Patient-clinician dynamics in remote consultations: a qualitative study of cardiology and rheumatology outpatient clinics in the UK.

OBJECTIVE: Explore the experiences of patients and clinicians in rheumatology and cardiology outpatient clinics during the first year of the COVID-19 pandemic, focusing on the impact of remote consultations on interpersonal dynamics. DESIGN: Qualitative study using semistructured interviews, conducted between February and June 2021. SETTING: The rheumatology and cardiology departments of a general hospital in England, UK. PARTICIPANTS: All clinicians and a convenience sample of 100 patients in each department who had taken part in a remote consultation in the past month were invited to take part. Twenty-five interviews were conducted (13 with patients, 12 with clinicians). RESULTS: Three themes were developed through the analysis: adapting to the dynamics of remote consultations, impact on the patient's experience and impact on the clinician's experience. The majority of remote consultations experienced by both patients and clinicians had been via telephone. Both clinicians and patients found remote consultations to be more business-like and focused, with the absence of pauses restricting time for reflection. For patients with stable, well-managed conditions, remote consultations were felt to be appropriate and could be more convenient than in-person consultations. However, the loss of visual cues meant some patients felt they could not give a holistic view of their condition and limited clinicians' ability to gather and convey information. Clinicians adjusted their approach by asking more questions, checking understanding more frequently and expressing empathy verbally, but felt patients still shared fewer concerns remotely than in person; a perception with which patients concurred. CONCLUSIONS: These findings highlight the importance of ensuring, for each patient, that remote care is appropriate. Future research should focus on developing ways to support both clinicians and patients to gather and provide all information necessary during remote consultations, to enhance communication and trust.

Treatment of adult, child and newborn cardiac arrest victims with COVID-19. Recommendations from the Interamerican Society of Cardiology / Sociedad Interamericana de Cardiología (SIAC), Mexican National Cardiologists Association / Asociación Nacional de Cardiólogos de México (ANCAM) and Mexican Society of Cardiology / Sociedad Mexicana de Cardiología (SMC).

La pandemia de COVID-19 ha infligido grandes estragos a la población y en especial al personal de salud. Los esfuerzos de reanimación exigen modificaciones potenciales de las guías internacionales existentes de reanimación cardiopulmonar (RCP) debido al elevado índice de contagiosidad del virus SARS-CoV-2. Se considera que hasta 15% de los casos de COVID-19 tiene una enfermedad grave y 5% padece un trastorno crítico con una mortalidad promedio del 3%, la cual varía según sean el país y las características de los pacientes. La edad y las comorbilidades como la hipertensión arterial, enfermedad cardiovascular, obesidad y diabetes incrementan la mortalidad hasta 24%. También se ha informado un aumento reciente del número de casos de paro cardíaco extrahospitalario (PCEH). Aunque el paro cardíaco (PC) puede ser efecto de factores diversos en estos pacientes, en la mayoría de los casos se ha demostrado que el origen es respiratorio, con muy pocos casos de causa cardíaca. Se debe considerar la indicación de iniciar o continuar las maniobras de RCP por dos razones fundamentales: la posibilidad de sobrevida de las víctimas, que hasta la fecha se ha registrado muy baja, y el riesgo de contagiar al personal de salud, que es muy alto.The COVID-19 pandemic is having a large impact on the general population, but it has taken a specially high toll on healthcare personnel. Resuscitation efforts require potential modifications of the present Cardiopulmonary Resuscitation (CPR) international guidelines because of the transmissibility rate of the new SARS-CoV 2 virus. It has been seen that up to 15% of COVID-19 patients have a severe disease, 5% have a critical form of infection and the mean death rate is 3%, although there are significant differences according to the country that reports it and patients' baseline conditions that include age, presence of arterial hypertension, cardiovascular disease, diabetes or obesity. In these high risk subjects, mortality might go up to 24%. There are also reports of a recent increase in out-of-hospital cardiopulmonary arrest (OHCA) victims. Cardiac arrest (CA) in these subjects might be related to many causes, but apparently, that phenomenon is related to respiratory diseases rather than cardiac issues. In this context, the decision to start or continue CPR maneuvers has to be carefully assessed, because of the low survival rate reported so far and the high contagion risk among healthcare personnel.

Collaboration between the National Association of Cardiologists of Mexico, the Mexican Society of Cardiology, and the University of Guanajuato. COVID-19 and Cardiac Imaging Personnel: Review of Sanitary Practices in Early 2021 / Colaboración de la Asociación Nacional de Cardiólogos de México y de la Sociedad Mexicana de Cardiología con la Universidad de Guanajuato. COVID-19 y personal de imagen cardiaca: Revisión de prácticas sanitarias al inicio de 2021

The authors of the image chapters of the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC), as well as personnel from the Department of Medicine and Nutrition of the University of Guanajuato, together with prominent experts in cardiovascular imaging from Mexico, have collaborated in the review, analysis and expansion of the various health strategies published in the first year of the coronavirus disease 2019 (COVID-19) pandemic, to safely perform cardiac imaging studies. This update aims to reduce the risk of COVID-19 transmission among patients and health-care personnel in the CT, MRI, and nuclear cardiology services. This work was expanded with supplementary information available free of charge on the website www.ancam-imagen.com.

Los capítulos de imagen de la Asociación Nacional de Cardiólogos de México (ANCAM) y de la Sociedad Mexicana de Cardiología (SMC), así como personal del Departamento de Medicina y Nutrición de la Universidad de Guanajuato, en conjunto con destacados expertos de la imagen cardiovascular en México, han colaborado en la revisión, análisis y ampliación de las diversas estrategias sanitarias publicadas en los primeros 15 meses de la pandemia de enfermedad por coronavirus 2019 (COVID-19) para realizar con seguridad los estudios de imagen cardiaca; esta actualización tiene como objetivo principal disminuir el riesgo de transmisión de la COVID-19 entre los pacientes y el personal de salud en los servicios de tomografía, resonancia y cardiología nuclear. Este trabajo se amplió con información suplementaria disponible sin costo en el sitio www.ancam-imagen.com.

Impact of COVID-19 pandemic on cardiology fellows academic training: beyond the clinical impact.

OBJETIVO: Determinar la percepción de los médicos internos residentes (MIR) de cardiología de España sobre el efecto de la pandemia por COVID-19 en su formación y la adaptación realizada por sus servicios. MÉTODOS: Estudio de corte transversal a través de una plataforma de encuesta digital con el objetivo de conocer la opinión individual de los MIR de cardiología sobre la influencia de la pandemia en su formación. Se realiza un análisis estadístico para determinar los factores que influyeron en la percepción de la formación afectada. RESULTADOS: Participó un total de 180 MIR de las 17 comunidades autónomas (CA). Los MIR de tercer año fueron los más afectados, junto con los que rotaban en imagen cardíaca. Los residentes de las CA con una prevalencia >5 casos/1,000 habitantes fueron los que mayor probabilidad tuvieron de ser desplazados de sus servicios. CONCLUSIONES: Según la opinión de los participantes, el efecto de la pandemia por COVID-19 en su formación fue más negativa en los residentes de tercer año y los que rotaban en imagen cardíaca. OBJECTIVE: The objectives were to analyze the perception of the Cardiology Fellows in Training (FIT) of Spain about the impact of the COVID-19 pandemic on their academic training and to know the adaptative changes performed by their department. METHODS: A cross-sectional study performed through a digital survey platform for Cardiology FIT. Chi2 analysis and logistic regression were performed to determine the factors that influenced on the perception of an affected training. RESULTS: A total of 180 FIT from the 17 regions of Spain participated. Third year FIT and those rotating in cardiac imaging were the most affected with statistically significant difference. The residents of the regions with a prevalence of >5 cases/1,000 inhabitants were the most likely to be displaced from their departments. CONCLUSIONS: According to the opinion of the participants, the impact of the COVID-19 pandemic on their academic training was more negative in third year FITs and those rotating in cardiac imaging.

Guide for cardiological referral for patients with paediatric multisystemic inflammatory syndrome and Kawasaki disease associated with SARS-CoV-2 / Guía para referencia cardiológica de pacientes con síndrome inflamatorio multisistémico pediátrico y enfermedad por Kawasaki asociados al SARS-CoV-2

We present an institutional guide for a referral to the specialized care center and initial management of pediatric patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with severe manifestations of pediatric inflammatory multisystemic syndrome or symptoms similar to Kawasaki syndrome, and who must have a multidisciplinary approach to ensure adequate treatment and safety for the team of Health.

Presentamos una guía para la referencia al centro de atención especializada y el manejo inicial de pacientes pediátricos infectados por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) con manifestaciones graves del síndrome multisistémico inflamatorio pediátrico o síntomas semejantes al síndrome de Kawasaki y que deben tener un abordaje multidisciplinario para garantizar un adecuado tratamiento y la mayor seguridad para el equipo de salud.

Return to exercise after COVID-19. Statement of the Mexican Society of Cardiology / Retorno al ejercicio después de COVID-19. Posicionamiento de la Sociedad Mexicana de Cardiología

The coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020; one consequence has been the increase in sedentary lifestyle and reduction of sports activity. Exercise benefits the immune defense system especially in older adults; it is recommended to keep a distance of 1.5 meters between people, and if walking or jogging is carried out, the space must be up to 5 and 10 meters respectively. The reported cases are mostly mild up to 80% and can be critical in up to 4.7%; the risk factors are well known, hypertension, diabetes and previous heart disease. Severe or critical cases present as symptoms of acute respiratory distress syndrome, and in the case of cardiovascular disease, they mainly occur as myopericarditis, acute coronary syndromes, cardiogenic shock, thrombotic events, among others. Returning to exercise after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is always recommended, however it will depend on the clinical picture what measures should be taken prior to its onset, and it is in moderate cases and especially in the severe ones where the evaluation and prescription prior to returning to exercise or sport should be guided by medical personnel experts in cardiopulmonary rehabilitation, especially in athletes.

La enfermedad por coronavirus 2019 (COVID-19) fue declarada pandemia el 11 de marzo de 2020; una consecuencia ha sido el incremento en el sedentarismo y la reducción de la actividad deportiva. El ejercicio beneficia el sistema inmunitario de defensa, especialmente en adultos mayores. Se recomienda guardar distancia de 1.5 metros entre personas, y si se realiza caminata o trote, el espacio debe ser de hasta 5 y 10 metros respectivamente. Los casos reportados son en su mayoría leves hasta en un 80%, y pueden ser críticos hasta en 4.7%; los factores de riesgo son bien conocidos: hipertensión, diabetes y enfermedad cardiaca previa. Los casos graves o críticos se presentan como cuadros de síndrome de distrés respiratorio agudo y ante afección cardiovascular cursan principalmente como miopericarditis, síndromes coronarios agudos, choque cardiogénico y eventos trombóticos, entre otros. El ejercicio después de la recuperación de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) siempre está recomendado, sin embargo, dependerá del cuadro clínico qué medidas se deben tomar previo a su inicio, y es en casos moderados y especialmente en los graves donde la evaluación y prescripción previa al retorno al ejercicio o deporte debe ser guiada por personal médico experto en rehabilitación cardiopulmonar, en especial en deportistas.

Recommendations for airway management in a suspected or confirmed case with COVID-19. A protocol of the Department of Cardiovascular Anesthesia of the National Institute of Cardiology Ignacio Chávez / Recomendaciones para el manejo de la vía aérea en caso sospechoso y/o confirmado con COVID-19. Protocolo del Departamento de Anestesiología Cardiovascular del Instituto Nacional de Cardiología Ignacio Chávez

The new coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), detected in Wuhan, China, causes coronavirus disease 2019 (COVID-19), which was declared pandemic, and has caused more than 19 million confirmed cases and more than 700 thousand deaths worldwide. When our institution was converted to COVID's hospital since early April 2020, specific care protocols were developed, with the aim of improving the quality of care and safety of patients and the staff involved in their management. Airway management represents one of the highest risks of direct contact infection with aerosol generation (orotracheal intubation, secretion aspiration, extubation, cardiopulmonary resuscitation, high flow oxygen therapy, noninvasive ventilation, and invasive ventilation). We present the current recommendations for airway management as well as a step-by-step airway management protocol to carry out a more secure procedure based on the literature reported so far.

El nuevo coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), detectado en Wuhan (China), causante de la enfermedad por coronavirus 2019 (COVID-19), que se declaró como pandemia, ha causado más de 19 millones de casos confirmados y más de 700 mil muertes en el mundo. Nuestra institución se reconvirtió a hospital COVID desde principios de abril del 2020, con lo que se desarrollaron protocolos de atención específicos, con el objetivo de mejorar la calidad de atención y seguridad de los pacientes y el personal involucrado en su manejo. El manejo de la vía aérea representa uno de los riesgos más altos de contagio por contacto directo en la generación de aerosoles (intubación orotraqueal, aspiración de secreciones, extubación, resucitación cardiopulmonar, terapia de oxígeno de alto flujo, ventilación no invasiva y ventilación invasiva). Presentamos las recomendaciones actuales para el manejo de la vía aérea, así como un protocolo de manejo paso a paso para llevar a cabo un procedimiento con mayor seguridad basados en la literatura reportada hasta el momento.

Zoom and its Discontents: Group Decision Making in Pediatric Cardiology in the Time of COVID (and Beyond) : Aurthors.

The emergence of Covid-19 has led to change within hospital-based healthcare. An example, has been to reconfigure clinical decision making meetings from traditional in-person (Face-to-face, FtF) to online video-conferencing (VC) format inorder to decrease contagion risk. Despite its widespread uptake, there is minimal empirical data evaluating this format. This narrative review considers the implications on medical decision-making when clinicians communicate remotely via Microsoft Teams. The discussion is informed by the psychological literature and by commentary obtained from a survey of paediatric cardiac clinicians who participated in clinical meetings when video-conferencing was first introduced. Whist video-conferencing can optimize clinician presence, this is potentially offset by compromises in current imaging quality, the group discussion, information sharing and decision quality. Implementing a shift from face-to-face to VC within the group decision-making process requires an appreciation of the changed environment, appropriate adaptations and the implemention of new technology solutions. Meanwhile, healthcare should carefully consider the potential implications of clinical decision making using online video conferencing, be prepared to adapt and evaluate prior to a shift away from face-to-face formats.

The Italian Society of Cardiology and Working Group on Telecardiology and Informatics 2023 updated position paper on telemedicine and artificial intelligence in cardiovascular disease.

In 2015, the Italian Society of Cardiology and its Working Group on Telemedicine and Informatics issued a position paper on Telecardiology, resuming the most eminent evidence supporting the use of information and communication technology in principal areas of cardiovascular care, ranked by level of evidence. More than 5 years later and after the global shock inflicted by the SARS-CoV-2 pandemic, an update on the topic is warranted. Recent evidence and studies on principal areas of cardiovascular disease will be therefore reported and discussed, with particular focus on telemedicine for cardiovascular care in the COVID-19 context. Novel perspectives and opportunities disclosed by artificial intelligence and its applications in cardiovascular disease will also be discussed. Finally, modalities by which machine learning have realized remote patient monitoring and long-term care in recent years, mainly filtering critical clinical data requiring selective hospital admission, will be provided.

Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on 'gender cardiovascular diseases'.

The coronavirus disease 19 (COVID-19), due to coronavirus 2 (SARS-CoV-2) infection, presents with an extremely heterogeneous spectrum of symptoms and signs. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality than women. In particular, cardiovascular diseases (preexistent or arising upon infection) play a central role in COVID-19 outcomes, differently in men and women. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Such variability can be ascribed to both sex-related biological factors and sex-related behavioural traits. Sex differences in cardiovascular disease and COVID-19 involve the endothelial dysfunction, the innate immune system and the renin-angiotensin system (RAS). Furthermore, the angiotensin-converting enzyme 2 (ACE2) is involved in disease pathogenesis in cardiovascular disease and COVID-19 and it shows hormone-dependent actions. The incidence of myocardial injury during COVID-19 is sex-dependent, predominantly in association with a greater degree of inflammation and coagulation disorders among men. Its pathogenesis is not fully elucidated, but the main theories foresee a direct role for the ACE2 receptor, the hyperimmune response and the RAS imbalance, which may also lead to isolated presentation of COVID-19-mediated myopericarditis. Moreover, the latest evidence on cardiovascular diseases and their relationship with COVID-19 during pregnancy will be discussed. Finally, authors will analyse the prevalence of the long-covid syndrome between the two sexes and its impact on the quality of life and cardiovascular health.

Effect of a Senior Cardiology Nursing Role on Streamlining Assessment of Emergency Cardiology Presentations During COVID-19: An Observational Study.

INTRODUCTION: The Emergency Cardiology Coordinator (ECC) was a senior nursing role implemented from 14 April 2020 to 15 September 2020 at the Gold Coast Hospital and Health Service in South-East Queensland, Australia to streamline and expedite assessment of patients presenting to the Emergency Department (ED) with suspected cardiac problems. ECC implementation occurred in the context of the emergence of COVID-19. Evaluation of the impact of the ECC role focussed primarily on the time interval from triage to cardiology consult (TTCC). METHODS: ED and Cardiology Department data were extracted from electronic medical records for the period 2 September 2019 to 1 March 2021. The TTCC for each presenting problem (chest pain, palpitations, shortness of breath, altered level of consciousness) was compared between patients seen by the ECC and those not seen on the days the ECC worked. The effect of COVID-19 on TTCC was assessed by an interrupted time series analysis. Data recorded by the ECC included patients seen and interventions provided. RESULTS: The ECC saw 378 patients. Most presented with chest pain (269/378, 71.2%). The ECC determined that 68.8% (260/378) required a cardiac assessment. Following COVID-19 the median weekly TTCC increased by 0.029 hours (1.74 min) each week on average relative to that beforehand (p=0.008). For patients seen by the ECC the median TTCC was 2.07 hours (interquartile range [IQR]: 1.44, 3.16) compared to 2.58 hours (IQR: 1.73, 3.80; p=0.007) for patients not seen by the ECC. Chest pain (ECC: 1.94 hours; no ECC: 2.41 hours; p=0.06) and non-obvious cardiac presenting problems (ECC: 1.77 hours; no ECC 3.05 hours; p=0.004) displayed the largest reductions in TTCC when the ECC was involved. Presentations with palpitations, respiratory distress and altered level of consciousness had similar TTCCs. CONCLUSION: The ECC role resulted in an overall decrease in TTCC despite the role coinciding with the emergence of COVID-19. In order to clarify the optimal strategy for the ECC role, further analyses involving patient risk factors and presenting problems along with a health economic evaluation of this model of care and the effect on patient outcomes will be required.

Nuclear Cardiology in the COVID-19 pandemic.

SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias…, during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease. The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocols.

[Prehospital ultrasound and cardiological emergencies]. / Échographie préhospitalière et urgences cardiologiques.

Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.