Reperfusion – ABC CARDIOL

IJCS

Editorial

Challenges in Worldwide Cardiovascular Urgencies and Emergencies

The Sustainable Health Agenda for the Americas 2018-2030 represents the highest level of strategic planning and policy framework in the Americas. Approved by the Pan American Sanitary Conference — the top authority of the Pan American Health Organization (PAHO) — one of its main objectives is to achieve the highest attainable standard of health care. In this context, timely, affordable, and high-quality access to urgent and emergency health care is an essential requirement. The original research by Uchimura et al. aimed to identify the various challenges that hinder the effectiveness of urgent and emergency care networks. These challenges include inadequate regulatory mechanisms, difficulties in financial management across different levels of government, a lack of evaluation and monitoring culture, and weaknesses in information systems.

Over the past decade, the mortality profile in the Americas was dominated by noncommunicable diseases, which accounted for 78% of all deaths. The leading causes of death in the region were ischemic heart diseases (I20-I25), which accounted for 14.1% of total deaths, and cerebrovascular diseases (I60-I69), which accounted for 7.2% of total deaths.

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IJCS

Original Article

The Impact of the COVID-19 Pandemic on ST Elevation Myocardial Infarction Care Indicators at a Public Hospital in Brazil

Túlio Torres Vargas et al. Lucas Yuji Sonoda Maria da Graça Lepre Hawerroth Stefania de Figueiredo Coutinho … Gabriela Gonçalves Ferreira Mariane da Mata Morato Mendes Marilene Ribeiro Almeida Costa André Schmidt Antonio Pazin Filho

Abstract

Background

International publications have shown that the COVID-19 pandemic has negatively impacted the indicators of care for ST-segment elevation acute myocardial infarction (STEMI), with a potential increase in morbidity and mortality.

Objectives

To compare mortality, time from symptom onset to primary angioplasty (total delay [TD]), time from symptom onset to initial medical contact (patient delay [PD]), and time from initial medical contact to guidewire insertion in the hemodynamics laboratory (system delay [SD]) among patients admitted for STEMI at the Hemodynamics Service of Santa Casa de Passos, Minas Gerais, Brazil before and after the declaration of the COVID-19 pandemic by the World Health Organization, assessing the impact of the COVID-19 pandemic on STEMI care indicators.

Methods

This is a before-and-after study involving patients hospitalized with STEMI undergoing primary angioplasty. Data were collected retrospectively through medical record review. Clinical and demographic profiles and outcomes between the pre-pandemic and pandemic groups were compared using the chi-square test for categorical variables or Student’s t-test for continuous variables. A significance level of p < 0.05 was adopted.

Results

There were no differences in TD (pre-pandemic: 300 min [± 159 min], 95% CI 277.1 to 322.6; pandemic: 300 min [± 148 min], 95% CI 274.3 to 326.6, p = 0.97). However, there was an increase in SD (pre-pandemic: 145 min [± 97 min], 95% CI 122.7 to 167.9; pandemic: 178 min [± 96 min], 95% CI 157.4 to 197.9, p = 0.037). There was no increase in PD (pre-pandemic: 145 min ± 133 min; pandemic: 130 min ± 117 min, p = 0.44), and no differences in mortality were observed (pre-pandemic: 9.7%; pandemic: 12%, p = 0.49).

Conclusion

The COVID-19 pandemic increased SD in the management of STEMI in the region of Passos, Minas Gerais. There were no differences in PD, TD, and in-hospital mortality.