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Andreß S, Felbel D, Buckert D, Rottbauer W, Imhof A, Stephan T. Deferral of non-emergency cardiac interventions is associated with increased emergency hospitalizations up to 24 months post-procedure. Clin Res Cardiol 2024:10.1007/s00392-024-02380-y. [PMID: 38446147 DOI: 10.1007/s00392-024-02380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/10/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Patients, whose non-emergency cardiac procedure was postponed during the COVID-19 pandemic, have shown signs of disease progression in the short term. Data on the long-term effects are currently lacking. AIM To assess outcomes through 3 years following deferral. METHODS This retrospective, single-center analysis includes consecutive patients whose non-emergency cardiovascular intervention was postponed during the first COVID-19-related lockdown (March 19 to April 30, 2020). Outcomes over 36 months post-procedure were analyzed and compared to a seasonal control group undergoing non-emergency intervention in 2019 as scheduled (n = 214). The primary endpoint was a composite of emergency cardiovascular hospitalization and death. Additionally, NT-proBNP levels were analyzed. RESULTS The combined endpoint occurred in 60 of 178 patients (33.7%) whose non-emergency transcatheter heart valve intervention, rhythmological procedure, or left heart catheterization was postponed. Primary endpoint events did not occur more frequently in the study group during the 36-month follow-up (p = 0.402), but within the first 24 months post-procedure (HR 1.77, 95% CI 1.20-2.60, p = 0.003). Deferred patients affected by an event in the postprocedural 24 months had significantly higher NT-proBNP levels at the time of intervention (p < 0.001) (AUC 0.768, p = 0.003, optimum cut-off 808.5 pg/ml, sensitivity 84.2%, specificity 65.8%) and thereafter (p < 0.001). CONCLUSION Deferral of non-emergency cardiovascular interventions is associated with poor outcomes up to 24 months post-procedure. Adverse effects affect patients who develop signs of acute heart failure, as indicated by NT-proBNP, prior to treatment. These findings could help improve resource allocation in times of limited capacity.
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Affiliation(s)
- Stefanie Andreß
- Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Bumburidi Y, Dzhalimbekova A, Malisheva M, Moolenaar RL, Horth R, Singer D, Otorbaeva D. Excess deaths directly and indirectly attributable to COVID-19 using routinely reported mortality data, Bishkek, Kyrgyzstan, 2020: a cross-sectional study. BMJ Open 2023; 13:e069521. [PMID: 37433726 DOI: 10.1136/bmjopen-2022-069521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Studies on excess deaths (ED) show that reported deaths from COVID-19 underestimate death. To understand mortality for improved pandemic preparedness, we estimated ED directly and indirectly attributable to COVID-19 and ED by age groups. DESIGN Cross-sectional study using routinely reported individual deaths data. SETTINGS The 21 health facilities in Bishkek that register all city deaths. PARTICIPANTS Residents of Bishkek who died in the city from 2015 to 2020. OUTCOME MEASURE We report weekly and cumulative ED by age, sex and causes of death for 2020. EDs are the difference between observed and expected deaths. Expected deaths were calculated using the historical average and the upper bound of the 95% CI from 2015 to 2019. We calculated the percentage of deaths above expected using the upper bound of the 95% CI of expected deaths. COVID-19 deaths were laboratory confirmed (U07.1) or probable (U07.2 or unspecified pneumonia). RESULTS Of 4660 deaths in 2020, we estimated 840-1042 ED (79-98 ED per 100 000 people). Deaths were 22% greater than expected. EDs were greater for men (28%) than for women (20%). EDs were observed in all age groups, with the highest ED (43%) among people 65-74 years of age. Hospital deaths were 45% higher than expected. During peak mortality (1 July -21 July), weekly ED was 267% above expected, and ED by disease-specific cause of death were above expected: 193% for ischaemic heart diseases, 52% for cerebrovascular diseases and 421% for lower respiratory diseases. COVID-19 was directly attributable to 69% of ED. CONCLUSION Deaths directly and indirectly associated with the COVID-19 pandemic were markedly higher than reported, especially for older populations, in hospital settings, and during peak weeks of SARS-CoV-2 transmission. These ED estimates can support efforts to prioritise support for persons at greatest risk of dying during surges.
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Affiliation(s)
- Yekaterina Bumburidi
- Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan
| | - Altynai Dzhalimbekova
- Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan
| | - Marina Malisheva
- Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan
- Central Asia Field Epidemiology Training Program, Bishkek, Kyrgyzstan
| | - Ronald L Moolenaar
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roberta Horth
- Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan
- Central Asia Field Epidemiology Training Program, Bishkek, Kyrgyzstan
| | - Daniel Singer
- Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan
| | - Dinagul Otorbaeva
- Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan
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Andreß S, Felbel D, Mack A, Rattka M, d'Almeida S, Buckert D, Rottbauer W, Imhof A, Stephan T. Predictors of worse outcome after postponing non-emergency cardiac interventions during the COVID-19 pandemic. Open Heart 2023; 10:e002293. [PMID: 37460272 DOI: 10.1136/openhrt-2023-002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Deferral of non-emergency cardiac procedures is associated with increased early emergency cardiovascular hospitalisation. This study aimed to identify predictors of worse clinical outcome after deferral of non-emergency cardiovascular interventions. METHODS This observational case-control study included consecutive patients whose non-emergency cardiac intervention has been postponed during COVID-19-related lockdown between 19 March and 30 April 2020 (n=193). Cox regression was performed to identify predictors of the combined 1-year end point emergency cardiovascular hospitalisation and death. All patients undergoing non-emergency interventions in the corresponding time period 2019 served as control group (n=216). RESULTS The combined end point of death and emergency cardiovascular hospitalisation occurred in 70 (36.3%) of 193 patients with a postponed cardiovascular intervention. The planned intervention was deferred by a median of 23 (19-36) days. Arterial hypertension (HR 2.27; 95% CI 1.00 to 5.12; p=0.049), chronic kidney disease (HR 1.89; 95% CI 1.03 to 3.49; p=0.041) as well as severe valvular heart disease (HR 3.08; 95% CI 1.68 to 5.64; p<0.001) were independent predictors of death or emergency hospitalisation. Kaplan-Maier estimators of the combined end point were 31% in patients with arterial hypertension, 56% in patients with severe valvular heart disease and 77% with both risk factors (HR 12.4, 95% CI 3.8 to 40.7; p<0.001) and only 9% in patients without these risk factors (log rank p<0.001). N-terminal pro-B-type natriuretic peptide (NT-proBNP) cut-point of ≥1109 pg/mL best predicts the occurrence of primary end point event in deferred patients (area under the curve 0.71; p<0.001; sensitivity 63.8%, specificity 69.4%). CONCLUSION Our results suggest that patients with either arterial hypertension, chronic kidney or severe valvular heart disease are at very high risk for emergency hospitalisation and increased mortality in case of postponed cardiac interventions even in supposed stable clinical status. Risk seems to be even higher in patients suffering from a combination of these conditions. If the ongoing or future pandemics force hospitals again to postpone cardiac interventions, the biomarker NT-proBNP is an applicable parameter for outpatient monitoring to identify those at risk for adverse cardiovascular events.
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Affiliation(s)
- Stefanie Andreß
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Alex Mack
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Manuel Rattka
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Sascha d'Almeida
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Germany
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Vidal-Perez R, Brandão M, Pazdernik M, Kresoja KP, Carpenito M, Maeda S, Casado-Arroyo R, Muscoli S, Pöss J, Fontes-Carvalho R, Vazquez-Rodriguez JM. Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic. World J Clin Cases 2022; 10:9556-9572. [PMID: 36186196 PMCID: PMC9516905 DOI: 10.12998/wjcc.v10.i27.9556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is known to present with respiratory symptoms, which can lead to severe pneumonia and respiratory failure. However, it can have multisystem complications such as cardiovascular manifestations. The cardiovascular manifestations reported comprise myocarditis, cardiogenic shock, arrhythmias, pulmonary embolism, deep vein embolism, acute heart failure, and myocardial infarction. There is also an indirect impact of the pandemic on the management of cardiovascular care that has been shown clearly in multiple publications. In this review, we summarize the deadly relation of COVID-19 with cardiovascular events and the wider impact on several cardiovascular care areas by the pandemic situation
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
| | - Mariana Brandão
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
| | - Michal Pazdernik
- Intensive Care Unit, Department of Cardiology, Institute for Clinical and Experimental Medicine Prague, Prague 14021, Czech Republic
| | | | - Myriam Carpenito
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Shingo Maeda
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kawasaki 210-0822, Japan
| | - Rubén Casado-Arroyo
- Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium
| | - Saverio Muscoli
- Unit of Cardiology, Policlinico Tor Vergata, Rome 00133, Italy
| | - Janine Pöss
- Heart Center Leipzig, University of Leipzig, Leipzig 04289, Germany
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto 4200-319, Portugal
| | - Jose Manuel Vazquez-Rodriguez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
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Malhi N, Moghaddam N, Hosseini F, Singer J, Lee T, Turgeon RD, Wong GC, Fordyce CB. Care and Outcomes of ST-Segment Elevation Myocardial Infarction Across Multiple COVID-19 Waves. Can J Cardiol 2022; 38:783-791. [PMID: 35151778 PMCID: PMC8830145 DOI: 10.1016/j.cjca.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are concerns of delays in ST-segment elevation myocardial infarction (STEMI) care during the COVID-19 pandemic. It is unclear whether the care and outcomes of STEMI patients differ between COVID-19 waves and compared with historical periods. METHODS Consecutive patients in the Vancouver Coastal Health Authority STEMI database were included to compare care during 3 distinct waves of the COVID-19 pandemic (9 months; March 2020 to January 2021) with an historical non-COVID-19 cohort. We compared STEMI incidence, baseline characteristics, and outcomes between groups. We also examined time from first medical contact (FMC) to reperfusion, symptom to FMC, and FMC to STEMI diagnosis, as well as predictors of delays. RESULTS The incidence of STEMI was similar during COVID-19 (n = 305; mean 0.93/day) and before COVID-19 (n = 949; 0.97/day; P = 0.80). The COVID-19 cohort showed significant delay in FMC-to-reperfusion (median 116 min vs 102 min; P < 0.001) and FMC-to-STEMI diagnosis (median 17 mins vs 11 min; P < 0.001). Delays in FMC-to-device times worsened across the 3 COVID-19 waves (FMC-to-device time ≤ 90 min in wave 1: 32.9%; in wave 2: 25.6%; in wave 3: 16.3%; P = 0.045 [47.5% before COVID-19; P < 0.001]). There were no significant predictors of delay were unique to the COVID-19 cohort. CONCLUSIONS This study demonstrates delays in reperfusion during the COVID-19 pandemic compared with the historical control, with delays increasing during subsequent waves within the pandemic. It is critical to further understand these care gaps to improve STEMI care for future waves of the current and future pandemics.
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Affiliation(s)
- Navraj Malhi
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nima Moghaddam
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Farshad Hosseini
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Terry Lee
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Ricky D. Turgeon
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham C. Wong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada,Corresponding author: Dr Christopher B. Fordyce, Level 9, 2775 Laurel Street, Vancouver, British Columbia V5Z1M9, Canada. Tel.: +1-604-875-5735; fax: +1-604-875-5736
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6
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Andreß S, Stephan T, Felbel D, Mack A, Baumhardt M, Kersten J, Buckert D, Pott A, Dahme T, Rottbauer W, Imhof A, Rattka M. Deferral of non-emergency cardiac procedures is associated with increased early emergency cardiovascular hospitalizations. Clin Res Cardiol 2022; 111:1121-1129. [PMID: 35604454 PMCID: PMC9125015 DOI: 10.1007/s00392-022-02032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
Background During the COVID-19 pandemic, in anticipation of a demand surge for high-care hospital beds, many hospitals postponed non-emergency interventions of cardiac patients. Aim The aim of this study was to assess the outcomes of cardiac patients whose non-emergency interventions had been deferred during the COVID-19 pandemic. Methods Patients whose non-emergency cardiac intervention had been cancelled between March 19th and April 30th, 2020 were included (study group). All patients were considered as deferrable according to current recommendations. Patients’ outcomes after 12 months were compared to a seasonal control group who underwent non-emergency interventions in 2019 as scheduled. The primary endpoint was a composite of emergency cardiovascular hospitalization and death. Secondary endpoints were levels of symptoms and cardiac biomarkers. Results Outcomes of 193 consecutive patients in the study group were assessed and compared to 216 controls. The primary endpoint occurred significantly more often in the study group (HR 2.42, 95%CI 1.63–3.61, p < 0.001). This was driven by an increase in hospitalizations. Subgroup analyses showed that especially patients with a deferred transcatheter heart valve intervention experienced early emergency hospitalization (HR 9.55, 95%CI 3.70–24.62, p < 0.001). These findings were accompanied by more pronounced symptoms and higher biomarker levels. Conclusions Deferral of non-emergency cardiac interventions to meet the higher demand for hospital beds during the COVID-19 crisis is associated with early emergency cardiovascular hospitalizations. Patients suffering from valvular heart disease especially constitute a vulnerable group. Consequently, our results suggest that current recommendations on the management of cardiovascular disease during the COVID-19 pandemic need revision. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02032-z.
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Affiliation(s)
- Stefanie Andreß
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Tilman Stephan
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Alex Mack
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Michael Baumhardt
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Johannes Kersten
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Dominik Buckert
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Alexander Pott
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Tillman Dahme
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Armin Imhof
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Manuel Rattka
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081, Ulm, Germany.
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Barker M, Sathananthan J, Perdoncin E, Devireddy C, Keegan P, Grubb K, Pop AM, Depta JP, Rai D, Abtahian F, Spence MS, Mailey J, Muir DF, Russo MJ, Pineda-Salazar J, Okoh A, Smith M, Dahle TG, Rana M, Alfadhel M, Meier D, Chatfield A, Akodad M, Chuang A, Samuel R, Nestelberger T, McAlister C, Lauck S, Webb JG, Wood DA. Same-Day Discharge Post-Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic: The Multicenter PROTECT TAVR Study. JACC Cardiovasc Interv 2022; 15:590-598. [PMID: 35331450 PMCID: PMC8936029 DOI: 10.1016/j.jcin.2021.12.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022]
Abstract
Objectives The aim of this study was to determine the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic. Background The COVID-19 pandemic has placed significant stress on health care systems worldwide. SDD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care while managing competing COVID-19 resource demands. Methods Patient selection for SDD was at the discretion of the local multidisciplinary heart team, across 7 international sites. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation. Results From March 2020 to August 2021, 124 of 2,100 patients who underwent elective transfemoral TAVR were selected for SDD. The average age was 78.9 ± 7.8 years, the median Society of Thoracic Surgeons score was 2.4 (IQR: 1.4-4.2), and 32.3% (n = 40) had preexisting PPMs. There were no major vascular complications, strokes, or deaths during the index admission. One patient (0.8%) required PPM implantation for complete heart block and was discharged the same day. No patient required a PPM between discharge home and 30-day follow-up. The composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new PPM at 30 days occurred in 5.7% patients (n = 6 of 106). Conclusions SDD post-TAVR is safe and feasible in selected patients at low risk for adverse clinical events postdischarge. This strategy may have a potential role in highly selected patients even when the COVID-19 pandemic abates.
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Affiliation(s)
- Madeleine Barker
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Kendra Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Andrei M Pop
- AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Jeremiah P Depta
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Farhad Abtahian
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Douglas F Muir
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Mark J Russo
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Pineda-Salazar
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alexis Okoh
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Meghan Smith
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Thom G Dahle
- Department of Cardiology, CentraCare Heart and Vascular Center, St. Cloud, Minnesota, USA
| | - Masud Rana
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mesfer Alfadhel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Chatfield
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Chuang
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rohit Samuel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Nestelberger
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron McAlister
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra Lauck
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada.
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8
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Wang Y, Kang L, Chien CW, Xu J, You P, Xing S, Tung TH. Comparison of the Characteristics, Management, and Outcomes of STEMI Patients Presenting With vs. Those of Patients Presenting Without COVID-19 Infection: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:831143. [PMID: 35360030 PMCID: PMC8964144 DOI: 10.3389/fcvm.2022.831143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives This study aimed to investigate the differences in the characteristics, management, and clinical outcomes of patients with and that of those without coronavirus disease 2019 (COVID-19) infection who had ST-segment elevation myocardial infarction (STEMI). Methods Databases including Web of Science, PubMed, Cochrane Library, and Embase were searched up to July 2021. Observational studies that reported on the characteristics, management, or clinical outcomes and those published as full-text articles were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included studies. Results A total of 27,742 patients from 13 studies were included in this meta-analysis. Significant delay in symptom onset to first medical contact (SO-to-FMC) time (mean difference = 23.42 min; 95% CI: 5.85–40.99 min; p = 0.009) and door-to-balloon (D2B) time (mean difference = 12.27 min; 95% CI: 5.77–18.78 min; p = 0.0002) was observed in COVID-19 patients. Compared to COVID-19 negative patients, those who are positive patients had significantly higher levels of C-reactive protein, D-dimer, and thrombus grade (p < 0.05) and showed more frequent use of thrombus aspiration and glycoprotein IIbIIIa (Gp2b3a) inhibitor (p < 0.05). COVID-19 positive patients also had higher rates of in-hospital mortality (OR = 5.98, 95% CI: 4.78–7.48, p < 0.0001), cardiogenic shock (OR = 2.75, 95% CI: 2.02–3.76, p < 0.0001), and stent thrombosis (OR = 5.65, 95% CI: 2.41–13.23, p < 0.0001). They were also more likely to be admitted to the intensive care unit (ICU) (OR = 4.26, 95% CI: 2.51–7.22, p < 0.0001) and had a longer length of stay (mean difference = 4.63 days; 95% CI: 2.56–6.69 days; p < 0.0001). Conclusions This study revealed that COVID-19 infection had an impact on the time of initial medical intervention for patients with STEMI after symptom onset and showed that COVID-19 patients with STEMI were more likely to have thrombosis and had poorer outcomes.
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Affiliation(s)
- Yanjiao Wang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Linlin Kang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Jiawen Xu
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Peng You
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Sizhong Xing
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Sizhong Xing
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- *Correspondence: Tao-Hsin Tung
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9
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Simsek M, Kantarci B, Boukerche A, Khan S. Machine Learning-Backed Planning of Rapid COVID-19 Tests With Autonomous Vehicles With Zero-Day Considerations. IEEE TRANSACTIONS ON EMERGING TOPICS IN COMPUTATIONAL INTELLIGENCE 2022. [DOI: 10.1109/tetci.2021.3131352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Perpetua EM, Russo MJ. Never Let a Crisis Go to Waste: What Have We Learned About Clinical Pathways for Transcatheter Structural Heart Interventions? STRUCTURAL HEART 2021; 5:605-607. [PMID: 35340993 PMCID: PMC8935932 DOI: 10.1080/24748706.2021.2006384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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11
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MitraClip for mitral valve regurgitation and transcatheter aortic valve implantation for severe aortic valve stenosis: state-of-the-art. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:155-162. [PMID: 34400917 PMCID: PMC8356826 DOI: 10.5114/aic.2021.107493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
There is a worldwide expansion in percutaneous therapy for valvular heart disease. Rapidly evolving technology and the general increase in life expectancy will support the evolution of new treatment options dedicated to structural heart interventions. Transcatheter aortic valve implantation for severe aortic valve stenosis and percutaneous mitral valve repair with the MitraClip system for severe mitral regurgitation have been demonstrated as a feasible, innovative alternative for surgical treatment. Despite the inequality in clinical experience, both procedures have encouraging results and now are a part of everyday clinical practice. More importantly, rapid development is expected in the next decades. However, the global coronavirus disease 2019 (COVID-19) pandemic imposed redistribution of healthcare resources. Hospitals were obliged to modify their workflow and limit TAVI and MitraClip procedures to urgent or in highly symptomatic patients. Despite this encumbrance improvement in technology and experience supported by robust evidence from current studies might extend indications for both procedures. The future holds promise for this treatment modality to become the preferred procedure for all patients despite age or risk and reserving surgical treatment for a minority. Thus, we present state-of-the-art and current evidence for both methods assumed to change the paradigm of treatment of valvular heart failure in the future.
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12
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Abstract
The spread of Coronavirus Disease 2019 (COVID-19) pandemic across the globe and the United States presented unprecedented challenges with dawn of new policies to reserve resources and protect the public. One of the major policies adopted by hospitals across the nations were postponement of non-emergent procedures such as transaortic valve replacement (TAVR), left atrial appendage closure device (LAAC), MitraClip and CardioMEMS. Guidelines were based mainly on the avoidable clinical outcomes occurring during COVID-19 era. As our understanding of the SARS-CoV-2 evolved, advanced cardiac procedures may safely continue through careful advanced coordination. We aim to highlight the new guidelines published by different major cardiovascular societies, and discuss solutions to safely perform procedures to improve outcomes in a patient population with high acuity of illness during the COVID-19 pandemic era.
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13
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Rashid M, Wu J, Timmis A, Curzen N, Clarke S, Zaman A, Nolan J, Shoaib A, Mohamed MO, de Belder MA, Deanfield J, Gale CP, Mamas MA. Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England. J Intern Med 2021; 290:88-100. [PMID: 33462815 PMCID: PMC8013521 DOI: 10.1111/joim.13246] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with underlying cardiovascular disease and coronavirus disease 2019 (COVID-19) infection are at increased risk of morbidity and mortality. OBJECTIVES This study was designed to characterize the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID-19 infection. METHODS This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID-19 infection between 1 March and 31 May 2020 were included. The primary outcome was in-hospital and 30-day mortality. RESULTS A total of 12 958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID-19-positive and were more likely to present with non-ST-elevation acute myocardial infarction. The COVID-19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with the non-COVID-19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID-19 ACS had higher in-hospital (adjusted odds ratio (aOR): 3.27; 95% confidence interval (CI): 2.41-4.42) and 30-day mortality (aOR: 6.53; 95% CI: 5.1-8.36) compared to patients with the non-COVID-19 ACS. CONCLUSION COVID-19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline-recommended treatment and significant mortality hazard.
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Affiliation(s)
- Muhammad Rashid
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | | | - Nick Curzen
- Coronary Research Group, Faculty of Medicine, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Sarah Clarke
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Azfar Zaman
- Department of Cardiology, Freemen Hospital, Newcastle Upon Tyne, UK
| | - James Nolan
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Ahmad Shoaib
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Mohamed O Mohamed
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - Mamas A Mamas
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.,Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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14
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Wood D. Society News. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Pop AM, Barker M, Hickman L, Barrow F, Sathananthan J, Stansfield W, Nikolov M, Mohamed E, Lauck S, Wang J, Webb JG, Wood DA. Same Day Discharge during the COVID-19 Pandemic in Highly Selected Transcatheter Aortic Valve Replacement Patients. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2021; 5:596-604. [PMID: 35340994 PMCID: PMC8935931 DOI: 10.1080/24748706.2021.1988780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) with a standardized clinical pathway allows most patients to achieve safe next-day discharge. This approach has been successfully implemented across global centers as part of the Benchmark Program. Considering restricted hospital resources resulting from the COVID-19 pandemic, a modified same day discharge (SDD) clinical pathway was implemented for selected TAVR patients at a single Benchmark site. Methods All patients accepted for TAVR were assessed for the SDD clinical pathway. Eligibility criteria included adequate social support and accessibility to the TAVR program post-discharge. Patients with preexisting conduction disease were excluded. The clinical pathway comprised of mobilization, bloodwork and electrocardiogram 4 hours post-TAVR and discharge ≥8 hours following groin hemostasis. Results From June to December 2020, 142 patients underwent TAVR at a single community Benchmark site. Of those, 29 highly selected patients were successfully discharged the same day using the SDD clinical pathway. There were no vascular access complications, permanent pacemaker (PPM) implantation, or mortality in the SDD group during index admission or at 30-day follow-up. When compared to a standard therapy group, there was no statistically significant difference in 30-day cardiovascular readmission. Conclusions This study demonstrates the safety and feasibility of same day discharge post-TAVR in a highly selected cohort of patients, with no observable difference in safety outcomes when compared to patients who were discharged according to standard institutional practice.Abbreviations: AS: aortic stenosis; ACT: Activated clotting time; AV: atrioventricular; AVB: atrioventricular block; BBB: bundle branch block; CAIC: Canadian Society for Cardiovascular Angiography; CCL: cardiac catheterization laboratory; CT: Computed topography; CV: cardiovascular; IQR: Interquartile Range; IVCD: intraventricular conduction delay; LBBB: left bundle branch block; LOS: length of stay; NDD: next day discharge; PPM: permanent pacemaker; RBBB: right bundle branch block; SCAI: Society for Cardiovascular Angiography and Intervention; SD: standard deviation; SDD: same day discharge; ST: standard therapy; STS PROM: society of thoracic surgeons predicted risk of mortality; TAVR: transcatheter aortic valve replacement; TF: transfemoral; THV: transcatheter heart valve; TTE: transthoracic echocardiogram; VARC: Valve Academic Research Consortium
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Affiliation(s)
- Andrei M Pop
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Madeleine Barker
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Hickman
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Firas Barrow
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - William Stansfield
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Michael Nikolov
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Elsayed Mohamed
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Sandra Lauck
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jia Wang
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Wu J, Mamas M, Rashid M, Weston C, Hains J, Luescher T, de Belder MA, Deanfield JE, Gale CP. Patient response, treatments, and mortality for acute myocardial infarction during the COVID-19 pandemic. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:238-246. [PMID: 32730620 PMCID: PMC7454506 DOI: 10.1093/ehjqcco/qcaa062] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022]
Abstract
Aim COVID-19 might have affected the care and outcomes of hospitalised acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment and mortality from AMI. Methods and Results Admission were classified as non ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1st January, 2019 and 22nd May, 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23rd March, 2020 (UK lockdown) median daily hospitalisations decreased more for NSTEMI (69 to 35; IRR 0.51, 95% CI 0.47-0.54) than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19th April, 2020. During lockdown, patients were younger (mean age 68.7 years vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%) or had cerebrovascular disease (7.0% vs. 8.6%). STEMI more frequently received primary PCI (81.8% vs 78.8%%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 hours), median duration of hospitalisation decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each >94.7%). Mortality at 30 days increased for NSTEMI (from 5.4% to 7.5%; OR 1.41, 95% CI 1.08-1.80), but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97). Conclusions During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less co-morbid and, for NSTEMI, had higher 30-day mortality.
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Affiliation(s)
- Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Worsley Building, Level 11, Clarendon Way, University of Leeds, Leeds LS2 9JT, UK.,Division of Clinical and Translational Research, School of Dentistry, University of Leeds, Leeds, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Clive Weston
- Glangwili General Hospital, Carmarthen, Wales, UK
| | - Julian Hains
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
| | - Tom Luescher
- Imperial College, National Heart and Lung Institute, London, UK
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
| | - John E Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College, London, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Worsley Building, Level 11, Clarendon Way, University of Leeds, Leeds LS2 9JT, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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17
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Su YH, Wu KH, Su CM, Cheng CY, Cheng CI, Kung CT, Chen FC. Influence of the Coronavirus Disease 2019 Pandemic on Patients with ST-Segment Elevation Myocardial Infarction in Taiwan. Emerg Med Int 2021; 2021:5576220. [PMID: 33953984 PMCID: PMC8063848 DOI: 10.1155/2021/5576220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 01/17/2023] Open
Abstract
The outbreak of the new coronavirus disease 2019 (COVID-19) has notably affected the medical system worldwide and influenced the health-seeking behavior of people while depleting medical resources, causing a delay in ST-elevation myocardial infarction (STEMI) management. In this single-center, retrospective cohort study, we compared the clinical pictures of nontransfer patients who presented to the emergency department directly and received primary percutaneous cardiovascular intervention (PPCI) from February 1 to April 30, 2020 (group 2, N = 28), with patients who received PPCI from February 1 to April 30, 2016-2019 (group 1, N = 130). A total of 158 patients with STEMI who received PPCI were included in the study. A decrease in the percentage of patients with door-to-balloon time <90 minutes was found in group 2 (64.3% vs. 81.5%, p = 0.044). The adjusted odds ratio was calculated using logistic regression, according to potential confounding factors such as age, sex, off-hours, and Killip class. An adjusted odds ratio of 2.45 (95% confidence interval, 1.1-6.0, p = 0.048) was reported for group 2. A decrease in the percentage of patients meeting the criteria of door-to-balloon time <90 minutes was demonstrated, and differences were revealed in the clinical pictures of patients with STEMI after the pandemic. While systemic factors contributed the most, improvements and adjustments in the protocols for managing patients with STEMI for better outcomes in the COVID-19 era have yet to be studied.
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Affiliation(s)
- Yuan-Heng Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Chih-Min Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Chi-Yung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Fu-Cheng Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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18
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Case Selection During the COVID-19 Pandemic: Who Should Go to the Cardiac Catheterization Laboratory? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:27. [PMID: 33758493 PMCID: PMC7972331 DOI: 10.1007/s11936-020-00892-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
Purpose of review To summarize the best available evidence and recommendations regarding case selection for cardiac catheterization laboratory (CCL) during the coronavirus disease 2019 (COVID-19) pandemic with emphasis on ST segment elevation myocardial infarction (STEMI) management. Recent findings The restructuring of cardiovascular services to preserve hospital beds and personal protective equipment during the COVID-19 pandemic had a profound effect on healthcare delivery around the world with unintended consequences. In the United States, a significant 38% reduction in CCL activations for STEMI was noted in the early phase of the pandemic. Similarly, a 34% decline in utilization of invasive angiography, an 18% reduction in primary percutaneous coronary intervention (PPCI), and a 19% increase in door-to-balloon (D2B) times were also observed. These trends coincided with a significant increase in out-of-hospital cardiac arrests and late MI presentations. A shift to pharmacological reperfusion has been advocated in Asia, which resulted in increased morbidity and mortality. Summary COVID-19 has negatively affected many aspects of STEMI care, including timely access to mechanical reperfusion, which has resulted in increased morbidity and mortality. Balancing optimal STEMI care with the risk of infection to healthcare workers during the pandemic is challenging. Recommendations provided by consensus documents are a helpful guidance.
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19
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Arbelo E, Angera I, Trucco E, Rivas-Gándara N, Guerra JM, Bisbal F, Jáuregui-Abularach M, Vallés E, Martin G, Sbraga F, Tolosana JM, Linhart M, Francisco-Pascual J, Montiel-Serrano J, Pereferrer D, Menéndez-Ramírez D, Jiménez J, Elamrani A, Borrás R, Dallaglio PD, Benito E, Santos-Ortega A, Rodríguez-Font E, Sarrias A, González-Matos CE, Martí-Almor J, Cabrera S, Mont L. Reduction in new cardiac electronic device implantations in Catalonia during COVID-19. Europace 2021; 23:456-463. [PMID: 33595062 PMCID: PMC7928966 DOI: 10.1093/europace/euab011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/13/2021] [Indexed: 12/27/2022] Open
Abstract
Aims During the COVID-19 pandemic, concern regarding its effect on the management of non-communicable diseases has been raised. However, there are no data on the impact on cardiac implantable electronic devices (CIED) implantation rates. We aimed to determine the impact of SARS-CoV2 on the monthly incidence rates and type of pacemaker (PM) and implantable cardiac defibrillator (ICD) implantations in Catalonia before and after the declaration of the state of alarm in Spain on 14 March 2020. Methods and results Data on new CIED implantations for 2017–20 were prospectively collected by nine hospitals in Catalonia. A mixed model with random intercepts corrected for time was used to estimate the change in monthly CIED implantations. Compared to the pre-COVID-19 period, an absolute decrease of 56.5% was observed (54.7% in PM and 63.7% in ICD) in CIED implantation rates. Total CIED implantations for 2017–19 and January and February 2020 was 250/month (>195 PM and >55 ICD), decreasing to 207 (161 PM and 46 ICD) in March and 131 (108 PM and 23 ICD) in April 2020. In April 2020, there was a significant fall of 185.25 CIED implantations compared to 2018 [95% confidence interval (CI) 129.6–240.9; P < 0.001] and of 188 CIED compared to 2019 (95% CI 132.3–243.7; P < 0.001). No significant differences in the type of PM or ICD were observed, nor in the indication for primary or secondary prevention. Conclusions During the first wave of the COVID-19 pandemic, a substantial decrease in CIED implantations was observed in Catalonia. Our findings call for measures to avoid long-term social impact.
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Affiliation(s)
- Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ignasi Angera
- Arrhythmia Section, Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - José M Guerra
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felipe Bisbal
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Miguel Jáuregui-Abularach
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Ermengol Vallés
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriel Martin
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Fabrizio Sbraga
- Department of Cardiac Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - José María Tolosana
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Markus Linhart
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - José Montiel-Serrano
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Damià Pereferrer
- Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Diego Menéndez-Ramírez
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Jesús Jiménez
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amin Elamrani
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Roger Borrás
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Paolo Domenico Dallaglio
- Arrhythmia Section, Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Eva Benito
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - Enrique Rodríguez-Font
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Axel Sarrias
- Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Carlos E González-Matos
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Julio Martí-Almor
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Cabrera
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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20
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Perpetua EM, Guibone KA, Keegan PA, Palmer R, Speight MK, Jagnic K, Michaels J, Nguyen RA, Pickett ES, Ramsey D, Schnell SJ, Wong SC, Reisman M. Best Practice Recommendations for Optimizing Care in Structural Heart Programs: Planning Efficient and Resource Leveraging Systems (PEARLS). STRUCTURAL HEART 2021; 5:168-179. [PMID: 35378800 PMCID: PMC8968322 DOI: 10.1080/24748706.2021.1877858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/11/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022]
Abstract
The COVID19 pandemic brought unprecedented disruption to healthcare. Staggering morbidity, mortality, and economic losses prompted the review and refinement of care for structural heart disease (SHD). To mitigate negative impacts in the face of crisis or capacity constraints, this paper offers best practice recommendations for Planning Efficient and Resource Leveraging Systems (PEARLS) in structural heart programs. A systematic assessment is recommended for hospital capacity, Heart Team roles and functions, and patient and procedural risks associated with increased resource utilization. Strategies, tactics, and pathways are provided for the delivery of patient-centered, efficient and resource-leveraging care from referral to follow-up. Through the optimal use of capacity and resources, paired with dynamic triage, forecasting, and surveillance, Heart Teams may aspire to plan and implement an optimized system of care for SHD. Abbreviations: AS: aortic stenosis; ASD: atrioseptal defect; COVID19: Coronavirus disease 19; LAAO: left atrial appendage occlusion; MI: myocardial infarction; MR: mitral regurgitation; PFO: patent foramen ovale; PVL: paravalvular leak; SHD: structural heart disease; SAVR: surgical aortic valve replacement; SDM: shared decision-making; TAVR: transcatheter aortic valve replacement; TMVr: transcatheter mitral valve repair; TMVR: transcatheter mitral valve replacement; TEE: transesophageal echocardiography; TTE: transthoracic echocardiography.
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21
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Seligman H, Sen S, Nijjer S, Al-Lamee R, Clifford P, Sethi A, Hadjiloizou N, Kaprielian R, Ramrakha P, Bellamy M, Khan MA, Kooner J, Foale RA, Mikhail G, Baker CS, Mayet J, Malik I, Khamis R, Francis D, Petraco R. Management of Acute Coronary Syndromes During the Coronavirus Disease 2019 Pandemic: Deviations from Guidelines and Pragmatic Considerations for Patients and Healthcare Workers. ACTA ACUST UNITED AC 2020; 15:e16. [PMID: 33318752 PMCID: PMC7726851 DOI: 10.15420/icr.2020.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is forcing cardiology departments to rapidly adapt existing clinical guidelines to a new reality and this is especially the case for acute coronary syndrome pathways. In this focused review, the authors discuss how COVID-19 is affecting acute cardiology care and propose pragmatic guideline modifications for the diagnosis and management of acute coronary syndrome patients, particularly around the appropriateness of invasive strategies as well as length of hospital stay. The authors also discuss the use of personal protective equipment for healthcare workers in cardiology. Based on shared global experiences and growing peer-reviewed literature, it is possible to put in place modified acute coronary syndrome treatment pathways to offer safe pragmatic decisions to patients and staff.
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Affiliation(s)
- Henry Seligman
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Sayan Sen
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Sukhjinder Nijjer
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Rasha Al-Lamee
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | | | | | | | | | | | | | | | - Jaspal Kooner
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | | | | | | | - Jamil Mayet
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust London, UK
| | - Ramzi Khamis
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Darrel Francis
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Ricardo Petraco
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
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22
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Desai PS, Fanous EJ, Tan W, Lee J, Trinh T, Rafique AM, Parikh RV, Press MC. Trajectory of Cardiac Catheterization for Acute Coronary Syndrome and Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic. Cardiol Res 2020; 12:47-50. [PMID: 33447325 PMCID: PMC7781261 DOI: 10.14740/cr1149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 01/20/2023] Open
Abstract
Background We sought to investigate the trajectory of cardiac catheterizations for acute coronary syndrome (ACS) and out-of-hospital cardiac arrest (OHCA) during the pre-isolation (PI), strict-isolation (SI), and relaxed-isolation (RI) periods of the coronavirus disease 2019 (COVID-19) pandemic at three hospitals in Los Angeles, CA, USA. Methods A retrospective analysis was conducted on adult patients undergoing urgent or emergent cardiac catheterization for suspected ACS or OHCA between January 1, 2020 and June 2, 2020 at three hospitals in Los Angeles, CA, USA. We designated January 1, 2020 to March 17, 2020 as the PI COVID-19 period, March 18, 2020 to May 5, 2020 as the SI COVID-19 period, and May 6, 2020 to June 2, 2020 as the RI COVID-19 period. Results From PI to SI, there was a significant reduction in mean weekly cases of catheterizations for non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA) (8.29 vs. 12.5, P = 0.019), with all other clinical categories trending downwards. From SI to RI, mean weekly cases of catheterizations for total ACS increased by 17%, NSTEMI/UA increased by 27%, and OHCA increased by 32%, demonstrating a “rebound effect”. Conclusions Cardiac catheterizations for ACS and NSTEMI/UA exhibited a “rebound effect” once social isolation was relaxed.
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Affiliation(s)
- Pooja S Desai
- Department of Internal Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Elias J Fanous
- Department of Internal Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Weiyi Tan
- Division of Interventional Cardiology, UCLA Medical Center, Los Angeles, CA, USA.,Division of Congenital Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - James Lee
- UCLA Cardiology Group, Henry Mayo Hospital, Valencia, CA, USA
| | - Tri Trinh
- UCLA Cardiology Group, Henry Mayo Hospital, Valencia, CA, USA
| | - Asim M Rafique
- Division of Interventional Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Rushi V Parikh
- Division of Interventional Cardiology, UCLA Medical Center, Los Angeles, CA, USA
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23
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Joseph J, Kotronias RA, Estrin-Serlui T, Cahill TJ, Kharbanda RK, Newton JD, Grebenik C, Dawkins S, Banning AP. Safety and operational efficiency of restructuring and redeploying a transcatheter aortic valve replacement service during the COVID-19 pandemic: The Oxford experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:26-31. [PMID: 33309231 PMCID: PMC7836266 DOI: 10.1016/j.carrev.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The risk of nosocomial COVID-19 infection for vulnerable aortic stenosis patients and intensive care resource utilization has led to cardiac surgery deferral. Untreated severe symptomatic aortic stenosis has a dismal prognosis. TAVR offers an attractive alternative to surgery as it is not reliant on intensive care resources. We set out to explore the safety and operational efficiency of restructuring a TAVR service and redeploying it to a new non-surgical site during the COVID-19 pandemic. METHODS The institutional prospective service database was retrospectively interrogated for the first 50 consecutive elective TAVR cases prior to and after our institution's operational adaptations for the COVID-19 pandemic. Our endpoints were VARC-2 defined procedural complications, 30-day mortality or re-admission and service efficiency metrics. RESULTS The profile of patients undergoing TAVR during the pandemic was similar to patients undergoing TAVR prior to the pandemic with the exception of a lower mean age (79 vs 82 years, p < 0.01) and median EuroScore II (3.1% vs 4.6%, p = 0.01). The service restructuring and redeployment contributed to the pandemic-mandated operational efficiency with a reduction in the distribution of pre-admission hospital visits (3 vs 3 visits, p < 0.001) and the time taken from TAVR clinic to procedure (26 vs 77 days, p < 0.0001) when compared to the pre-COVID-19 service. No statistically significant difference was noted in peri-procedural complications and 30-day outcomes, while post-operative length of stay was significantly reduced (2 vs 3 days, p < 0.0001) when compared to pre-COVID-19 practice. CONCLUSIONS TAVR service restructuring and redeployment to align with pandemic-mandated healthcare resource rationalization is safe and feasible.
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Affiliation(s)
- Jubin Joseph
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rafail A Kotronias
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | | | - Thomas J Cahill
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rajesh K Kharbanda
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James D Newton
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Catherine Grebenik
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Dawkins
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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24
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Iliopoulos DC. COVID-19: A Greek Perspective. J Card Surg 2020; 36:1637-1640. [PMID: 32985717 PMCID: PMC7549190 DOI: 10.1111/jocs.15027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
Greece has managed to timely and properly implement a public health safety plan and contained the burden of the coronavirus disease (COVID-19) pandemic. On the contrary, COVID-19 has led to a national catastrophe in countries with superior infrastructures, such as Italy, Spain, France, and the United States. At a time when our nation's healthcare resources were insufficient to meet this unprecedented demand, it was necessary to prioritize needs in the hopes of maximizing lives saved. Although delaying definitive treatment of disorders presented a risk to specific individuals, countless others afforded life-saving resources necessary to overcome the most threatening manifestation of this illness. The cataclysm of COVID-19 offered an opportunity to reshape health care in ways that may not have seemed possible just a few months ago. To help scientists and clinicians across disciplines connect their strengths, so that together we can advance the state of the art in medicine and lead the way to a new era of computational medicine.
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Affiliation(s)
- Dimitrios C Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research, Medical School, University of Athens, Athens, Greece.,4th Cardiac Surgery Department, Hygeia Hospital, Athens, Greece
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25
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Haddad K, Potter BJ, Matteau A, Gobeil F, Mansour S. Implications of COVID-19 on Time-Sensitive STEMI Care: A Report From a North American Epicenter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 30:33-37. [PMID: 32988743 PMCID: PMC7501080 DOI: 10.1016/j.carrev.2020.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 12/02/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has forced dramatic changes to the healthcare systems throughout the world. Time-sensitive management of cardiovascular emergencies such as ST-elevation myocardial infarction (STEMI) has yet to be evaluated in the context of these new policies, particularly in so-called “hot spot” cities. Methods We evaluated the early impact of the pandemic on STEMI performance in the Greater Montreal Area. A total of 167 patients from 3 different study periods were included. Patients presenting in the lockdown period from mid-March to mid-May 2020 (Group C, 53 patients) were compared to those from mid-March to mid-May 2019 (Group A, 60 patients) and the 2020 pre-COVID-19 period (Group B, 54 patients). Results The number of STEMI admissions was unaffected during the lockdown. However, significantly longer delays between symptom onset and first medical contact (FMC) were noted (Group C 189.0 IQR [70.0, 840.0] min vs. Group A 103.0 IQR [42.5, 263.0] min vs. Group B 91.0 IQR [38.0, 235.5 min], P = 0.007). In contrast, additional safety protocols do not appear to have significantly affected delays between FMC and first intracoronary device activation (Group C 102 IQR [73.0, 133.0] min vs. Group A 104 IQR [87.0, 146.0] min vs. Group B 99.5 IQR [80.0, 150.0] min, P = 0.37). Patients that presented during the outbreak were more likely to be unstable with a higher incidence of Killip classes II-IV compared to groups A and B (28.3% vs. 18.3% vs. 5.6% respectively, P = 0.008). Worse in-hospital outcomes were also noted with a significantly higher rate of major adverse cardiac events (Group A 5.0% vs. Group B 11.1% vs. Group C 22.6%, P = 0.007). Conclusion During the lockdown period, many patients appear to have been reluctant to present to hospitals. This was associated with more unstable STEMI presentations and worse in-hospital course. Importantly, the health care system appears able to ensure timely acute cardiac care while ensuring that COVID-19 protocols are respected.
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Affiliation(s)
- Kevin Haddad
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM) Research Center, Montréal, Québec, Canada
| | - Brian J Potter
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM) Research Center, Montréal, Québec, Canada
| | - Alexis Matteau
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM) Research Center, Montréal, Québec, Canada
| | - François Gobeil
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM) Research Center, Montréal, Québec, Canada; Cité-de-la-Santé Hospital, Laval, Québec, Canada
| | - Samer Mansour
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM) Research Center, Montréal, Québec, Canada; Cité-de-la-Santé Hospital, Laval, Québec, Canada.
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26
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Dehghani P, Davidson LJ, Grines CL, Nayak K, Saw J, Kaul P, Bagai A, Garberich R, Schmidt C, Ly HQ, Giri J, Meraj P, Shah B, Garcia S, Sharkey S, Wood DA, Welt FG, Mahmud E, Henry TD. North American COVID-19 ST-Segment-Elevation Myocardial Infarction (NACMI) registry: Rationale, design, and implications. Am Heart J 2020; 227:11-18. [PMID: 32425198 PMCID: PMC7229476 DOI: 10.1016/j.ahj.2020.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 12/26/2022]
Abstract
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19), has resulted in a global pandemic. Patients with cardiovascular risk factors or established cardiovascular disease are more likely to experience severe or critical COVID-19 illness and myocardial injury is a key extra-pulmonary manifestation. These patients frequently present with ST-elevation on an electrocardiogram (ECG) due to multiple etiologies including obstructive, non-obstructive, and/or angiographically normal coronary arteries. The incidence of ST-elevation myocardial infarction (STEMI) mimics in COVID-19-positive hospitalized patients, and the association with morbidity and mortality is unknown. Understanding the natural history and appropriate management of COVID-19 patients presenting with ST elevation is essential to inform patient management decisions and protect healthcare workers. Methods The Society for Cardiovascular Angiography and Interventions (SCAI) and The Canadian Association of Interventional Cardiology (CAIC) in conjunction with the American College of Cardiology Interventional Council have collaborated to create a multi-center observational registry, NACMI. This registry will enroll confirmed COVID-19 patients and persons under investigation (PUI) with new ST-segment elevation or new onset left bundle branch block (LBBB) on the ECG with clinical suspicion of myocardial ischemia. We will compare demographics, clinical findings, outcomes and management of these patients with a historical control group of over 15,000 consecutive STEMI activation patients from the Midwest STEMI Consortium using propensity matching. The primary clinical outcome will be in- hospital major adverse cardiovascular events (MACE) defined as composite of all-cause mortality, stroke, recurrent MI, and repeat unplanned revascularization in COVID-19 confirmed or PUI. Secondary outcomes will include the following: reporting of etiologies of ST Elevation; cardiovascular mortality due to myocardial infarction, cardiac arrest and /or shock; individual components of the primary outcome; composite primary outcome at 1 year; as well as ECG and angiographic characteristics. Conclusion The multicenter NACMI registry will collect data regarding ST elevation on ECG in COVID-19 patients to determine the etiology and associated clinical outcomes. The collaboration and speed with which this registry has been created, refined, and promoted serves as a template for future research endeavors.
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada; Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada
| | - Laura J Davidson
- Northwestern University, Feinberg School of Medicine, Chicago, IL; American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC; Society for Cardiovascular Angiography and Interventions, Washington, DC
| | - Cindy L Grines
- Society for Cardiovascular Angiography and Interventions, Washington, DC; Northside Cardiovascular Institute, Atlanta, GA
| | - Keshav Nayak
- Society for Cardiovascular Angiography and Interventions, Washington, DC; Deparment of Cardiology Scripps Mercy Hospital, San Diego, CA
| | - Jacqueline Saw
- Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada; Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Prashant Kaul
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC; Society for Cardiovascular Angiography and Interventions, Washington, DC; Piedmont Heart Institute, Atlanta, GA
| | - Akshay Bagai
- Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Hung Q Ly
- Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada; Department of Medicine, Montreal Heart Institute, Université de Montréal
| | - Jay Giri
- Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA
| | - Perwaiz Meraj
- Society for Cardiovascular Angiography and Interventions, Washington, DC; Hofstra North Shore - LIJ School of Medicine, Manhasset, NY
| | - Binita Shah
- Department of Medicine (Cardiology), VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY
| | - Santiago Garcia
- Society for Cardiovascular Angiography and Interventions, Washington, DC; Minneapolis Heart Institute, Minneapolis, MN
| | | | - David A Wood
- Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada; Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul's and Vancouver General Hospital, Vancouver, Canada
| | - Frederick G Welt
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC; Society for Cardiovascular Angiography and Interventions, Washington, DC; Cardiovascular Division, University of Utah Health, Salt Lake City, UT
| | - Ehtisham Mahmud
- Society for Cardiovascular Angiography and Interventions, Washington, DC; University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla, CA
| | - Timothy D Henry
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC; Society for Cardiovascular Angiography and Interventions, Washington, DC; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH.
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27
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Wood DA, Sathananthan J. "Minimalist" transcatheter aortic valve implantation during the COVID-19 pandemic: previously optional but now a necessity. EUROINTERVENTION 2020; 16:e451-e452. [PMID: 32763865 DOI: 10.4244/eijv16i6a82] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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28
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Chikwe J, Gaudino M, Hameed I, Robinson NB, Bakaeen FG, Menicanti L, Doenst T, Zheng Z, Lemma M, Falk V, Tatoulis J, Girardi LN, Fremes S, Ruel M. Committee Recommendations for Resuming Cardiac Surgery Activity in the SARS-CoV-2 Era: Guidance From an International Cardiac Surgery Consortium. Ann Thorac Surg 2020; 110:725-732. [PMID: 32422121 PMCID: PMC7227574 DOI: 10.1016/j.athoracsur.2020.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 01/19/2023]
Abstract
Recommendations for the safe and optimized resumption of cardiac surgery care, research, and education during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) era were developed by a cardiovascular research consortium, based in 19 countries and representing a wide spectrum of experience with COVID-19. This guidance document provides a framework for restarting cardiac surgery in the outpatient and inpatient settings, in accordance with the current understanding of SARS-CoV-2, the risks posed by interrupted cardiovascular care, and the available recommendations from major societies.
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Affiliation(s)
- Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Faisal G Bakaeen
- Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lorenzo Menicanti
- Department of Cardiac-Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller, University of Jena, Jena, Germany
| | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China
| | - Massimo Lemma
- Department of Cardiac Surgery, Jilin Heart Hospital, Changchun, China
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charite, Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, German Heartcenter Berlin, Berlin, Germany; German Center for Cardiovascular Research, Berlin, Germany; Department of Health Science and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - James Tatoulis
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Leonard N Girardi
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen Fremes
- Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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29
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Wood DA, Mahmud E, Thourani VH, Sathananthan J, Virani A, Poppas A, Harrington RA, Dearani JA, Swaminathan M, Russo AM, Blankstein R, Dorbala S, Carr J, Virani S, Gin K, Packard A, Dilsizian V, Légaré JF, Leipsic J, Webb JG, Krahn AD. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership. Ann Thorac Surg 2020; 110:733-740. [PMID: 32380058 PMCID: PMC7198197 DOI: 10.1016/j.athoracsur.2020.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- David A. Wood
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada,Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada,Address correspondence to Dr Wood, Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, 2775 Laurel St, 9th Flr, Vancouver, British Columbia V5Z 1M9, Canada
| | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada,Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Athena Poppas
- Brown University School of Medicine, Providence, Rhode Island
| | | | - Joseph A. Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Carr
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sean Virani
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada,Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada,Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan Packard
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Children’s Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean-François Légaré
- New Brunswick Heart Centre, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada,Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G. Webb
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada,Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada,Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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30
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Tay EL, Hayashida K, Chen M, Yin WH, Park DW, Seth A, Kao HL, Lin MS, Ho KW, Buddhari W, Chandavimol M, Posas FE, Nguyen QN, Kong W, Rosli MA, Hon J, Firman D, Lee M. Transcatheter aortic valve implantation during the COVID-19 pandemic: Clinical expert opinion and consensus statement for Asia. J Card Surg 2020; 35:2142-2146. [PMID: 32720374 DOI: 10.1111/jocs.14722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The impact of the COVID-19 pandemic on the treatment of patient with aortic valve stenosis is unknown and there is uncertainty on the optimal strategies in managing these patients. METHODS This study is supported and endorsed by the Asia Pacific Society of Interventional Cardiology. Due to the inability to have face to face discussions during the pandemic, an online survey was performed by inviting key opinion leaders (cardiac surgeon/interventional cardiologist/echocardiologist) in the field of transcatheter aortic valve implantation (TAVI) in Asia to participate. The answers to a series of questions pertaining to the impact of COVID-19 on TAVI were collected and analyzed. These led subsequently to an expert consensus recommendation on the conduct of TAVI during the pandemic. RESULTS The COVID-19 pandemic had resulted in a 25% (10-80) reduction of case volume and 53% of operators required triaging to manage their patients with severe aortic stenosis. The two most important parameters used to triage were symptoms and valve area. Periprocedural changes included the introduction of teleconsultation, preprocedure COVID-19 testing, optimization of protests, and catheterization laboratory set up. In addition, length of stay was reduced from a mean of 4.4 to 4 days. CONCLUSION The COVID-19 pandemic has impacted on the delivery of TAVI services to patients in Asia. This expert recommendation on best practices may be a useful guide to help TAVI teams during this period until a COVID-19 vaccine becomes widely available.
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Affiliation(s)
- Edgar L Tay
- Department of Cardiology and Cardiothoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | | | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Hsien Yin
- Cardiac Department, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Centre, Seoul, South Korea
| | - Ashok Seth
- Department of Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kay-Woon Ho
- Department of Cardiology, National Heart Centre, Singapore
| | - Wacin Buddhari
- Cardiac Center, Division of Cardiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Quang N Nguyen
- Vietnam National Heart Institute, Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - William Kong
- Department of Cardiology and Cardiothoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - M A Rosli
- Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Jimmy Hon
- Department of Cardiology and Cardiothoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Michael Lee
- Department of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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31
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Natarajan MK, Wijeysundera HC, Oakes G, Cantor WJ, Miner SES, Welsford M, Cheskes S, Le May MR, Jeffrey J, Ko DT. Early Observations During the COVID-19 Pandemic in Cardiac Catheterization Procedures for ST-Elevation Myocardial Infarction Across Ontario. CJC Open 2020; 2:678-683. [PMID: 32838257 PMCID: PMC7376355 DOI: 10.1016/j.cjco.2020.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background In response to the COVID-19 pandemic, Ontario issued a declaration of emergency, implementing public health interventions on March 16, 2020. Methods We compared cardiac catheterization procedures for ST-elevation myocardial infarction (STEMI) between January 1 and May 10, 2020 to the same time frame in 2019. Results From March 16 to May 10, 2020, after implementation of provincial directives, STEMI cases significantly decreased by up to 25%. The proportion of patients who achieved guideline targets for first medical contact balloon for primary percutaneous coronary intervention (PCI) decreased substantially to 28% (median, 101 minutes) for patients who presented directly to a PCI site and to 37% (median, 149 minutes) for patients transferred from a non-PCI site, compared with 2019. Conclusions STEMI cases across Ontario have been substantially affected during the COVID-19 pandemic.
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Affiliation(s)
- Madhu K Natarajan
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, ICES Toronto, Toronto, Ontario, Canada
| | | | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steven E S Miner
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Welsford
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sheldon Cheskes
- Department of Family Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michel R Le May
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Dennis T Ko
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, ICES Toronto, Toronto, Ontario, Canada
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32
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Patel S, Kaushik A, Sharma AK. Prioritizing cardiovascular surgical care in COVID-19 pandemic: Shall we operate or defer? J Card Surg 2020; 35:2768-2772. [PMID: 32668048 PMCID: PMC7404879 DOI: 10.1111/jocs.14864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) has affected a large population across the world. Patients with cardiovascular disease have increased morbidity and mortality due to coronavirus disease. The burden over the health care system has to be reduced in this global pandemic to provide optimal care of patients with COVID-19, as well not compromising those who are in need of emergent cardiovascular care. METHODS There is a very limited data published defining which cardiovascular procedures are to be performed or to be deferred in the COVID-19 pandemic. In this article, we have reviewed a few published guidelines regarding cardiovascular surgery in COVID-19 pandemics. CONCLUSION After reviewing a few available guidelines regarding cardiovascular surgery in COVID-19, we conclude to perform only those surgeries which cannot be deferred to a certain period of time, to reduce the burden of the health care system of the country, provide optimal care to patients with COVID-19, and to protect health care workers and cardiovascular patients from COVID-19.
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Affiliation(s)
- Surendra Patel
- Department of Trauma and Emergency Cardiothoracic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Atul Kaushik
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alok Kumar Sharma
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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33
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Harky A, Chor CYT, Khare Y. COVID-19 and its impact on cardiology service. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:ahead of print. [PMID: 33525237 PMCID: PMC7927521 DOI: 10.23750/abm.v91i4.9828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
| | | | - Yuti Khare
- St. George's Medical School, University of London, London, SW17 0RE, UK.
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34
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Buick JE, Cheskes S, Feldman M, Verbeek PR, Hillier M, Leong YC, Drennan IR. COVID-19: What paramedics need to know! CAN J EMERG MED 2020; 22:426-430. [PMID: 32290887 PMCID: PMC7205552 DOI: 10.1017/cem.2020.367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Jason E. Buick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
- Sunnybrook Center for Prehospital Medicine, Sunnybrook Health Sciences Center, Toronto, ON
| | - Sheldon Cheskes
- Sunnybrook Center for Prehospital Medicine, Sunnybrook Health Sciences Center, Toronto, ON
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Michael Feldman
- Sunnybrook Center for Prehospital Medicine, Sunnybrook Health Sciences Center, Toronto, ON
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON
| | - P. Richard Verbeek
- Sunnybrook Center for Prehospital Medicine, Sunnybrook Health Sciences Center, Toronto, ON
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON
| | - Morgan Hillier
- Sunnybrook Center for Prehospital Medicine, Sunnybrook Health Sciences Center, Toronto, ON
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON
| | - Yuen Chin Leong
- Sunnybrook Center for Prehospital Medicine, Sunnybrook Health Sciences Center, Toronto, ON
- Faculty of Medicine, University of Toronto, Toronto, ON
| | - Ian R. Drennan
- Sunnybrook Center for Prehospital Medicine, Sunnybrook Health Sciences Center, Toronto, ON
- Institute of Medical Science, University of Toronto, Toronto, ON
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35
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Wood DA, Mahmud E, Thourani VH, Sathananthan J, Virani A, Poppas A, Harrington RA, Dearani JA, Swaminathan M, Russo AM, Blankstein R, Dorbala S, Carr J, Virani S, Gin K, Packard A, Dilsizian V, Légaré JF, Leipsic J, Webb JG, Krahn AD. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership. J Am Coll Cardiol 2020; 75:3177-3183. [PMID: 32380033 PMCID: PMC7198172 DOI: 10.1016/j.jacc.2020.04.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/14/2022]
Affiliation(s)
- David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Athena Poppas
- Brown University School of Medicine, Providence, Rhode Island
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Carr
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sean Virani
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan Packard
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Children's Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean-François Légaré
- New Brunswick Heart Centre, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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36
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Affiliation(s)
- Bharat Khialani
- Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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37
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COVID -19 pandemic and paediatric population with special reference to congenital heart disease. Indian Heart J 2020; 72:141-144. [PMID: 32768011 PMCID: PMC7411102 DOI: 10.1016/j.ihj.2020.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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38
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Lauck S, Forman J, Borregaard B, Sathananthan J, Achtem L, McCalmont G, Muir D, Hawkey MC, Smith A, Højberg Kirk B, Wood DA, Webb JG. Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes. Eur J Cardiovasc Nurs 2020; 19:537-544. [PMID: 32498556 PMCID: PMC7717283 DOI: 10.1177/1474515120934057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic continues to significantly impact the treatment of people living with aortic stenosis, and access to transcatheter aortic valve implantation. Transcatheter aortic valve implantation (TAVI) programmes require unique coordinated processes that are currently experiencing multiple disruptions and are guided by rapidly evolving protocols. We present a series of recommendations for TAVI programmes to adapt to the new demands, based on recent evidence and the international expertise of nurse leaders and collaborators in this field. Although recommended in most guidelines, the uptake of the role of the TAVI programme nurse is uneven across international regions. COVID-19 is further highlighting why a nurse-led central point of coordination and communication is a vital asset for patients and programmes. We propose an alternative streamlined evaluation pathway to minimize patients' pre-procedure exposure to the hospital environment while ensuring appropriate treatment decision and shared decision-making. The competing demands created by COVID-19 require vigilant wait list management, with risk stratification, telephone surveillance and optimized triage and prioritization. A minimalist approach with close scrutiny of all parts of the procedure has become an imperative to avoid any complications and ensure patients' accelerated recovery. Lastly, we outline a nurse-led protocol of rapid mobilization and reconditioning as an effective strategy to facilitate safe next-day discharge home. As the pandemic abates, TAVI programmes must facilitate access to care without compromising patient safety, enable hospitals to manage the competing demands created by COVID-19 and establish new processes to support patients living with valvular heart disease.
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Affiliation(s)
- Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Jacqueline Forman
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Leslie Achtem
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | | | - Douglas Muir
- James Cook University Hospital, Middlesbrough, UK
| | | | - Amanda Smith
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Canada
| | - Bettina Højberg Kirk
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
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39
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Schiavone M, Gobbi C, Biondi-Zoccai G, D’Ascenzo F, Palazzuoli A, Gasperetti A, Mitacchione G, Viecca M, Galli M, Fedele F, Mancone M, Forleo GB. Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties. J Clin Med 2020; 9:E1683. [PMID: 32498230 PMCID: PMC7356537 DOI: 10.3390/jcm9061683] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Since an association between myocardial infarction (MI) and respiratory infections has been described for influenza viruses and other respiratory viral agents, understanding possible physiopathological links between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute coronary syndromes (ACS) is of the greatest importance. The initial data suggest an underestimation of ACS cases all over the world, but acute MI still represents a major cause of morbidity and mortality worldwide and should not be overshadowed during the coronavirus disease (Covid-19) pandemic. No common consensus regarding the most adequate healthcare management policy for ACS is currently available. Indeed, important differences have been reported between the measures employed to treat ACS in China during the first disease outbreak and what currently represents clinical practice across Europe and the USA. This review aims to discuss the pathophysiological links between MI, respiratory infections, and Covid-19; epidemiological data related to ACS at the time of the Covid-19 pandemic; and learnings that have emerged so far from several catheterization labs and coronary care units all over the world, in order to shed some light on the current strategies for optimal management of ACS patients with confirmed or suspected SARS-CoV-2 infection.
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Affiliation(s)
- Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
| | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Fabrizio D’Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, AOUS Le Scotte Hospital, University of Siena, 53100 Siena, Italy;
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Gianfranco Mitacchione
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Maurizio Viecca
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Massimo Galli
- Department of Infectious Diseases, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy;
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
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40
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Khan JM, Khalid N, Shlofmitz E, Forrestal BJ, Yerasi C, Case BC, Chezar-Azerrad C, Musallam A, Rogers T, Waksman R. Guidelines for Balancing Priorities in Structural Heart Disease During the COVID-19 Pandemic. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1030-1033. [PMID: 32736981 PMCID: PMC7261108 DOI: 10.1016/j.carrev.2020.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/01/2022]
Abstract
During the novel coronavirus disease 2019 (COVID-19) pandemic, many hospitals have been asked to postpone elective and surgical cases. This begs the question, “What is elective in structural heart disease intervention?” The recently proposed Society for Cardiovascular Angiography and Interventions/American College of Cardiology consensus statement is, unfortunately, non-specific and insufficient in its scope and scale of response to the COVID-19 pandemic. We propose guidelines that are practical, multidisciplinary, implementable, and urgent. We believe that this will provide a helpful framework for our colleagues to manage their practices during the surge and peak phases of the pandemic. General principles that apply across structural heart disease interventions include tracking and reporting cardiovascular outcomes, “healthcare distancing,” preserving vital resources and personnel, shared decision-making between the heart team and hospital administration on resource-intensive cases, and considering delaying research cases. Specific guidance for transcatheter aortic valve replacement and MitraClip procedures varies according to pandemic phase. During the surge phase, treatment should broadly be limited to those at increased risk of complications in the near term. During the peak phase, treatment should be limited to inpatients for whom it may facilitate discharge. Keeping our patients and ourselves safe is paramount, as well as justly rationing resources. Many elective and surgical cases have been postponed during the COVID-19 pandemic. We propose guidelines for managing structural heart disease during the pandemic. General principles include preserving vital resources and personnel. Specific guidance for TAVR and mitral valve repair changes with pandemic phase. Keeping our patients and ourselves safe and justly rationing resources is paramount.
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Affiliation(s)
- Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Yerasi C, Case BC, Forrestal BJ, Chezar-Azerrad C, Hashim H, Ben-Dor I, Satler LF, Mintz GS, Waksman R. Treatment of ST-Segment Elevation Myocardial Infarction During COVID-19 Pandemic. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1024-1029. [PMID: 32471712 PMCID: PMC7241397 DOI: 10.1016/j.carrev.2020.05.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022]
Abstract
The number of cases of the coronavirus-induced disease-2019 (COVID-19) continues to increase exponentially worldwide. In this crisis situation, the management of ST-segment elevation myocardial infarction (STEMI) is challenging. In this review, we outline the risks and benefits of primary PCI vs. thrombolysis for STEMI. While thrombolysis may seem like a good choice, many patients have a contraindication and could end up using more resources. Also, with a high probability of the angiogram showing non-obstructed coronary arteries during acute infections, primary PCI should be the preferred strategy. During the COVID-19 pandemic, management of STSTEMI is challenging. Many patients have a contraindication to thrombolysis and end up using resources with this treatment. There is a high probability that an infected patient will show a normal angiogram. Primary PCI should be the preferred strategy in STEMI patients, with precautions.
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Affiliation(s)
- Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Gary S Mintz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Tam DY, Naimark D, Natarajan MK, Woodward G, Oakes G, Rahal M, Barrett K, Khan YA, Ximenes R, Mac S, Sander B, Wijeysundera HC. The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 Pandemic. Can J Cardiol 2020; 36:1308-1312. [PMID: 32447059 PMCID: PMC7241392 DOI: 10.1016/j.cjca.2020.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Abstract
In Ontario on March 16, 2020, a directive was issued to all acute care hospitals to halt nonessential procedures in anticipation of a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for 3 key groups of cardiovascular disease patients: coronary artery disease, valvular heart disease, and arrhythmias. We provided predictions based on COVID-19 epidemiology available in real-time, in 3 phases. First, in the initial crisis phase, in a worst case scenario, we showed that the potential number of waitlist related cardiac deaths would be orders of magnitude less than those who would die of COVID-19 if critical cardiac care resources were diverted to the care of COVID-19 patients. Second, with better local epidemiology data, we predicted that across 5 regions of Ontario, there may be insufficient resources to resume all elective outpatient cardiac procedures. Finally in the recovery phase, we showed that the estimated incremental growth in waitlist for all cardiac procedures is likely substantial. These outputs informed timely data-driven decisions during the COVID-19 pandemic regarding the provision of cardiovascular care.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Madhu K Natarajan
- Division of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Raphael Ximenes
- COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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43
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Boukhris M, Hillani A, Moroni F, Annabi MS, Addad F, Ribeiro MH, Mansour S, Zhao X, Ybarra LF, Abbate A, Vilca LM, Azzalini L. Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective. Can J Cardiol 2020; 36:1068-1080. [PMID: 32425328 PMCID: PMC7229739 DOI: 10.1016/j.cjca.2020.05.018] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock. The cardiac manifestations of COVID-19 might be related to the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications. COVID-19 has profoundly reshaped usual care of both ambulatory and acute cardiac patients, by leading to the cancellation of elective procedures and by reducing the efficiency of existing pathways of urgent care, respectively. Decreased use of health care services for acute conditions by non-COVID-19 patients has also been reported and attributed to concerns about acquiring in-hospital infection. Innovative approaches that leverage modern technologies to tackle the COVID-19 pandemic have been introduced, which include telemedicine, dissemination of educational material over social media, smartphone apps for case tracking, and artificial intelligence for pandemic modelling, among others. This article provides a comprehensive overview of the pathophysiology and cardiovascular implications of COVID-19, its impact on existing pathways of care, the role of modern technologies to tackle the pandemic, and a proposal of novel management algorithms for the most common acute cardiac conditions.
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Affiliation(s)
- Marouane Boukhris
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Ali Hillani
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | - Mohamed Salah Annabi
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université de Laval, Québec, Québec, Canada
| | - Faouzi Addad
- Division of Cardiology, Abderrahmen Mami Hospital, Ariana, Tunisia
| | | | - Samer Mansour
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Xiaohui Zhao
- Institute of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Luiz Fernando Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Antonio Abbate
- Division of Cardiology, VCU Pauley Heart Center and Wright Center for Clinical and Translationa Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Luz Maria Vilca
- Department of Obstetrics and Gynecology, Buzzi Hospital-ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Simsek M, Kantarci B. Artificial Intelligence-Empowered Mobilization of Assessments in COVID-19-like Pandemics: A Case Study for Early Flattening of the Curve. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103437. [PMID: 32423150 PMCID: PMC7277766 DOI: 10.3390/ijerph17103437] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022]
Abstract
The global outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic has uncovered the fragility of healthcare and public health preparedness and planning against epidemics/pandemics. In addition to the medical practice for treatment and immunization, it is vital to have a thorough understanding of community spread phenomena as related research reports 17.9–30.8% confirmed cases to remain asymptomatic. Therefore, an effective assessment strategy is vital to maximize tested population in a short amount of time. This article proposes an Artificial Intelligence (AI)-driven mobilization strategy for mobile assessment agents for epidemics/pandemics. To this end, a self-organizing feature map (SOFM) is trained by using data acquired from past mobile crowdsensing (MCS) campaigns to model mobility patterns of individuals in multiple districts of a city so to maximize the assessed population with minimum agents in the shortest possible time. Through simulation results for a real street map on a mobile crowdsensing simulator and considering the worst case analysis, it is shown that on the 15th day following the first confirmed case in the city under the risk of community spread, AI-enabled mobilization of assessment centers can reduce the unassessed population size down to one fourth of the unassessed population under the case when assessment agents are randomly deployed over the entire city.
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45
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Mehta JJ, Patel J, Ayoub B, Mohanty BD. Caution regarding potential changes in AVR practices during the COVID-19 pandemic. J Card Surg 2020; 35:1168-1169. [PMID: 32365415 PMCID: PMC7267406 DOI: 10.1111/jocs.14602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To improve resource allocation in face of the COVID‐19 pandemic, hospitals around the country are restricting the performance of elective surgery to preserve ventilators, operating rooms, ICU beds and protect anesthesiologists. For patients with severe aortic stenosis, efforts to bring treatment to symptomatic patients amid this pandemic might lead to favored use of catheter based management using minimalist techniques that do not require these elements. In this context, some patients with well tested surgical indications for valve replacement may be treated by catheter‐based methods. It is important that outcomes for these cases are followed closely both at respective sites and in national registries. As we recover from this pandemic, surgical cases should once again be driven by multi‐disciplinary discussion and clinical trial data, and not a mentality of crisis management.
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Affiliation(s)
- Jeet J Mehta
- Division of Cardiology, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jaymin Patel
- Division of Cardiology, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Bassam Ayoub
- Division of Cardiology, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Bibhu D Mohanty
- Division of Cardiology, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Wood DA, Mahmud E, Thourani VH, Sathananthan J, Virani A, Poppas A, Harrington RA, Dearani JA, Swaminathan M, Russo AM, Blankstein R, Dorbala S, Carr J, Virani S, Gin K, Packard A, Dilsizian V, Légaré JF, Leipsic J, Webb JG, Krahn AD. Safe Reintroduction of Cardiovascular Services During the COVID-19 Pandemic: From the North American Society Leadership. Can J Cardiol 2020; 36:971-976. [PMID: 32380228 PMCID: PMC7198201 DOI: 10.1016/j.cjca.2020.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 01/28/2023] Open
Affiliation(s)
- David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Athena Poppas
- Brown University School of Medicine, Providence, Rhode Island
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Carr
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sean Virani
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan Packard
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Children's Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean-François Légaré
- New Brunswick Heart Centre, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jonathon Leipsic
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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47
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Affiliation(s)
- Mladen I Vidovich
- Division of Cardiology, Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois.,Division of Cardiology, Jesse Brown VA Medical Center, Chicago, Illinois
| | - David L Fischman
- Division of Cardiology, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric R Bates
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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48
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Bainey KR, Bates ER, Armstrong PW. ST-Segment-Elevation Myocardial Infarction Care and COVID-19: The Value Proposition of Fibrinolytic Therapy and the Pharmacoinvasive Strategy. Circ Cardiovasc Qual Outcomes 2020; 13:e006834. [PMID: 32339038 DOI: 10.1161/circoutcomes.120.006834] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kevin R Bainey
- Canadian VIGOUR Center, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.)
| | - Eric R Bates
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (E.R.B.)
| | - Paul W Armstrong
- Canadian VIGOUR Center, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.)
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49
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Cosentino N, Assanelli E, Merlino L, Mazza M, Bartorelli AL, Marenzi G. An In-hospital Pathway for Acute Coronary Syndrome Patients During the COVID-19 Outbreak: Initial Experience Under Real-World Suboptimal Conditions. Can J Cardiol 2020; 36:961-964. [PMID: 32376346 PMCID: PMC7162765 DOI: 10.1016/j.cjca.2020.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
Owing to the COVID-19 outbreak in Lombardy, Italy) there is an urgent need to manage cardiovascular emergencies, including acute coronary syndrome (ACS), with appropriate standards of care and dedicated preventive measures and pathways against the risk of SARS-CoV-2 infection. For this reason, the Government of Lombardy decided to centralize the treatment of ACS patients in a limited number of centers, including our university cardiology institute, which in the past 4 weeks became a cardiovascular emergency referral center in a regional hub-and-spoke system. Therefore, we rapidly developed a customized pathway to allocate patients to the appropriate hospital ward, and treat them according to ACS severity and risk of suspected SARS-CoV-2 infection. We present here the protocol dedicated to ACS patients adopted in our center since March 13, 2020, and our initial experience in the management of ACS patients during the first 4 weeks of its use. Certainly, the protocol has room for further improvement as everyone's experience grows, but we hope that it could be a starting point, adaptable to different realities and local resources.
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Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Emilio Assanelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Luca Merlino
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Mario Mazza
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
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Hassan A, Arora RC, Adams C, Bouchard D, Cook R, Gunning D, Lamarche Y, Malas T, Moon M, Ouzounian M, Rao V, Rubens F, Tremblay P, Whitlock R, Moss E, Légaré JF. Cardiac Surgery in Canada During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons. Can J Cardiol 2020; 36:952-955. [PMID: 32299752 PMCID: PMC7194553 DOI: 10.1016/j.cjca.2020.04.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022] Open
Abstract
On March 11, 2020, the World Health Organization declared that COVID-19 was a pandemic.1 At that time, only 118,000 cases had been reported globally, 90% of which had occurred in 4 countries.1 Since then, the world landscape has changed dramatically. As of March 31, 2020, there are now nearly 800,000 cases, with truly global involvement.2 Countries that were previously unaffected are currently experiencing mounting rates of the novel coronavirus infection with associated increases in COVID-19–related deaths. At present, Canada has more than 8000 cases of COVID-19, with considerable variation in rates of infection among provinces and territories.3 Amid concerns over growing resource constraints, cardiac surgeons from across Canada have been forced to make drastic changes to their clinical practices. From prioritizing and delaying elective cases to altering therapeutic strategies in high-risk patients, cardiac surgeons, along with their heart teams, are having to reconsider how best to manage their patients. It is with this in mind that the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors have come together to formulate a series of guiding statements. With strong representation from across the country and the support of the Canadian Cardiovascular Society, the authors have attempted to provide guidance to their colleagues on the subjects of leadership roles that cardiac surgeons may assume during this pandemic: patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences.
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Affiliation(s)
- Ansar Hassan
- New Brunswick Heart Center, Dalhousie University, Saint John, New Brunswick, Canada
| | - Rakesh C Arora
- Max Rady College of Medicine, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey Adams
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Denis Bouchard
- Montréal Heart Institute, Department of Surgery, University of Montréal, Montréal, Québec, Canada
| | - Richard Cook
- St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek Gunning
- Royal Columbian Hospital, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yoan Lamarche
- Montréal Heart Institute, Department of Surgery, University of Montréal, Montréal, Québec, Canada
| | - Tarek Malas
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Michael Moon
- Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maral Ouzounian
- Department of Surgery, Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Rao
- Department of Surgery, Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Fraser Rubens
- Ottawa Heart Institute, Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Philippe Tremblay
- Maritime Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Emmanuel Moss
- Jewish General Hospital, Department of Surgery, McGill University, Montréal, Québec, Canada
| | - Jean-François Légaré
- New Brunswick Heart Center, Dalhousie University, Saint John, New Brunswick, Canada.
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