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Sawalha K, Fancher AJ, Al'Aref S, Lopez Candales A. No-Show Rates in a Cardiology Clinic During the COVID-19 Pandemic: A Retrospective Analysis From a Safety-Net Hospital. Cureus 2025; 17:e80897. [PMID: 40255849 PMCID: PMC12009133 DOI: 10.7759/cureus.80897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2025] [Indexed: 04/22/2025] Open
Abstract
BACKGROUND The COVID-19 pandemic proved to be a formidable crisis leading to massive disruptions in healthcare delivery that compromised routine access to care across the United States. The strain of the pandemic on the healthcare system limited routine outpatient visits and regular follow-up for all patients. Patients struggling with social determinants of health (SDOH) have long suffered from limited access to healthcare and the pandemic exacerbated this issue. Patients with chronic cardiac conditions need regular follow-up to ensure the highest quality of care and limited outpatient accessibility can be highly disruptive to their health. Thus, patients with chronic cardiac conditions who also struggle with SDOH were a population that was particularly vulnerable to the strain of the pandemic. METHODS A retrospective analysis was performed to assess the impact of the COVID-19 pandemic on the urban underserved patient population. Data were collected from the University Health System in Kansas City, MO, between 2019 and 2022. This safety-net hospital was selected because 66% of its patients are on Medicare, Medicaid, or uninsured, making its patient population a strong representation of the larger U.S. population struggling with SDOH. A report of in-person, outpatient cardiology visits scheduled during the specified timeframe was generated with demographic data and visit status. All visits scheduled that were completed or resulted in a no-show were included, with all other visits excluded. No-show rates were calculated overall and within each subgroup analyzed by dividing the number of no-shows by the total number of visits scheduled. No-show rates and percent change in no-show rates by year were analyzed for the whole population and stratified by gender, race, ethnicity, and insurance status. RESULTS No-show rates increased in 12 out of 17 (71.0%) patient subgroups including male patients, Black patients, non-Hispanic patients, patients in the "other" category of ethnicity, those on a Self-Pay Discount Program, Medicaid, and Medicaid MC Plus. These groups all had no-show rates suggesting that nearly or greater than a third of their patients were not receiving the cardiovascular care they needed by the end of the pandemic. The highest no-show rates in 2022 were observed in the following patient subgroups: Black 1,915 (35.08%), Self-Pay Discount 490 (39.3%), Medicaid 873 (36.2%), and Medicaid MC Plus 689 (32.9%). CONCLUSION The COVID-19 pandemic significantly increased no-show rates for outpatient cardiology visits, particularly among underserved populations, highlighting the vulnerability of low socioeconomic status patients. This disruption in routine care underscores the need for continued development of strategies to ensure consistent healthcare access during crises. University Health System employs many outreach and other programs to help those struggling with SDOH and yet the strain of the pandemic was still seen. Other studies have demonstrated that telehealth may serve as a bridge to addressing care gaps in the underserved population. Further research is required to assess the short and long-term health impacts of missed appointments and to continue developing solutions for improving healthcare access in patients struggling with SDOH.
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Affiliation(s)
- Khalid Sawalha
- Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Andrew J Fancher
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Subhi Al'Aref
- Cardiology, University of Arkansas for Medical Sciences, Little Rock, USA
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Ahmed R, Ahmed M, Khlidj Y, Rehman OU, Al-Mukhtar L, Abou Khater N, Khurram Mustaq Gardezi S, Rashid M, Collins P, Jain H, Ramphul K, Baig M, Chahal A, Kouranos V, Behary Paray N, Sharma R. Nationwide Cross-Sectional Analysis of Mortality Trends in Patients with Sarcoidosis and Non-Ischemic Cardiovascular Disease-The Impact of Gender, Ethnicity, Geographical Location, and COVID-19 Pandemic. J Clin Med 2024; 13:7463. [PMID: 39685921 PMCID: PMC11642065 DOI: 10.3390/jcm13237463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 12/01/2024] [Accepted: 12/03/2024] [Indexed: 12/13/2024] Open
Abstract
Background and Objectives: The epidemiological data regarding mortality rates of adults with sarcoidosis and non-ischemic cardiovascular disease (CVD) are limited. A retrospective observational analysis was conducted to identify trends and disparities related to sarcoidosis and non-ischemic cardiovascular disease mortality among the adult US population from 1999 to 2022. Methods: We used the Centers for Disease Control and Prevention (CDC) WONDER database to extract death certificate data for the adult US population (≥25 years). The age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and annual percent changes (APCs) were determined using Joinpoint. Results: Between 1999 and 2022, 23,642 deaths were identified related to non-ischemic CVD + sarcoidosis. The overall AAMR increased from 0.2 (95% CI, 0.2 to 0.3) in 1999 to 0.5 (95% CI, 0.5 to 0.6) in 2022. Females had a higher AAMR than males (0.6 vs. 0.5). Non-Hispanic (NH) blacks had the highest AAMR, followed by NH whites and Hispanic or Latinos. The southern region had the highest AAMR (0.7: 95% CI, 0.6-0.7), followed by the Midwest (0.6, 95% CI, 0.54-0.669), the Northeast (0.5, 95% CI, 0.5 to 0.6), and the West (0.4; 95% CI, 0.3-0.4). Urban and rural areas had comparable mortality rates (0.5 vs. 0.6). People aged 65+ had the highest AAMRs. Conclusions: The overall mortality rates for non-ischemic CVD and sarcoidosis have increased in the US from 1999 to 2022. Females and NH blacks had higher AAMRs, while a minimal variation was observed based on geographical regions. Early diagnosis and prompt management are the keys to reducing the mortality burden of non-ischemic CVD plus sarcoidosis.
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Affiliation(s)
- Raheel Ahmed
- Royal Brompton Hospital, Part of Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UK; (R.A.); (P.C.); (V.K.); (R.S.)
- National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
| | - Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi 46000, Pakistan;
| | - Yehya Khlidj
- Faculty of Medicine, University of Algiers 1, Algiers 16000, Algeria;
| | - Obaid Ur Rehman
- Services Institute of Medical Sciences, Lahore 54000, Pakistan;
| | - Laith Al-Mukhtar
- Department of Medicine, University Hospitals Plymouth, Plymouth PL6 8DH, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, UK;
| | - Noha Abou Khater
- Sheikh Shakhbout Medical City, Abu Dhabi P.O. Box 11001, United Arab Emirates; (N.A.K.); (S.K.M.G.)
| | | | - Muhammad Rashid
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK;
| | - Peter Collins
- Royal Brompton Hospital, Part of Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UK; (R.A.); (P.C.); (V.K.); (R.S.)
- National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
| | - Hritvik Jain
- All India Institute of Medical Sciences, Jodhpur 342000, India;
| | | | | | - Anwar Chahal
- Wellspan Clinic, York, PA 17403, USA;
- Mayo Clinic, Rochester, NY 13400, USA
| | - Vasilis Kouranos
- Royal Brompton Hospital, Part of Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UK; (R.A.); (P.C.); (V.K.); (R.S.)
- National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
| | | | - Rakesh Sharma
- Royal Brompton Hospital, Part of Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UK; (R.A.); (P.C.); (V.K.); (R.S.)
- National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
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Rath B, Doldi F, Willy K, Ellermann C, Köbe J, Güner F, Reinke F, Lange PS, Frommeyer G, Eckardt L. Ventricular arrhythmia burden in ICD patients during the second wave of the COVID-19 pandemic. Clin Res Cardiol 2024; 113:1463-1468. [PMID: 37902845 PMCID: PMC11420382 DOI: 10.1007/s00392-023-02320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
AIM COVID-19 has been associated with cardiovascular complications including ventricular arrhythmias (VA) and an increased number of out-of-hospital cardiac arrests. Nevertheless, several authors described a decrease of VA burden in patients with an implantable defibrillator (ICD) during the first wave of the COVID-19 pandemic. The objective of this study was to determine if these observations could be transferred to later periods of the pandemic as well. METHODS We retrospectively analyzed a total of 1674 patients with an ICD presenting in our outpatient clinic during the second wave of the COVID-19 pandemic and during a control period for the occurrence of VA requiring ICD interventions. RESULTS Seven hundred ninety-five patients with an ICD had a device interrogation in our ambulatory clinic during the second wave of the COVID-19 pandemic compared to eight hundred seventy-nine patients in the control period. There was significant higher amount of adequate ICD therapies in the course of the COVID-19 period. Thirty-six patients (4.5%) received in total eighty-five appropriate ICD interventions during COVID-19, whereas only sixteen patients (1.8%) had sustained VA in the control period (p = 0.01). CONCLUSION In contrast to the first wave of COVID-19, which was characterized by a decrease or least stable number of ICD therapies in several centers, we found a significant increase of VA in ICD patients during the second wave of COVID-19. Possible explanations for this observation include higher infectious rates, potential cardiac side effects of the vaccination as well as personal behavioral changes, or reduced utilization of medical services.
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Affiliation(s)
- Benjamin Rath
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Florian Doldi
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kevin Willy
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Fatih Güner
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Philipp Sebastian Lange
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Cullen MW, Damp JB, Soukoulis V, Keating FK, Abudayyeh I, Yang EH, Kondapaneni M, Polk DM, Rose-Jones LJ, Theriot P, Weissman G. Program Directors Survey on the Impact of the COVID-19 Pandemic on Cardiology Fellowship Training. JACC. ADVANCES 2024; 3:101008. [PMID: 39130007 PMCID: PMC11312764 DOI: 10.1016/j.jacadv.2024.101008] [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: 11/15/2023] [Revised: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 08/13/2024]
Abstract
Background The COVID-19 pandemic catalyzed unprecedented changes to medical education, including CV fellowship programs. CV fellowship PDs offer a unique perspective regarding the impact of the pandemic on CV medical education. Objectives The 4th annual Cardiovascular Diseases (CV) Fellowship Program Directors (PDs) Survey sought to understand the impact of the COVID-19 pandemic on CV fellows and fellowship programs. Methods The survey contained 31 items examining the clinical, educational, and academic impact of the COVID-19 pandemic on CV fellowship programs. Results Survey response rate was 54%. Most respondents (58%) represented university-based programs. Most PDs felt that changes to clinical practice during the COVID-19 negatively impacted fellow education in cardiac catheterization (66%), outpatient cardiology (52%), nuclear imaging (51%), and echocardiography (50%). Despite improving attendance, 75% of PDs felt that virtual educational conferences adversely impacted interaction between participants. Only 22% felt they improved fellow education. Most PDs (85%) reported a negative impact of the pandemic on fellow well-being and burnout, and 57% reported a decrease in research productivity among fellows. Even though virtual recruitment allowed programs to interview more competitive candidates, most PDs felt that virtual interviews adversely impacted interactions between their fellows and candidates (71%) and their ability to convey the culture of their program (60%). Conclusions Most CV fellowship PDs felt the COVID-19 pandemic brought changes that negatively impacted the clinical training, didactic learning, academic productivity, and well-being among cardiology fellows. The implications of these changes on the competency of cardiologists that trained during the COVID-19 pandemic deserve future study.
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Affiliation(s)
- Michael W. Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie B. Damp
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Victor Soukoulis
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Friederike K. Keating
- Division of Cardiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Islam Abudayyeh
- Department of Medicine, Charles Drew Univ. Loma Linda Veterans Healthcare, Loma Linda, California, USA
| | - Eric H. Yang
- Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Meera Kondapaneni
- Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Donna M. Polk
- Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
| | - Lisa J. Rose-Jones
- Division of Cardiovascular Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Paul Theriot
- American College of Cardiology, Washington, DC, USA
| | - Gaby Weissman
- Department of Cardiology, Medstar Heart and Vascular Institute and Georgetown University, Washington, DC, USA
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Musbat S, Reuveni I, Magnezi R. Improvements in mental health associated with increased electronic communication and deterioration in physical health in adults aged 50+ during the COVID-19 pandemic. Front Public Health 2024; 12:1369707. [PMID: 38975353 PMCID: PMC11224488 DOI: 10.3389/fpubh.2024.1369707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Background Previous studies have documented changes in physical health, mental health and social parameters during COVID-19. At the same time, there are no comprehensive analyses of these parameters designed as longitudinal studies on large-scale older populations before and during the pandemic. Objective This longitudinal study aims to provide a quantitative analysis of the COVID-19 impact on the physical, mental, and social parameters in adults aged 50 and older before, in the early stages, and during the COVID-19 pandemic. Methods The data for this study were collected from three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), a supranational longitudinal database: pre-COVID (October 2019-March 2020), early-COVID (June-September 2020), and during-COVID (June-August 2021). The sample included 31,526 individuals, compared across the three-time points through nonparametric group comparison tests. Results Physical health was subjectively rated as poorer in the during-COVID wave compared to the pre-COVID wave. Additionally, the number of illnesses or health conditions reported in the during-COVID wave was significantly higher than in the pre-COVID wave, with the biggest increases registered for cardiovascular diseases. The results also show that employment and overall social contact decreased while loneliness increased over time. Unexpectedly, mental health issues, such as sadness or depression and trouble sleeping, decreased significantly in the COVID waves compared to the pre-COVID wave. The analysis of two additional pre-COVID waves (2015, 2017) revealed that poorer pre-COVID mental health reflected in high values of sadness or depression and trouble sleeping was not an isolated peak but represented a typical baseline. The positive influence on the individuals' mental health during COVID-19 was found to be electronic communication, which showed higher values than face-to-face communication and lowered the odds of sadness or depression. Conclusion Future policies should thus consider the positive impact of electronic contacts on mental health to promote overall health in adults aged 50 and older.
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Affiliation(s)
- Shay Musbat
- Department of Management, Health Systems Management Program, Bar-Ilan University, Ramat Gan, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Racheli Magnezi
- Department of Management, Health Systems Management Program, Bar-Ilan University, Ramat Gan, Israel
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Brooman-White R, Blakeman T, McNab D, Deaton C. Informing understanding of coordination of care for patients with heart failure with preserved ejection fraction: a secondary qualitative analysis. BMJ Qual Saf 2024; 33:232-245. [PMID: 37802647 DOI: 10.1136/bmjqs-2023-016583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community. AIM To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England. METHODS We applied systems thinking methodology to examine the relationship between work-as-imagined and work-as-done for coordination of care for patients with HFpEF. We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie. RESULTS Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between work-as-imagined and work-as-done. Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs. CONCLUSIONS There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work.
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Affiliation(s)
- Rosalie Brooman-White
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Blakeman
- Centre for Primary Care, University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Duncan McNab
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Sritharan HP, Bhat A, Chia J, Allahwala UK, Bhindi R. Impact of the COVID-19 pandemic on provision of interventional cardiology and cardiac surgery services in Australia: a review of Medicare claims data. Intern Med J 2024; 54:382-387. [PMID: 38323485 DOI: 10.1111/imj.16342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted healthcare service provision worldwide. There is limited information on changes in invasive cardiovascular services during the pandemic, particularly in Australia. AIM We sought to assess temporal trends on the use of interventional cardiology and cardiac surgery services before and following the COVID-19 pandemic in Australia. METHODS Medicare Benefits Schedule items data from the Australian Government Services Australia on outpatient and private hospital interventional cardiology procedures (coronary angiogram, percutaneous coronary intervention and transcatheter aortic valve implantation) and cardiac surgery procedures (coronary artery bypass grafting [CABG] and surgical valve replacement, repair and annuloplasty) were analysed from March 2019 to 2021. This was superimposed on monthly COVID-19 case data obtained from the Australian Department of Health and Aged Care epidemiology reports. RESULTS A sustained reduction in CABG (-10.1%) and surgical valve intervention (-11.1%) was appreciated from March 2019-2020 to March 2020-2021, in the first year of the COVID-19 pandemic. During this period, an overall increase (+25.9%) in the use of transcatheter aortic valve implantation was observed. Following the initial period of mandated isolation in March-April 2020, a reduction in coronary angiography (-29.1%) and percutaneous coronary intervention (-19.5%) was observed in comparison to March-April 2019; however, this was largely attenuated over time. CONCLUSIONS The COVID-19 pandemic has resulted in reductions in the use of interventional cardiology and cardiac surgery services, with cardiac surgery most affected. However, an increase in uptake of transcatheter aortic valve implantation has been observed during the pandemic. This may have implications for future planning and resource allocation in the aftermath of the pandemic.
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Affiliation(s)
- Hari P Sritharan
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Aditya Bhat
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Justin Chia
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Stadnik-Zawalska K, Tomys-Składowska J, Zawalski P, Buczkowski K, Migdalski A. The impact of the first and the second wave of the COVID-19 pandemic on vascular surgery practice in the leading regional center: a comparative, retrospective study. Eur J Med Res 2024; 29:127. [PMID: 38365805 PMCID: PMC10870438 DOI: 10.1186/s40001-024-01720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/08/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND We conducted an analysis of the vascular surgery regional center reorganization in response to the first and the second wave of the coronavirus disease-2019 (COVID-19) pandemic to see what lessons we learned from the first wave. METHODS The study included a total of 632 patients admitted to the vascular surgery department in three periods: March-May 2020, October-December 2020, and October-December 2019 as a control period. RESULTS In the pandemic periods the number of admitted patients decreased in relation to the control period. There was a reduction in performed procedures. We observed an increase in the ratio of less invasive procedures. There was a significant decline in hospitalization time in comparison to the control period. CONCLUSIONS The reduction of scheduled admissions and procedures affected vascular centers all over the world. Minimally invasive procedures were more willingly performed to shorten the hospitalization time and reduce the patient's exposure to hospital infection. It allowed us to treat more patients during the second wave. Nevertheless, an increased number of vascular patients should be expected in the future, which will result from the failure to perform elective procedures during the pandemic.
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Affiliation(s)
- Katarzyna Stadnik-Zawalska
- Department of Vascular Surgery and Angiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 85-094, Bydgoszcz, Poland
| | | | - Patryk Zawalski
- Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-168, Bydgoszcz, Poland
| | - Krzysztof Buczkowski
- Department of Family Medicine, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 85-094, Bydgoszcz, Poland
| | - Arkadiusz Migdalski
- Department of Vascular Surgery and Angiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 85-094, Bydgoszcz, Poland.
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Birrell H, Isles C, Fersia O, Anwar M, Mondoa C, McFadyen A. Assessment of the diagnostic value of NT-proBNP in heart failure with preserved ejection fraction. THE BRITISH JOURNAL OF CARDIOLOGY 2024; 31:002. [PMID: 39323949 PMCID: PMC11421065 DOI: 10.5837/bjc.2024.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a common concern in the medical field due to its prevalence in an ageing western population. HFpEF is associated with significant morbidity and mortality not dissimilar to heart failure (HF) with reduced ejection fraction. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and echocardiography are the guideline diagnostic indicators of HF and their use is being examined in this study, with the aim to consider NT-proBNP thresholds performance as a rule-out test. The current National Institute for Health and Care Excellence (NICE) and European guidelines recommend a single NT-proBNP threshold of >400 ng/L and >125 ng/L, respectively, to trigger echocardiographic assessment of HF in the outpatient setting. NT-proBNP levels are known to increase with age and worsening renal function. Unsurprisingly, a single threshold significantly increases demand for echocardiography. NT-proBNP measurements and echocardiograms performed within six months of each other were included for 469 patients with suspected HF. A significant relationship between NT-proBNP levels and diastolic dysfunction was established. NT-proBNP levels and age are significant predictors of diastolic dysfunction in uni-variant (odds ratio 1.251, 95% confidence interval [CI], p<0.001) and multi-variant analysis (odds ratio 1.174, 95%CI, p=0.002). High negative-predictive values (NPVs) were obtained in severe diastolic impairment with the NPV being 95% at the European NT-proBNP cut-off of 125 ng/L, 95% at the NICE cut-off of 400 ng/L, 93% at 1,000 ng/L and 92% at 2,000 ng/L. There is a significant association between NT-proBNP and diastolic dysfunction. NT-proBNP and age can predict diastolic dysfunction, and age can predict NT-proBNP levels, thus, these variables should be considered when considering referral for an echocardiogram. Most importantly, at higher NT-proBNP cut-offs the NPVs remain above 90% suggesting that different thresholds for subpopulations could yield a more effective strategy and mitigate the increased demand for echocardiography.
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Affiliation(s)
| | - Christopher Isles
- Consultant Physician Cardiology Department, Dumfries and Galloway Royal Infirmary, A75 Cargenbridge, Dumfries, DG2 8RX
| | | | | | - Catherine Mondoa
- Consultant Cardiology Nurse Cardiology Department, Forth Valley Royal Hospital, Stirling Road, Larbert, FK5 4WR
| | - Angus McFadyen
- Independent Statistics Consultant akm-stats, 16 Ingram Street, Glasgow, G1 1HA
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Abuelgasim E, Adam S, Ahluwalia A, Evbayekha E. Cardiology service and COVID-19: the international impact. COVID-19’S CONSEQUENCES ON THE CARDIOVASCULAR SYSTEM 2024:135-144. [DOI: 10.1016/b978-0-443-19091-9.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Bouchard K, Lalande K, Coutinho T, Mulvagh S, Pacheco C, Liu S, Saw J, So D, Reed JL, Chiarelli A, Stragapede E, Robert H, Lappa N, Sun L, Wells G, Tulloch H. Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient-Informed Investigation. J Am Heart Assoc 2023; 12:e032141. [PMID: 38084731 PMCID: PMC10863752 DOI: 10.1161/jaha.123.032141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient-informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities. METHODS AND RESULTS Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient-piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self-management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short- and longer-term follow-up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate. CONCLUSIONS This early-stage, pretrial research has important implications for the acute and long-term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient-oriented research.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Thais Coutinho
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Sharon Mulvagh
- Division of CardiologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Christine Pacheco
- Department of CardiologyUniversity of Montréal Hospital CentreMontréalQuebecCanada
| | - Shuangbo Liu
- Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Jacqueline Saw
- Division of CardiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Derek So
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Jennifer L. Reed
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Elisa Stragapede
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Helen Robert
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Nadia Lappa
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Louise Sun
- Stanford MedicineStanford UniversityStanfordCAUSA
| | - George Wells
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Heather Tulloch
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
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12
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Brewer LC, Abraham H, Clark D, Echols M, Hall M, Hodgman K, Kaihoi B, Kopecky S, Krogman A, Leth S, Malik S, Marsteller J, Mathews L, Scales R, Schulte P, Shultz A, Taylor B, Thomas R, Wong N, Olson T. Efficacy and Adherence Rates of a Novel Community-Informed Virtual World-Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial. J Am Heart Assoc 2023; 12:e030883. [PMID: 38014699 PMCID: PMC10727355 DOI: 10.1161/jaha.123.030883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology-based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center-based CR. This study aims to evaluate efficacy and adherence of the virtual world-based CR program compared with center-based CR within a community-informed, implementation science framework. METHODS Using a noninferiority, hybrid type 1 effectiveness-implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12-week Destination Cardiac Rehab or the center-based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board-approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. CONCLUSIONS The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05897710.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
- Center for Health Equity and Community Engagement ResearchMayo ClinicRochesterMN
| | - Helayna Abraham
- Department of Internal MedicineMayo Clinic College of MedicineRochesterMN
| | - Donald Clark
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Melvin Echols
- Department of Cardiovascular MedicineMorehouse School of MedicineAtlantaGA
| | - Michael Hall
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Karen Hodgman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Brian Kaihoi
- Global Products and ServicesMayo Clinic Center for InnovationRochesterMN
| | - Stephen Kopecky
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Ashton Krogman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shawn Leth
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shaista Malik
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Jill Marsteller
- Center for Health Services and Outcomes ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Lena Mathews
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Robert Scales
- Department of Cardiovascular MedicineMayo Clinic College of MedicinePhoenixAZ
| | - Phillip Schulte
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Adam Shultz
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Bryan Taylor
- Department of Cardiovascular MedicineMayo Clinic College of MedicineJacksonvilleFL
| | - Randal Thomas
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Nathan Wong
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Thomas Olson
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
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13
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Cosentino F, Verma S, Ambery P, Treppendahl MB, van Eickels M, Anker SD, Cecchini M, Fioretto P, Groop PH, Hess D, Khunti K, Lam CSP, Richard-Lordereau I, Lund LH, McGreavy P, Newsome PN, Sattar N, Solomon S, Weidinger F, Zannad F, Zeiher A. Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2023; 44:4141-4156. [PMID: 37448181 DOI: 10.1093/eurheartj/ehad445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.
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Affiliation(s)
- Francesco Cosentino
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Philip Ambery
- Late-stage Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Diabetes, Monash University, Melbourne, Australia
| | - David Hess
- Department of Physiology and Pharmacology, University of Western Ontario, Robarts Research Institute, London, ON, Canada
- Department of Pharmacology, University of Toronto, Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | | | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Philip N Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott Solomon
- Harvard Medical School, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France
| | - Andreas Zeiher
- Cardio Pulmonary Institute, Goethe University of Frankfurt, Frankfurt, Germany
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14
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Meloni A, Pistoia L, Lupi A, Righi R, Vallone A, Missere M, Renne S, Fina P, Riva A, Gamberini MR, Cecinati V, Sorrentino F, Rosso R, Messina G, Ricchi P, Positano V, Mavrogeni S, Quaia E, Cademartiri F, Pepe A. Impact of the COVID-19 Pandemic on Iron Overload Assessment by MRI in Patients with Hemoglobinopathies: The E-MIOT Network Experience. Tomography 2023; 9:1711-1722. [PMID: 37736989 PMCID: PMC10514849 DOI: 10.3390/tomography9050136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The E-MIOT (Extension-Myocardial Iron Overload in Thalassemia) project is an Italian Network assuring high-quality quantification of tissue iron overload by magnetic resonance imaging (MRI). We evaluated the impact of the COVID-19 pandemic on E-MIOT services. METHODS The activity of the E-MIOT Network MRI centers in the year 2020 was compared with that of 2019. A survey evaluated whether the availability of MRI slots for patients with hemoglobinopathies was reduced and why. RESULTS The total number of MRI scans was 656 in 2019 and 350 in 2020, with an overall decline of 46.4% (first MRI: 71.7%, follow-up MRI: 36.9%), a marked decline (86.9%) in the period March-June 2020, and a reduction in the gap between the two years in the period July-September. A new drop (41.4%) was recorded in the period October-December for two centers, due to the general reduction in the total amount of MRIs/day for sanitization procedures. In some centers, patients refused MRI scans for fear of getting COVID. Drops in the MRI services >80% were found for patients coming from a region without an active MRI site. CONCLUSIONS The COVID-19 pandemic had a strong negative impact on MRI multi-organ iron quantification, with a worsening in the management of patients with hemoglobinopathies.
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Affiliation(s)
- Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.); (F.C.)
- Unità Operativa Complessa Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.); (F.C.)
| | - Amalia Lupi
- Istituto di Radiologia, Dipartimento di Medicina, Università di Padova, 35128 Padova, Italy; (A.L.); (E.Q.)
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, 44023 Lagosanto, Italy;
| | - Antonino Vallone
- Reparto di Radiologia, Azienda Ospedaliera “Garibaldi” Presidio Ospedaliero Nesima, 95126 Catania, Italy;
| | - Massimiliano Missere
- Unità Operativa Complessa Radiodiagnostica, Gemelli Molise SpA, Fondazione di Ricerca e Cura “Giovanni Paolo II”, 86100 Campobasso, Italy;
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia, Presidio Ospedaliero “Giovanni Paolo II”, 88046 Lamezia Terme, Italy;
| | - Priscilla Fina
- Unità Operativa Complessa Diagnostica per Immagini, Ospedale “Sandro Pertini”, 00157 Roma, Italy;
| | - Ada Riva
- Struttura Complessa di Radiologia, Ospedale “SS. Annunziata” ASL Taranto, 74121 Taranto, Italy;
| | - Maria Rita Gamberini
- Unità Operativa di Day Hospital della Talassemia e delle Emoglobinopatie, Dipartimento della Riproduzione e dell’Accrescimento, Azienda Ospedaliero-Universitaria “S. Anna”, 44124 Cona, Italy;
| | - Valerio Cecinati
- Struttura Semplice di Microcitemia, Ospedale “SS. Annunziata” ASL Taranto, 74100 Taranto, Italy;
| | - Francesco Sorrentino
- Unità Operativa Semplice Dipartimentale Day Hospital Talassemici, Ospedale “Sant’Eugenio”, 00143 Roma, Italy;
| | - Rosamaria Rosso
- Unità Operativa Talassemie ed Emoglobinopatie, Azienda Ospedaliero-Universitaria Policlinico “Vittorio Emanuele”, 95100 Catania, Italy;
| | - Giuseppe Messina
- Centro Microcitemie, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89100 Reggio Calabria, Italy;
| | - Paolo Ricchi
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, 80131 Napoli, Italy;
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.); (F.C.)
- Unità Operativa Complessa Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | | | - Emilio Quaia
- Istituto di Radiologia, Dipartimento di Medicina, Università di Padova, 35128 Padova, Italy; (A.L.); (E.Q.)
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.); (F.C.)
| | - Alessia Pepe
- Istituto di Radiologia, Dipartimento di Medicina, Università di Padova, 35128 Padova, Italy; (A.L.); (E.Q.)
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15
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Ingram S, Offiah G. Implementation and Outcomes of an Advanced Nurse Practitioner Telephone Chest Pain Clinic Developed in Response to the COVID-19 Pandemic. J Nurse Pract 2023; 19:104599. [PMID: 37065708 PMCID: PMC10089617 DOI: 10.1016/j.nurpra.2023.104599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Introduction During the COVID-19 pandemic, a virtual telephone advanced nurse practitioner (ANP) led chest pain clinic was set up because face-to-face clinic visits had ceased. Methods This retrospective cohort analysis compared the ANP virtual chest pain clinic to the face-to-face nurse specialist-led clinic. Results Autonomous nursing management was significantly higher in the virtual clinic, and significantly fewer patients were referred for functional testing. Coronary arterial disease (CAD) diagnosis did not differ. Conclusion ANP autonomy and experience enabled continued chest pain assessment and CAD diagnosis via a virtual telephone clinic.
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16
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Chih S, Clarke BA, Albert M, Buchan CA, Kafil TS, Kim DH, Kumar D, Smith SJ, Solera Rallo JT, Stubbs MJ, McDonald MA. The COVID-19 Pandemic and Adult Cardiac Transplantation: Impact, Interventions, and Implications. Can J Cardiol 2023; 39:853-864. [PMID: 36965667 PMCID: PMC10035809 DOI: 10.1016/j.cjca.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023] Open
Abstract
In this review, we provide a comprehensive overview of the impact of the COVID-19 pandemic on adult heart transplantation. We highlight the decline in the number of adult transplantations performed throughout the pandemic as a consequence of restrictions imposed on individual programs and hospitals. There were challenges to maintaining cardiac transplant activity at multiple levels, including organ donation in intensive care units, logistical difficulties with organ procurement, and rapidly changing resource considerations at health system and jurisdictional levels. We also review the impact of COVID-19 on cardiac transplant recipients. Despite the high rates of morbidity and mortality observed during the initial phases of the pandemic among heart transplant patients infected with COVID-19, the availability of effective vaccines, pre-exposure prophylaxis, and specific antiviral therapies have drastically improved outcomes over time. Vaccines have proven to be safe and effective in reducing infections and illness severity, but specific considerations in the immunocompromised solid organ transplant population apply, including the need for additional booster doses to achieve sufficient immunisation. We further outline the strong rationale for vaccination before transplantation wherever possible. Finally, the COVID-19 response created a number of barriers to safe and efficient post-transplantation care. Given the need for frequent evaluation and monitoring, especially in the first several months after cardiac transplantation, the pandemic provided the impetus to improve virtual care delivery and explore noninvasive rejection surveillance through gene expression profiling. We hope that lessons learned will allow us to prepare and pivot effectively during future pandemics and health care emergencies.
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Affiliation(s)
- Sharon Chih
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Brian A Clarke
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Albert
- Department of Medicine and Critical Care, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; CIUSSS-NIM Research Centre, Department of Surgery, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Canada, Ottawa, Ontario, Canada
| | - Tahir S Kafil
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel H Kim
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Canada
| | - Deepali Kumar
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stuart J Smith
- Division of Cardiology, London Health Sciences Centre, Western University, London, Canada
| | - Javier Tomas Solera Rallo
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Stubbs
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael A McDonald
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada.
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17
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Shields GE, Rowlandson A, Dalal G, Nickerson S, Cranmer H, Capobianco L, Doherty P. Cost-effectiveness of home-based cardiac rehabilitation: a systematic review. Heart 2023; 109:913-920. [PMID: 36849233 DOI: 10.1136/heartjnl-2021-320459] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE Centre-based cardiac rehabilitation (CR) is recognised as cost-effective for individuals following a cardiac event. However, home-based alternatives are becoming increasingly popular, especially since COVID-19, which necessitated alternative modes of care delivery. This review aimed to assess whether home-based CR interventions are cost-effective (vs centre-based CR). METHODS Using the MEDLINE, Embase and PsycINFO databases, literature searches were conducted in October 2021 to identify full economic evaluations (synthesising costs and effects). Studies were included if they focused on home-based elements of a CR programme or full home-based programmes. Data extraction and critical appraisal were completed using the NHS EED handbook, Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists and were summarised narratively. The protocol was registered on the PROSPERO database (CRD42021286252). RESULTS Nine studies were included in the review. Interventions were heterogeneous in terms of delivery, components of care and duration. Most studies were economic evaluations within clinical trials (8/9). All studies reported quality-adjusted life years, with the EQ-5D as the most common measure of health status (6/9 studies). Most studies (7/9 studies) concluded that home-based CR (added to or replacing centre-based CR) was cost-effective compared with centre-based options. CONCLUSIONS Evidence suggests that home-based CR options are cost-effective. The limited size of the evidence base and heterogeneity in methods limits external validity. There were further limitations to the evidence base (eg, limited sample sizes) that increase uncertainty. Future research is needed to cover a greater range of home-based designs, including home-based options for psychological care, with greater sample sizes and the potential to acknowledge patient heterogeneity.
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Affiliation(s)
- Gemma E Shields
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Aleix Rowlandson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Garima Dalal
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Stuart Nickerson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Lora Capobianco
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, The University of Manchester, Manchester, UK
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18
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Curtis HJ, MacKenna B, Wiedemann M, Fisher L, Croker R, Morton CE, Inglesby P, Walker AJ, Morley J, Mehrkar A, Bacon SC, Hickman G, Evans D, Ward T, Davy S, Hulme WJ, Macdonald O, Conibere R, Lewis T, Myers M, Wanninayake S, Collison K, Drury C, Samuel M, Sood H, Cipriani A, Fazel S, Sharma M, Baqir W, Bates C, Parry J, Goldacre B. OpenSAFELY NHS Service Restoration Observatory 2: changes in primary care clinical activity in England during the COVID-19 pandemic. Br J Gen Pract 2023; 73:e318-e331. [PMID: 37068964 PMCID: PMC10131234 DOI: 10.3399/bjgp.2022.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. AIM To describe changes in the volume and variation of coded clinical activity in general practice across six clinical areas: cardiovascular disease, diabetes, mental health, female and reproductive health, screening and related procedures, and processes related to medication. DESIGN AND SETTING With the approval of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY. METHOD Common primary care activities were analysed using Clinical Terms Version 3 codes and keyword searches from January 2019 to December 2020, presenting median and deciles of code usage across practices per month. RESULTS Substantial and widespread changes in clinical activity in primary care were identified since the onset of the COVID-19 pandemic, with generally good recovery by December 2020. A few exceptions showed poor recovery and warrant further investigation, such as mental health (for example, for 'Depression interim review' the median occurrences across practices in December 2020 was down by 41.6% compared with December 2019). CONCLUSION Granular NHS general practice data at population-scale can be used to monitor disruptions to healthcare services and guide the development of mitigation strategies. The authors are now developing real-time monitoring dashboards for the key measures identified in this study, as well as further studies using primary care data to monitor and mitigate the indirect health impacts of COVID-19 on the NHS.
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Affiliation(s)
- Helen J Curtis
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Brian MacKenna
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Milan Wiedemann
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Louis Fisher
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Richard Croker
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Caroline E Morton
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Peter Inglesby
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Alex J Walker
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Jessica Morley
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Amir Mehrkar
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Sebastian Cj Bacon
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - George Hickman
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - David Evans
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Tom Ward
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Simon Davy
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - William J Hulme
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Orla Macdonald
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | | | - Tom Lewis
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple
| | - Martin Myers
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | | | | | - Charles Drury
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester
| | - Miriam Samuel
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Harpreet Sood
- University College London Hospitals NHS Foundation Trust, London
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford
| | - Manuj Sharma
- Department of Primary Care and Population Health, University College London, London
| | | | | | | | - Ben Goldacre
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
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19
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Archontakis S, Oikonomou E, Sideris K, Laina A, Tirovola D, Paraskevopoulou D, Kostakis P, Doundoulakis I, Arsenos P, Ntalakouras I, Charitakis E, Gatzoulis K, Tsioufis K, Sideris S. Safety of same-day discharge versus overnight stay strategy following cardiac device implantations: a high-volume single-centre experience. J Interv Card Electrophysiol 2023; 66:471-481. [PMID: 36063282 PMCID: PMC9442569 DOI: 10.1007/s10840-022-01319-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The strategy of cardiac implantable electronic device (CIED) implantations performed as day-case admissions has gained a wider acceptance overtime; however, data on safety are still limited. This study aims to investigate the safety of a same-day discharge protocol introduced in our hospital for the postprocedural management of patients undergoing CIED implantation. METHODS Α prospective, non-interventional, non-randomised study performed in a single high-volume implanting centre for a 16-month period (March 2020 to June 2021). At total of 821 of 965 (85.1%) patients scheduled for elective CIED implantation were considered to be eligible for inclusion in the Short-stay Device Management Protocol. These patients were compared with a historical group of 932 patients, meeting the same inclusion criteria. RESULTS Procedure was successful in 812 patients (98.9%), committed to same-day discharge versus 921 of 932 patients (98.8%) admitted for overnight stay (p = 0.87). Overall, 90-day complication rate was comparable in both groups (4.14% vs 4.07%, p = 0.95), as was major (1.46% vs. 1.82%, p = 0.55) and minor (2.67% vs. 2.25%, p = 0.64) complication rates. The composite early post-procedural complication rates and late post-procedural complication rates were comparable among groups (0.97 vs 1.18%, p = 0.70 and 0.73% vs 0.64%, p = 0.83, respectively). Six hundred sixty-seven patients (84%) preferred the same-day discharge strategy. Finally, a reduction of 792 bed-days was recorded, resulting in possible financial Health System benefits. CONCLUSIONS Same-day discharge is feasible and safe in the majority of patients referred for CIED implantation. Additionally, same-day discharge is preferred by patients and may reduce procedure-related costs due to significant bed-day reductions.
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Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Evangelos Oikonomou
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ageliki Laina
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Tirovola
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Paraskevopoulou
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Panagiotis Kostakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Petros Arsenos
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Ntalakouras
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Emmanouil Charitakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece.
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20
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Gedik TE, Unal D, Suzan V, Bag Soytas R, Arman P, Bektan Kanat B, Ulugerger Avci G, Suna Erdincler D, Doventas A, Yavuzer H. The impact of COVID-19 pandemic on the geriatric inpatient unit. Curr Med Res Opin 2023; 39:259-265. [PMID: 36398760 DOI: 10.1080/03007995.2022.2148460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to determine the effects of the pandemic on the inpatients in the geriatric unit by comparing the demographic and clinical characteristics, reasons for hospitalization, morbidity, and mortality of the patients before and during the pandemic. METHODS The population of this retrospective, cross-sectional study consisted of inpatients in the geriatric unit for two years (11 March 2019-10 March 2021). The patients were separated into two groups according to the hospitalization time as pre-COVID-19 and COVID-19 period. Hospitalization types, reasons for hospitalization, length of stay, demographic data, chronic diseases, drugs, developed morbidities, discharge, and 1-year mortality status of the patients were recorded. RESULTS Three hundred and fifty patients were included in our study. The mean age was 80.4 ± 8.02. It was observed that the number of hospitalized patients decreased by ∼50% in the COVID-19 period. However, there was a significant decrease in hospitalization due to the control of chronic diseases during the COVID-19 period (p = .008). The number of inpatients from the emergency department was found to be higher during the COVID-19 period (p < .001). Regarding the presence of geriatric syndromes, polypharmacy (p = .011) and delirium (p = .035) were found to be significantly less in the pre-COVID-19 period. The percentage of malnutrition was also detected as lower, but it was not statistically significant. In terms of 1-year mortality, although not statistically significant, the all-cause mortality rate was higher during the COVID-19 period (p = .08). CONCLUSIONS Pandemic has greatly affected the geriatric unit. The prognosis of the patients has worsened and mortality rates have increased. Physiological and psychological deterioration caused by quarantine measures, worsening chronic diseases, and immunosenescence affected the prognosis of geriatric patients. This adds to the previous literature by proving the fact that older individuals are the most vulnerable group in the pandemic.
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Affiliation(s)
- Tugce Emiroglu Gedik
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Damla Unal
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Veysel Suzan
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rabia Bag Soytas
- Department of Geriatrics, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Pınar Arman
- Deparment of Geriatrics, Kutahya Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Bahar Bektan Kanat
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulru Ulugerger Avci
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Suna Erdincler
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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21
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Mgbemena O, Becoats K, Tfirn I, Sadic E, Rathore A, Antoine S, Velarde G. Improving Access to Cardiovascular Care Through Telehealth: A Single-Center Experience. Cardiol Res 2023; 14:63-68. [PMID: 36896220 PMCID: PMC9990546 DOI: 10.14740/cr1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/11/2023] [Indexed: 02/27/2023] Open
Abstract
Background Historically, access to healthcare has been a serious shortcoming of our healthcare system. Approximately 14.5% of US adults lack readily available access to health care and this has been worsened by the coronavirus disease 2019 (COVID-19) pandemic. There are limited data on the use of telehealth in cardiology. We share our single-center experience in improving access to care via telehealth at the University of Florida, Jacksonville cardiology fellows' clinic. Methods Demographic and social variables were collected 6 months before and 6 months after the initiation of telehealth services. The effect of telehealth was determined via Chi-square and multiple logistic regression while controlling for demographic covariates. Results We analyzed 3,316 cardiac clinic appointments over 1 year. Of these, 1,569 and 1,747 were before and after the start of telehealth, respectively. Fifteen percent (272 clinical encounters) out of the 1,747 clinic visits during the post-telehealth era were through telehealth, completed via audio or video consultation. Overall, there was a 7.2 % increase in attendance after the implementation of telehealth (P value < 0.001). Patients who attended their scheduled follow-up had significantly greater odds of being in the post-telehealth group while controlling for marital status and insurance type (odds ratio (OR): 1.31, 95% confidence interval (CI): 1.07 - 1.62). Patients who attended had higher odds of having City-Contract insurance - an institution-specific indigenous care plan (OR: 3.51, 95% CI: 1.79 - 6.87) compared to private insurance. Patients who attended also had higher odds of being previously married (OR: 1.34, 95% CI: 1.05 - 1.70) or married/dating (OR: 1.39, 95% CI: 1.05 - 1.82) compared to patients who were single. Surprisingly, telehealth did not lead to an increase in the use of Mychart, our electronic patient portal (P value = 0.55). Conclusions Telehealth enhanced patients' access to care by improving appointment show-rate in a cardiology fellows' clinic during the COVID-19 pandemic. Telehealth as a resource adjunct to traditional care in cardiology fellows' clinic should be further explored.
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Affiliation(s)
- Okechukwu Mgbemena
- Department of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Kyeesha Becoats
- Department of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ian Tfirn
- Center for Data Solutions, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Edin Sadic
- Department of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Azeem Rathore
- Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Steve Antoine
- Department of Cardiology, University of Florida, Gainesville, FL, USA
| | - Gladys Velarde
- Department of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
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22
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Makkar K, Sharma YP, Batta A, Hatwal J, Panda PK. Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome. World J Cardiol 2023; 15:13-22. [PMID: 36714367 PMCID: PMC9850671 DOI: 10.4330/wjc.v15.i1.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies. AIM To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS). METHODS In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded. RESULTS Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006). CONCLUSION Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
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Affiliation(s)
- Kunaal Makkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Prashant Kumar Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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23
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Brewer LC, Abraham H, Kaihoi B, Leth S, Egginton J, Slusser J, Scott C, Penheiter S, Albertie M, Squires R, Thomas R, Scales R, Trejo-Gutierrez J, Kopecky S. A Community-Informed Virtual World-Based Cardiac Rehabilitation Program as an Extension of Center-Based Cardiac Rehabilitation: MIXED-METHODS ANALYSIS OF A MULTICENTER PILOT STUDY. J Cardiopulm Rehabil Prev 2023; 43:22-30. [PMID: 35881503 PMCID: PMC10340723 DOI: 10.1097/hcr.0000000000000705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Innovative methods for delivering cardiac rehabilitation (CR) that provide strategies to circumvent the mounting barriers to traditional CR have the potential to widen access to a well-established secondary prevention strategy. Our study assesses the feasibility and acceptability of a novel virtual world-based CR (VWCR) program, Destination Rehab , as an extension of a conventional center-based CR program. METHODS Adult cardiac patients hospitalized at Mayo Clinic hospitals with a diagnosis for CR and ≥1 modifiable, lifestyle risk factor target-sedentary lifestyle (<3 hr physical activity/wk), unhealthy diet (<5 servings fruits and vegetables/d), or current smoking (>1 yr)-were recruited. Patients participated in an 8-wk health education program using a virtual world (VW) platform from a prior proof-of-concept study and a post-intervention focus group. Primary outcome measures included feasibility and acceptability. Secondary outcome measures included changes from baseline to post-intervention in cardiovascular (CV) health behaviors and biometrics, CV health knowledge, and psychosocial factors. RESULTS Of the 30 enrolled patients (age 59.1 ± 9.7 yr; 50% women), 93% attended ≥1 session and 71% attended ≥75% of sessions. The overall VWCR experience received an 8 rating (scale 0-10) and had high acceptability. Clinically relevant trends were noted in CV health behaviors and biometrics, although not statistically significant. CONCLUSIONS The VWCR program is a feasible, highly acceptable, and innovative platform to potentially influence health behaviors and CV risk and may increase accessibility to disadvantaged populations with higher CV disease burdens.
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Affiliation(s)
- LaPrincess C Brewer
- Departments of Cardiovascular Medicine (Drs Brewer, Squires, Thomas, and Kopecky and Ms Leth) and Internal Medicine (Dr Abraham), Mayo Clinic College of Medicine, Rochester, Minnesota; Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Drs Brewer, and Penheiter); Global Products and Services, Mayo Clinic Center for Innovation, Rochester, Minnesota (Mr Kaihoi); Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, Minnesota (Mr Egginton); Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota (Messrs Slusser and Scott); Center for Health Equity and Community Engagement Research, Mayo Clinic, Jacksonville, Florida (Ms Albertie); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona (Dr Scales); and Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida (Dr Trejo-Gutierrez)
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24
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Denton F, Waddell A, Kite C, Hesketh K, Atkinson L, Cocks M, Jones H, Randeva H, Davenport N, Powell R, Clark C, Kyrou I, Harwood AE, McGregor G. Remote maintenance cardiac rehabilitation (MAINTAIN): A protocol for a randomised feasibility study. Digit Health 2023; 9:20552076231152176. [PMID: 36818155 PMCID: PMC9936404 DOI: 10.1177/20552076231152176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023] Open
Abstract
Background Long-term adherence to exercise is often poor for people with coronary heart disease (CHD) who have completed supervised, centre-based cardiac rehabilitation. The aim of this study is to assess the feasibility of a remotely prescribed, delivered and monitored cardiac rehabilitation intervention using a wearable device to support long-term adherence to exercise and physical activity during maintenance of cardiac rehabilitation. Methods After completing cardiac rehabilitation, 30 participants with CHD, will be randomised (1:1) to an intervention (n = 15) or a usual care group (n = 15) in a 12-month feasibility randomised controlled trial (RCT). The intervention will comprise of an exercise consultation, personalised exercise prescription delivered via a wearable activity monitor using biometric feedback, regular monitoring via check-ins, and feedback text-messages for 6-months. Participants will be assessed at baseline (following completion of cardiac rehabilitation) and at three-, six-, and 12-months post-randomisation. The primary outcome will be feasibility, including assessment of eligibility, recruitment, adherence, and acceptability. Secondary outcomes will include exercise capacity, physical activity behaviours, cardiovascular disease risk and quality of life. Semi-structured interviews will be conducted at three-, six-, and 12-months post-randomisation (and with those who drop-out) to explore the acceptability of the study intervention and procedures. A questionnaire will be offered to those who decline participation. Discussion The MAINTAIN study will evaluate the feasibility of conducting a future definitive multi-centre RCT testing a remotely prescribed and monitored long-term mHealth maintenance exercise programme, versus usual care, for people with CHD who have completed cardiac rehabilitation. Trial registration number ClinicalTrials.gov, NCT05292287. Registered on 22/03/2022.
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Affiliation(s)
- Francesca Denton
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Alexander Waddell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Chris Kite
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- School of Public Health Studies, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Katie Hesketh
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lou Atkinson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Matthew Cocks
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Helen Jones
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Harpal Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nathan Davenport
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Richard Powell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Cain Clark
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ioannis Kyrou
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Laboratory of Dietetics and Quality of Life, School of Food and Nutritional Sciences, Department of Food Science & Human Nutrition, Agricultural University of Athens, Athens, Greece
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy E Harwood
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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25
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STACHTEAS P, STACHTEAS C, SYMVOULAKIS EK, SMYRNAKIS E. The Role of Telemedicine in the Management of Patients with Chronic Diseases in Primary Care During the COVID-19 Pandemic. MAEDICA 2022; 17:931-938. [PMID: 36818259 PMCID: PMC9923072 DOI: 10.26574/maedica.2022.17.4.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Introduction:The COVID-19 pandemic has rapidly spread to many countries and has led various primary healthcare services of chronic diseases to be neglected and only partially be replaced by telemedicine services. This study aims to investigate the role of telemedicine in the management of patients with noncommunicable diseases in primary health care during the COVID-19 pandemic. Method: A narrative review of the literature was carried out through searching the PubMed and Google Scholar databases. Results: From the initial stages of the pandemic, several scientific medical societies issued guidelines which urged citizens and health personnel to adopt digital means in the provision of regular chronic care as much as possible. The significant benefits of the telemedicine sessions partially only filled the gap of the deferred chronic care. On the other hand, many barriers need to be addressed in order to achieve an equitable and high-quality implementation of telemedicine services. Conclusion:The widespread application of telemedicine and self-monitoring was brought about by the COVID-19 pandemic and currently, they have become common ways of managing non-communicable diseases in primary health care. Innovations introduced need to be maintained and integrated into conventional traditional practices, so that health systems are more resilient to future public health emergencies.
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Affiliation(s)
- Panagiotis STACHTEAS
- Laboratory of Primary Health Care, General Practice and Health Services Research, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Charalampos STACHTEAS
- Laboratory of Primary Health Care, General Practice and Health Services Research, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Emmanouil K. SYMVOULAKIS
- Laboratory of Primary Health Care, General Practice and Health Services Research, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Emmanouil SMYRNAKIS
- Laboratory of Primary Health Care, General Practice and Health Services Research, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
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26
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Vandermolen S, Ricci F, Chahal CAA, Capelli C, Barakat K, Fedorowski A, Westwood M, Patel RS, Petersen SE, Gallina S, Pugliese F, Khanji MY. 'The Digital Cardiologist': How Technology Is Changing the Paradigm of Cardiology Training. Curr Probl Cardiol 2022; 47:101394. [PMID: 36100095 DOI: 10.1016/j.cpcardiol.2022.101394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
In the same way that the practice of cardiology has evolved over the years, so too has the way cardiology fellows in training (FITs) are trained. Propelled by recent advances in technology-catalyzed by COVID-19-and the requirement to adapt age-old methods of both teaching and health care delivery, many aspects, or 'domains', of learning have changed. These include the environments in which FITs work (outpatient clinics, 'on-call' inpatient service) and procedures in which they need clinical competency. Further advances in virtual reality are also changing the way FITs learn and interact. The proliferation of technology into the cardiology curriculum has led to some describing the need for FITs to develop into 'digital cardiologists', namely those who comfortably use digital tools to aid clinical practice, teaching, and training whilst, at the same time, retain the ability for human analysis and nuanced assessment so important to patient-centred training and clinical care.
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Affiliation(s)
- Sebastian Vandermolen
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, EC1A 7BE, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK
| | - Fabrizio Ricci
- Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Chieti, Italy; Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35 - 205 02, Malmö, Sweden; Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy
| | - C Anwar A Chahal
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, EC1A 7BE, UK; Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA; Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London (London, UK)
| | - Khalid Barakat
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, EC1A 7BE, UK
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35 - 205 02, Malmö, Sweden; Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mark Westwood
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK
| | - Riyaz S Patel
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, EC1A 7BE, UK; Institute of Cardiovascular Science, University College London (London, UK)
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, EC1A 7BE, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK
| | - Sabina Gallina
- Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Chieti, Italy
| | - Francesca Pugliese
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, EC1A 7BE, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK
| | - Mohammed Y Khanji
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, EC1A 7BE, UK; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK; Newham University Hospital. Glen Road, Plaistow, Barts Health NHS Trust. London, UK.
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Vainieri M, Nuti S, Mantoan D. Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy. BMJ Open 2022; 12:e061415. [PMID: 36424104 PMCID: PMC9692139 DOI: 10.1136/bmjopen-2022-061415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES During 2020 many countries reduced the number of elective surgeries to free up beds and cope with the COVID-19 outbreak. This situation led healthcare systems to prioritise elective interventions and reduce the overall volumes of treatments.The aim of this paper is to analyse whether the pandemic and the prioritisation policies on elective surgery were done considering the potential inappropriateness highlighted by the measurement of geographic variation. SETTING The setting of the study is acute care with a focus on elective surgical procedures. Data were analysed at the Italian regional level. PARTICIPANTS The study is observational and relies on national hospitalisation records from 2019 to 2020. The analyses refer to the 21 Italian regional health systems, using 48 917 records for 2019 and 33 821 for 2020. The surgical procedures analysed are those considered at high risk of unwarranted variation: coronary angioplasty, cholecystectomy, colectomy, knee replacement, hysterectomy, tonsillectomy, hip replacement and vein stripping. PRIMARY AND SECONDARY OUTCOME MEASURES Primary measures were the hospitalisation rate and its reduction per procedure, to understand the level of potential inappropriateness. Secondary measures were the SD and high/low ratio, to map the level of geographic variation. RESULTS For some procedures, there is a linear negative relationship (eg, tonsillectomy: ρ = -0.92, p<0.01; vein stripping: ρ = -0.93, p<0.01) between the reduction in hospitalisation and its starting point. The only two procedures for which no significant differences were registered are cholecystectomy (ρ = -0.22, p=0.31) and hysterectomy (ρ = -0.22, p=0.33). In particular, in all cases, data show that regions with higher 2019 hospitalisation rates registered a larger reduction. CONCLUSIONS The Italian data show that the pandemic seems to have led hospital managers and health professionals to cut surgical interventions more likely to be inappropriate. Hence, these findings can inform and guide the healthcare system to manage unwarranted variation when coming back to the new normal. This new starting point (lower volumes in some selected elective surgical procedures) should be used to plan elective surgical treatments that can be cancelled because of their high risk of inappropriateness.
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Affiliation(s)
- Milena Vainieri
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina Nuti
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Domenico Mantoan
- AGENAS, Agenzia Nazionale per i Servizi Sanitari Regionali, Roma, Italy
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Kodsi M, Bhat A. Temporal trends in cardiovascular care: Insights from the COVID-19 pandemic. Front Cardiovasc Med 2022; 9:981023. [PMID: 36426232 PMCID: PMC9680953 DOI: 10.3389/fcvm.2022.981023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/30/2022] [Indexed: 04/12/2024] Open
Abstract
In response to the ongoing COVID-19 pandemic, public health care measures have been implemented to limit spread of the contagion and ensure adequate healthcare resource allocation. Correlating with these measures are observed changes in the incidence and outcomes of cardiovascular conditions in the absence of COVID-19 infection. The pandemic has resulted in a reduction in acute coronary syndrome, heart failure and arrhythmia admissions but with worsened outcomes in those diagnosed with these conditions. This is concerning of an underdiagnosis of cardiovascular diseases during the pandemic. Furthermore, cardiovascular services and investigations have decreased to provide healthcare allocation to COVID-19 related services. This threatens an increasing future prevalence of cardiovascular morbidity in healthcare systems that are still adapting to the challenges of a continuing pandemic. Adaption of virtual training and patient care delivery platforms have been shown to be useful, but adequate resources allocation is needed to ensure effectiveness in vulnerable populations.
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Affiliation(s)
- Matthew Kodsi
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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29
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Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review. Health Policy 2022; 126:1195-1205. [PMID: 36257867 PMCID: PMC9556803 DOI: 10.1016/j.healthpol.2022.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.
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Sandhu AT, Zheng J, Tisdale RL, Kohsaka S, Turakhia MP, Heidenreich PA. Medical therapy for patients with recent-onset heart failure with reduced ejection fraction during the COVID-19 pandemic: Insights from the Veteran's affairs healthcare system. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 22:100210. [PMID: 36156887 PMCID: PMC9481472 DOI: 10.1016/j.ahjo.2022.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
This study aims to evaluate trends in guideline-directed medical therapy (GDMT) for patients with recent-onset heart failure with reduced ejection fraction (HFrEF) following the onset of the COVID-19 pandemic using an interrupted time series analysis in the Veteran's Affairs Healthcare System. Among 71,428 patients with recent-onset HFrEF between 1/1/2018 and 2/28/2021, we found the pandemic was not associated with differences in treatment rates for beta-blockers, renin-angiotensin-aldosterone system inhibitors, or mineralocorticoid receptor antagonists; there was a 2.6 % absolute decrease (95 % CI: 0.5 %-4.7 %) in ARNI rates in April 2020; which decreased over the pandemic. Despite the changes to healthcare delivery, the COVID-19 pandemic was associated with minimal changes in GDMT rates among patients with recent-onset HFrEF.
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Affiliation(s)
- Alexander T. Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States of America
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Jimmy Zheng
- Stanford University School of Medicine, Stanford, CA, United States of America
| | - Rebecca L. Tisdale
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mintu P. Turakhia
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States of America
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
- Center for Digital Health, Stanford University Stanford, CA, United States of America
| | - Paul A. Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States of America
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
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31
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Lesaine E, Francis-Oliviero F, Domecq S, Bijon M, Cetran L, Coste P, Lhuaire Q, Miganeh-Hadi S, Pradeau C, Rouanet F, Sevin F, Sibon I, Saillour-Glenisson F. Effects of healthcare system transformations spurred by the COVID-19 pandemic on management of stroke and STEMI: a registry-based cohort study in France. BMJ Open 2022; 12:e061025. [PMID: 36130741 PMCID: PMC9494013 DOI: 10.1136/bmjopen-2022-061025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the impact of changes in use of care and implementation of hospital reorganisations spurred by the COVID-19 pandemic (first wave) on the acute management times of patients who had a stroke and ST-segment elevation myocardial infarction (STEMI). DESIGN Two cohorts of patients who had an STEMI and stroke in the Aquitaine Cardio-Neuro-Vascular (CNV) registry. SETTING 6 emergency medical services, 30 emergency units (EUs), 14 hospitalisation units and 11 cathlabs in the Aquitaine region. PARTICIPANTS This study involved 9218 patients (6436 patients who had a stroke and 2782 patients who had an STEMI) in the CNV Registry from January 2019 to August 2020. METHOD Hospital reorganisations, retrieved in a scoping review, were collected from heads of hospital departments. Other data were from the CNV Registry. Associations between reorganisations, use of care and care management times were analysed using multivariate linear regression mixed models. Interaction terms between use-of-care variables and period (pre-wave, per-wave and post-wave) were introduced. MAIN OUTCOME MEASURES STEMI cohort, first medical contact-to-procedure time; stroke cohort, EU admission-to-imaging time. RESULTS Per-wave period management times deteriorated for stroke but were maintained for STEMI. Per-wave changes in use of care did not affect STEMI management. No association was found between reorganisations and stroke management times. In the STEMI cohort, the implementation of systematic testing at admission was associated with a 41% increase in care management time (exp=1.409, 95% CI 1.075 to 1.848, p=0.013). Implementation of plan blanc, which concentrated resources in emergency activities, was associated with a 19% decrease in management time (exp=0.801, 95% CI 0.639 to 1.023, p=0.077). CONCLUSIONS The pandemic did not markedly alter the functioning of the emergency network. Although stroke patient management deteriorated, the resilience of the STEMI pathway was linked to its stronger structuring. Transversal reorganisations, aiming at concentrating resources on emergency care, contributed to maintenance of the quality of care. TRIAL REGISTRATION NUMBER NCT04979208.
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Affiliation(s)
- Emilie Lesaine
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | - Florence Francis-Oliviero
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
- Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France
| | - Sandrine Domecq
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | - Marine Bijon
- Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France
| | - Laura Cetran
- Coronary Care Unit, CHU de Bordeaux Hôpital Cardiologique, Pessac, France
| | - Pierre Coste
- Coronary Care Unit, CHU de Bordeaux Hôpital Cardiologique, Pessac, France
- University of Bordeaux, Talence, France
| | - Quentin Lhuaire
- Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France
| | - Sahal Miganeh-Hadi
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | | | | | - Floriane Sevin
- CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
| | - Igor Sibon
- Neurology, Stroke Unit, CHU de Bordeaux, Bordeaux, France
- INCIA CNRS UMR 5287, University of Bordeaux, Talence, France
| | - Florence Saillour-Glenisson
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France
- Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France
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32
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Palazzuoli A, Metra M, Collins SP, Adamo M, Ambrosy AP, Antohi LE, Ben Gal T, Farmakis D, Gustafsson F, Hill L, Lopatin Y, Tramonte F, Lyon A, Masip J, Miro O, Moura B, Mullens W, Radu RI, Abdelhamid M, Anker S, Chioncel O. Heart failure during the COVID-19 pandemic: clinical, diagnostic, management, and organizational dilemmas. ESC Heart Fail 2022; 9:3713-3736. [PMID: 36111511 PMCID: PMC9773739 DOI: 10.1002/ehf2.14118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023] Open
Abstract
The coronavirus 2019 (COVID-19) infection pandemic has affected the care of patients with heart failure (HF). Several consensus documents describe the appropriate diagnostic algorithm and treatment approach for patients with HF and associated COVID-19 infection. However, few questions about the mechanisms by which COVID can exacerbate HF in patients with high-risk (Stage B) or symptomatic HF (Stage C) remain unanswered. Therefore, the type of HF occurring during infection is poorly investigated. The diagnostic differentiation and management should be focused on the identification of the HF phenotype, underlying causes, and subsequent tailored therapy. In this framework, the relationship existing between COVID and onset of acute decompensated HF, isolated right HF, and cardiogenic shock is questioned, and the specific management is mainly based on local hospital organization rather than a standardized model. Similarly, some specific populations such as advanced HF, heart transplant, patients with left ventricular assist device (LVAD), or valve disease remain under investigated. In this systematic review, we examine recent advances regarding the relationships between HF and COVID-19 pandemic with respect to epidemiology, pathogenetic mechanisms, and differential diagnosis. Also, according to the recent HF guidelines definition, we highlight different clinical profile identification, pointing out the main concerns in understudied HF populations.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, S. Maria alle Scotte HospitalUniversity of Siena53100SienaItaly
| | - Marco Metra
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Sean P. Collins
- Department of Emergency MedicineVanderbilt University Medical CentreNashvilleTNUSA
| | - Marianna Adamo
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Andrew P. Ambrosy
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA,Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Laura E. Antohi
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu” BucharestBucharestRomania
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Dimitrios Farmakis
- Cardio‐Oncology Clinic, Heart Failure Unit, “Attikon” University HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece,University of Cyprus Medical SchoolNicosiaCyprus
| | | | - Loreena Hill
- School of Nursing and MidwiferyQueen's UniversityBelfastUK
| | - Yuri Lopatin
- Volgograd Medical UniversityCardiology CentreVolgogradRussia
| | - Francesco Tramonte
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, S. Maria alle Scotte HospitalUniversity of Siena53100SienaItaly
| | - Alexander Lyon
- Cardio‐Oncology ServiceRoyal Brompton Hospital and Imperial College LondonLondonUK
| | - Josep Masip
- Intensive Care Department, Consorci Sanitari IntegralUniversity of BarcelonaBarcelonaSpain,Department of CardiologyHospital Sanitas CIMABarcelonaSpain
| | - Oscar Miro
- Emergency Department, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of MedicineUniversity of PortoPortoPortugal
| | - Wilfried Mullens
- Cardiovascular PhysiologyHasselt University, Belgium, & Heart Failure and Cardiac Rehabilitation Specialist, Ziekenhuis Oost‐LimburgGenkBelgium
| | - Razvan I. Radu
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu” BucharestBucharestRomania
| | - Magdy Abdelhamid
- Cardiology Department, Kasr Alainy School of MedicineCairo UniversityNew Cairo, 5th settlementCairo11865Egypt
| | - Stefan Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin BerlinBerlinGermany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu” Bucharest; University for Medicine and Pharmacy “Carol Davila” BucharestBucharestRomania
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33
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Plummer NR, Alcock H, Madden S, Brander J, Manara A, Harvey DJ, Gardiner DC. The impact of COVID-19 on organ donation and transplantation in the UK: lessons learned from the first year of the pandemic. Anaesthesia 2022; 77:1237-1250. [PMID: 36099651 DOI: 10.1111/anae.15833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
Abstract
The COVID-19 pandemic had a major impact on UK deceased organ donation and transplantation activity. We used national audit data from NHS Blood and Transplant to explore in detail the effects of the pandemic in comparison with 12 months pre-pandemic, and to consider the impact of the mitigating strategies and challenges placed on ICU by 'waves' of patients with COVID-19. Between 11 March 2020 and 10 March 2021, referrals to NHS Blood and Transplant of potential organ donors were initially inversely related to the number of people with COVID-19 undergoing mechanical ventilation in intensive care (incident rate ratio (95%CI) per 1000 patients 0.93 (0.88-0.99), p = 0.018), although this pattern reversed during the second wave (additional incident rate ratio (95%CI) 1.12 (1.05-1.19), p < 0.001). Adjusted numbers of donors (incident rate ratio (95%CI) 0.71 (0.61-0.81), p < 0.001) and organs retrieved (incident rate ratio (95%CI) 0.89 (0.82-0.97), p = 0.007) were inversely dependent on COVID-19 workload, though weekly numbers of transplants were unrelated (incident rate ratio (95%CI) 0.95 (0.86-1.04), p = 0.235). Non-COVID-19 mortality fell from 15,007 to 14,087 during the first wave (rate ratio (95%CI) 0.94 (0.92-0.96), p < 0.001) but climbed from 18,907 to 19,372 during the second wave (rate ratio (95%CI) 1.02 (1.00-1.05), p = 0.018). There were fewer in-hospital deaths from cardiac arrest and intracranial catastrophes throughout (rate ratio (95%CI) 0.83 (0.81-0.86), p < 0.001 and rate ratio (95%CI) 0.88 (0.85-0.91), p < 0.001, respectively). There were overall fewer eligible donors (n = 4282) when compared with pre-pandemic levels (n = 6038); OR (95%CI) 0.58 (0.51-0.66), p < 0.001. The total number of donations during the year fell from 1620 to 1140 (rate ratio (95%CI) 0.70 (0.65-0.76), p < 0.001), but the proportion of eligible donors who proceeded to donation (27%) was unchanged (OR (95%CI) 0.99 (0.91-1.08), p = 0.821). The reduction in donations and transplantation during the pandemic was multifactorial, but these data highlight the impact in the UK of a fall in eligible donors and an inverse relationship of referrals to COVID-19 workload. Despite the challenges faced, the foundations underpinning the UK deceased organ donation programme remained strong.
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Affiliation(s)
- N R Plummer
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,East Midlands School of Anaesthesia, Health Education England East Midlands, Leicester, UK
| | - H Alcock
- East Midlands School of Anaesthesia, Health Education England East Midlands, Leicester, UK
| | - S Madden
- NHS Blood and Transplant, Bristol, UK
| | - J Brander
- NHS Blood and Transplant, Bristol, UK
| | - A Manara
- NHS Blood and Transplant, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - D J Harvey
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,NHS Blood and Transplant, Bristol, UK
| | - D C Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,NHS Blood and Transplant, Bristol, UK
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34
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Nadarajah R, Wu J, Hurdus B, Asma S, Bhatt DL, Biondi-Zoccai G, Mehta LS, Ram CVS, Ribeiro ALP, Van Spall HG, Deanfield JE, Lüscher TF, Mamas M, Gale CP. The collateral damage of COVID-19 to cardiovascular services: a meta-analysis. Eur Heart J 2022; 43:3164-3178. [PMID: 36044988 PMCID: PMC9724453 DOI: 10.1093/eurheartj/ehac227] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 07/21/2023] Open
Abstract
AIMS The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jianhua Wu
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- School of Dentistry, University of Leeds, Leeds, UK
| | - Ben Hurdus
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samira Asma
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Laxmi S. Mehta
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C. Venkata S. Ram
- Apollo Hospitals and Medical College, Hyderabad, Telangana, India
- University of Texas Southwestern Medical School, Dallas, TX, USA
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia
| | - Antonio Luiz P. Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - John E. Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College, London, UK
| | - Thomas F. Lüscher
- Imperial College, National Heart and Lung Institute, London, UK
- Royal Brompton & Harefield Hospital, Imperial College, London, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Chris P. Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Stachteas P, Symvoulakis M, Tsapas A, Smyrnakis E. The impact of the COVID-19 pandemic on the management of patients with chronic diseases in Primary Health Care. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/152606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Emil-Marian A, Reka K, Vasile Adrian M, Septimiu V, Eliza-Mihaela A, Eliza R. Impact of COVID-19 pandemic on Vascular Surgery Unit activity in Central Romania. Front Surg 2022; 9:883935. [PMID: 36081587 PMCID: PMC9445812 DOI: 10.3389/fsurg.2022.883935] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/18/2022] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 outbreak has placed substantial pressure on the medical systems worldwide. This study aimed to investigate the influence of the prepandemic vs. pandemic period on the activity of the Vascular Surgery Unit of a large emergency hospital in Eastern Europe. We performed a retrospective review of the vascular surgery cases admitted, comparing the statistics from the two time periods. We examined data of a total of 1,693 patients over the two periods. We report a 34.51% decrease in the surgical procedures performed during the pandemic period, with a disproportionate 80.6% decrease in the number of cases admitted with a diagnosis of venous insufficiency diagnosis and an increase of 67.21% in the number of patients admitted with acute arterial ischemia. Furthermore, individuals not classed as emergencies were delayed or denied surgical care. The number of nonurgent procedures conducted by our Vascular Surgery Unit decreased significantly, whereas the number of emergency surgeries increased. COVID-19′s effect is projected to have a long-term impact on how surgical treatments are provided in Romania.
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Affiliation(s)
- Arbănași Emil-Marian
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, Târgu-Mureș, Romania
| | - Kaller Reka
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, Târgu-Mureș, Romania
| | - Mureșan Vasile Adrian
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, Târgu-Mureș, Romania
- Department of Surgery, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu-Mureș, Târgu-Mureș, Romania
- Correspondence: Arbănași Emil-Marian
| | - Voidăzan Septimiu
- Department of Epidemiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu-Mureș, Târgu-Mureș, Romania
| | - Arbănași Eliza-Mihaela
- Faculty of Pharmacy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu-Mureș, Târgu-Mureș, Romania
| | - Russu Eliza
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, Târgu-Mureș, Romania
- Department of Surgery, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu-Mureș, Târgu-Mureș, Romania
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Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists. HYPOTHESIS A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity. METHODS The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands. RESULTS From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity. CONCLUSION The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.
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Axenhus M, Schedin-Weiss S, Winblad B, Wimo A. Changes in mortality trends amongst common diseases during the COVID-19 pandemic in Sweden. Scand J Public Health 2022; 50:748-755. [PMID: 34933630 PMCID: PMC9361422 DOI: 10.1177/14034948211064656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE It has been found that COVID-19 increases deaths within common diseases in countries that have implemented strict lockdowns. In order to elucidate the proper national response to a pandemic, the mortality rates within COVID-19 and various diseases need to be studied in countries whose pandemic response differ. Sweden represents a country with lax pandemic restrictions, and we aimed to study the effects of COVID-19 on historical mortality rates within common diseases during 2020. METHODS Regression models and moving averages were used to predict expected premature mortality per the ICD-10 during 2020 using historical data sets. Predicted values were then compared to recorded premature mortality to identify changes in mortality trends. RESULTS Seasonal increased mortality was found within neurological diseases. Infectious diseases, tumours and cardiac disease mortality rates decreased compared to expected outcome. CONCLUSIONS Changes in mortality trends were observed for several common diseases during the COVID-19 pandemic. Neurological and cardiac conditions, infections and tumours are examples of diseases that were heavily affected by the pandemic. The indirect effects of COVID-19 on certain patient populations should be considered when determining pandemic impact.
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Affiliation(s)
- Michael Axenhus
- Division of Neurogeriatrics, Centre for
Alzheimer Research, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Sweden
- Theme Inflammation and Aging,
Karolinska University Hospital, Sweden
| | - Sophia Schedin-Weiss
- Division of Neurogeriatrics, Centre for
Alzheimer Research, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Centre for
Alzheimer Research, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Sweden
- Theme Inflammation and Aging,
Karolinska University Hospital, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Centre for
Alzheimer Research, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet, Sweden
- Primary Care, Hudiksvall-Nordanstig,
Sweden
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Exploring Nurses’ Working Experiences during the First Wave of COVID-19 Outbreak. Healthcare (Basel) 2022; 10:healthcare10081406. [PMID: 36011063 PMCID: PMC9407994 DOI: 10.3390/healthcare10081406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
During the COVID-19 outbreak, nurses employed in the clinical sector faced a number of difficulties associated with excessive workload, increased stress, and role ambiguity, which impacted nurses themselves and patient care. The aim of the present study was to investigate how Greek hospital nurses working in non-COVID units experienced the virus outbreak during the first wave of the pandemic. A descriptive qualitative research design was applied using a content analysis approach. To recruit the study participants a purposive sampling strategy was used. Ten nurses participated in the study. Data collection was conducted through semi-structured interviews. Content analysis revealed three themes namely, (a) emotional burden, (b) professional commitment, and (c) abrupt changes. Six subthemes were formulated and assimilated under each main theme respectively. Organizational changes, emotional burdens and feelings of fear and uncertainty, appeared to have a crucial effect on nurses and patient care. However, the professional commitment and the nurses’ effort to provide excellent nursing care remained high. Nurses demonstrated that despite the burdens caused by the COVID-19 outbreak, the pandemic era created opportunities for thoroughness and accuracy in nursing care.
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Tardif JC, Pfeffer MA, Kouz S, Koenig W, Maggioni AP, McMurray JJV, Mooser V, Waters DD, Grégoire JC, L'Allier PL, Jukema WJ, White HD, Heinonen T, Black DM, Laghrissi-Thode F, Levesque S, Guertin MC, Dubé MP. Pharmacogenetics-guided dalcetrapib therapy after an acute coronary syndrome: the dal-GenE trial. Eur Heart J 2022; 43:3947-3956. [PMID: 35856777 PMCID: PMC9565632 DOI: 10.1093/eurheartj/ehac374] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/24/2022] [Accepted: 06/30/2022] [Indexed: 12/05/2022] Open
Abstract
Aims In a retrospective analysis of dal-Outcomes, the effect of dalcetrapib on
cardiovascular events was influenced by an adenylate cyclase type 9
(ADCY9) gene polymorphism. The dal-GenE study was conducted to test
this pharmacogenetic hypothesis. Methods and results dal-GenE was a double-blind trial in patients with an acute coronary syndrome within
1–3 months and the AA genotype at variant rs1967309 in the ADCY9 gene.
A total of 6147 patients were randomly assigned to receive dalcetrapib 600 mg or placebo
daily. The primary endpoint was the time from randomization to first occurrence of
cardiovascular death, resuscitated cardiac arrest, non-fatal myocardial infarction, or
non-fatal stroke. After a median follow-up of 39.9 months, the primary endpoint occurred
in 292 (9.5%) of 3071 patients in the dalcetrapib group and 327 (10.6%) of 3076 patients
in the placebo group [hazard ratio 0.88; 95% confidence interval (CI) 0.75–1.03;
P = 0.12]. The hazard ratios for the components of the primary
endpoint were 0.79 (95% CI 0.65–0.96) for myocardial infarction, 0.92 (95% CI 0.64–1.33)
for stroke, 1.21 (95% CI 0.91–1.60) for death from cardiovascular causes, and 2.33 (95%
CI 0.60–9.02) for resuscitated cardiac arrest. In a pre-specified on-treatment
sensitivity analysis, the primary endpoint event rate was 7.8% (236/3015) in the
dalcetrapib group and 9.3% (282/3031) in the placebo group (hazard ratio 0.83; 95% CI
0.70–0.98). Conclusion Dalcetrapib did not significantly reduce the risk of occurrence of the primary endpoint
of ischaemic cardiovascular events at end of study. A new trial would be needed to test
the pharmacogenetic hypothesis that dalcetrapib improves the prognosis of patients with
the AA genotype. Clinical Trial Registration Trial registration dal-GenE ClinicalTrials.gov Identifier: NCT02525939
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Affiliation(s)
- Jean Claude Tardif
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, PQ, H1T1C8 Canada.,Beaulieu-Saucier Pharmacogenomics Centre, Université de Montréal, Montreal, Canada.,The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Marc A Pfeffer
- Department of Medicine, The Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon Kouz
- Department of Medicine, Centre Hospitalier Régional de Lanaudière, Joliette, Canada
| | - Wolfgang Koenig
- Department of Medicine, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Department of Medicine, German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.,Department of Medicine, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - John J V McMurray
- Department of Medicine, British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Vincent Mooser
- Department of Medicine, McGill University, Montreal, Canada
| | | | - Jean C Grégoire
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, PQ, H1T1C8 Canada
| | - Philippe L L'Allier
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, PQ, H1T1C8 Canada
| | - Wouter J Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Medicine, Durrer Center for Cardiovascular Research, Amsterdam, The Netherlands
| | - Harvey D White
- Green Lane Cardiovascular Unit, Auckland City Hospital, University of Auckland, New Zealand
| | - Therese Heinonen
- DalCor Pharmaceuticals, Montreal, Canada.,DalCor Pharmaceuticals, Sarasota, FL, USA
| | - Donald M Black
- DalCor Pharmaceuticals, Montreal, Canada.,DalCor Pharmaceuticals, Sarasota, FL, USA
| | | | - Sylvie Levesque
- The Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | | | - Marie Pierre Dubé
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, PQ, H1T1C8 Canada.,Beaulieu-Saucier Pharmacogenomics Centre, Université de Montréal, Montreal, Canada
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Hampson C, Evans W, McKay L, Menzies L. Measuring the Impact of the COVID-19 Pandemic on Diagnostic Delay in Rare Disease. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/21-00181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rare diseases are individually rare but collectively common, with a combined prevalence of 3.5–5.9%. A common feature of many diseases is a substantial delay in patients receiving a correct diagnosis; this protracted path to diagnosis is termed ‘the diagnostic odyssey’. During the COVID-19 pandemic, significant concerns have emerged from both clinicians and patients regarding a disproportionate effect of the pandemic on diagnosis and management of rare disease. Such concerns prompted a study to explore this question further, the results of which are presented here.
A cross-sector multi-stakeholder coalition was formed, Action for Rare Disease Empowerment (ARDEnt), with representation from patients with rare diseases and carers, patient advocacy groups, clinicians, academics, data scientists, and industry. A mixed methods approach was used to collect and collate information about the impact of the pandemic on diagnostic delay in rare disease. Currently, there is a lack of systematic recording and reporting of rare disease diagnosis in the UK, which created challenges in directly measuring diagnosis rates. Therefore, the group was dependent on a mix of data sources to reflect healthcare provided during 2020 compared with previous years. The findings were synthesised to describe the impact of the pandemic along the path to diagnosis, from the moment of first concern and engagement with health services, to the availability of definitive testing.
In conclusion, evidence suggests the pandemic has exacerbated the problem of diagnostic delay for rare diseases, affecting all points on the path to diagnosis. The authors recommend three actions to help address this: optimising remote clinical consultations; enhancing the use of health informatics in rare diseases; and proactively identifying patients with undiagnosed rare diseases missed due to the pandemic. This study also highlights the need for better reporting of rare disease diagnoses, a core metric to measure the impact of health system changes that may be put into place to address the priorities of The UK Rare Diseases Framework, also published this year.
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Affiliation(s)
| | - William Evans
- School of Medicine, Nottingham University, UK; Niemann–Pick, Washington, Tyne and Wear, UK
| | - Lucy McKay
- Clinical Genetics Department, Great Ormond Street Hospital, London, UK
| | - Lara Menzies
- Medics4RareDiseases Charity, Loudwater, Buckinghamshire, UK; The Royal Society of Medicine, London, UK
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From Survey Results to a Decision-Making Matrix for Strategic Planning in Healthcare: The Case of Clinical Pathways. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137806. [PMID: 35805466 PMCID: PMC9265412 DOI: 10.3390/ijerph19137806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Abstract
Background: It is a well-known fact that the information obtained from a survey can be used in a healthcare organizational analysis; however, it is very difficult to compare the different results found in the literature to each other, even through the use of metanalysis, as the methodology is often not consistent. Methods: Data from a survey analyzing the organizational and managerial responses adopted in pathology-specific clinical pathways (CPs) during the first two waves of the COVID-19 pandemic were used for constructing a decisional matrix, a tool called SPRIS system, consisting of four different sheets. The first sheet reports the results of the survey and, using a streetlight color system, identifies strengths and weaknesses; the second one, by assigning a priority score, establishes the priority of intervention on each of the strengths and weaknesses identified; the third sheet reports the subjective items of the questionnaire in order to identify threats and opportunities and their probability of happening; in the last sheet, a SWOT Analysis is used to calculate the performance index of the whole organization. Results: The SPRIS system, applied to data concerning the adaptation of four CPs to the COVID-19 pandemic, showed that, whereas all the CPs had a good performance index, some concerns remained unsolved and need be addressed. Conclusions: The SPRIS system showed to be an easily constructed tool that is able to give an overview of the organization analyzed by the survey and to produce an index that can be used in a direct quality comparison between different services or organizations.
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Palmer C, Richardson D, Rayner J, Drake MJ, Cotterill N. Professional perspectives on impacts, benefits and disadvantages of changes made to community continence services during the COVID-19 pandemic: findings from the EPICCC-19 national survey. BMC Health Serv Res 2022; 22:783. [PMID: 35705988 PMCID: PMC9199465 DOI: 10.1186/s12913-022-08163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic required changes to the organisation and delivery of NHS community continence services which assess and treat adults and children experiencing bladder and bowel difficulties. Although strong evidence exists for the physical and mental health benefits, improved quality of life, and health service efficiencies resulting from optimally organised community-based continence services, recent audits identified pre-pandemic pressures on these services. The aim of this study was to explore professional perceptions of changes made to community continence services due to the COVID-19 pandemic and consequent impacts on practice, care provision and patient experience. METHODS Online survey of 65 community continence services in England. Thematic analysis using constant comparison of open-ended questions. Frequency counts of closed-ended questions. RESULTS Sixty-five services across 34 Sustainability and Transformation Partnership areas responded to the survey. Use of remote/virtual consultations enabled continuation of continence care but aspects of 'usual' assessment (examinations, tests) could not be completed within a remote assessment, requiring professionals to decide which patients needed subsequent in-person appointments. Remote appointments could increase service capacity due to their time efficiency, were favoured by some patients for their convenience, and could increase access to care for others. However, the limited ability to complete aspects of usual assessment raised concerns that diagnoses could be missed, or inappropriate care initiated. The format also restricted opportunities to identify non-verbal cues that could inform professional interpretation; and made building a therapeutic relationship between professional and patient more challenging. Remote appointments also posed access challenges for some patient groups. A third of participating services had experienced staff redeployment, resulting in long wait times and some patients being left without care; or reported additional caseload, which had delayed care provision for patients with continence issues. Participants perceived continence care to have been deprioritised, and more generally undervalued, and called for greater recognition of the impact of continence care. CONCLUSIONS Remote appointments offer efficiency and convenience. However, 'in-person' approaches are highly valued for optimum quality, patient-centred continence care, and good team relationships. Failure to restore redeployed continence staff will diminish patient health and quality of life, with associated costs to the NHS.
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Affiliation(s)
- Cecily Palmer
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Davina Richardson
- Bladder & Bowel UK, Disabled Living, Burrows House, 10 Priestley Rd, Wardley Industrial Estate, M28 2LY Manchester, UK
| | - Juliette Rayner
- ERIC, The Children’s Bowel & Bladder Charity, 36 Old School House, Kingswood Foundation, Britannia Rd, BS15 8DB Bristol, UK
| | - Marcus J. Drake
- Translational Health Sciences, Bristol Medical School, Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB UK
| | - Nikki Cotterill
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England, Blackberry Hill, Bristol, BS16 1DD UK
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Patron E, Messerotti Benvenuti S, Ponchia A, Del Piccolo F, Gentili C, Palomba D. The impact of COVID-19-related quarantine on psychological outcomes in patients after cardiac intervention: a multicenter longitudinal study. Transl Psychiatry 2022; 12:235. [PMID: 35668067 PMCID: PMC9169951 DOI: 10.1038/s41398-022-01984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
Mandatory quarantine during the COVID-19 pandemic had substantial negative consequences on psychological health in the general population. Depression, anxiety, and insomnia were reported to increase the morbidity and mortality risk in cardiac patients after cardiac interventions. Nonetheless, a gap in the evidence appeared regarding the effects of COVID-19-related quarantine on psychological outcomes in patients after cardiac interventions. The present study aimed to longitudinally investigate the effects of quarantine on depressive, anxiety, and insomnia symptoms in a group of patients who underwent cardiac intervention. Seventy-three patients admitted for cardiac rehabilitation completed a psychological assessment before and a reassessment after the quarantine and were included in the quarantine group. The control group included 76 patients who completed both evaluations before the quarantine. Depressive (Beck Depression Inventory-II; BDI-II), anxiety (Beck Anxiety Inventory-II; BAI), and insomnia (Sleep Condition Indicator; SCI) symptoms were evaluated in both groups at one (assessment) and eight (reassessment) months after cardiac intervention. The statistical analyses revealed that at reassessment, the quarantine group showed higher global depressive, anxiety, and insomnia symptoms than the control group and increased cognitive symptoms of depression. A higher presence of clinically relevant depressed patients was seen in the quarantine group. The present results showed that the COVID-19-related mandatory quarantine negatively affected psychological outcomes in patients after cardiac intervention, increasing the probability for these patients to be depressed. This, in turn, could influence patients' health in a critical period for morbidity and mortality risk. This underlines the priority of integrating and improving targeted mental health support as the pandemic continues, especially for cardiac patients.
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Affiliation(s)
- Elisabetta Patron
- Department of General Psychology, University of Padua, Padua, Italy.
| | - Simone Messerotti Benvenuti
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Andrea Ponchia
- Unit of Cardiac Rehabilitation, ULSS 6 Euganea, Padua, Italy
| | | | - Claudio Gentili
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Daniela Palomba
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
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Ding WY, Cranley J, Begley D, Rao A, Snowdon RL, Mellor G, Gupta D. Impact of COVID-19 pandemic on cardiac rhythm management services: Views from the United Kingdom. Heart Rhythm O2 2022; 3:536-541. [PMID: 35756140 PMCID: PMC9213026 DOI: 10.1016/j.hroo.2022.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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Babalola OJ, Sesay HW, Blebo LS, Whesseh FK, Umeokonkwo CD, Adewuyi PA, Amo-Addae M. The influence of first wave of COVID-19 outbreak on routine healthcare services, Liberia, August 2020: a mixed study approach. BMC Health Serv Res 2022; 22:684. [PMID: 35597931 PMCID: PMC9123861 DOI: 10.1186/s12913-022-08074-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic left countries to rapidly implement diverse and stringent public health measures without recourse to mitigate its effect on the sustenance of routine healthcare services. This study described routine health service disruption and restoration strategies at 6 months into the epidemic in Liberia. METHODS Liberia, with 15 counties, has 839 health facilities, with one-third in Montserrado County. A cross-sectional study using a mixed approach - quantitative and qualitative research with concurrent triangulation was conducted using a structured guide for group discussions among key health workers at 42 secondary and most patronized health facilities in 14 counties and 7 Montserrado districts. Additionally, routine health data between January and June 2019 and 2020 were extracted from the source documents to the electronic checklist. We performed a descriptive analysis of quantitative data and plotted the line graph of the relative percentage change. Transcribed audio recording notes were synthesized using ATLAS ti for content analysis to identify the themes and subthemes in line with the study objectives and excerpts presented in the results. RESULTS Liberia declared COVID-19 outbreak on March 16, 2020. From conducted interviews at 41 health facilities, 80% reported disruption in routine health services. From January to June 2020, scheduled routine immunization outreaches conducted decreased by 47%. Using a relative percentage change, outpatient attendance decreased by 32% in May, inpatient admission by 30% in April, malaria diagnosis and treatment by 40% in April, and routine antenatal obstetric care by 28% in April. The fear of contacting COVID-19 infection, redeployment of healthcare workers to COVID-19 response, restriction of movement due to lockdown, inadequate or lack of PPE for healthcare workers, lack of drugs and vaccine supplies for clients, and partial closure of routine healthcare services were common perceived reasons for disruptions. Massive community health education and strict compliance with COVID-19 nonpharmacological measures were some of the health facility recovery strategies. CONCLUSIONS The COVID-19 outbreak in Liberia caused a disruption in routine healthcare services, and strategies to redirect the restoration of routine healthcare services were implemented. During epidemics or global health emergencies, countries should sustain routine health services and plan for them.
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Affiliation(s)
- Obafemi J Babalola
- African Field Epidemiology Network (AFENET), Liberia Office, 22 Russel Ave., 21 Street, Sinkor, Central Monrovia, Montserrado County, Liberia.
- Liberia Field Epidemiology Training Program, Central Monrovia, Montserrado County, Liberia.
| | - Himiede W Sesay
- African Field Epidemiology Network (AFENET), Liberia Office, 22 Russel Ave., 21 Street, Sinkor, Central Monrovia, Montserrado County, Liberia
- Liberia Field Epidemiology Training Program, Central Monrovia, Montserrado County, Liberia
| | - Lily S Blebo
- African Field Epidemiology Network (AFENET), Liberia Office, 22 Russel Ave., 21 Street, Sinkor, Central Monrovia, Montserrado County, Liberia
- Liberia Field Epidemiology Training Program, Central Monrovia, Montserrado County, Liberia
| | - Faith K Whesseh
- African Field Epidemiology Network (AFENET), Liberia Office, 22 Russel Ave., 21 Street, Sinkor, Central Monrovia, Montserrado County, Liberia
- Liberia Field Epidemiology Training Program, Central Monrovia, Montserrado County, Liberia
| | - Chukwuma D Umeokonkwo
- African Field Epidemiology Network (AFENET), Liberia Office, 22 Russel Ave., 21 Street, Sinkor, Central Monrovia, Montserrado County, Liberia
- Liberia Field Epidemiology Training Program, Central Monrovia, Montserrado County, Liberia
| | - Peter A Adewuyi
- African Field Epidemiology Network (AFENET), Liberia Office, 22 Russel Ave., 21 Street, Sinkor, Central Monrovia, Montserrado County, Liberia
- Liberia Field Epidemiology Training Program, Central Monrovia, Montserrado County, Liberia
| | - Maame Amo-Addae
- African Field Epidemiology Network (AFENET), Liberia Office, 22 Russel Ave., 21 Street, Sinkor, Central Monrovia, Montserrado County, Liberia
- Liberia Field Epidemiology Training Program, Central Monrovia, Montserrado County, Liberia
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47
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Grad DA, Chereches RM, Strilciuc S, Muresanu D. Scars of stroke care emerge as COVID-19 shifts to an endemic in many countries. J Med Life 2022; 15:589-591. [PMID: 35815080 PMCID: PMC9262269 DOI: 10.25122/jml-2022-1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Razvan Mircea Chereches
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Stefan Strilciuc
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dafin Muresanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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48
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Negative Impact of the COVID-19 Pandemic on Kidney Disease Management-A Single-Center Experience in Romania. J Clin Med 2022; 11:jcm11092452. [PMID: 35566576 PMCID: PMC9104278 DOI: 10.3390/jcm11092452] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 12/20/2022] Open
Abstract
Background: The evolution of the COVID-19 pandemic affected healthcare systems worldwide. The patients with chronic kidney disease (CKD), diabetes, and cardiovascular disease were most affected and had an unfavorable outcome. Methods: We examined the activity of the Nephrology Department from Târgu-Mureș County Emergency Hospital retrospectively, comparing two periods: June 2020–November 2021 (COVID-19 period) and June 2018–November 2019 (non-COVID-19 period). Results: In the COVID-19 period, there were fewer one-day hospitalizations registered, 77.27% more dialysis catheters were installed, and 43.75% more arteriovenous fistulas were performed. An overall increase in the number of patients requiring dialysis during the pandemic was recorded, as of the number of dialysis sessions performed. Moreover, we observed a statistically significant increase in the number of dialysis sessions per patient and a statistically significant increase in the number of hospitalization days in the pandemic interval. Acute kidney injury (AKI) and urosepsis were the diagnoses that increased the most among in-patients during the pandemic, while all other nephrology diagnoses decreased. Conclusions: The COVID-19 pandemic accelerated kidney pathology and worsened the outcomes of nephrology patients in our center. The number of chronic and patient’s access to one-day hospitalization decreased in order to minimalize the exposure and the risk of infection. In contrast, the need for emergency dialysis increased significantly.
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49
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Axenhus M, Schedin-Weiss S, Tjernberg L, Wimo A, Eriksdotter M, Bucht G, Winblad B. Changes in dementia diagnoses in Sweden during the COVID-19 pandemic. BMC Geriatr 2022; 22:365. [PMID: 35473668 PMCID: PMC9039601 DOI: 10.1186/s12877-022-03070-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The COVID-19 pandemic has caused large disruptions to healthcare systems. Refocus on COVID-19 related care might have contributed to indirect effects on other healthcare areas. Care focused on acute conditions have been negatively affected although research into the effects on chronic and care intensive patient groups such as patients with dementia diseases is lacking. In this study we evaluated dementia diagnosis trends in Sweden during 2015–2020 according to International Classification of Disease version 10 coding of common dementia diseases. Methods Regional and national statistics in the form of International Classification of Disease version 10 coding, COVID-19 incidence, mortality data, and population census data were collected from the National Institute of Health and Welfare. Logistic regression analysis was performed to identify trends of dementia diagnosis during 2015–2020. Correlation test was performed between COVID-19 incidence, mortality rates, and dementia coding. Results Dementia diagnosis incidence has been declining since 2015 and further decline was noted in many regions in Sweden during 2020. As COVID-19 incidence increased, fewer cases of dementia were diagnosed, a decrease that differentially impacted women and those who were advanced in age. Conclusions Dementia diagnosis incidence in Sweden has been on a decline since 2015. The COVID-19 pandemic caused a further larger decline in dementia diagnosis incidence during 2020. COVID-19 incidence, but not mortality, was associated with decrease in dementia diagnosis incidence. There might be a large number of undiagnosed patients with dementia and healthcare reforms should be enacted to address this. Women and elderly are particularly vulnerable groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03070-y.
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Affiliation(s)
- Michael Axenhus
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden. .,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.
| | - Sophia Schedin-Weiss
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - Lars Tjernberg
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden.,The primary care of Hudiksvall-Nordanstig, the Region of Gävleborg, Gävle, Sweden
| | - Maria Eriksdotter
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Gustaf Bucht
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
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50
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Weber T, Amar J, de Backer T, Burkard T, van der Giet M, Gosse P, Januszewicz A, Kahan T, Mancia G, Mayer CC, Muiesan ML, Stergiou GS, Tsioufis K, Vaisse B, Kreutz R. Covid-19 associated reduction in hypertension-related diagnostic and therapeutic procedures in Excellence Centers of the European Society of Hypertension. Blood Press 2022; 31:71-79. [PMID: 35465794 DOI: 10.1080/08037051.2022.2060182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Jaques Amar
- Department of Hypertension, Toulouse University Hospital, Toulouse, France
| | - Tine de Backer
- Cardiovascular Center, Heymans Institute of Clinical Pharmacology, University Hospital Gent, Gent, Belgium
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, University Hospital Basel, Basel, Switzerland
| | - Marcus van der Giet
- Hypertension Centre Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Philippe Gosse
- Unité Hypertension Artérielle, University of Bordeaux, Bordeaux, France
| | | | - Thomas Kahan
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | | | - Christopher C. Mayer
- Health and Bioresources Division, Austrian Institute of Technology, Vienna, Austria
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell’ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - George S. Stergiou
- Third Department of Medicine, Sotiria Hospital, Hypertension Center STRIDE-7, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernard Vaisse
- Service de Rythmologie et d’Hypertension, Pôle Cardiovasculaire et Thoracique, Marseille, France
| | - Reinhold Kreutz
- Hypertension Centre Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
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