Practice guidelines – ABC CARDIOL

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Research Letter

Adapted Catheterization Laboratory Practices during the COVID-19 Pandemic: The Instituto Dante Pazzanese de Cardiologia Protocol

Daniel Chamié et al. Fernanda Oliveira Sérgio Braga José Ribamar Costa … Dimytri Alexandre Alvim de Siqueira Rodolfo Staico Ricardo Costa Galo Maldonado Luiz Fernando Leite Tanajura Marinella Patrizia Centemero Áurea Jacob Chaves Andrea Cláudia Sousa Leão Abizaid Rafaela Andrade Penalva Freitas Nancy Toledo Coelho Louis Nakayama Ohe Cely Abboud Fausto Feres

Introduction

The global coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus began in Wuhan, China, in December 2019, and it has affected over 4.4 million people worldwide, with 302,169 deaths as of May 16, 2020. ¹

Though respiratory symptoms are the most common presentation of COVID-19, cardiac involvement is a prominent feature of this disease, occurring in 20% to 30% of hospitalized patients and contributing to 40% of deaths. ^2-4 COVID-19-related cardiac involvement has been documented by elevations in cardiac biomarkers, and it often presents with changes in the ST-T segment in the 12-lead electrocardiogram (ECG), for which the catheterization laboratory team is often activated. Furthermore, catheterization laboratory activities must continue for care of non-COVID-19 patients who present with genuine acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), and highly symptomatic stable ischemic heart disease.

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Artigo Original

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Mariana A. Coutinho-Myrrha et al. Rosângela C. Dias Aline A. Fernandes Christiano G. Araújo … Mark A. Hlatky Danielle G. Pereira Raquel R. Britto

Background:

The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD.

Objectives:

To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD.

Methods:

The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI.

Results:

The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach’s α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO₂max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient.

Conclusions:

The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.

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Artigo Original

Implementing clinical guidelines on acute myocardial infarction care in an emergency service

Claudia Caminha Escosteguy et al. Alfredo Brasil Teixeira Margareth Crisostomo Portela Artur Eduardo Cotrim Guimarães … Sheyla Maria Lemos Lima Vanja Maria Bessa Ferreira Claudia Brito

BACKGROUND: The implementation of clinical guidelines on acute myocardial infarction (AMI) care produces better results. OBJECTIVE: To present a multidisciplinary program to implement these guidelines in a large public emergency center and check its impact. METHODS: Evaluation study on health services, with “before and after” type design, to assess the indicators of quality of AMI care before and after implementation of training strategies and to facilitate emergency teams’ acceptance of clinical guidelines. This includes the development of educational and awareness-raising materials and continued supervision. Relative risk estimate (RR) and confidence intervals (95%). RESULTS: Pre-program group, 78 cases of AMI; post-program group, 66 cases of AMI. Most cases were treated only in the emergency room, due to small number of vacancies in the coronary care unit. We observed a significant increase (p<0.05) in the use of various interventions evaluated (process indicators): beta-blockers, 83%; angiotensin-converting enzyme inhibitors, 22%; lipid-lowering agents, 69%; intravenous nitrate, 55%; coronary reperfusion in acute myocardial infarction with ST-segment elevation, 98%. The use of aspirin from the first day of the IAM reached 95.5% of cases. The loss of opportunity of coronary reperfusion in patients with this indication, reduced from 71.4% to 17.6% post-training. CONCLUSION: The program achieved a significant impact and its propagation to other units may contribute to better assist IAM in the public health system.

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Adapted Catheterization Laboratory Practices during the COVID-19 Pandemic: The Instituto Dante Pazzanese de Cardiologia Protocol

Introduction

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Background:

Objectives:

Methods:

Results:

Conclusions:

Implementing clinical guidelines on acute myocardial infarction care in an emergency service

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