Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the availability of cardiology services and management of cardiac conditions. Elective surgeries, outpatient appointments and cardiac imaging have been largely cancelled across the world due to the risk of infection transmission and the need for reallocation of resources to deal with the increasing number of COVID-19 patients. The impact on patients with cardiac co-morbidities during these times may be drastic. However, cardiologists and hospitals across the world have implemented measures to ensure on-going monitoring and care of patients remotely. In this review, we discuss the impact of COVID-19 on cardiac services including interventional cardiology services, cardiac imaging and outpatient appointments. In addition, implications for future research and clinical practice are also discussed.
IntroductionSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19, constitutes a public health emergency of international concern. The virus has spread globally through aerosol and contact transmission since the discovery of the SARS-CoV-2 in December 2019 in Wuhan, China. 1 As of 8 October 2020, 36,002,827 cases of COVID-19 have been reported worldwide, including 1,049,810 deaths. 2 The majority of early reported cases had the common symptoms of fever, dry cough and dyspnoea, as well as less common symptoms of headache, myalgia and sputum production. Computerised tomography (CT) scans showed bilateral lung opacities in almost all patients. 3 A meta-analysis of risk factors of critical COVID-19 patients showed that patients with dyspnoea were more likely to deteriorate into a critical condition than those who presented with fever only. There was an increased risk among the elderly (especially males over 65 years) and patients with comorbidities, such as diabetes, hypertension, cardiovascular and respiratory disease. 4 The assessment of dyspnoea is therefore an essential part of managing patients presenting with suspected COVID-19.The pandemic has placed increasing strain on scarce healthcare resources such as hospital beds and clinician time. This has been due to both increased demand and the need for stringent infection control procedures. As a result, many countries have relied on primary care systems to reduce the fl ow of patients through hospital emergency departments.A large amount of community-based diagnosis and triage of COVID-19 is currently being performed by video and telephone consultation. This has presented clinicians with a new challenge in risk-stratifying patients with shortness of breath. Dyspnoea is a diverse symptom and can be present in those who are critically ill but also in the worried well. Objective modes of assessment are required to differentiate these patient groups.The transformation of primary care from face-to-face to remote consultations has been aided by technology such as
This bibliometric analysis aims to identify publications and highlight the key areas that have shaped modern clinical practices for aortic valve replacement (AVR). In this paper, the top 100 most cited manuscripts for AVR are analyzed. The Thomson Reuters Web of Science database was searched using the terms "aortic valve replacement," "AVR," "sAVR," "tAVR," or "TAVI." The results were ranked by citation number and the top 100 articles were further analyzed by evaluating the subject, author, journal, year of publication, institution, and country of origin. Thirty-thousand and eight hundred eligible papers were examined, with an accumulation of 81 851 citations in total and a mean citation of 819 per manuscript (ranged: 344-4180). The New England Journal of Medicine A search was completed on the Thomson Reuters Web of Science citation indexing database using the search terms "aortic valve replacement," "AVR," "sAVR," "tAVR," or "TAVI." The search was limited to full manuscripts in English and includes publications from 1970 to 2020. The manuscripts were sorted by the number of citations. The resulting list was then divided by the manuscripts' year of publication. This method was initially developed by Paladugu et al and replicated by O'Sullivan et al, Kavanagh et al, and Chan et al 2-5 Due to the surge in AVR performed using the transcatheter approach by cardiologists and cardiac surgeons, this research identifies the top five most cited papers for TAVI and AVR. The top 100 articles obtained were further analyzed by looking at the journal, authorship, institution, country, year of publication, article type and topic. Only full manuscripts were considered in this study; letters to the editor and correspondences were excluded. The generated total citation count was inclusive of articles indexed in the
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