Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 37
Filter
3.
Rev Cardiovasc Med ; 22(3): 677-690, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1439022

ABSTRACT

Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when patients elapse from a sub-acute to a more stabilized chronic phase. The lack of an accurate approach for each HF subtype is probably the main cause of the inconclusive data in reducing the trend of recurrent hospitalizations. Most care programs are based on the main diagnosis and the HF stages, but a model focused on the specific HF etiology is lacking. The HF clinic route based on the HF etiology and the underlying diseases responsible for HF could become an interesting approach, compared with the traditional programs, mainly based on non-specific HF subtypes and New York Heart Association class, rather than on detailed etiologic and epidemiological data. This type of care may reduce the 30-day readmission rates for HF, increase the use of evidence-based therapies, prevent the exacerbation of each comorbidity, improve patient compliance, and decrease the use of resources. For all these reasons, we propose a dedicated outpatient HF program with a daily practice scenario that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of financial resources, together with optimal medical titration and management.


Subject(s)
Ambulatory Care/organization & administration , COVID-19 , Cardiology Service, Hospital/organization & administration , Delivery of Health Care, Integrated/organization & administration , Heart Failure/therapy , Telemedicine/organization & administration , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/physiopathology , Humans , Patient Readmission , Prognosis
4.
Open Heart ; 8(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1195855

ABSTRACT

BACKGROUND: The response to COVID-19 has required cancellation of all but the most urgent procedures; there is therefore a need for the reintroduction of a safe elective pathway. METHODS: This was a study of a pilot pathway performed at Barts Heart Centre for the admission of patients requiring elective coronary and structural procedures during the COVID-19 pandemic (April-June 2020). All patients on coronary and structural waiting lists were screened for procedural indications, urgency and adverse features for COVID-19 prognosis and discussed at dedicated multidisciplinary teams. Dedicated admission pathways involving preadmission isolation, additional consent, COVID-19 PCR testing and dedicated clean areas were used. RESULTS: 143 patients (101 coronary and 42 structural) underwent procedures (coronary angiography, percutaneous coronary intervention, transcatheter aortic valve intervention and MitralClip) during the study period. The average age was 68.2; 74% were male; and over 93% had one or more moderate COVID-19 risk factors. All patients were COVID-19 PCR negative on admission with (8.1%) COVID-19 antibody positive (swab negative). All procedures were performed successfully with low rates of procedural complications (9.8%). At 2-week follow-up, no patients had symptoms or confirmed COVID-19 infection with significant improvements in quality if life and symptoms. CONCLUSION: We demonstrated that patients undergoing coronary and structural procedures can be safely admitted during the COVID-19 pandemic, with no patients contracting COVID-19 during their admission. Reassuringly, patients reflective of typical practice, that is, those at moderate or higher risk, were treated successfully. This pilot provides important information applicable to other settings, specialties and areas to reintroduce services safely.


Subject(s)
COVID-19 , Cardiology Service, Hospital/organization & administration , Coronary Angiography/methods , Elective Surgical Procedures , Heart Valve Prosthesis Implantation/methods , Infection Control , Percutaneous Coronary Intervention/methods , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Elective Surgical Procedures/trends , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Organizational Innovation , Outcome and Process Assessment, Health Care , Risk Adjustment/methods , SARS-CoV-2 , Safety Management/organization & administration , United Kingdom/epidemiology
7.
J Invasive Cardiol ; 33(2): E71-E76, 2021 02.
Article in English | MEDLINE | ID: covidwho-1063668

ABSTRACT

In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.


Subject(s)
COVID-19 , Cardiac Catheterization/methods , Cardiology Service, Hospital , Coronary Care Units , Critical Care , Infection Control , Laboratories, Hospital/organization & administration , Organizational Innovation , ST Elevation Myocardial Infarction , COVID-19/epidemiology , COVID-19/therapy , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Coronary Care Units/methods , Coronary Care Units/organization & administration , Critical Care/methods , Critical Care/organization & administration , Critical Care/trends , Humans , Infection Control/methods , Infection Control/organization & administration , New York City/epidemiology , Patient Care Team/organization & administration , Perioperative Care/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy
8.
Europace ; 22(12): 1841-1847, 2020 12 23.
Article in English | MEDLINE | ID: covidwho-1059442

ABSTRACT

AIMS: To chart the effect of the COVID-19 pandemic on the activity of interventional electrophysiology services in affected regions. METHODS AND RESULTS: We reviewed the electrophysiology laboratory records in three affected cities: Wenzhou in China, Milan in Italy, and London in the UK. We inspected catheter lab records and interviewed electrophysiologists in each centre to gather information on the impact of the pandemic on working patterns and on the health of staff members and patients. There was a striking decline in interventional electrophysiology activity in each of the centres. The decline occurred within a week of the recognition of widespread community transmission of the virus in each region and shows a striking correlation with the national figures for new diagnoses of COVID-19 in each case. During the period of restriction, workflow dropped to <5% of normal, consisting of emergency cases only. In two of three centres, electrophysiologists were redeployed to perform emergency work outside electrophysiology. Among the centres studied, only Wenzhou has seen a recovery from the restrictions in activity. Following an intense nationwide programme of public health interventions, local transmission of COVID-19 ceased to be detectable after 18 February allowing the electrophysiology service to resume with a strict testing regime for all patients. CONCLUSION: Interventional electrophysiology is vulnerable to closure in times of great social difficulty including the COVID-19 pandemic. Intense public health intervention can permit suppression of local disease transmission allowing resumption of some normal activity with stringent precautions.


Subject(s)
COVID-19/epidemiology , Cardiac Electrophysiology , Cardiology Service, Hospital/organization & administration , COVID-19 Testing , China/epidemiology , Humans , Italy/epidemiology , London/epidemiology , Pandemics , SARS-CoV-2 , Workflow
9.
J Invasive Cardiol ; 33(2): E71-E76, 2021 02.
Article in English | MEDLINE | ID: covidwho-984012

ABSTRACT

In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.


Subject(s)
COVID-19 , Cardiac Catheterization/methods , Cardiology Service, Hospital , Coronary Care Units , Critical Care , Infection Control , Laboratories, Hospital/organization & administration , Organizational Innovation , ST Elevation Myocardial Infarction , COVID-19/epidemiology , COVID-19/therapy , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Coronary Care Units/methods , Coronary Care Units/organization & administration , Critical Care/methods , Critical Care/organization & administration , Critical Care/trends , Humans , Infection Control/methods , Infection Control/organization & administration , New York City/epidemiology , Patient Care Team/organization & administration , Perioperative Care/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy
10.
Eur Heart J Qual Care Clin Outcomes ; 7(3): 247-256, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-880797

ABSTRACT

AIMS: Limited data exist on the impact of COVID-19 on national changes in cardiac procedure activity, including patient characteristics and clinical outcomes before and during the COVID-19 pandemic. METHODS AND RESULTS: All major cardiac procedures (n = 374 899) performed between 1 January and 31 May for the years 2018, 2019, and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression was performed to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period. Overall, there was a deficit of 45 501 procedures during the COVID period compared to the monthly averages (March-May) in 2018-2019. Cardiac catheterization and device implantations were the most affected in terms of numbers (n = 19 637 and n = 10 453), whereas surgical procedures such as mitral valve replacement, other valve replacement/repair, atrioseptal defect/ventriculoseptal defect repair, and coronary artery bypass grafting were the most affected as a relative percentage difference (Δ) to previous years' averages. Transcatheter aortic valve replacement was the least affected (Δ -10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterization [OR 1.25 95% confidence interval (CI) 1.07-1.47, P = 0.006] and cardiac device implantation (OR 1.35 95% CI 1.15-1.58, P < 0.001). CONCLUSION: Cardiac procedural activity has significantly declined across England during the COVID-19 pandemic, with a deficit in excess of 45 000 procedures, without an increase in risk of mortality for most cardiac procedures performed during the pandemic. Major restructuring of cardiac services is necessary to deal with this deficit, which would inevitably impact long-term morbidity and mortality.


Subject(s)
COVID-19 , Cardiology Service, Hospital , Cardiovascular Diseases , Cardiovascular Surgical Procedures , Diagnostic Techniques, Cardiovascular , Infection Control/methods , COVID-19/epidemiology , COVID-19/prevention & control , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Cardiovascular Diseases/mortality , Cardiovascular Diseases/therapy , Cardiovascular Surgical Procedures/classification , Cardiovascular Surgical Procedures/statistics & numerical data , Diagnostic Techniques, Cardiovascular/classification , Diagnostic Techniques, Cardiovascular/statistics & numerical data , England/epidemiology , Female , Humans , Male , Middle Aged , Mortality , Organizational Innovation , Risk Assessment , Risk Factors , SARS-CoV-2
11.
J Am Coll Cardiol ; 76(11): 1375-1384, 2020 09 15.
Article in English | MEDLINE | ID: covidwho-764912

ABSTRACT

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease-2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the U.S. population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.


Subject(s)
Cardiology Service, Hospital/organization & administration , Coronavirus Infections , Emergency Service, Hospital/organization & administration , Infection Control , Myocardial Infarction , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral , Thrombolytic Therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Diagnosis, Differential , Humans , Infection Control/methods , Infection Control/organization & administration , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Organizational Innovation , Pandemics/prevention & control , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/trends , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Risk Assessment , SARS-CoV-2 , Thrombolytic Therapy/methods , Thrombolytic Therapy/trends , United States
12.
J Am Coll Cardiol ; 76(1): 72-84, 2020 07 07.
Article in English | MEDLINE | ID: covidwho-617527

ABSTRACT

The COVID-19 pandemic has presented a major unanticipated stress on the workforce, organizational structure, systems of care, and critical resource supplies. To ensure provider safety, to maximize efficiency, and to optimize patient outcomes, health systems need to be agile. Critical care cardiologists may be uniquely positioned to treat the numerous respiratory and cardiovascular complications of the SARS-CoV-2 and support clinicians without critical care training who may be suddenly asked to care for critically ill patients. This review draws upon the experiences of colleagues from heavily impacted regions of the United States and Europe, as well as lessons learned from military mass casualty medicine. This review offers pragmatic suggestions on how to implement scalable models for critical care delivery, cultivate educational tools for team training, and embrace technologies (e.g., telemedicine) to enable effective collaboration despite social distancing imperatives.


Subject(s)
Cardiology Service, Hospital , Coronavirus Infections , Critical Care , Delivery of Health Care , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Civil Defense/methods , Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Care/methods , Critical Care/organization & administration , Critical Care/trends , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Humans , Organizational Objectives , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2
13.
Can J Cardiol ; 36(8): 1313-1316, 2020 08.
Article in English | MEDLINE | ID: covidwho-733905

ABSTRACT

The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.


Subject(s)
Cardiology Service, Hospital , Cardiovascular Diseases , Coronavirus Infections , Ethics, Institutional , Infection Control/methods , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
15.
Intern Med J ; 50(8): 1000-1003, 2020 08.
Article in English | MEDLINE | ID: covidwho-705125

ABSTRACT

An increase in coronavirus disease (COVID-19) infections prompted Level 4 lockdown throughout New Zealand from 25 March 2020. We have investigated trends in coronary and electrophysiology (EP) procedures before and during this lockdown. The number of acute procedures for ST elevation myocardial infarction remained stable. In contrast, the number of in-patient angiograms and percutaneous intervention procedures fell by 53% compared with the previous 4 weeks in 2020 and by 56% compared with the corresponding period in 2019. Further study is required to determine the reasons for these trends.


Subject(s)
Cardiology Service, Hospital , Coronavirus Infections , Infection Control/statistics & numerical data , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral , ST Elevation Myocardial Infarction , Betacoronavirus , COVID-19 , Cardiac Electrophysiology/methods , Cardiac Electrophysiology/trends , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/statistics & numerical data , Coronary Angiography/statistics & numerical data , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Hospitalization/statistics & numerical data , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , New Zealand/epidemiology , Pandemics/prevention & control , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy , Workload/statistics & numerical data
17.
J Cardiovasc Med (Hagerstown) ; 21(9): 654-659, 2020 09.
Article in English | MEDLINE | ID: covidwho-681583

ABSTRACT

OBJECTIVE: By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. METHODS: We describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. RESULTS: From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home. CONCLUSION: Our preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.


Subject(s)
Cardiac Surgical Procedures , Cardiology Service, Hospital , Coronavirus Infections , Heart Defects, Congenital , Infection Control , Pandemics , Perinatal Care , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infant, Newborn , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Perinatal Care/methods , Perinatal Care/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Postoperative Care/methods , Pregnancy , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL