Rural and Remote Cardiology During the COVID-19 Pandemic: Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement

Abstract

The Challenges Rural and remote Australians and New Zealanders have a higher rate of adverse outcomes due to acute myocardial infarction, driven by many factors. The prevalence of cardiovascular disease (CVD) is also higher in regional and remote populations, and people with known CVD have increased morbidity and mortality from coronavirus disease 2019 (COVID-19). In addition, COVID-19 is associated with serious cardiac manifestations, potentially placing additional demand on limited regional services at a time of diminished visiting metropolitan support with restricted travel. Inter-hospital transfer is currently challenging as receiving centres enact pandemic protocols, creating potential delays, and cardiovascular resources are diverted to increasing intensive care unit (ICU) and emergency department (ED) capacity. Regional and rural centres have limited staff resources, placing cardiac services at risk in the event of staff infection or quarantine during the pandemic.

Letter to the Editor: CSANZ Consensus Guidelines for Interventional Cardiology Services Delivery During COVID-19 Pandemic in Australia and New Zealand

“…However, we are concerned that some cardiac services have interpreted these statements as a rationale to convert to a routine fibrinolysis strategy for all patients with STEMI rather than maintaining a primary percutaneous coronary intervention (PPCI) service, despite extremely low notification rates of COVID-19 infection of 3.4/100,000 population [3], and this in the context of a high case ascertainment [4]. Indeed, more recently, the CSANZ Consensus Statement on Rural and Remote Cardiology during COVID19 Pandemic [5], referred to a scenario where "fibrinolysis-first models of care for STEMI be considered, including in metropolitan PCI centres" and highlighted the implications this may have on perceived or real availability of European imported tenecteplase and local stock shortages. Significantly, this has prompted the Agency for Clinical Innovation (ACI) in New South Wales to contact PCI units throughout the state regarding changes in reperfusion strategy and potentially addressing perceived shortages in fibrinolytic drug stores [6].…”

COVID-19 and Heart, Lung and Circulation: Riding the 2020 Waves of Change in Australia & New Zealand✰

“…Adaptive health care delivery models and resource allocation would be required throughout the health care system [ 1 ]. Subsequently, nine comprehensive CSANZ Position or Consensus Statements [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ] and an Executive Summary of a tenth [ 16 ], were fast-tracked to on-line publication in Heart, Lung and Circulation . Designed as “living documents” that would be revised as needed (e.g., when more detailed information became available), each Statement comprehensively outlined the changed models of care with respect to different aspects of cardiovascular practice: acute heart failure and assessing the critically ill [ 7 ] assessing suspected acute coronary syndromes [ 8 ], interventional cardiology services delivery [ 9 ], echocardiography services [ 10 ], management of cardiac electrophysiology and cardiac implantable electronic devices [ 11 ], genetic heart diseases [ 12 ], paediatric and congenital heart disease [ 13 ], cardiac rehabilitation and secondary prevention [ 14 ], rural and remote cardiology [ 15 ], and cardiovascular nursing [ 16 ].…”

CSANZ COVID-19 Cardiovascular Nursing Care Consensus Statement: Executive Summary

“… Guidance should be taken from resources produced by the National COVID-19 Clinical Evidence Taskforce [ 5 ], Australian Federal Government PPE Guidelines [ 6 ], the Australian Commission on Safety and Quality in Health Care Guidelines [ 7 ], the Australian and New Zealand Intensive Care Society Coronavirus Guidelines [ 8 ], Australian [ 9 ] or New Zealand Resuscitation Guidelines [ 10 ] and COVID-19 recommendations by the International Liaison Committee on Resuscitation (ILCOR) [ 11 ], and the Australian College for Emergency Medicine [ 12 ]. Patients With Pre-Existing Cardiovascular Disease Have Higher Morbidity and Mortality Population groups with higher rates of pre-existing cardiovascular disease, such as Indigenous people, and those in rural and remote areas are at higher risk of poor outcomes [ 13 ]. Older people, including those in aged care settings are at high risk of poor outcomes [ 14 ].…”

“…Patients With Pre-Existing Cardiovascular Disease Have Higher Morbidity and Mortality Population groups with higher rates of pre-existing cardiovascular disease, such as Indigenous people, and those in rural and remote areas are at higher risk of poor outcomes [ 13 ]. Older people, including those in aged care settings are at high risk of poor outcomes [ 14 ].…”