Management of acute coronary syndromes during the COVID-19 outbreak in Lombardy: The “macro-hub” experience

Carugo, Stefano; Ferlini, Marco; Castini, Diego; Andreassi, Aida; Guagliumi, Giulio; Metra, Marco; Lombardi, C; Cuccia, Claudio; Savonitto, Stefano; Piatti, Luigi; D’Urbano, Maurizio; Vandoni, Pietro; Lettino, Maddalena; Marenzi, Giancarlo; Montorfano, Matteo; Zangrillo, Alberto; Castiglioni, Battistina; Ponti, Roberto De; Visconti, Luigi Oltrona

doi:10.1016/j.ijcha.2020.100662

Cited by 15 publications

(21 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, the lack of timely access to hospital care would be supported by the reported increase in the number of out-of-hospital cardiac arrest deaths 5 , 6 . Moreover, we observed an increase in-hospital mortality among STEMI patients in Lombardy, where the high prevalence of Covid-19 was associated with worse STEMI outcomes 7 . This could result from a delay in seeking hospital care by patients suffering a heart attack, which, in turn, would undermine the efficacy of a primary PTCA.…”

Section: Discussionmentioning

confidence: 69%

Indirect impact of Covid-19 on hospital care pathways in Italy

Spadea

Gnavi

Landriscina

et al. 2021

Sci Rep

View full text Add to dashboard Cite

Earlier in 2020, seven Italian regions, which cover 62% of the Italian population, set up the Mimico-19 network to monitor the side effects of the restrictive measures against Covid-19 on volumes and quality of care. To this aim, we retrospectively analysed hospital discharges data, computing twelve indicators of volume and performance in three clinical areas: cardiology, oncology, and orthopaedics. Weekly indicators for the period January–July 2020 were compared with the corresponding average for 2018–2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown, and post-lockdown. The weekly trend of hospitalisations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Malignant neoplasms surgery volumes differed substantially by site, with a limited reduction for lung cancer (< 20%) and greater declines (30–40%) for breast and prostate cancers. The percentage of timely surgery for femoral neck in the elderly remained constantly higher than the previous 2 years whereas hip and knee replacements fell dramatically. Hospitalisations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. General trends did not show important differences across regions, regardless of the different burden of Covid-19. Preventive and primary care services should adopt a pro-active approach, moving towards the identification of at-risk conditions that were neglected during the pandemic and timely addressing patients to the secondary care system.

show abstract

Section: Discussionmentioning

confidence: 69%

Indirect impact of Covid-19 on hospital care pathways in Italy

Spadea

Gnavi

Landriscina

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…There is the chance that patients with NSTEMI did not seek medical help because their symptoms were less frequently characterized by precordial pain or chest discomfort, thus increasing their reluctance to expose themselves to the in-hospital risk of COVID-19 infection. In line with this hypothesis, data from the Lombardy region in Italy showed that, during the COVID-19 pandemic, patients with AMI presented more frequently with dyspnea and atypical symptoms ( 40 ). In addition, an association between increasing age and pre-existing comorbidities and a poorer outcome following COVID-19 infection was largely emphasized by the media at the start of the pandemic, affecting the choice of some patients with NSTEMI to remain at home, since they considered themselves at high risk in case of infection due of their older age and concomitant illnesses.…”

Section: Clinical Characteristics and Outcomes Of Patients With Ami During Covid-19mentioning

confidence: 79%

“…An observation common to studies was that during the pandemic a higher percentage of patients were admitted with STEMI as compared to NSTEMI ( 25 , 28 , 40 ). Indeed, a large database of 99 English hospitals showed that, on average, hospitalization for NSTEMI was reduced by 50% and by 25% for STEMI ( 28 ).…”

Section: Clinical Characteristics and Outcomes Of Patients With Ami During Covid-19mentioning

confidence: 99%

Acute Myocardial Infarction During the COVID-19 Pandemic: An Update on Clinical Characteristics and Outcomes

Toscano

Cosentino

Campodonico

et al. 2021

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic. On top of respiratory complications, COVID-19 is associated with major direct and indirect cardiovascular consequences, with the latter probably being even more relevant, especially in the setting of time-dependent cardiovascular emergencies. A growing amount of data suggests a dramatic decline in hospital admissions for acute myocardial infarction (AMI) worldwide during the COVID-19 pandemic, mostly since patients did not activate emergency medical systems because hospitals were perceived as dangerous places regarding the infection risk. Moreover, during the COVID-19 pandemic, patients with AMI had a significantly higher in-hospital mortality compared to those admitted before COVID-19, potentially due to late arrival to the hospital. Finally, no consensus has been reached regarding the most adequate healthcare management pathway for AMI and shared guidance on how to handle patients with AMI during the pandemic is still needed. In this review, we will provide an update on epidemiology, clinical characteristics, and outcomes of patients with AMI during the COVID-19 pandemic, with a special focus on its collateral cardiac impact.

show abstract

“…Two of the main issues possibly related to that increase were the fear of in-hospital infection and the "surprise effect" of the pandemic on the healthcare systems, typical of the first pandemic wave [10]. It was unknown if information campaigns, adopted to increase citizens' awareness to call EMS in case of effected need, and re-organization of EMS and healthcare systems [28,29] may have prevented a similar increase during the second wave, avoiding the correlation between COVID-19 and OHCA incidence. Our study highlights that also in one of the first Region early affected by the pandemic, where the first case of COVID-19 in Europe was documented, and where multiple actions were adopted to mitigate the pandemic effect, an increase in OHCAs with a significant correlation between COVID-19 and OHCA incidence was observed also during the second pandemic wave, but only in high COVID-19 incidence provinces.…”

Section: Discussionmentioning

confidence: 99%

Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The relationship between COVID-19 and out-of-hospital cardiac arrests (OHCAs) has been shown during different phases of the first pandemic wave, but little is known about how to predict where cardiac arrests will increase in case of a third peak. Aim To seek for a correlation between the OHCAs and COVID-19 daily incidence both during the two pandemic waves at a provincial level. Methods We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided the study period into period 1, the first 157 days after the outbreak and including the first pandemic wave and period 2, the second 158 days including the second pandemic wave. We calculated the cumulative and daily incidence of OHCA and COVID-19 for the whole territory and for each province for both periods. Results A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCAs was observed both during the first and the second pandemic period in the whole territory (R = 0.4, p<0.001 for period 1 and 2) and only in those provinces with higher COVID-19 cumulative incidence (period 1: Cremona R = 0.3, p = 0.001; Lodi R = 0.4, p<0.001; Pavia R = 0.3; p = 0.01; period 2: Varese R = 0.4, p<0.001). Conclusions Our results suggest that strictly monitoring the pandemic trend may help in predict which territories will be more likely to experience an OHCAs’ increase. That may also serve as a guide to re-allocate properly health resources in case of further pandemic waves.

show abstract

Management of acute coronary syndromes during the COVID-19 outbreak in Lombardy: The “macro-hub” experience

Cited by 15 publications

References 11 publications

Indirect impact of Covid-19 on hospital care pathways in Italy

Indirect impact of Covid-19 on hospital care pathways in Italy

Acute Myocardial Infarction During the COVID-19 Pandemic: An Update on Clinical Characteristics and Outcomes

Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence

Contact Info

Product

Resources

About