Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey

Background

The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak.

Methods

The International Atomic Energy Agency (IAEA) surveyed 669 centers in 107 countries worldwide, including 135 facilities in 19 LATAM countries, to assess cardiovascular procedure volumes in March 2019, April 2020, and April 2021, and changes in center practices and staffing conditions one year into the COVID-19 pandemic.

Findings

LATAM centers reported a 21 % decrease in procedure volumes in April 2021 from pre-pandemic-baseline, vs. a 0 % change in the rest of the world (RoW), and greater volume reductions for almost all procedure types. Centers in Central America and Mexico reported the largest procedure reductions (47 % reduction) compared to the Caribbean (15 %), and South America (14 %, p = 0.01), and this LATAM region was a significant predictor of lower procedure recovery in multivariable regression. More LATAM centers reported reduced salaries and increased layoffs of clinical staff compared to RoW, and LATAM respondents estimated that half of physician and non-physician staff experienced excess psychological stress related to the pandemic, compared to 25 % and 30 % in RoW (p < 0.001).

Conclusions

Cardiovascular testing recovery in LATAM trailed behind RoW for most procedure types, with centers in Central America and Mexico reporting the greatest volume reductions. This study found lasting impacts of COVID-19 on cardiovascular care in LATAM and the need for mental health support for LATAM healthcare workers in current and future pandemics.

Position of the international forum of internal medicine on habits, lifestyle changes and a healthy environment for the prevention of cardiovascular diseases

Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of death worldwide and each year more people die from CVD than from any other cause. These data call for a paradigm shift, where health promotion and cardiovascular prevention will acquire a central role in health policies. From this perspective, dedicating time during the consultation to promoting the acquisition of heart-healthy habits would be indicated in all individuals, regardless of cardiovascular risk classification, the role of the internist being fundamental. This position document from the International Forum of Internal Medicine (FIMI) presents the main indications regarding changes in lifestyle and acquisition of healthy habits to prevent CVD. The different sections will address topics including: nutrition, physical activity, sedentary lifestyle, obesity, smoking, alcohol consumption, sleep, stress, environmental problems related to CVD and specific conditions in women. A section is included about starting CVD promotion and prevention measures at an early age, childhood and adolescence, also mentioning epigenetic aspects related to CVD. Social determinants in CVD are also taken into account, since some of these aspects, such as low socioeconomic level, modify cardiovascular risk and should be taken into account.

[Position of the international forum of internal medicine on habits, lifestyle changes and a healthy environment for the prevention of cardiovascular diseases]

Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of death worldwide and each year more people die from CVD than from any other cause. These data call for a paradigm shift, where health promotion and cardiovascular prevention will acquire a central role in health policies. From this perspective, dedicating time during the consultation to promoting the acquisition of heart-healthy habits would be indicated in all individuals, regardless of cardiovascular risk classification, the role of the internist being fundamental. This position document from the International Forum of Internal Medicine (FIMI) presents the main indications regarding changes in lifestyle and acquisition of healthy habits to prevent CVD. The different sections will address topics including: nutrition, physical activity, sedentary lifestyle, obesity, smoking, alcohol consumption, sleep, stress, environmental problems related to CVD and specific conditions in women. A section is included about starting CVD promotion and prevention measures at an early age, childhood and adolescence, also mentioning epigenetic aspects related to CVD. Social determinants in CVD are also taken into account, since some of these aspects, such as low socioeconomic level, modify cardiovascular risk and should be taken into account.

May Measurement Month 2017-19: an analysis of blood pressure screening results from Paraguay. Eur Heart J Suppl 2022;24:F34-F37. [PMID: 36225272 PMCID: PMC9547519 DOI: 10.1093/eurheartjsupp/suac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

The aim of this study was to highlight the importance of measuring blood pressure (BP) and to identify and reduce the BPs of those people who require intervention to lower their BP according to current guidelines. A total of 7782 individuals aged ≥18 years were recruited during the 3 years of the May Measurement Month (MMM) campaign (2017: 1196, 2018: 2285, 2019: 4301). Recruitment was through opportunistic sampling at a variety of screening sites distributed throughout the country. Each participant underwent a pre-specified questionnaire with questions on risk factors concluding with three BP measurements at 1 min intervals and measurement of weight and height. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or those receiving antihypertensive therapy. Of all 7782 participants, 3323 had hypertension (42.7%) of whom 61.8% were aware and 50.4% were not receiving antihypertensive medication. Of those treated (49.6%), 43.8% had controlled BP (<140/90 mmHg). Among all hypertensive patients (with and without medication), 21.7% had controlled BP. In relation to previous surveys carried out in the country, awareness of hypertension increased two-fold, with no change in the proportion of hypertensive patients on treatment and the proportion of hypertensive patients with controlled BP which remained low.

[Feasibility of using artificial intelligence for screening COVID-19 patients in ParaguayViabilidade do uso de inteligência artificial na triagem de pacientes com COVID-19 no Paraguai]

Objetivo.

Estudiar la factibilidad de utilización de la inteligencia artificial como método sensible y específico para el cribado de COVID-19 en pacientes con afecciones respiratorias empleando imágenes de tórax obtenidas con tomógrafo y una plataforma de telemedicina.

Métodos.

Entre marzo del 2020 y junio del 2021 se realizó un estudio observacional descriptivo multicéntrico de factibilidad basada en inteligencia artificial (IA) para el cribado de COVID-19 en imágenes de tórax de pacientes con afecciones respiratorias que acudieron a hospitales públicos. El diagnóstico de las imágenes tomográficas de tórax se realizó a través de la plataforma de IA; luego, se comparó con el diagnóstico molecular (RT-PCR) para determinar la concordancia entre ambos y analizar su factibilidad para el cribado de pacientes con sospecha de COVID-19. Las imágenes y los resultados diagnóstico se enviaron a través de una plataforma de telemedicina.

Resultados.

Se realizó el cribado de 3 514 pacientes con sospecha diagnóstica de COVID-19, en 14 hospitales a nivel nacional. La mayoría de los pacientes tenían entre 27 y 59 años, seguidos por los mayores de 60 años. La edad promedio fue de 48,6 años; el 52,8% eran de sexo masculino. Los hallazgos más frecuentes fueron neumonía grave, neumonía bilateral con derrame pleural, enfisema pulmonar bilateral y opacidad difusa en vidrio esmerilado, entre otros. Se determinó un promedio de 93% de concordancia y 7% de discordancia entre las imágenes analizadas mediante IA y la RT-PCR. La sensibilidad y especificidad del sistema de IA, obtenidas comparando el resultado del cribado obtenido por IA con la RT-PCR, fueron de 93% y 80% respectivamente.

Conclusiones.

Es viable la utilización de IA sensible y específica para la detección rápida estratificada de COVID-19 en pacientes con afecciones respiratorias utilizando imágenes obtenidas mediante tomografía de tórax y una plataforma de telemedicina en los hospitales públicos de Paraguay.

Registro Nacional de Síndrome Coronario Agudo en Paraguay (RENASCA-PY)

Objetivo:

Determinar el tratamiento inicial y la mortalidad intrahospitalaria de pacientes con síndrome coronario agudo que acudieron a centros hospitalarios de referencia de Paraguay.

Método:

Estudio observacional y multicéntrico en pacientes mayores de 18 años con diagnóstico confirmado de síndrome coronario agudo.

Resultados:

Se incluyó a 780 pacientes desde mayo de 2015 hasta febrero de 2016; la edad media fue de 64.1 ± 12.3 años y el género masculino representó el 64.1%. La presentación clínica fue la de síndrome coronario agudo con elevación del ST en 40.1% y sin elevación del ST en 59.9%. En pacientes con elevación del ST se observó un alto porcentaje de consultas tardías, mayor de 12 h de evolución en 49.8%; en aquéllos con menos de 12 h de evolución se indicó la reperfusión en 52.2%, el 36.3% recibió fibrinolíticos y 15.9% intervención coronaria percutánea primaria. La mortalidad hospitalaria del síndrome coronario agudo fue de 10.3%, con elevación del segmento ST en 12.8% y sin elevación del segmento ST en 8.6%.

Conclusiones:

El tratamiento del síndrome coronario agudo en el Paraguay requiere un abordaje integral, que promueva consultas más tempranas y aumente la institución de tratamientos de reperfusión en la red de servicios de salud; el objetivo es mejorar los índices de respuesta terapéutica y disminuir la mortalidad hospitalaria.

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia

Background

The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known.

Objectives

This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia.

Methods

The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison.

Results

Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020.

Conclusions

The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

Rapid screening for COVID-19 by applying artificial intelligence to chest computed tomography images: A feasibility study

Aim:

The aim of the study was to present the results and impact of the application of artificial intelligence (AI) in the rapid diagnosis of COVID-19 by telemedicine in public health in Paraguay.

Methods:

This is a descriptive, multi-centered, observational design feasibility study based on an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties attending the country’s public hospitals. The patients’ digital CT images were transmitted to the AI diagnostic platform, and after a few minutes, radiologists and pneumologists specialized in COVID-19 downloaded the images for evaluation, confirmation of diagnosis, and comparison with the genetic diagnosis (reverse transcription polymerase chain reaction (RT-PCR)). It was also determined the percentage of agreement between two similar AI systems applied in parallel to study the viability of using it as an alternative method of screening patients with COVID-19 through telemedicine.

Results:

Between March and August 2020, 911 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of patients was 50.7 years, 62.6% were male and 37.4% female. Most of the diagnosed respiratory conditions corresponded to the age group of 27–59 years (252 studies), the second most frequent corresponded to the group over 60 years, and the third to the group of 19–26 years. The most frequent findings of the radiologists/pneumologists were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes, among others. Overall, an average of 86% agreement and 14% diagnostic discordance was determined between the two AI systems. The sensitivity of the AI system was 93% and the specificity 80% compared with RT-PCR.

Conclusion:

Paraguay has an AI-based telemedicine screening system for the rapid stratified detection of COVID-19 from chest CT images of patients with respiratory conditions. This application strengthens the integrated network of health services, rationalizing the use of specialized human resources, equipment, and inputs for laboratory diagnosis.

National electrocardiographic mapping by telemedicine for diagnosis and prevention of cardiological pathologies in Paraguay

Introduction:

Telemedicine tools offer multiple advantages to achieve an epidemiological screening of communities in rural settings countrywide. However, evidence on the cardiological pathology surveillance in these communities is limited. The feasibility of telemedicine as an electrocardiographic (EKG) mapping tool for the diagnosis and prevention of cardiological pathologies in Paraguay was investigated.

Methods:

A descriptive study was conducted in 60 telediagnostic centers countrywide in Paraguay to evaluate the feasibility of telemedicine as an EKG mapping tool for the diagnosis and prevention of cardiological pathologies over a period of 5 years from 2014 to 2018. The adherence rate was determined comparing yearly scheduled visits versus fulfilled visits at the telemedicine platform.

Results:

During the study, 246,217 remote EKG diagnoses were performed in 60 hospitals using telemedicine. The patients were 19.4% children/adolescents and 80.6% adults. The results of EKG tests in the children/adolescent group were 79.4% normal and 20.6% abnormal. The most frequent abnormal heart rhythms observed were sinusal bradicardia (10.6%), sinusal tachycardia (3.2%), and unspecified arrhythmia (2.8%). In the adult group, the results were 66.3% normal and 33.7% abnormal. The most frequent abnormal heart rhythms in this group were sinusal bradicardia (11.2%), blockade of the right branch (4.8%), and left ventricular hypertrophy (4.7%). The most frequent cardiovascular risk factors observed were the association of hypertension and obesity (40%), hypertension and diabetes (20%), and hypertension and dyslipidemia (19%). During the test period (2014–2018), the average rate of patient adherence to the prevention program was 2.26 for each 1000 diagnosis.

Conclusion:

These results demonstrate the feasibility of telemedicine as an EKG mapping tool for the diagnosis and prevention of cardiological pathologies in low-resource countries, thus enhancing cardiovascular disease surveillance and optimizing human and financial resources.

[Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay]

Objetivo.

Determinar la viabilidad y puesta en marcha de un sistema de telediagnóstico para dar asistencia sanitaria a poblaciones remotas y dispersas del Paraguay.

Métodos.

El estudio fue realizado en todos los hospitales regionales, generales y principales hospitales distritales de las 18 regiones sanitarias del Paraguay. En el sistema se registraron los datos clínicos y las imágenes tomográficas, ecográficas y trazados electrocardiográficos del paciente que precisaba de un diagnóstico por parte de un médico especialista. Esta información se transmitió a los especialistas en imagenología y en cardiología para su diagnóstico remoto y posterior envío del informe a los hospitales conectados al sistema. Se analizó el costo-beneficio e impacto de la herramienta de telediagnóstico desde la perspectiva del Sistema Nacional de Salud.

Resultados.

Entre enero de 2014 y mayo de 2015 se realizaron 34 096 telediagnósticos distribuidos en 25 hospitales a través del Sistema de Telemedicina del Ministerio de Salud. El costo unitario promedio del diagnóstico remoto fue de USD 2,6 (dólares estadounidenses) para electrocardiograma (ECG), tomografía y ecografía, mientras que el costo unitario para el diagnóstico “cara a cara” fue de UDS 11,8 para ECG; USD 68,6 para tomografía y USD 21,5 para ecografía. La reducción del costo mediante el diagnóstico remoto fue de 4,5 veces para ECG; 26,4 veces para tomografía y de 8,3 veces para ecografía. En términos monetarios, la implementación del sistema de telediagnóstico, durante los 16 meses del estudio, significó un ahorro promedio de USD 2 420 037.

Conclusión.

Paraguay cuenta con un sistema de telediagnóstico para electrocardiografía, tomografía y ecografía aplicando las tecnologías de la información y comunicación (TIC) de bajo costo, basadas en software libre y escalable a otros tipos de estudios diagnósticos a distancia; de interés para la salud pública. Con una aplicación práctica del telediagnóstico, se contribuyó al fortalecimiento de la red integrada de servicios y programas de salud, lo que permitió maximizar el tiempo del profesional y su productividad, mejorar la calidad, aumentar el acceso y la equidad, y disminuir los costos.