[ANMCO Position paper: Reorganization of cardiology in the era of the COVID-19 pandemic]. / Position paper ANMCO: Riorganizzazione della cardiologia in epoca di pandemia COVID-19.

The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic, new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.

Impact of Social Determinants and Digital Literacy on Telehealth Acceptance for Pediatric Cardiology Care Delivery during the Early Phase of the COVID-19 Pandemic.

OBJECTIVES: To determine whether telehealth acceptance by parents of children with heart disease is predicted by sociodemographic and/or by parental digital literacy, and to assess parental perceptions of telehealth usability and reliability. STUDY DESIGN: We conducted a single center study comparing telehealth acceptance versus visit cancellation/rescheduling for pediatric cardiology visits during the early phase of the COVID-19 pandemic. All parent/guardians who consented to survey completion received a validated survey assessing their digital literacy. Consenting parents who accepted telehealth received an additional validated survey assessing their perceptions of telehealth usability and reliability. RESULTS: A total of 849 patients originally were scheduled for in-person visits between March 30 and May 8, 2020. Telehealth acceptance was highest among younger, publicly insured, Hispanic patients with primary diagnoses of arrhythmia/palpitations, chest pain, dysautonomia, dyslipidemia and acquired heart disease. Among parents who completed surveys, a determinant of telehealth acceptance was digital literacy. Telehealth was determined to be a usable and reliable means for health care delivery. CONCLUSION: Although the potential for inequitable selection of telehealth due to sociodemographic factors exists, we found that such factors were not a major determinant for pediatric cardiology care within a large, diverse, free-standing pediatric hospital.

Impact and role of pulmonary embolism response teams in venous thromboembolism associated with COVID-19.

Venous thromboembolism associated with COVID-19, particularly acute pulmonary embolism, may represent a challenging and complex clinical scenario. The benefits of having a multidisciplinary pulmonary embolism response team (PERT) can be important during such a pandemic. The aim of PERT in the care of such patients is to provide fast, appropriate, multidisciplinary, team-based approach, with the common goal to tailor the best therapeutic decision making, prioritizing always optimal patient care, especially given lack of evidence-based clinical practice guidelines in the setting of COVID-19, which potentially confers a significant prothrombotic state. Herein, we would like to briefly emphasize the importance and potential critical role of PERT in the care of patients in which these two devastating illnesses are present together.

Rethinking heart failure care and health technologies from early COVID-19 experiences - A narrative review.

Heart Failure (HF), a common chronic disease, requires multidisciplinary care to optimise outcomes. The COVID-19 pandemic, its impact on people's movement and access to health services, introduced severe challenges to chronic disease management. The era that will evolve after this pandemic is likely to provide uncertainty and service model disruptions. HF treatment is based on guidelines derived from randomised clinical trial evidence. Translational shortfalls from trials into practice have been overcome with post-trial service improvement studies like OPTIMIZE-HF where a team using a process of care can translate evidence to the general population. However, gaps remain for vulnerable populations e.g. those with more severe HF, with multiple comorbid conditions, and certain demographic groups and/or residents in remote locations. Health technology has come with great promise, to fill some of these gaps. The COVID-19 pandemic provides an opportunity to observe, from Australian healthcare lens, HF management outside the traditional model of care. This narrative review describes relatively recent events with health technology as a solution to improve on service gaps.

Exploring the impact of the COVID-19 pandemic on provision of cardiology services: a scoping review.

The coronavirus disease-19 (COVID-19) pandemic has forced hospitals to prioritize COVID-19 patients, restrict resources, and cancel all non-urgent elective cardiac procedures. Clinical visits have only been facilitated for emergency purposes. Fewer patients have been admitted to the hospital for both ST-segment elevation myocardial infarctions (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI) and a profound decrease in heart failure services has been reported. A similar reduction in the patient presentation is seen for ischemic heart disease, decompensated heart failure, and endocarditis. Cardiovascular services, including catheterization, primary percutaneous coronary intervention (PPCI), cardiac investigations such as electrocardiograms (ECGs), exercise tolerance test (ETT), dobutamine stress test, computed tomography (CT) angiography, transesophageal echocardiography (TOE) have been reported to have declined and performed on a priority basis. The long-term implications of this decline have been discussed with major concerns of severe cardiac complications and vulnerabilities in cardiac patients. The pandemic has also had psychological impacts on patients causing them to avoid seeking medical help. This review discusses the effects of the COVID-19 pandemic on the provision of various cardiology services and aims to provide strategies to restore cardiovascular services including structural changes in the hospital to make up for the reduced staff personnel, the use of personal protective equipment in healthcare workers, and provides alternatives for high-risk cardiac imaging, cardiac interventions, and procedures. Implementation of the triage system, risk assessment scores, and telemedicine services in patients and their adaptation to the cardiovascular department have been discussed.

Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown.

[Figure: see text].

[Impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital]. / Impact de la pandémie de COVID-19 sur les activités du service de cardiologie de l'hôpital national Ignace Deen du CHU de Conakry.

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.

Resilience and response of the congenital cardiac network in Italy during the COVID-19 pandemic.

: The worldwide response to the current COVID-19 pandemic has been focused on how to prevent the disease and to protect the high-risk patient from a potentially lethal infection. Several consensus and guidelines articles have been published dealing with the cardiac patient with systemic hypertension, heart transplant or heart failure. Very little is known about the patients, both in the pediatric as well as in the adult age, with congenital heart disease. The peculiar physiology of the heart with a native, repaired or palliated congenital heart defect deserves a specialized care. Hereby we describe the early recommendations issued by the Italian Society of Pediatric Cardiology and Congenital Heart Disease and how the network of the congenital cardiac institutions in Italy reacted to the threat of potential wide spread of the infection among this fragile kind of patient.

Regional extracorporeal membrane oxygenation retrieval service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic: an interdisciplinary team approach to maintain service provision despite increased demand.

OBJECTIVES: Coronavirus disease 2019 is a new contagious disease that has spread rapidly across the world. It is associated with high mortality in those who develop respiratory complications and require admission to intensive care. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy option for selected severely ill patients who deteriorate despite the best supportive care. During the coronavirus disease 2019 pandemic, extra demand led to staff reorganization; hence, cardiac surgery consultants joined the ECMO retrieval team. This article describes how we increased service provisions to adapt to the changes in activity and staffing. METHODS: The data were collected from 16 March 2020 to 8 May 2020. The patients were referred through a dedicated Web-based referral portal to cope with increasing demand. The retrieval team attended the referring hospital, reviewed the patients and made the final decision to proceed with ECMO. RESULTS: We reported 41 ECMO retrieval runs during this study period. Apart from staffing changes, other retrieval protocols were maintained. The preferred cannulation method for veno-venous ECMO was drainage via the femoral vein and return to the right internal jugular vein. There were no complications reported during cannulation or transport. CONCLUSIONS: Staff reorganization in a crisis is of paramount importance. For those with precise transferrable skills, experience can be gained quickly with appropriate supervision. Therefore, the team members were selected based on skill mix rather than on roles that are more traditional. We have demonstrated that an ECMO retrieval service can be reorganized swiftly and successfully to cope with the sudden increase in demand by spending cardiac surgeons services to supplement the anaesthetic-intensivist roles.

COVID-19 and its impact on cardiology service.

COVID-19 has impacted the primary management of cardiac conditions, decreasing the number of interventions of coronary diseases. Elective coronary treatments and imaging have been largely cancelled across the world to make way for increased resources for COVID-19 patients. The impact on these cardiac patients during these times may be drastic. The number of hospital patients presenting with coronary symptoms during the outbreak has also decreased internationally. In this review, we discuss how COVID-19 has affected primary cardiac intervention globally and our service, possible reasons why, and how morbidity rates can be reduced by introducing scoring systems and telemedicine.

Overview of the 84th Annual Scientific Meeting of the Japanese Circulation Society　- Change Practice!

Due to the COVID-19 pandemic, the 84thAnnual Meeting of the Japanese Circulation Society (JCS) was held in a web-based format for the first time in its history as "The Week for JCS 2020" from Monday, July 27 to Sunday, August 2, 2020. All sessions, including general abstracts, were streamed live or on-demand. The main theme of the meeting was "Change Practice!" and the aim was to organize the latest findings in the field of cardiovascular medicine and discuss how to change practice. The total number of registered attendees was over 16,800, far exceeding our expectations, and many of the sessions were viewed by far more people than at conventional face-to-face scientific meetings. At this conference, the power of online information dissemination was fully demonstrated, and the evolution of online academic meetings will be a direction that cannot be reversed in the future. The meeting was completed with great success, and we express our heartfelt gratitude to all affiliates for their enormous amount of work, cooperation, and support.

Simulation and Improvement of Patients' Workflow in Heart Clinics during COVID-19 Pandemic Using Timed Coloured Petri Nets.

The COVID-19 epidemic has spread across the world within months and creates multiple challenges for healthcare providers. Patients with cardiovascular disease represent a vulnerable population when suffering from COVID-19. Most hospitals have been facing difficulties in the treatment of COVID-19 patients, and there is a need to minimise patient flow time so that staff health is less endangered, and more patients can be treated. This article shows how to use simulation techniques to prepare hospitals for a virus outbreak. The initial simulation of the current processes of the heart clinic first identified the bottlenecks. It confirmed that the current workflow is not optimal for COVID-19 patients; therefore, to reduce waiting time, three optimisation scenarios are proposed. In the best situation, the discrete-event simulation of the second scenario led to a 62.3% reduction in patient waiting time. This is one of the few studies that show how hospitals can use workflow modelling using timed coloured Petri nets to manage healthcare systems in practice. This technique would be valuable in these challenging times as the health of staff, and other patients are at risk from the nosocomial transmission.

Outpatient vascular clinic management in COVID-19 pandemic.

INTRODUCTION: The recent Sars-CoV2 pandemic has dramatically slowed patients' access to our clinic for vascular pathology when the contagion curve peaked. The need to restore the assistance activity has led us to adopt new individual prophylaxis and hygiene measures. METHODS: Doctors and staff must wear dedicated clothes. Mask and gloves are mandatory for patients. A visit is scheduled every 60 minutes to allow the sanitation of the rooms. The day before the visit patients are contacted by telephone for the Covid-19 risk triage. In the presence of symptoms the visit is postponed. In the presence of other risk factors a IgG/IgM Rapid Test for Covid-19 is performed on admission to the clinic. In the presence of fever, if an extraordinary rapid test cannot be performed, the visit must be postponed. Rapid test positive patients cannot be visited: they are placed in solitary confinement at their home waiting for a nasopharyngeal swab for Covid-19. When the rapid test is positive, immediate room sanitation also occurs. The rooms dedicated to the outpatient clinic as well as medical and not medical instruments are disinfected. CONCLUSION: The one adopted can be a useful management model for any type of care activity in order to guarantee the safety of patients and all the staff. KEY WORDS: COVID-19, Management, vascular, Outpatient clinic.

Transition of a Large Tertiary Heart Failure Program in Response to the COVID-19 Pandemic: Changes That Will Endure.

The coronavirus disease 2019 (COVID-19) pandemic imposed severe restrictions on traditional methods of patient care. During the pandemic, the heart failure program at New York-Presbyterian Hospital in New York, NY rapidly and comprehensively transitioned its care delivery model and administrative organization to conform to a new healthcare environment while still providing high-quality care to a large cohort of patients with heart failure, heart transplantation, and left ventricular assist device. In addition to the widespread adoption of telehealth, our program restructured outpatient care, initiating a shared clinic model and introducing a comprehensive remote monitoring program to manage patients with heart failure and heart transplant. All conferences, including administrative meetings, support groups, and educational seminars were converted to teleconferencing platforms. Following the peak of COVID-19, many of the new changes have been maintained, and the program structure will be permanently altered as a lasting effect of this pandemic. In this article, we review the details of our program's transition in the face of COVID-19 and highlight the programmatic changes that will endure.

The impact of the COVID-19 pandemic on cardiology services.

OBJECTIVE: The COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity. METHODS: We analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision. RESULTS: There has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation. CONCLUSIONS: As ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.

Safety measures and clinical outcome of Nuclear Cardiology Department during Covid-19 lockdown pandemic: Northern Italy experience.

BACKGROUND: The Covid-19 pandemic led to a complete renewal of clinical activities of Italian hospitals. During the lockdown, all hospitals in Italy had to suspend non-urgent clinical activities. The prolonged suspension of elective activities could have caused a series of problems. METHODS: A new ad hoc protocol was designed. Single-day fast-imaging protocol with regadenoson-stress 99mTc-tetrofosmin imaging was preferred. Patients were contacted by phone 4 days before the test and answered to a questionnaire which will be repeated on the day of the exam. Body temperature <37.5 degrees C and no Covid-19 symptoms were necessary to enter the unit. Patients wore surgical mask and gloves. Social distancing was maintained throughout the examination. Healthcare professionals wore a personal protective equipment. RESULTS: A total of 46 patients were studied from April 7 to May 15, 2020, before the publication of the recommendations from ASNC and SNMMI. None of the patients experienced complications. Follow-up of patients discharged was carried by phone. No Covid-19 infection symptoms were reported. On May 18, 2020 all the healthcare providers of nuclear cardiology department underwent serological testing IgG and IgM and none were positive. CONCLUSION: Strict ad hoc hygiene protocol for Covid-19 pandemic avoids diagnostic-therapeutic delay and lengthening of waiting lists. Our experience confirms that pursuing WHO recommendations and recent indication of ASNC and SNMMI is safe for both health providers and patients. Moreover, the incidence of significant inducible ischemia rises when correct stratification of patients is performed.