RESUMEN
Background: The East Timor Hearts Fund (ETHF) has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. With international border closures due to the COVID-19 pandemic, development of collaborative telehealth services was required. Methods: Scoping discussions identified major challenges (structural, patient-related and medical system-related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared to an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. Results: 23 patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared to an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients, 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23, 73.9%) and Dili-based (18/23, 78.3%) with a mean age of 25.9 ± 7.2 years old. The majority (12/23, 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-minute walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. 11 patients (47.8%) were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at current inability to provide interventional services was highlighted. Conclusion: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.
RESUMEN
Background: In Timor-Leste, cardiac interventions and surgical procedures are largely provided by the East Timor Hearts Fund. Since March 2020, no Timorese patients have been able to travel to Australia for humanitarian cardiac procedures. Methods: We describe patients awaiting cardiac intervention as of March 2020, documenting their outcomes eighteen months later in August 2021. Contact with healthcare facilities (the national hospital, local clinics or online telehealth) was identified. Major adverse cardiac events (MACE;death, heart failure admission or stroke) were documented and demographic characteristics compared between patients experiencing MACE versus those remaining symptomatically stable. Results: In March 2020, 35 patients were waitlisted for cardiac intervention (68.6% female, mean age 26.8 ± 9.4 yrs). Eighteen months later, 9 (25.7%) patients experienced definite MACE, comprising 3 sudden deaths and 14 admissions for decompensated heart failure. A further 10 patients (28.6%) had newly-disconnected phone numbers, implying possible additional deaths. 15 patients attended online telehealth clinics;7 (46.7%) had deteriorating NYHA scores. 14 patients (40.0%) were symptomatically stable. Patients experiencing MACE had been waitlisted a median of 30 months by August 2021 compared to 22 months for stable patients. Conclusions: At least one-quarter and possibly over half of a humanitarian charity’s patient list died or developed severe heart failure following eighteen months’ delay to cardiac intervention during international border closures from COVID-19. Patients attending online telehealth clinics reported high rates of morbidity and deteriorating symptoms. Abrupt border closures leaving a country without access to humanitarian surgery highlight the vulnerabilities of short-term medical mission models.
RESUMEN
The global coronavirus disease (COVID-19) pandemic poses an unprecedented stress on healthcare systems internationally. These Health system-wide demands call for efficient utilisation of resources at this time in a fair, consistent, ethical and efficient manner would improve our ability to treat patients. Excellent co-operation between hospital units (especially intensive care unit [ICU], emergency department [ED] and cardiology) is critical in ensuring optimal patient outcomes. The purpose of this document is to provide practical guidelines for the effective use of interventional cardiology services in Australia and New Zealand. The document will be updated regularly as new evidence and knowledge is gained with time. Goals Considerations.