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Nogueira RG, Etter K, Nguyen TN, Ikeme S, Wong C, Frankel M, Haussen DC, Del Rio C, McDaniel M, Sachdeva R, Devireddy CM, Al-Bayati AR, Mohammaden MH, Doheim MF, Pinheiro AC, Liberato B, Jillella DV, Bhatt NR, Khanna R. Changes in the care of acute cerebrovascular and cardiovascular conditions during the first year of the covid-19 pandemic in 746 hospitals in the USA: retrospective analysis. BMJ MEDICINE 2023; 2:e000207. [PMID: 37215071 PMCID: PMC10186086 DOI: 10.1136/bmjmed-2022-000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/16/2023] [Indexed: 05/24/2023]
Abstract
Objective To measure the impact of the covid-19 pandemic on admissions to hospital and interventions for acute ischemic stroke and acute myocardial infarction. Design A retrospective analysis. Setting 746 qualifying hospitals in the USA from the Premier Healthcare Database. Participants Patients aged 18 years and older who were admitted to hospital with a primary diagnosis of acute ischemic stroke or acute myocardial infarction between 1 March 2019 and 28 February 2021. Main outcome measures Relative changes in volumes were assessed for acute ischemic stroke and acute myocardial infarction hospital admissions as well as intravenous thrombolysis, mechanical thrombectomy, and percutaneous coronary intervention (overall and for acute myocardial infarction only) across the first year of the pandemic versus the prior year. Mortality in hospital and length of stay in hospital were also compared across the first year of the pandemic versus the corresponding period the year prior. These metrics were explored across the different pandemic waves. Results Among 746 qualifying hospitals, admissions to hospital were significantly reduced after the covid-19 pandemic compared with before the pandemic for acute ischemic stroke (-13.59% (95% confidence interval-13.77% to -13.41%) and acute myocardial infarction (-17.20% (-17.39% to -17.01%)), as well as intravenous thrombolysis (-9.47% (-9.99% to -9.02%)), any percutaneous coronary intervention (-17.89% (-18.06% to -17.71%)), and percutaneous coronary intervention for acute myocardial infarction (-14.36% (-14.59% to -14.12%)). During the first year of the pandemic versus the previous year, the odds of mortality in hospital for acute ischemic stroke were 9.00% higher (3.51% v 3.16%; ratio of the means 1.09 (95% confidence interval (1.03 to 1.15); P=0.0013) and for acute myocardial infarction were 18.00% higher (4.81% v 4.29%; ratio of the means 1.18 (1.13 to 1.23); P<0.0001). Conclusions We observed substantial decreases in admissions to hospital with acute ischemic stroke and acute myocardial infarction, but an increase in mortality in hospital throughout the first year of the pandemic. Public health interventions are needed to prevent these reductions in future pandemics.
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Affiliation(s)
- Raul G Nogueira
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katherine Etter
- Global Provider and Payer Value Demonstration, Health Economics and Market Access, Johnson & Johnson, Raynham, MA, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Shelly Ikeme
- Franchise Health Economics and Market Access, Johnson & Johnson, New Brunswick, NJ, USA
| | - Charlene Wong
- Global Provider and Payer Value Demonstration, Health Economics and Market Access, Johnson & Johnson, Raynham, MA, USA
| | - Michael Frankel
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Carlos Del Rio
- Department of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Michael McDaniel
- Department of Cardiology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Rajesh Sachdeva
- Department of Cardiology, Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Chandan M Devireddy
- Department of Cardiology, Emory University Hospital Midtown, Emory University School of Medicine, Atlanta, GA, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Mohamed F Doheim
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Agostinho C Pinheiro
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bernardo Liberato
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Dinesh V Jillella
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
| | - Nirav R Bhatt
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rahul Khanna
- Medical Device Epidemiology, Johnson and Johnson Medical Devices, New Brunswick, NJ, USA
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Rodriguez-Ramos MA. Effect of COVID-19 Pandemic on Performance Measures in Acute Myocardial Infarction. ACTA ACUST UNITED AC 2021; 61:52-56. [PMID: 33849419 DOI: 10.18087/cardio.2021.3.n1496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/15/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022]
Abstract
Objective To assess performance measures of attention of STEMI in Coronary Intensive Care Unit in General Hospital Camilo Cienfuegos.Methods Admitted patients with STEMI, from February-April 2020, were compared with patients from similar period from 2015-2019, and patients from January 2019 to January 2020. Primary endpoint were performance measures according to the 2017 AHA / ACC Clinical Performance and Quality Measures for Adults with STEMI document, and secondary endpoint were all-cause in-hospital mortality and major acute coronary events.Results Only 35 patients were admitted from February-April 2020. When comparing with similar periods from recent years, in-hospital death (8.3 % vs. 20 %; p=0.03), major complications (38.7 % vs. 57.1 %; p=0.03), and cardiogenic shock (6.9 % vs. 17.4 %; p=0.04) were significantly higher. When comparing with 2019 and January 2020, in-hospital death (9.6 %; p=0.04), and major complications (35.8 % p=0.03) were significantly higher in February-April 2020; however, there was no difference in prevalence of cardiogenic shock (8 %; p=0.12).Conclusion COVID-19 pandemic had decreased prevalence of STEMI, as well as some performance measures of attention in this center.
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Chieffo A, Tarantini G, Naber C, Barbato E, Roffi M, Stefanini G, Buchanan G, Buszman P, Moreno R, Zawiślak B, Cayla G, Danenberg H, Da Silveira J, Nef H, James SK, Mauri Ferre J, Voskuil M, Witt N, Windecker S, Baumbach A, Dudek D. Performing elective cardiac invasive procedures during the COVID-19 outbreak: a position statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EUROINTERVENTION 2021; 16:1177-1186. [PMID: 33416050 PMCID: PMC9724975 DOI: 10.4244/eij-d-20-01291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The rearrangement of healthcare services required to face the coronavirus disease 2019 (COVID-19) pandemic led to a drastic reduction in elective cardiac invasive procedures. We are already facing a "second wave" of infections and we might be dealing during the next months with a "third wave" and subsequently new waves. Therefore, during the different waves of the COVID-19 pandemic we have to face the problems of how to perform elective cardiac invasive procedures in non-COVID patients and which patients/procedures should be prioritised. In this context, the interplay between the pandemic stage, the availability of healthcare resources and the priority of specific cardiac disorders is crucial. Clear pathways for "hot" or presumed "hot" patients and "cold" patients are mandatory in each hospital. Depending on the local testing capacity and intensity of transmission in the area, healthcare facilities may test patients for SARS-CoV-2 infection before the interventional procedure, regardless of risk assessment for COVID-19. Pre-hospital testing should always be conducted in the presence of symptoms suggestive of SARS-CoV-2 infection. In cases of confirmed or suspected COVID-19 positive patients, full personal protective equipment using FFP 2/N95 masks, eye protection, gowning and gloves is indicated during cardiac interventions for healthcare workers. When patients have tested negative for COVID-19, medical masks may be sufficient. Indeed, individual patients should themselves wear medical masks during cardiac interventions and outpatient visits.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Christoph Naber
- Medizinische Klinik I, Kardiologie und Intensivmedizin, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy,Cardiovascular Research Center Aalst, Aalst, Belgium
| | - Marco Roffi
- Division of Cardiology, University Hospitals, Geneva, Switzerland
| | - Giulio Stefanini
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gill Buchanan
- Department of Cardiology, North Cumbria Integrated Care NHS Foundation Trust, Cumbria, United Kingdom
| | - Piotr Buszman
- Cardiology Department, Andrzej Frycz-Modrzewski Kraków University, American Heart of Poland, Bielsko-Biała, Poland
| | - Raul Moreno
- Cardiology Department, Hospital La Paz and IDIPAZ, Madrid, Spain
| | - Barbara Zawiślak
- Intensive Cardiac Care Unit, University Hospital Kraków, Kraków, Poland
| | - Guillaume Cayla
- Department of Cardiology, CHU Nimes, Montpellier University, Nimes, France
| | - Haim Danenberg
- Interventional Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Joao Da Silveira
- Centro Hospitalar e Universitário do Porto, Hospital de Santo António, Porto, Portugal
| | - Holger Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Stefan K. James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Michiel Voskuil
- Interventional Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nils Witt
- Department of Clinical Science and Education, Karolinska Institute, Division of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Stephan Windecker
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Barts Heart Centre, London, United Kingdom,Yale University School of Medicine, New Haven, CT, USA
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland,Maria Cecilia Hospital GVM, Cotignola, Ravenna, Italy
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Pilz S. Letter to the Editor Re: Global perspective of COVID-19 epidemiology for a full-cycle pandemic. Eur J Clin Invest 2021; 51:e13447. [PMID: 33131076 DOI: 10.1111/eci.13447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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5
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Spaccarotella C, Migliarino S, Mongiardo A, Curcio A, de Rosa S, Corcione N, Quirino A, Barreca GS, Giancotti A, Peronace C, Marascio N, Matera G, Indolfi C. Fast-track ruling in/out SARS-CoV-2 infection with rapid 0/1.5 h molecular test in patients with acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2020; 21:975-979. [PMID: 33156158 DOI: 10.2459/jcm.0000000000001117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Patients with acute coronary syndrome (ACS) often arrive in the catheterization (cath) lab directly from the field or an emergency department without an accurate triage for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Although in the pandemic period the treatment in the cath laboratory of high-risk ACS should not be delayed because the operators wear special protection systems, the subsequent risk of contagion in a non-Covid coronary care unit could be high in the case of patients positive for SARS-CoV-2. METHODS We tested the possibility of a fast-track protocol in 51 consecutive patients (mean age 65 ± 12 years) transferred from spokes centres or from the field to our HUB centre and admitted to our coronary care unit (CCU). Once the patient had arrived in the cath lab, the nasopharyngeal swab was performed. The real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated rapid molecular Xpert Xpress test. Meanwhile, coronary angiography or percutaneous coronary intervention was performed if necessary. RESULTS In this fast-track protocol, the time to perform nasopharyngeal swab was 11 ± 11 min; time spent to transport nasopharyngeal swab to the laboratory was 29 ± 20 min; time to detect viral nucleic acid was 68 ± 16 min. The overall time from the execution of nasopharyngeal swab to the result was 109 ± 26 min. The results were immediately put into the hospital computer system and made readily available. Depending on the test result, patients were then transferred to the regular CCU or Covid area. CONCLUSION This study demonstrates that 0-1.5 h fast-track triage for coronavirus disease 2019 (COVID 19) is feasible in patients with ACS. The execution of nasopharyngeal swab in the cath lab and its analysis with a rapid molecular test allows rapid stratification of SARS-CoV-2 infection.
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Affiliation(s)
- Carmen Spaccarotella
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro
| | | | | | - Antonio Curcio
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro
| | - Salvatore de Rosa
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro
| | - Nicola Corcione
- Division of Cardiology Clinica Pineta Mare, Castel Volturno, Neaples, Italy
| | - Angela Quirino
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Giorgio Settimo Barreca
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Aida Giancotti
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Cinzia Peronace
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Nadia Marascio
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Giovanni Matera
- Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro
| | - Ciro Indolfi
- Division of Cardiology.,Center for Cardiovascular Research University, Magna Graecia, Catanzaro.,Mediterranea Cardiocentro, Naples
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6
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Decrease of Cardiovascular Emergencies During the COVID-19 Pandemic. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2020. [DOI: 10.2478/jce-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The new coronavirus (COVID-19) outbreak was declared a pandemic by the World Health Organization on March 11, 2020. Since then, important changes have been observed in the medical world, both in terms of patient management and patient presentations to the hospital. A dramatic decrease in the number of cardiovascular emergencies presenting to the emergency rooms has been reported in every country affected by the COVID-19 pandemic. This resulted mainly from the fear of patients to present at the hospital due to the risk of infection with the new coronavirus. Moreover, a significant increase in the time spent for investigations and specialized treatment has been reported for patients suffering from acute cardiovascular diseases. This adds to the longer times reported from symptom onset to presentation, and also to the longer period spent for triage in the emergency room. The aim of this paper is to highlight the dramatic reduction in the number of cardiovascular emergencies during the COVID-19 period and its possible explanations.
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7
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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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9
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Chieffo A, Stefanini GG, Price S, Barbato E, Tarantini G, Karam N, Moreno R, Buchanan GL, Gilard M, Halvorsen S, Huber K, James S, Neumann FJ, Möllmann H, Roffi M, Tavazzi G, Ferré JM, Windecker S, Dudek D, Baumbach A. EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic. EUROINTERVENTION 2020; 16:233-246. [PMID: 32404302 DOI: 10.4244/eijy20m05_01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
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10
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Chieffo A, Stefanini GG, Price S, Barbato E, Tarantini G, Karam N, Moreno R, Buchanan GL, Gilard M, Halvorsen S, Huber K, James S, Neumann FJ, Möllmann H, Roffi M, Tavazzi G, Mauri Ferré J, Windecker S, Dudek D, Baumbach A. EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic. Eur Heart J 2020; 41:1839-1851. [PMID: 32405641 PMCID: PMC7239193 DOI: 10.1093/eurheartj/ehaa381] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Emanuele Barbato
- Department of Advanced Biomedical Sciences University Federico II, Naples, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Nicole Karam
- European Hospital Georges Pompidou (Cardiology Department) and University of Paris, Paris, France
| | - Raul Moreno
- Cardiology Department, Hospital La Paz and IDIPAZ, Madrid, Spain
| | - Gill Louise Buchanan
- Department of Cardiology, North Cumbria Integrated Care NHS Foundation Trust, Cumbria, UK
| | - Martine Gilard
- Service de Cardiologie, Brest University Hospital, Brest, France
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, Oslo, Norway
| | - Kurt Huber
- 3Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical School, Vienna, Austria
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Helge Möllmann
- Department of Cardiology St.-Johannes-Hospital Klinik für Innere Medizin I, Dortmund, Germany
| | - Marco Roffi
- Division of Cardiology, University Hospitals, Geneva, Switzerland
| | - Guido Tavazzi
- Department of clinical-surgical, diagnostic and pediatric sciences, Unit of anaesthesia and intensive care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | | | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and Maria Cecilia Hospital GVM, Cotignola, Ravenna, Italy
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Barts Heart Centre, London, UK and Yale University School of Medicine, New Haven, CT, USA
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