Criterios de ordenación temporal de las intervenciones quirúrgicas en patología cardiovascular. Documento oficial de la Sociedad Española de Cardiología y de la Sociedad Española de Cirugía Cardiovascular

Recomendaciones de la Sociedad Española de Cirugía Cardiovascular y Endovascular ante la pandemia de COVID-19. En representación de la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE)

Ante el contexto sanitario de pandemia por COVID-19, la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) asume la obligación de elaborar y transmitir una serie de recomendaciones para asegurar una adecuada cobertura sanitaria de la población, al mismo tiempo que para minimizar la exposición y el riesgo de contagio tanto de pacientes como de profesionales. Para ello, y dentro del marco global que formulan las instrucciones del Ministerio de Sanidad, Consejería de Sanidad y Direcciones o Gerencia de cada uno de los centros sanitarios, debe organizarse un plan de contingencia de los distintos servicios de cirugía cardiovascular. Este plan de contingencia debe mantener el correcto funcionamiento de los servicios de cirugía cardiovascular, asegurando el adecuado cumplimiento de las siguientes dimensiones asistenciales: a) la correcta atención de los pacientes urgentes y emergentes, b) la elaboración de una lista de pacientes preferentes y criterios temporales de tratamiento, c) la demora justificada y segura de aquellos pacientes de tratamiento electivo cuya enfermedad y situación clínica lo permitan y d) la aplicación concreta de los programas de ECMO en el contexto de la COVID-19.

Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery

Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups. Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources.

[Intervention to reduce variability in surgical indications and the waiting list of priority 1 patients. An experience in Galicia (Spain)]

The aims of this study were to homogenize priority 1 surgical indications in Galician hospitals and propose a methodology designed to ensure that that the waiting times of priority 1 patients do not exceed 30 days. The priority 1 surgical indications of the distinct surgical services in Galicia were obtained and reviewed and were then sent for validation to the scientific societies. To reduce waiting times to less than 30 days, a procedure of periodic patient monitoring was established, with allocation of tasks to all the parties involved. Comparison of the mean waiting times before and after the implantation of periodic monitoring showed that this procedure reduced the mean waiting time by 55.7%. The mean waiting time was reduced in all the surgical specialities except one. In almost all of the surgical specialities, the procedure established reduced the number of patients on the waiting lists and the mean waiting time to less than 30 days.

[Infectious endocarditis: degree of discordance between clinical guidelines recommendations and clinical practice]

INTRODUCTION AND OBJECTIVES

The present study was made to investigate the degree of discordance between the recommendations of clinical guidelines and actual practice in the care of patients with infectious endocarditis.

MATERIAL AND METHODS

Data was gathered on 34 patients that were admitted to our hospital for native valve infection over a 4-year period. The degree of discordance (%) was obtained by comparing each clinical history with a catalog of 15 specific actions recommended in the clinical guidelines for four consecutive phases: pre-diagnosis, hospital diagnosis, antibiotic treatment, and surgical treatment. A system was constructed, scoring each phase with the greatest detected error (on a severity scale of 0 to 8 points) and adding together the scores for the four phases.

RESULTS

The mean degree of discordance was 30.5% (range, 0-66%). Scores of more than six points were clearly associated with an unfavourable evolution.

CONCLUSIONS

The recommendations of clinical guidelines for infectious endocarditis are inadequately followed in practice, which can affect the course of the disease. It is necessary to increase adherence to clinical guidelines in practice, in order to improve the care of patients with this serious disease.