1
|
Zamorano JL, Appleby C, Benamer H, Frankenstein L, Musumeci G, Nombela-Franco L. Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement. Catheter Cardiovasc Interv 2023; 102:547-557. [PMID: 37431253 DOI: 10.1002/ccd.30760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/01/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is recommended for a growing range of patients with severe aortic stenosis in the European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) 2021 Guidelines update. However, guideline implementation programs are needed to ensure the application of clinical recommendations which will favorably influence disease outcomes. An Expert Council was convened to identify whether cardiology services across Europe are set up to address the growing needs of patients with severe aortic stenosis for increased access to TAVI by identifying the key challenges faced in growing TAVI programs and mapping associated solutions. Wide variation exists across Europe in terms of TAVI availability and capacity to deliver the increased demand for TAVI in different countries. The recommendations of this Expert Council focus on the short-to-medium-term aspects where the most immediate, actionable impact can be achieved. The focus on improving procedural efficiency and optimizing the patient pathway via clinical practice and patient management demonstrates how to mitigate the current major issues of shortfall in catheterization laboratory, workforce, and bed capacity. Procedural efficiencies may be achieved through steps including streamlined patient assessment, the benchmarking of standards for minimalist procedures, standardized approaches around patient monitoring and conduction issues, and the implementation of nurse specialists and dedicated TAVI coordinators to manage organization, logistics, and early mobilization. Increased collaboration with wider stakeholders within institutions will support successful TAVI uptake and improve patient and economic outcomes. Further, increased education, collaboration, and partnership between cardiology centers will facilitate sharing of expertise and best clinical practice.
Collapse
Affiliation(s)
- José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
2
|
Boulos PK, Freeman SV, Henry TD, Mahmud E, Messenger JC. Interaction of COVID-19 With Common Cardiovascular Disorders. Circ Res 2023; 132:1259-1271. [PMID: 37167359 PMCID: PMC10171313 DOI: 10.1161/circresaha.122.321952] [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] [Indexed: 05/13/2023]
Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Peter K. Boulos
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Scott V. Freeman
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (E.M.)
| | - John C. Messenger
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| |
Collapse
|
3
|
"Be Your Own Doctor" Experiences of Patients With Transcatheter Aortic Valve Implantation During the Pandemic: A Qualitative Study. Res Theory Nurs Pract 2023; 37:3-16. [PMID: 36792317 DOI: 10.1891/rtnp-2022-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background and Purpose: Although patients have had reduced access to healthcare institutions due to the COVID-19 pandemic and the related preventive measures, there is no current data on how the pandemic has affected patients who underwent transcatheter aortic valve implantation (TAVI), despite their need for close follow-up.This study investigated TAVI patients' experiences with self-care management during the pandemic. Methods: This study adopted a descriptive qualitative design. The sample consisted of 24 patients recruited using purposive sampling. Data were collected by telephone and analyzed using inductive content analysis. Results: The data were grouped under three themes: "vulnerability," "worsening of psychological condition," and "expectations." The most challenging self-care behaviors reported by TAVI patients were determined to be doing regular physical activity, managing their symptoms, complying with treatment, and attending regular check-ups. They also reported experiencing psychological problems such as fear, concern, and abandonment and stated a need for better communication and follow-up at home during the pandemic. Implications for Practice: The pandemic has more than ever demonstrated the importance of effective self-care for cardiovascular patients. Nurses should plan individualized interventions regarding the problems in self-care management that we identified in this study. In this regard, the use of secure digital applications such as telerehabilitation can be effective. Also, nurses should develop community-based and political initiatives to allow sustainable self-care management to be effectively implemented in special patient groups in extraordinary circumstances such as pandemics.
Collapse
|
4
|
Alzaglool S, Al-Jaiuossi O. Early experience of aortic surgery during the COVID-19 pandemic in the United Kingdom: A multicenter study. J Card Surg 2022; 37:5686. [PMID: 36168794 DOI: 10.1111/jocs.16964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/06/2023]
|
5
|
Stickels CP, Nadarajah R, Gale CP, Jiang H, Sharkey KJ, Gibbison B, Holliman N, Lombardo S, Schewe L, Sommacal M, Sun L, Weir-McCall J, Cheema K, Rudd JHF, Mamas M, Erhun F. Aortic stenosis post-COVID-19: a mathematical model on waiting lists and mortality. BMJ Open 2022; 12:e059309. [PMID: 35710248 PMCID: PMC9207579 DOI: 10.1136/bmjopen-2021-059309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/20/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To provide estimates for how different treatment pathways for the management of severe aortic stenosis (AS) may affect National Health Service (NHS) England waiting list duration and associated mortality. DESIGN We constructed a mathematical model of the excess waiting list and found the closed-form analytic solution to that model. From published data, we calculated estimates for how the strategies listed under Interventions may affect the time to clear the backlog of patients waiting for treatment and the associated waiting list mortality. SETTING The NHS in England. PARTICIPANTS Estimated patients with AS in England. INTERVENTIONS (1) Increasing the capacity for the treatment of severe AS, (2) converting proportions of cases from surgery to transcatheter aortic valve implantation and (3) a combination of these two. RESULTS In a capacitated system, clearing the backlog by returning to pre-COVID-19 capacity is not possible. A conversion rate of 50% would clear the backlog within 666 (533-848) days with 1419 (597-2189) deaths while waiting during this time. A 20% capacity increase would require 535 (434-666) days, with an associated mortality of 1172 (466-1859). A combination of converting 40% cases and increasing capacity by 20% would clear the backlog within a year (343 (281-410) days) with 784 (292-1324) deaths while awaiting treatment. CONCLUSION A strategy change to the management of severe AS is required to reduce the NHS backlog and waiting list deaths during the post-COVID-19 'recovery' period. However, plausible adaptations will still incur a substantial wait to treatment and many hundreds dying while waiting.
Collapse
Affiliation(s)
| | - Ramesh Nadarajah
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Houyuan Jiang
- Judge Business School, University of Cambridge, Cambridge, UK
| | - Kieran J Sharkey
- Department of Mathematical Sciences, University of Liverpool, Liverpool, UK
| | - Ben Gibbison
- Cardiac Anaesthesia and Intensive Care, Bristol Medical School, Bristol, UK
| | - Nick Holliman
- Department of Informatics, King's College London, London, UK
| | - Sara Lombardo
- Department of Mathematical Sciences, Loughborough University, Loughborough, UK
| | - Lars Schewe
- School of Mathematics and Maxwell Institute for Mathematical Sciences, University of Edinburgh, Edinburgh, UK
| | - Matteo Sommacal
- Department of Mathematics, Physics and Electrical Engineering, Northumbria University, Newcastle upon Tyne, UK
| | - Louise Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jonathan Weir-McCall
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | | | - James H F Rudd
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Feryal Erhun
- Judge Business School, University of Cambridge, Cambridge, UK
| |
Collapse
|
6
|
Berisha N, Klein K, Veulemans V, Maier O, Piayda K, Binnebößel S, Afzal S, Polzin A, Westenfeld R, Horn P, Jung C, Kelm M, Quast C, Zeus T. Structured Allocation of Transcatheter Aortic Valve Replacement Patients during Coronavirus Disease 2019 Pandemic: Impact on Patient Selection and Clinical Results. J Cardiovasc Dev Dis 2022; 9:jcdd9060189. [PMID: 35735818 PMCID: PMC9224926 DOI: 10.3390/jcdd9060189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 12/04/2022] Open
Abstract
Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and 456 TAVR patients after (COVID-19 group) the implementation of our allocation algorithm were compared. Concerning patient characteristics, the COVID-19 group revealed a higher rate of cardiac decompensations/cardiogenic shocks (10.5% vs. 1.3%; p < 0.001), severe angina pectoris (Canadian Cardiovascular Society (CCS) II, III and IV: 18.7% vs. 11.8%; p = 0.004), troponin elevation (>14 ng/L: 84.9% vs. 77%; p = 0.003) and reduced left ventricular ejection fraction (LVEF) (<45%: 18.9% vs. 12%; p = 0.006). Referring to procedural characteristics, more predilatations (46.3% vs. 35.1%; p = 0.001) and a longer procedural time (80.2 min (+/−29.4) vs. 66.9 min (+/−17.5); p < 0.001) were observed. The success rate was evenly high; no differences in safety parameters were reported. Examining the utilization of hospital resources, the COVID-19 group showed a shorter in-hospital stay (8.4 days (+/−5.9) vs. 9.5 days (+/−9.33); p = 0.041) and fewer TAVR patients were treated per month (39 (+/−4.55) vs. 46.11 (+/−7.57); p = 0.03). Our allocation algorithm supported prioritization of sicker patients with similar efficient and safe TAVR procedures. In-hospital stay could be shortened.
Collapse
Affiliation(s)
- Nora Berisha
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Kathrin Klein
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Oliver Maier
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Kerstin Piayda
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Stephan Binnebößel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Shazia Afzal
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
- CARID (Cardiovascular Research Institute Düsseldorf), Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Christine Quast
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (N.B.); (K.K.); (V.V.); (O.M.); (K.P.); (S.B.); (S.A.); (A.P.); (R.W.); (P.H.); (C.J.); (M.K.); (C.Q.)
- Correspondence: ; Tel.: +49-211-18801; Fax: +49-211-18812
| |
Collapse
|
7
|
Garrido J, Martínez-Rodríguez D, Rodríguez-Serrano F, Pérez-Villares J, Ferreiro-Marzal A, Jiménez-Quintana M, Villanueva R. Mathematical model optimized for prediction and health care planning for COVID-19. Med Intensiva 2022; 46:248-258. [PMID: 35256322 PMCID: PMC8882409 DOI: 10.1016/j.medine.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has threatened to collapse hospital and ICU services, and it has affected the care programs for non-COVID patients. The objective was to develop a mathematical model designed to optimize predictions related to the need for hospitalization and ICU admission by COVID-19 patients. DESIGN Prospective study. SETTING Province of Granada (Spain). POPULATION COVID-19 patients hospitalized, admitted to ICU, recovered and died from March 15 to September 22, 2020. STUDY VARIABLES The number of patients infected with SARS-CoV-2 and hospitalized or admitted to ICU for COVID-19. RESULTS The data reported by hospitals was used to develop a mathematical model that reflects the flow of the population among the different interest groups in relation to COVID-19. This tool allows to analyse different scenarios based on socio-health restriction measures, and to forecast the number of people infected, hospitalized and admitted to the ICU. CONCLUSIONS The mathematical model is capable of providing predictions on the evolution of the COVID-19 sufficiently in advance as to anticipate the peaks of prevalence and hospital and ICU care demands, and also the appearance of periods in which the care for non-COVID patients could be intensified.
Collapse
Affiliation(s)
- J.M. Garrido
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain,Instituto de Biopatología y Medicina Regenerativa (IBIMER), Universidad de Granada, Granada, Spain,Servicio de Cirugía Cardiovascular, Hospital Virgen de las Nieves, Granada, Spain,Corresponding author
| | - D. Martínez-Rodríguez
- Instituto Universitario de Matemática Multidisciplinar, Universitat Politècnica de València, Valencia, Spain
| | - F. Rodríguez-Serrano
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain,Instituto de Biopatología y Medicina Regenerativa (IBIMER), Universidad de Granada, Granada, Spain
| | - J.M. Pérez-Villares
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A. Ferreiro-Marzal
- Servicio de Cirugía Cardiovascular, Hospital Virgen de las Nieves, Granada, Spain
| | - M.M. Jiménez-Quintana
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - R.J. Villanueva
- Instituto Universitario de Matemática Multidisciplinar, Universitat Politècnica de València, Valencia, Spain
| |
Collapse
|
8
|
Dobson LE, Prendergast BD. Heart valve disease: a journey of discovery. BRITISH HEART JOURNAL 2022; 108:774-779. [PMID: 35459727 DOI: 10.1136/heartjnl-2021-320146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
In the centenary year of the British Cardiovascular Society (BCS), this review article outlines the influence of UK cardiologists and surgeons on the field of heart valve disease, many of whom can rightly claim 'world firsts' in the field. From the description of endocarditis as we know it today at the turn of the 20th century, to the first mitral valvotomy, heart valve replacement and invention of the Ross procedure. These advances have transformed the outlook of patients with symptomatic valve disease from palliation and certain death to curative treatment and near normal life expectancy. Transcatheter aortic valve implantation (TAVI) was adopted early in the UK, and thanks to the comprehensive national database, the UK TAVI registry is one of the world's largest, contributing real-world patient data to inform clinical practice. The more recent concepts of 'Heart Valve Centres of Excellence' and specialist valve clinics have been developed by the BCS-affiliated British Heart Valve Society which continues to drive improved standards for patients with heart valve disease. The next 100 years will no doubt be equally thrilling in terms of innovation for heart valve disease, with artificial intelligence, transcatheter therapies and cutting-edge technology continuing to improve patient care and clinical outcomes.
Collapse
Affiliation(s)
| | - Bernard D Prendergast
- Department of Cardiology, St Thomas' Hospital, London, UK .,Heart Vascular and Thoracic Institute, Cleveland Clinic London Hospital, London, England, UK
| |
Collapse
|
9
|
Zhou ES, Bhatia SK. Divergent Effects of COVID-19 Pandemic on Reported Adverse Events for Percutaneous Aortic Valve Prostheses and Non-Allograft Tissue Valves. Am J Cardiol 2022; 167:151-153. [PMID: 34986986 PMCID: PMC8720367 DOI: 10.1016/j.amjcard.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Elsa S Zhou
- Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| | - Sujata K Bhatia
- Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| |
Collapse
|
10
|
Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
11
|
Bonalumi G, Giambuzzi I, Buratto B, Barili F, Garatti A, Pilozzi Casado A, Di Mauro M, Parolari A. The day after tomorrow: cardiac surgery and coronavirus disease-2019. J Cardiovasc Med (Hagerstown) 2022; 23:75-83. [PMID: 34958311 DOI: 10.2459/jcm.0000000000001223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The impact of the coronavirus disease-2019 (COVID-19) pandemic forced the governments worldwide to deal with an unprecedented health crisis. The aim of this review is to summarize what happened to cardiac surgery worldwide during the first wave of this pandemic. A literature search was performed to extrapolate key concepts regarding guidelines and reorganization of cardiac surgery wards during COVID-19. Supporting literature was also included to discuss the hot topics related to COVID-19 and cardiac surgery. Hence, both official documents from national scientific societies and single- or multiple-center experiences during the pandemics are reviewed and discussed. In Italy, the first western country hit by the pandemic, two different models were proposed to cope with the need for ICU/ward beds and to reallocate cardiac surgical services: Hub-and-Spoke system ('Hubs', dedicated to perform urgent and nondeferrable surgery, and 'Spokes', turned into COVID centers) and/or a progressive reduction in surgical activity. Worldwide, several guidelines/consensus statements were published, suggesting how to deal with the outbreak. Two different approaches for stratifying surgical indications were proposed: dynamic, based on the number of hospitalized COVID-19 patients; static, based only on the severity of the cardiovascular disease. Moreover, the importance of personal protective equipment was stressed. Several measures should have been adopted to deal with an unprecedented need for healthcare resources allocation to care for COVID-19 patients, putting the healthcare systems under serious stress. Cardiac surgery has, as have most surgical activities, been asked to reduce its own activity, giving priority to emergency and nondeferrable cases.
Collapse
Affiliation(s)
- Giorgia Bonalumi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS
| | - Ilaria Giambuzzi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS
- DISCCO, University of Milan
| | - Beatrice Buratto
- SC Universitary Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, Milan
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo
| | - Andrea Garatti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Alessandro Parolari
- Unit of Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy
| |
Collapse
|
12
|
Tan JH, Teoh TK, Ivanova J, Varcoe R, Jadhav S, Baig K, Gunarathne A. Changes to transcatheter aortic valve replacement (TAVR) services during the first wave of the COVID-19 pandemic: A single centre experience from United Kingdom tertiary hospital. Hellenic J Cardiol 2022; 67:36-41. [PMID: 35798181 PMCID: PMC9251899 DOI: 10.1016/j.hjc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 07/01/2022] [Indexed: 12/25/2022] Open
Abstract
AIMS COVID-19 had a devastating impact on patients with severe aortic stenosis (AS). Like many cardiac procedures, transcatheter aortic valve replacement (TAVR) services were suspended during the first wave of COVID-19. We took the opportunity to evaluate the clinical outcomes and identify any delays at different stages of the TAVR pathway during the COVID-19 pandemic. METHODS Prospectively collected data on 210 consecutive TAVR patients between March 2019 and March 2021 were analysed. We compared the clinical outcomes and 30-day mortality rates of TAVR cases pre-pandemic and during the pandemic. We also looked to identify any time lags from the initial referral to respective stages of the TAVR workup. RESULTS A total of 134 patients underwent TAVR prior to the national lockdown (March 2019-March 2020), compared to 76 patients during COVID-19 (April 2020-April 2021). Success rates of TAVR were similar (99% prior to the pandemic and 97.4% during COVID-19). The 30-day survival rates were 98.6% and 94.7%, respectively. Median length of stay post TAVR was 2 days during COVID-19 and 2.5 days prior to the pandemic (p = 0.064). Patients were seen quicker in clinic (median of 33 days) during COVID-19, compared to 51 days before COVID-19 (p = 0.044). No significant difference in times from referral to discussion at TAVR multidisciplinary team (MDT) meetings, CT Aortogram and TAVR implantation, in both groups. CONCLUSIONS Reconfiguring the patient pathway during COVID-19 allowed TAVR to be performed safely, with a similar success rate and no excess complications or increased 30-day mortality. There proved to be no delay in the respective stages of patient TAVR workup, during the pandemic.
Collapse
Affiliation(s)
- Joon Heng Tan
- Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, United Kingdom.
| | - Tsu Kuan Teoh
- Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Julia Ivanova
- Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Richard Varcoe
- Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Sachin Jadhav
- Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Kamran Baig
- Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Ashan Gunarathne
- Trent Cardiac Centre, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, United Kingdom
| |
Collapse
|
13
|
Williams MC, Shaw L, Hirschfeld CB, Maurovich-Horvat P, Nørgaard BL, Pontone G, Jimenez-Heffernan A, Sinitsyn V, Sergienko V, Ansheles A, Bax JJ, Buechel R, Milan E, Slart RHJA, Nicol E, Bucciarelli-Ducci C, Pynda Y, Better N, Cerci R, Dorbala S, Raggi P, Villines TC, Vitola J, Malkovskiy E, Goebel B, Cohen Y, Randazzo M, Pascual TNB, Dondi M, Paez D, Einstein AJ. Impact of COVID-19 on the imaging diagnosis of cardiac disease in Europe. Open Heart 2021; 8:e001681. [PMID: 34353958 PMCID: PMC8349647 DOI: 10.1136/openhrt-2021-001681] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.
Collapse
Affiliation(s)
| | - Leslee Shaw
- Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | | | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Vladimir Sergienko
- National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
| | - Alexey Ansheles
- National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronny Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Elisa Milan
- UOC Nuclear Medicine- Ospedale Cà Foncello, Treviso, Italy
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, Groningen, The Netherlands
| | - Edward Nicol
- Department of Imaging, Royal Brompton Hospital, London, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, London, UK
- Guys and St Thomas NHS Trust and King's College London, London, UK
| | | | - Nathan Better
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Paolo Raggi
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Todd C Villines
- Medicine (Cardiology), Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Eli Malkovskiy
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Yosef Cohen
- Technion Israel Institute of Technology, Haifa, Israel
| | - Michael Randazzo
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
| | | |
Collapse
|
14
|
Garrido JM, Martínez-Rodríguez D, Rodríguez-Serrano F, Pérez-Villares JM, Ferreiro-Marzal A, Jiménez-Quintana MM, Villanueva RJ. Mathematical model optimized for prediction and health care planning for COVID-19. Med Intensiva 2021; 46:S0210-5691(21)00034-6. [PMID: 33926752 PMCID: PMC7936565 DOI: 10.1016/j.medin.2021.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has threatened to collapse hospital and ICU services, and it has affected the care programs for non-COVID patients. The objective was to develop a mathematical model designed to optimize predictions related to the need for hospitalization and ICU admission by COVID-19 patients. DESIGN Prospective study. SETTING Province of Granada (Spain). POPULATION COVID-19 patients hospitalized, admitted to ICU, recovered and died from March 15 to September 22, 2020. STUDY VARIABLES The number of patients infected with SARS-CoV-2 and hospitalized or admitted to ICU for COVID-19. RESULTS The data reported by hospitals was used to develop a mathematical model that reflects the flow of the population among the different interest groups in relation to COVID-19. This tool allows to analyse different scenarios based on socio-health restriction measures, and to forecast the number of people infected, hospitalized and admitted to the ICU. CONCLUSIONS The mathematical model is capable of providing predictions on the evolution of the COVID-19 sufficiently in advance as to anticipate the peaks of prevalence and hospital and ICU care demands, and also the appearance of periods in which the care for non-COVID patients could be intensified.
Collapse
Affiliation(s)
- J M Garrido
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, España; Instituto de Biopatología y Medicina Regenerativa (IBIMER), Universidad de Granada, Granada, España; Servicio de Cirugía Cardiovascular, Hospital Virgen de las Nieves, Granada, España.
| | - D Martínez-Rodríguez
- Instituto Universitario de Matemática Multidisciplinar, Universitat Politècnica de València, Valencia, España
| | - F Rodríguez-Serrano
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, España; Instituto de Biopatología y Medicina Regenerativa (IBIMER), Universidad de Granada, Granada, España
| | - J M Pérez-Villares
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - A Ferreiro-Marzal
- Servicio de Cirugía Cardiovascular, Hospital Virgen de las Nieves, Granada, España
| | - M M Jiménez-Quintana
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - R J Villanueva
- Instituto Universitario de Matemática Multidisciplinar, Universitat Politècnica de València, Valencia, España
| |
Collapse
|
15
|
Harky A, Seyedzenouzi G, Sanghavi R, Premkumar G, Badran A. COVID-19 and its implications on patient selection for TAVI and SAVR: Are we heading into a new era? J Card Surg 2020; 36:265-267. [PMID: 33135180 DOI: 10.1111/jocs.15181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Ria Sanghavi
- School of Medicine and Surgery, University Of Central Lancashire, Preston, Lancashire, UK
| | | | - Abdul Badran
- Department of Cardiothoracic Surgery, University Hospitals Southampton, Southampton, UK
| |
Collapse
|
16
|
Shafi AMA, Awad WI. Transcatheter aortic valve implantation versus surgical aortic valve replacement during the COVID-19 pandemic-Current practice and concerns. J Card Surg 2020; 36:260-264. [PMID: 33135366 DOI: 10.1111/jocs.15182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
COVID-19 has had a dramatic impact on the provision of healthcare. COVID-19 can manifest with cardiac and thrombotic presentations. Additionally, patients with cardiovascular comorbidities are at an increased risk of adverse outcomes related to COVID-19 infection. This in turn has led to a significant reduction in the provision of cardiac surgery with alternative management options utilized to address patients with significant disease. In terms of aortic valve disease, transcatheter aortic valve implantation (TAVI) provides advantages over surgical aortic valve replacement in with a lower burden on healthcare resources. COVID-19 also resulted in changes in management strategies and as such TAVI is now being considered in younger- and low-risk patients. However, long term data with regard to TAVI is still unknown, and the use in patient groups that have been excluded in the large pivotal studies that established TAVI as an alternative to surgery has raised specific concerns in the use of TAVI as the preferred treatment choice. With the long term ramification unknown, it is essential that decisions are made with caution.
Collapse
Affiliation(s)
- Ahmed M A Shafi
- Department of Cardiothoracic Surgery, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | - Wael I Awad
- Department of Cardiothoracic Surgery, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| |
Collapse
|
17
|
Shah BN, Schlosshan D, McConkey HZR, Buch MH, Marshall AJ, Cartwright N, Dobson LE, Allen C, Campbell B, Khan P, Savill PJ, Briffa NP, Chambers JB. Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care. Heart 2020; 106:1549-1554. [PMID: 32868279 DOI: 10.1136/heartjnl-2020-317600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 11/03/2022] Open
Abstract
The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict 'normal' practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic-such as increased use of virtual clinics-should be further developed and evaluated.
Collapse
Affiliation(s)
- Benoy Nalin Shah
- Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | | | | | - Mamta Heena Buch
- Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK
| | | | - Neil Cartwright
- Cardiac Surgery, Northern General Hospital, Sheffield, Sheffield, UK
| | - Laura Elizabeth Dobson
- Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Christopher Allen
- Guy's & St Thomas' Hospital, Kings College, Rayne Institute, London, London, UK
| | - Brian Campbell
- Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | | | - Peter John Savill
- Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | | | | |
Collapse
|
18
|
Gonzálvez-García A, Jiménez-Valero S, Jurado-Román A, Galeote G, Moreno R. Transcatheter Aortic Valve Implantation During COVID-19 Pandemic: The Device Also Matters. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:66-67. [PMID: 32921594 PMCID: PMC7834872 DOI: 10.1016/j.carrev.2020.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Alfonso Jurado-Román
- Unit of Interventional Cardiology, Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain
| | - Guillermo Galeote
- Unit of Interventional Cardiology, Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain
| | - Raúl Moreno
- Unit of Interventional Cardiology, Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain.
| |
Collapse
|
19
|
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98115, USA
| |
Collapse
|