact on their own education with the primary reasons given being 'virtual fatigue' and not taking time off to attend virtual meetings leading to lack of engagement. 40% of respondents reported that staffing shortages made it difficult to attend virtual meetings. When asked about any positive impact of COVID on their education 43% said the ability to view sessions on their own time without travel requirements was positive. The impact of COVID on fellows' education was seen with reduced disease specific education due to focus on COVID and reduced fellow time on the wards (55% & 48% respectively).74% of respondents reported a negative impact on their professional relationships within their own center. The primary reasons were physical and emotional fatigue (43%) and staffing shortages (37%). The inability to socialize outside the work setting also had a significant impact. Fortunately, few had family or colleagues ill with COVID, but 3 reported death of co-workers or family members. Though most reported no positive impact on their work relationships (62%), "bunker mentality" and increased patience with colleagues were reported by 35%. 64% of respondents reported fatigue and lack of opportunity to see colleagues outside their own institution as a negative impact on those relationships. 76% described no positive impact on those relationships. 60% of respondents related a negative impact on their own research as there was no time to focus on research and/or most non-COVID research stopped, leading to lack of connection with research colleagues. 81% of respondents reported 'burnout' and 18% reported Post Traumatic Stress Syndrome (PTSD). When asked what the most significant impact of COVD on professionalism the overwhelming responses were emotional and physical fatigue and isolation from colleagues. The emotional stress of family and colleagues ill and sometimes dying from COVID takes a toll. Conclusion(s): In summary, in addition to the stress and physical toll the pandemic created for health care providers, transplant professionals reported a loss of ability to advance the field of transplantation due to the inability to attend professional meetings, participate in transplant-related research, and network with colleagues on topics other than COVID related care.

3.
Acta Cardiologica ; 77:41-42, 2022.
Article in English | EMBASE | ID: covidwho-2062410

ABSTRACT

Background/Introduction: Earlier studies reported how significantly COVID-19 impacted the cardiology services globally. Many countries are surfing subsequent waves of COVID-19, yet, there is no global data in general nor from Iraq in particular regarding the extent of return of cardiac services to normal during the second year of the pandemic. Purpose: To investigate the rate of change in cardiac services during the second year of the pandemic in Iraq. Methods: A 23- item online survey was sent via social media to healthcare professionals who were involved in providing cardiac services. The survey focused on the rate of changes in non-invasive and invasive cardiac services in 2021 compared with 2020 and the type of PPE currently used by participants. It also assessed the academic achievements of respondents during the pandemic compared to the pre-pandemic era. Results: Thirty-two healthcare professionals responded, 15.6% were women, 15.6% work in COVID-19 designated hospitals, 81.3% were interventional cardiologists, 9.4% were clinical cardiologists and 9.3% were pharmacists. Respondents were FITs in 54.3%. Transthoracic echocardiography and hospital admissions were the most reported cardiac services returning to the prepandemic rate of 25 and 18.8%, respectively. Telemedicine is used by 56.3% in outpatient consultations. Vaccine received by 93.8%, most commonly used PPE was a surgical mask (71.88%). Compared to pre-pandemic, no change in the number of academic publications was recorded in 37.5% while 46.9% reported a decline in their contribution to conferences during a pandemic, and 12.5% published COVID-19 related research..

4.
Cardiology in the Young ; 32(Supplement 2):S229, 2022.
Article in English | EMBASE | ID: covidwho-2062111

ABSTRACT

Background and Aim: Chest pain is a one of the most common com-plaints in children admitted to the Hospitals. Although it was among the most common reasons for referral to the pediatric car-diologist before COVID-19 era, this tendency is changed during covid pandemic. The primary objective of this study was to inves-tigate the aetiological causes, clinical characteristics and the follow up symptoms in terms of changing habits of parents and children admitted to the ED for acute chest pain during pandemic. Method(s): We reviewed the medical records of children under the age of 18 who presented with chest pain as the chief complaint from 1 January 2020 to 1 April 2021, at Istanbul University-Cerrahpasa Pediatric Emergency Clinic retrospectively from the hospital data-base. The study population comprised 128 boys and 119 girls. Result(s): All the children underwent ECG examination. While the ECG results of 239 children were normal, 6 sinus tachycardia, 1 supra-ventricular tachycardia and 1 incomplete left bundle branch block were observed. 33 patients had an echocardiography. Eight patients with an abnormal Echo result already had been examined and diag-nosed prior to their emergency admission. Blood samples were taken from 48 children for troponin. 17 samples wereabove the cut-off value which was set to 0.004 g/dl A total of 32 SARS-Cov2 swab samples were taken from suspicious cases and analyzed with RT-PCR. Consequently, 8 of these children were Covid-19 positive. 7 patients had no history of chronic disease, while 1 patient had ALL. All of these patients had mild symptoms and none of them required hospitali-zation. The total number of children who were referred to a pediatric cardiologist for a further examination together with the follow-up patients of the pediatric cardiology department is 52 Conclusion(s): In conclusion, Chest pain is a common referral com-plaint in children and is rarely due to cardiac diseases. To date car-diac reasons of chest pain was the major concern of patients and families attending the ED. However we found that Patient/family concerns regarding 'vulnerability to the severe covid infection has emerged as an important discourse during the pandemic on attend-ences to ED because of chest pain.

5.
Journal of the Intensive Care Society ; 23(1):206-207, 2022.
Article in English | EMBASE | ID: covidwho-2042951

ABSTRACT

Introduction: In recent years, the use of ultrasound in critical care has revolutionized the bedside assessment of ICU patients. Though operator dependent, the advantage of repeatability and being relatively inexpensive makes it imperative for critical care physicians to stay updatedwith thismodality. The purpose of this report is to describe an incidental finding of pericardial effusion in a patent admitted with respiratory distress. Main body: A 26 years old female was admitted with shortness of breath and increase in oxygen requirements. She had a background of cerebral palsy, tracheostomized since 2009 after being operated for scoliosis and had a vagal nerve stimulator in situ. On admission, her 1st covid swab was negative. She normally required home ventilation only at night, however 2 days prior to admission, she required 24 hours of ventilator support. A large leak was noted on the ventilator and had a non-cuffed tracheostomy tube in situ, which was later changed to a cuffed one. A quick bedside FICE (Focused Intensive Care Echocardiography) revealed a large circumferential pericardial effusion with fibrin strands. There was no haemodynamic compromise on admission, however the large pericardial effusion could have been an attributing factor to her severe respiratory distress. She progressively started deteriorating hemodynamically, requiring intravenous fluids and vasopressor support. A definitive ECHO done by the cardiologist confirmed the findings of FICE. There was a rapid change in her condition post-pericardiocentesis. As per the institute protocol, a second covid swab was sent for her, which reported positive. Covid-19 RTPCR testing was not validated on pericardial fluid, hence was not undertaken. The culture of pericardial fluid revealed staphylococcus aureus, but there was a high index of suspicion of COVID and bacterial pericarditis was unlikely. Conclusion: Echocardiographic evaluation of Pericardial effusion is of paramount importance for timely and appropriate diagnosis. In view of quick bed side diagnosis with ultrasound, our patient was able to survive this life-threatening condition and treatment was initiated promptly. If left undiagnosed based on clinical presentation, it could have been catastrophic for a completely treatable cause. Brief description of ultrasound video: Pericardial effusion appears as an echo-free space between the 2 layers of pericardium. This video shows a 4-chamber echocardiographic view suggestive of a globular pericardial effusion with fibrin strands. An element of hemodynamic compromise was visible on 4-chambered view as well as para-sternal long axis view.

6.
Journal of Thoracic Oncology ; 17(9):S508-S509, 2022.
Article in English | EMBASE | ID: covidwho-2031530

ABSTRACT

Introduction: Lung cancer symptoms and secondary effects of cancer treatments impact quality of life and induce patients to excessive rest and lack of physical activity resulting in severe deconditioning. Exercise has been shown to increase performance status, strength, endurance and reduce emotional issues in lung cancer patients. Despite these benefit this approach is a poorly utilized strategy and several barriers must be overcome due to limited data, lack of awareness of the benefits of exercise, and limited patient motivation. Several programs of adapted physical activity are developing to support lung cancer patients during oncological treatments, adopting a personalized approaches. Rowing programs have been reported in cancer survivors to reduce risk factors and the impact of treatments complications, particularly lymphedema in breast cancer survivors. A pioneering program of adapted physical activity was developed by a multidisciplinary team in collaboration with an association for the support of cancer patients (Sicilian Association for Oncological Support), using rowing in patients with active metastatic cancer, to evaluate feasibility, response of patients, and to increase awareness of the benefits of physical activity in the fight against lung cancer. Methods: The program was launched in December 2019 from the idea of a young world rowing champion, but the advent of the COVID-19 pandemic led to the postponement of this project, which was subsequently developed from March 2021 to July 2021. The team was composed by oncologists, sports medicine specialists, two coaches specialised in adapted physical activity programs and a cardiologist. The voluntary logistic assistance was warranted by the rowing society “Canottieri Peloro”, which effectively allowed the project to be carried out, providing patients with equipment, a specialised team doctor and a well-equipped gym. In this preliminary experience we managed to include a small number of patients to assess the feasibility/validity of this approach and improve patients’ needs and satisfaction. Results: Four patients affected by metastatic lung adenocarcinoma with EGFR mutations joined the project (1 M/3 F;median age was 59.5, range 47-68;ECOG PS: 1). All patients presented well-controlled and mild symptoms related to the disease (cough, dyspnea, bone or chest pain) and were receiving active oncological treatments (first line EGFR-TKI: 2 patients;second line EGFR-TKI and maintenance chemotherapy). After a baseline clinical, oncological and cardiological evaluation personalized training program was developed. Briefly, indoor training and individual rowing sessions have been administered to patients. All patients reported full adherence to the training, developing a growing motivation and interest in improving physical performance. We did not recorded any worsening of symptoms or problems related to cancer treatments. The full contact with water and nature and the peculiar backwards motion of rowing had a positive impact on patients, that enjoyed the experience, reducing their anxiety for the future. Conclusions: This preliminary experience, previous developed as a support activity for lung cancer patients, might pave the way for further exploration of the role of rowing in this setting and promote a pivotal project to better define specific programs for metastatic cancer patients to improve compliance and response to cancer treatments. Keywords: Lung cancer, Adapted physical activity, Rowing

7.
Medical Journal of Malaysia ; 77:44, 2022.
Article in English | EMBASE | ID: covidwho-2006902

ABSTRACT

Introduction: Coronary artery disease complicates 0.01% of pregnancies. In this case study, we illustrate the successful management strategy of a pregnancy with a cardiometabolic disorder who conceived after a ST-elevation myocardial infarction (STEMI). Case Description: A 41-year-old woman in her third pregnancy was referred to our maternal-fetal-medicine unit at 8 weeks of gestation. She had a history of an acute inferior myocardial infarction (MI) Killip 1 with 70% occlusion of the left anterior descending artery and ectatic vessels, which was successfully thrombolysed 1 year prior. On presentation, she had uncontrolled type 2 diabetes, chronic hypertension on treatment, and was morbidly obese with a BMI of 44 kg/m2. She had 2 previous lower segment caesarean sections and an umbilical hernia repair. A systematic effort involving a multidisciplinary team, both at tertiary and community level, was coordinated from the start, which successfully prevented any cardiac events during pregnancy. She recovered from Covid-19 category 4a at 28 weeks with no cardio-respiratory implications. She went on to have a lower segment caesarean section near term with tubal ligation. Post-operative recovery was uneventful, and she continued to see cardiologists and endocrinologists. Discussion: Specific risks such as MI recurrence, pre-eclampsia and low birth weight baby can be minimised through comprehensive antenatal and perinatal plans supported by patient compliance. Our case showed that pregnancy after MI results in good maternal-fetal outcome provided the pre-pregnancy cardiac performance status is good, early multidisciplinary management, patient-centred approach, close antenatal monitoring, adequate delivery preparation and patient compliance.

8.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003413

ABSTRACT

Background: In 2014, appropriate use criteria (AUC) were introduced for initial outpatient pediatric transthoracic echocardiograms (TTEs). These criteria classified common indications for echocardiograms as appropriate (A), may be appropriate (M), and rarely appropriate (R). In 2020, a subsequent AUC guideline provided further direction regarding utilization of TTE in longitudinal follow-up of congenital heart disease (CHD). In response to the COVID-19 pandemic, a Kentucky executive order prohibited elective medical procedures from 3/18/2020-4/27/2020. Simultaneously, the American Society of Echocardiography recommended limiting rarely appropriate studies. Our primary objective was to determine if the cessation of elective medical procedures in Kentucky during the COVID-19 pandemic resulted in a decrease in the proportion of rarely appropriate outpatient TTEs interpreted at the open echocardiography lab at Norton Children's Hospital. Differences in appropriateness of echocardiogram orders by provider type were evaluated, and diagnostic yield of outpatient pediatric TTEs prior to and during this time period were compared. Methods: A retrospective chart review was conducted comparing proportions of rarely appropriate outpatient pediatric TTEs performed pre-COVID (3/21/2019-4/28/2019) and during COVID (3/19/2020-4/27/2020). All outpatient TTEs interpreted at our institution performed on subjects <=18yrs of age in Kentucky facilities during the relevant time periods were eligible for inclusion. Studies performed outside of Kentucky were excluded. TTE indication was determined by chart review and echocardiogram reports. Appropriateness of indication was evaluated using pediatric AUC guidelines for initial outpatient TTE or CHD follow-up. Variables collected included study date, indication, findings, referring provider type, and prior known cardiac diagnosis when relevant. The statistical analyses used for the data consisted of descriptive, bivariate, and logistic regression modeling. Results: Of 767 TTEs reviewed, 486 met inclusion criteria: 364 pre-COVID vs. 122 during COVID. TTE indication was classifiable in 354 (72.8%) of studies. Of TTEs preCOVID, 100 (37.7%) were rarely appropriate vs. 18 (20.2%) during COVID (p=0.002, Table 1.) Pediatric cardiologists tended to order fewer rarely appropriate TTEs than pediatricians pre-COVID (35.9% vs. 46.4%), although this difference was not statistically significant. Cardiologists ordered the majority of outpatient TTEs during COVID (77/89 TTEs, 86.5%), limiting the ability to compare TTE indications by provider type. There was no significant difference in diagnostic yield of initial outpatient TTEs with 32 (8.9%) abnormal studies pre-COVID vs. 12 (10.9%) during COVID (p=0.574, Figure 1). Conclusion: The executive order prohibiting elective procedures during the COVID-19 pandemic in Kentucky resulted in a decrease in the proportion of rarely appropriate outpatient pediatric TTEs. There was no significant difference in diagnostic yield of initial outpatient TTEs between time periods, suggesting that clinically significant echocardiogram findings were still detected despite more prudent utilization of echocardiography during this time. Diagnostic yield classification of initial outpatient pediatric transthoracic echocardiograms (TTEs) performed pre-COVID and during COVID elective procedure restrictions at Norton Children's Hospital.

9.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003115

ABSTRACT

Background: During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, pediatric heart centers were forced to rapidly alter the way patient care was provided in order to minimize interruption to patient care as well as exposure to the virus. In this study, we used a survey-based approach to characterize the changes that occurred in pediatric cardiology practices across the country during and just following the initial peak of COVID-19. Methods: In this survey based descriptive study we characterize changes that occurred within pediatric cardiology practices across the United States and describe provider experience and attitudes towards these changes during the pandemic. decision making during this period. This survey was emailed to an existing list serve of American Academy of Pediatrics Section on Cardiology and Cardiothoracic Surgery (AAP:SOCCS) members. Recipients of the survey included pediatric cardiologists, cardiothoracic surgeons, and fellows-intraining. The questionnaire was initially distributed in June 2020 and was active through August 2020. Results: Surveys were returned by 79 participants across 28 states. Areas of practice of respondents included general cardiology, non-invasive imaging, electrophysiology, heart failure/transplant, interventional cardiology, and adults with congenital heart disease. Common changes that were implemented included decreased numbers of procedures, limiting visitors, and shifting towards telemedicine encounters. There was a high level of satisfaction among providers with telemedicine encounters and a variety of platforms were utilized. Echocardiography was less likely to be performed during the pandemic as compared to prior to the pandemic in nearly all clinical scenarios presented. More than half of respondents expressed concerns about financial stability with regards to personal or practice situation but most were not frequently concerned about their personal safety. Conclusion: Pediatric cardiology practice across the country was heavily impacted by COVID-19 and required many adaptations including minimization of non-essential procedures and increasing use of telemedicine. Providers were generally satisfied with telemedicine and utilized several platforms. Financial concerns were common;however, most participants were not frequently concerned about personal safety. Inter-institutional collaboration could be useful in creating standardized protocols based on shared experiences that could be rapidly implemented in future public health crises. Experience with Telemedicine. A) Barriers to implementing telemedicine. B) Provider rated effectiveness of telemedicine. C) Home monitoring devices used as part of telemedicine program. D) Provider satisfaction vs perceived patient satisfaction with telemedicine encounters. Likelihood of Performing Echocardiography Prior to and During COVID-19 Pandemic. Participants were asked to rate the likelihood for each scenario as always, frequently, occasionally, or never. Responses were converted to a 5-point scale. Pre- and post- responses were analyzed using Wilcoxon signed-rank test. Significant decreases in likelihood of echocardiography were found in nearly all situations.

10.
Atemwegs- und Lungenkrankheiten ; 48(7):276-285, 2022.
Article in German | EMBASE | ID: covidwho-1997975

ABSTRACT

Especially at the beginning of a pandemic, the risks of infection for health professionals but also for other professions are increased. As a result, more than 220,000 insurance claims due to COVID19 have been reported to the statutory accident insurance institutions (DGUV) since the end of December 2021. COVID19 can be recognized as either an accident at work or an occupational disease. To do this, certain conditions relating to diagnosis and occupational exposure must be met. The recognition rate for occupational diseases is approximately twice as high as for accidents at work (60.0 vs. 30.2%). The most commonly affected by occupational SARSCoV2 infections are nurses in the hospital and in inpatient geriatric care. In 2021, educators were also frequently affected. The assessment of the causal relationship usually does not cause any major problems, as the occupations with an increased risk of infection are already well described in epidemiological studies. So far, there is little experience with the assessment of longterm consequences of COVID19. There are two reasons for this. „Rehabilitation before retirement“also applies to the DGUV. Several specific rehabilitation services have been developed for patients with postCOVID symptoms, the effectiveness of which needs to be evaluated. As a further reason for the lack of experience in the assessment, it must be taken into account that naturally the spontaneous course of the longterm consequences of COVID19 cannot yet be known. An assessment is probably best carried out by the discipline in whose area the most pronounced symptoms fall, i.e. in the case of shortness of breath by pulmonologists, in the case of cardiac arrhythmias by cardiologists or in fatigue and concentration disorders by neurologists. If necessary, the assessment should be carried out with the support of the other disciplines. The good news, the likelihood of severe, longterm courses of COVID19 has been significantly reduced by vaccination.

11.
Journal of General Internal Medicine ; 37:S343, 2022.
Article in English | EMBASE | ID: covidwho-1995838

ABSTRACT

BACKGROUND: Virtual cardiology care, defined as care delivered by phone or video, expanded rapidly in the Veterans Health Administration (VA) at the onset of the COVID-19 pandemic and remains a significant proportion of all VA cardiology care. However, factors influencing whether a visit is conducted virtually are poorly understood. METHODS: In this mixed-methods study, we first analyzed a nationwide cohort of Veterans who had a cardiology visit before COVID-19 (1/1/2019-3/ 10/2020), some of whom had follow-up visits before COVID and others afterwards (3/10-2020-3/10/2021). We assessed the hazard of receiving cardiology-related video care and any virtual care with a survival model adjusted for baseline patient sociodemographic and clinical characteristics;we performed analyses with and without adjustment for geographic region via Veterans Integrated Service Network location (VISN). Then, we conducted qualitative interviews with VA cardiologists to further characterize the variation identified in the hazard of video and virtual care utilization. RESULTS: We analyzed 416,621 Veterans;average patient age was 69.1 years and 5.0% were female. Older, low-income, and rural-dwelling Veterans had a lower hazard (i.e. time to event) of using video care (adjusted hazard ratio for ages 75 and older 0.80, 95% CI 0.75-0.86;for low-income status 0.94, 95% CI 0.89-0.98;for highly rural residents 0.77, 95% CI 0.68-0.87). The hazard ratios for a video-based encounter varied across geographic regions, with adjusted hazard ratios for use of video care as low as 0.06 (95% CI 0.04-0.07) compared to the reference region with highest use of video care. In our qualitative assessment, cardiologists (N=7) suggested patient, provider, and system-level factors influencing visit modality. At the patient level, clinicians perceived that older, lower-income, and rural-dwelling Veterans had more difficulty accessing video technology, but also benefited disproportionately from virtual care from the convenience of avoiding travel to a VA facility. At the provider level, clinicians preferred virtual care for routine follow-up visits and visits for conditions when most pertinent information could be collected from history (e.g. stable coronary artery disease). At the system level, clinicians noted explicit and implicit nudges toward certain modalities, such as differential productivity accounting (e.g. video visits counting as more productivity units than phone visits) and praise for high video care users, and differed in their perception of whether the system or clinician primarily drove choice of visit modality. CONCLUSIONS: Likelihood and timing of virtual cardiology care varies across VA patients and sites due to patient, clinician, and system factors. VA cardiologists perceive variability in the degree to which autonomy over visit modality choice lies with providers versus the system. Policies intended to alter visit modality mix should consider these types of influences as well as varying autonomy in modality choice.

12.
European Journal of Heart Failure ; 24:263-264, 2022.
Article in English | EMBASE | ID: covidwho-1995536

ABSTRACT

Background: Despite several pharmacological advances, the morbidity and mortality in heart failure (HF) remain high, posing a problem for both patients and the National Health System. The natural history of this disease alternates phases of stability and phases of exacerbation, with a progressive decline in the patient's functional capacity and quality of life;this has led to the development of remote monitoring systems. These devices are emerging as an important tool for the effective HF management, even during the COVID-19 pandemic. Methods: We enrolled 6 patients with end-stage HF, who received the combined CardioMEMS / Levosimendan strategy to reduce the number of hospitalizations and optimize both tailored adjustment of home therapy and infusions of Levosimendan. Specifically, CardioMEMS is a wireless sensor that can be implanted in the pulmonary artery, where it detects cardiac filling pressures, an objective measure of the patient's hemodynamic congestion;these pressures increase two weeks before the onset of symptomatic congestion. Results: The 6 patients (72.25±4.60 years;33.33% female) who received the device did not have any complications related to the procedure. Patients were monitored daily by CardioMEMS;if the cardiologist detected a tendency for pulmonary artery diastolic pressure (PAPd) to rise, patients were contacted for home therapeutic changes. If no further changes were possible, the patient was hospitalized for the infusion of Levosimendan. In particular, following the implantation of CardioMEMS, a significant reduction in HF unscheduled hospital admissions was recorded (hospitalizations / month: pre-CardioMEMS 0.657±0.303 vs post-CardioMEMS 0.029±0.021, p 0.0313) (Figure 1). In addition, lower pulmonary arterial pressures were recorded at 6-months FU on CardioMEMS monitoring (pre vs post: PAPs: 51.25±2.56 vs 42.75±2.46 mmHg, p 0.0168;PAPd: 26.25±0.85 vs 20.25±0.85 mmHg, p 0.0034), a reduction in the echocardiographic E/e' ratio (20.86±1.77 vs 14.13±2.02, p 0.0057), an improvement in the quality of life (EQ5D 75.17±2.06 vs 108.60±8.70, p 0.0078) and a reduction in IL-6 levels (p 0.0211). Conclusions: In this study we present the first experience of serial infusions of Levosimendan guided by CardioMEMS. Our results support the usefulness of this device in remote management of the HF patient, especially during this pandemic.

13.
European Journal of Heart Failure ; 24:187, 2022.
Article in English | EMBASE | ID: covidwho-1995531

ABSTRACT

Background: about 25% of patients admitted for HF are readmitted to hospital within 30 days. Fluid congestion is the leading cause for short-term readmission. Lung ultrasound (LUS) has become widely used to assess pulmonary congestion of cardiac origin for hospitalized patients on admission and before discharge but also for patients with HF undergoing outpatient follow-up. Inferior vena cava ultrasonography (IVCUS) seems also to be a useful tool in the care of patients with chronic HF. General practitioners (GPs) can safely use POCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. Furthermore, they have expressed a need for greater training to diagnose and manage HF. An effective advanced fluid management programme, consisting in an intervention providing tailored therapy guided by intravascular volume assessment, is associated with improving readmission and mortality in HF. However, experts report long waiting lists for HF clinics and emphasize that scheduled follow-up appointments with a cardiologist do not regularly occur within two weeks of discharge, as recommended in guidelines. Purpose: to assess if POCUS, including LUS and IVC collapse index (IVCCI), can help in-hospital management in the general ward and if GPs can early identify signs of fluid overload after discharge, providing early referral and optimal therapy according to 2021 ESC guidelines. Methods: observational pilot study to test routine POCUS performed on hospital admission, before discharge and after 2 weeks in the GP ambulatory setting, after an in-hospital training period. 30-day HR was retrospectively compared to the clinical standard. Results: among 250 consecutive SARS-CoV-2 negative patients admitted to the department of internal medicine, 56 (22.4%) have been hospitalized for acute decompensated HF (17.8% HFrEF, 26.8%, HFmrEF, 55.4% HFpEF). 17 patients (30% M/F 6/11: group 1) underwent POCUS, while 39 patients (70% M/F 25/14, group 2) the standard management. Mean age difference (group1: 80.6±9.6 vs group2: 82.8±8.2) as well as comorbidities were not significant among groups (t-test p<0.19), while mean length of stay (MLS) for group1 (6.5±2.9 days) vs group2 (12±6.2 days) was significant (t-test p<0.001). LUS on discharge excluded persistent congestion in 76.5% (B-lines ≥ 3: 23.5%, yet 75% of these patients had no findings on ascultation), while IVCCI was >50%, 30-50%, <30% respectively in 52.9%,17.6% and 29.4%). 3 patients were evaluated after 2 weeks by GP. The 30-day HR was 5.8% (group1) vs 12.8% (group2) (χ2 test p<0.0012). Conclusions: POCUS seems to have contributed to reduce MLS, encouraging attainment of an optimal volume status at discharge and prescription of an optimal therapy. LUS and IVCUS are simple tools which may be performed soon after discharge by GP, contributing to reduce 30-day HR improving post discharge quality of care.

14.
Medicina (Brazil) ; 55(2), 2022.
Article in English | EMBASE | ID: covidwho-1979696

ABSTRACT

Intensive Care Medicine gained prominence in 2020 and 2021 due to the COVID-19 pandemic. It is a recent medical specialty, which many physicians and the public know little about. This article makes a historical perspective, from the emergence of the first areas for observation of critically ill patients in the nineteenth century to the present, to the impact of the pandemic and its consequences.

15.
Heart Lung and Circulation ; 31:S271, 2022.
Article in English | EMBASE | ID: covidwho-1977302

ABSTRACT

Background: Single institutions specialising in fetal cardiology often have too few cases to develop robust prognostic indicators for specific conditions. The Australia and New Zealand (ANZ) Fetal Cardiology Working Group instigated a multicentre study to examine fetal risk factors for early postnatal intervention in Tetralogy of Fallot (ToF). Centralised data analysis was not possible due to COVID-19 travel restrictions and ethical constraints related to sharing of retrospectively acquired images. A study of inter-observer agreement of standardised in utero cardiac measurements was undertaken to assess the feasibility of combining data from multiple centres. Methods: Ten fetuses with ToF were randomly identified. Deidentified images were distributed securely to ten ANZ fetal cardiologists. The pulmonary valve (PV) annulus, main pulmonary artery (MPA), branch pulmonary arteries (BPA), aortic valve (AV) annulus, ascending aorta (AA), and ductus arteriosus (DA) were measured in triplicate following a defined protocol. Inter-rater reliability was assessed using a two-way random effects model to calculate the intra-class coefficient (ICC). Results: Measurements were available for seven ANZ fetal cardiologists. There was moderate inter-observer agreement for PV (ICC 0.74, 95% CI 0.49–0.91) and AV (0.71, 95% CI 0.48–0.90), and good agreement for MPA (0.81, 95% CI 0.62–0.94) and AA (0.91, 95% CI 0.80–0.97). Inadequate data were available for BPA and DA analysis. Multi-variate analysis found no patient or investigator factors that influenced measurement variability. Conclusion: Fetal cardiac structures can be measured using a defined measurement protocol by multiple investigators with at least moderate agreement. Analysis of large datasets by multiple investigators is a reasonable alternative to centralised data analysis.

16.
Journal of Cardiovascular Computed Tomography ; 16(4):S51, 2022.
Article in English | EMBASE | ID: covidwho-1966809

ABSTRACT

Introduction: Over the past decade, through numerous technical advances and clinical studies, cardiovascular computed tomography (CCT) has gained increasing acceptance;recently evidenced by receiving multiple class 1, level A recommendations in the 2021 AHA/ACC Chest Pain Guidelines. We aimed to evaluate recent CCT practice and practitioner trends in the US Medicare population with the motivation of guiding practice, training, and advocacy. Methods: A retrospective cross-sectional analysis of Medicare Part B pay-for-service physician payments was performed between 2013-2020. CCT/FFRCT exams and providers were identified by unique HCPCS codes. Providers, exams, cost, and payment denials were analyzed. Medical specialty, gender, and geo-location of providers were summarized. Results: From 2013 to 2019, the number of providers of CCT exams and the number of exams increased significantly. Providers of CAC scoring increased >210%. Providers of coronary CTA in the hospital setting increased 36% and in independent testing facilities by 9%. CAC scoring exams increased 724% and coronary CTA exams increased 126% (see Figure). In the first year of the COVID-19 pandemic (2020), CAC scoring usage decreased by -9.3% and coronary CTA by -3.3%. Since initial reimbursement in 2018, FFRCT usage has increased by 654% but was applied in only 4% of coronary CTA exams. In 2020, contrary to a moderate CCT exam decline, FFRCT analysis increased by 376% compared to the previous year. Medicare insurance acceptance of cardiac CT became more favorable into 2020 (see Figure). CAC scoring denials decreased from 61.6% to 33.2% and coronary CTA denials decreased slightly from 7.3% to 6.4%. FFRCT denials decreased significantly from 64% to 6%. In 2019, 30.5% of CCT providers were cardiologists with the remainder being predominantly radiologists. On the other hand, 76.2% of FFRCT providers were cardiologists. A slightly lower percentage of FFRCT billing physicians were female compared to CCT billing physicians (14.2% vs 17.9%). CA, NY, MN, TX, and PA had the highest FFRCT utilization. Conclusions: In general, both CAC scoring and coronary CTA utilization have increased, along with a large increase in the utilization of FFRCT over the study time period. This increase in utilization was accompanied by a significant increase in providers and a decrease in reimbursement denials. In the first year of the COVID-19 pandemic, CCT usage was robust and only decreased moderately. [Formula presented]

17.
European Journal of Clinical Pharmacology ; 78:S130, 2022.
Article in English | EMBASE | ID: covidwho-1955961

ABSTRACT

Introduction: Zolpidem and zopiclone are widely used for sleep disorders, yet their abuse and dependence potential has been underestimated. The electronic prescription of zolpidem/zopiclone became mandatory on 17.07.2019 in Greece. Objectives: To investigate descriptive characteristics of zolpidem/ zopiclone prescriptions and the impact of the mandatory electronic prescription mandate. Methods: Anonymized prescriptions of zopiclone (ATC: N05CF01) and/or zolpidem (ATC: NC05CF02) that were executed in pharmacies between 01.10.2018 and 01.10.2021 were obtained from the Greek nationwide prescription database. The database covers almost the entire Greek population and it is administrated by IDIKA of the Greek Ministry of Health. We investigated descriptive characteristics of prescriptions, and calculated themonthly number of prescriptions taking into consideration dates with potential impact, i.e., the date of the mandatory electronic prescription mandate (on 17.07.2019) and the date of the first case of COVID-19 in Greece (on 26.02.2020). Results and Conclusion: During the investigated period of three years, there were 1229842 executed prescriptions of zolpidem (89.4%), zopiclone (10.4%) or both (0.3%), considering 156554 unique patients. The patients weremainly elderly (73.1%were ≥ 65 years old) andwomen (64.5%). The majority of the prescription physicians (69.9%) were general practitioners or internists, followed by 17% psychiatrists or neurologists, 5.3% cardiologists, 4.5% physicians in specialty training, 1% nephrologists and 2.4% of physicians with another specialty. After the mandatory electronic prescription mandate and before COVID- 19 in Greece, i.e., between 08.2019 to 03.2020, there was a notable increase of prescriptions in comparison to the previous period from 10.2018 to 07.2019 (median 37267 vs median 34106;Mann-Whitney U=9, p-value=0.009). After COVID-19, the median monthly number of prescriptions was 36363, yet there were variations ranging from 16963 to 39956. In conclusion, the mandatory electronic prescription system could increase the surveillance of drugs with abuse potential such as zolpidem and zopiclone. Nevertheless, the large number of prescriptions in elderly patients and prescribed by primary care physicians is worrisome and warrants further investigation.

18.
Journal of Hypertension ; 40:e177, 2022.
Article in English | EMBASE | ID: covidwho-1937731

ABSTRACT

Objective: The objective was to analyze time-trends in the rates of patients who had at least one reimbursement of an antihypertensive drug without reimbursement in the past 12 month for each year from 2017 to 2021, and to study changes according to sex, age, history of cardiovascular diseases, group of antihypertensive drugs and lockdown/curefew periods. Design and method: We used data from the French national healthcare database (“Systéme National des données De Santé”-SNDS) covering 99% of the French population. For each year and weeks from 1st January 2017 to 23 of May 2021, patients who initiated an antihypertensive drug treatment in France were selected. Crude and age-standardized rates of patients initiating an antihypertensive drug in overall population living in France were calculated and compared with the 2017-2019 incidence with incidence rate ratio (IRR) adjusted for age and time-trends. Consultations (with general practitioner (GP) or cardiologist) were also recorded over the study period Results: In 2020, 1,518,686 persons initiated an antihypertensive therapy in France which was less than the mean number 2017-2019 (n = 1,549,215). The age-standardized incidence in the French population were 2.2% for 2017, 2.3% for 2018, 2.4% for 2019 and 2.2% for 2020. The initiation of an antihypertensive treatment declined by 11% in 2020 as compared to 2017-2019 (reaching -30% during the first national lockdown), with a major differences between men (-5%) and women (-16%), and age groups (-2% in people aged < 45 years old, and -17% in more than 85 years). A similar decline was found between people with a personal history of cardiovascular disease and those without. Among antihypertensive treatments, the greater decrease in the initiation was observed for diuretics (-20%) and ARBs (-19%). In 2021, initiation of antihypertensive drugs were still diminished compared to 2017-2019 but in a lower extent (-4%). An increase was even observed in the youngest age group (+6%) and in men (+4%). Conclusions: The pandemic had a major impact on the initiation of antihypertensive drugs and therefore the incidence and/or screening of hypertension with an important age and sex effect and no catch-up effect was observed in 2021.

19.
Journal of Hypertension ; 40:e171-e172, 2022.
Article in English | EMBASE | ID: covidwho-1937716

ABSTRACT

Objective: During the last two years Covid 19 has turned into a deadly pandemia, but it also has a devastating effect on noninfectious chronic diseases, particularly on cardiovascular diseases. This situations was described by Prof. Hector Bueno as “sindemia”. SARS Covid-2 - related respiratory syndrome has a direct and strong biological, patophysiological and social interactions with cardiovascular system. Another serious problem is the admission to hospital because, many of cardiologial units and ICU s were transformed into Covid 19 wards. That is why the outpatient treatment of cardiovascular diseases and risk factors became even more important. Design and method: According to the regulations of the National Healthcare Fund in Bulgaria, all patients with cardiovascular diseases must have an annual examination by cardiologist. We studied the real -life data from one outpatient cardiological practice in Sofia, Bulgaria. 634 patients had to be checked in 2021 15 of these patients had died with Covid 19 infection, one with myocardial infarction and one with stroke. Results: Only 243 patients attended the annual cardiological examination.172 of them were with worsened control of blood pressure, 48 with new symptoms of heart failure, 16 with newly found atrial fibrillation and 13 with newly diagnosed diabetes mellitus. In just one day the cardiologist met a patient with new decompensated diabetes, patient with new ECG data for myocardial cicatrix, patient with atrial fibrillation and patient with several collapses and ventricular tachycardia on ECG Holter! Many patients had antiaplatelet and anticoagulant treatment prescribed after Covid 19 infection, but also had uncontrolled hypertension and that increases the risk of hemorrhagic stroke Conclusions: Covid 19 infection, as an endothelial disease, has a devastating impact on patients with cardiovascular, cerebrovascular, pulmonary and metabolic disorders. The absence of team approach to the therapy leads to very high rate of mortality and long term consequences. The outpatient care of cardiovascular diseases is strongly damaged in Bulgaria. That results in bad control of arterial hypertension, delayed hospitalizations for acute coronary syndromes and heart failure, uncertain control of anticoagulation. It is time to recover healthcare system!.

20.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927704

ABSTRACT

RATIONALE4,4-44,4% of children suffer from post-COVID syndrome, commonly known as long- COVID, after an acute SARS-CoV-2 infection. However, an uniform clinical definition, and guidelines to diagnose or treat children suspected of long-COVID are lacking. Multiple careprograms have been initiated worldwide. In this study, we aimed to assess the currently available pediatric international long-COVID care programs and explore the characteristics of their patient cohorts.METHODSWe established an international network (IP4C) and performed a crosssectional analysis from aggregated data collected by its members using a survey. Topics included: the used definition for long-covid in children, the organization of pediatric long-COVID clinics and long-COVID patients characteristics. Descriptive analysis of the aggregated data was used to summarize and compare each of these categories across countries. RESULTSWe included data concerning organization of care from 17 cohorts based in 13 different countries. A wide range of definitions for long COVID was used, which differed mostly in duration of symptoms and the necessity of microbiologically proven SARS-COV-2 infection. 66,6-100% of patients in the long- COVID cohorts suffered from complaints for more than twelve weeks, and 49,5-97,3% of patients had a positive RT-PCR or serology for SARS-CoV-2. Most long-COVID care programs consisted of real-life visits with multidisciplinary teams, consisting of general pediatricians, pediatric lung specialists, cardiologists and infectiologist, a physiotherapist and psychologist. The type of investigations performed at the long-COVID clinics ranged from assessment of medical history (100%) and standardized questionnaires (91%) to in depth evaluation of organ functioning (e.g. spirometry performed in 0-100% of patients). Aggregated data of 431 long-COVID patients from 11 dedicated long-COVID care programs were analyzed. Mean age of patients ranged from 6,5-16,4 years old. Girls were overrepresented in most cohorts (20-65%). 28-81,8% of patient had a positive medical history, most commonly atopic syndrome, asthma and prematurity. Most patients (90- 100%) suffered from asymptomatic or mild acute COVID-19. Frequent long-COVID symptoms were fatigue, headaches, concentration difficulties, dyspnea and sleep disturbances. 5-37% of patients had severe limitations in daily life. CONCLUSIONSThis is the first study to describe the organization of pediatric long-COVID care. It demonstrates that pediatric long-COVID is recognized worldwide as a multisystemic disease, but its definition and care programs for pediatric long- COVID patients differ between cohorts. A clear definition of pediatric long-COVID is needed to improve international scientific collaboration and patient care. Our international network will facilitate further collaboration in investigation pathophysiology and therapeutic interventions in order to provide evidence based medical care for these patients.

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