Covid period: Pathway and data in cardiology

ABSTRACT

During the lockdown period due to COVID 19, total hospital admissions drastically decreased, mainly for the fear of contagion. In the first days of lockdown, our hospital decided to separate the pathway of COVID 19 positive/suspicious patients and COVID 19 free patients, to avoid the spread of the disease. After arriving in the pre-triage camping tend, vital parameters and temperature were measured to all patients and a questionnaire was submitted to identify subjects at risk of COVID-19 contact. After the immediate pre-triage, patients were separated into suspected/ positive and negative, a rapid serological test (10minutes) and oral-pharyngeal antigen swab (20minutes) were executed, at the result of these two exams, the patients were sent on a COVID-free pathway or in dedicated area of hospitalization for COVID patients. To guarantee the best possible assistance for urgent pathologies, our hospital has equipped the COVID structure with the necessary diagnostic methods including CT and a dedicated angiograph for neuroradiology, vascular radiology and interventional cardiology, to allow the execution of coronary angiography and angioplasty in patients with STEMI and NSTEMI. A team dedicated to the COVID operating room consisting of a doctor, 2 nurses and a technician and was available 24/24 hours for any emergencies. From March 4 to today, the operating room has been used for a definitive pacemaker implant in a patient with complete AV block, 13 STEMI patients came from 'Rete IMA ', our regional emergency medical system (our hospital is the provincial HUB) or in hospital with their own means of transport or transported by 118. Of these 13 patients, 4 died during the hospital stay. Since March 2020, the pathways for cardiological patients with acute pathologies have been differentiated, minimizing the possibility of contact between the two populations and always guaranteeing hospital users the best treatment indicated for the various emergency/ urgent pathologies. The reduction in the number of ACS is around 30% (the reduction for unstable angina and NSTEMI is greater), but the complexity of cases has increased, we have seen an increase in heart attacks with complications (cardiogenic shock, ruptures) compared to the same period of the last year. Probably the late presentation (sometimes even a few days after the onset of symptoms) makes these patients particularly at risk of complications, pre and post-procedural.