Faced with a heart attack, for care to be successful, several factors must come together: immediate consultation of the patient, early diagnosis and the rapid action of the institution (Getty)
Faced with the occurrence of a heart attack, the intervention time is vital: the objective is to save that heart that is being damaged by the obstruction of one of the arteries that nourish it with blood. For the care to be successful, several factors must come together: immediate consultation of the patient, early diagnosis and the rapid action of the institution to carry out the intervention.
During the COVID-19 pandemic, some of these variables were modified: this is reflected in a study carried out by specialists from the Argentine Society of Cardiology (SAC) presented during the 47th Argentine Congress of Cardiology that is carried out from today and until October 16 in virtual format and with the remote participation of nearly 10,000 registrants, along with prominent international guests.
The objective of the work, called the Report of the Continuous Registry of Infarction ARGEN-AMI-ST of the SAC in the first year of the pandemic was to compare the main indicators of AMI from April 2020 to March 2021 with the historical registry of admitted cases. For this, the ARGEN-AMI-ST infarction continuous registry database was analyzed, which includes patients with AMI (acute myocardial infarction) with ST segment elevation (a type of infarction with a reserved prognosis) since 2016 on a basis of which approximately 50 medical institutions in Argentina participate by providing their data.
According to the survey, out-of-hospital times (before arriving at the hospital) were impacted with delays: from the onset of pain to consultation: 120 minutes versus 105 minutes in the historical record, and from symptoms to admission to the institution (pain-admission): 180 minutes versus 130 minutes in the historical record (almost 1 hour more delay).
Myocardial infarction occurs when the cells of the heart begin to be damaged as a result of the sudden obstruction of one of the arteries that supply it with blood (INTERMOUNTAIN HEALTHCARE)
The time to reperfusion (regain blood flow), known as door-to-needle time, with the use of fibrinolytics did not differ significantly between the two periods (75 minutes versus 60 minutes), but an increase in total ischemia time was observed ( 232 minutes versus 180 minutes respectively). While the door-to-balloon time, that is, the time from when the patient entered the healthcare center until the angioplasty balloon was dilated inside their arteries, was shorter (95 minutes versus 118 minutes).
Myocardial infarction occurs when the cells of the heart begin to be damaged as a result of the sudden obstruction of one of the arteries that feed it with blood, this lack of oxygenation and nutrients produces ischemia of the heart muscle. Usually, the obstruction occurs due to a clot formed by breaking a plaque of cholesterol that was lodged in the wall of the artery. In this case, angioplasty is used to unclog the artery, an intervention through which a balloon catheter is inserted to remove the obstruction. During the procedure, in the vast majority of cases, a stent is placed. There are also, although with a lower level of efficacy, thrombolytic drugs that are applied with the aim of dissolving the thrombus.
Regarding the survey carried out, Carlos Tajer, former president of the SAC and one of the authors of the work, warned that “in all countries, fewer heart attacks were treated during the pandemic; It is estimated that the reduction was between 30% and 40%, something that is attributed to the lack of consultation due to fear of contagion ”.
Heart after acute myocardial infarction (CNIC)
The study made it possible to observe “a change in the age of the patients, an older age during the pandemic at the time of hospitalization, difficulties for referral and delays reflected in the times of consultation and admission to the institutions. But the most relevant thing was that the patients consulted with a delay of an additional hour compared to the previous average, which led to the total time of cardiac suffering being prolonged and compromising the results of the treatment to unclog the arteries “, he indicated
“However, there is something that was good: the way in which the treatment systems worked: although the patients consulted later, the institutional times were shorter than those that had been registered in the control period. Thus, the door-to-balloon time was shorter, “said Juan Gagliardi, director of the National Registry of Acute Myocardial Infarction with ST Segment Elevation (ARGEN-AMI-ST) of the Argentine Society of Cardiology and co-author of the study .
“It is likely that this responds to more specific structures being assembled, there was greater alertness and, therefore, patients received coronary reperfusion procedures (angioplasty) more quickly compared to the control group,” Gagliardi completed.
“During 2020 we clearly saw a reluctance to consult for acute symptoms due to fear of catching the virus, concern about the legal problems that could involve moving to the hospital for those citizens who were not exempt from isolation, cancellation of scheduled medical appointments, decrease in the staffing of health workers considered a population at risk for COVID-19 due to preventive leave, decrease in staffing of health workers due to viral infection and diversion of institutional resources (for example, intensive care beds for the priority care of patients infected by COVID-19, among others ”, stated Alejandro Hershson, president of the Argentine Society of Cardiology and of the Congress Organizing Committee.
A 40% drop in the use of coronary angioplasty was reported in patients with acute myocardial infarction and an 80% drop in procedures such as aortic valve replacement (Gettyimages)
“It is in this context that the study presented in Congress on the impact of inattention during the pandemic on patients with Acute Myocardial Infarction is relevant,” he said.
Different studies reported a 40% drop in the use of coronary angioplasty in patients with acute myocardial infarction and an 80% drop in procedures such as aortic valve replacement, which if not performed in patients with symptoms in the presence of stricture of this valve implies a very high risk of death in the two years following diagnosis.
“The main challenge posed by the pandemic was how patients with cardiovascular disease (CVD) had to be protected from COVID-19 infection and at the same time from the consequences of their own disease,” Hershson stressed.
The specialist stressed that “quality and access to health are essential to reduce mortality from CVD, but people who live in middle-income countries like ours have 3 times the risk of presenting fatal cardiovascular disease than those in countries high income. Although this increased risk is associated with socio-cultural differences, poor access to health services constitutes a central component of this excess of fatal cardiovascular events, ”said Hershson.
“The health system paid all the effort to prevent the health overflow that COVID-19 could have led and, without a doubt, the strategy was successful, but this was done at the expense of an impact on outpatient care due to the closure of clinics, delays in the care of cardiovascular problems that required interventions and reduction of available beds in the coronary unit; it is unrealistic to pretend that everything would have worked perfectly in the face of an unprecedented challenge of this magnitude, but we hope that we have learned enough so that in the face of new threats we can coordinate the care of cardiovascular and other neglected diseases with greater efficiency ”, highlighted Tajer.
“The lesson that this pandemic leaves behind is the great need that once someone has any symptoms, they do not have to delay the consultation because it can worsen the evolution of the condition,” said Héctor Alfredo Deschle, president-elect of the Argentine Society of Cardiology, who will take office in 2022.
Deschle added that “one of the obstacles that remain to be overcome in cardiovascular health care is the awareness on the part of the population that the most important thing in preventive matters is in their own hands: not smoking, not overeating. of salt, not having an extremely sedentary life, taking care of cholesterol and sugar levels ”.
Maintaining quality control of the care processes in the event of a heart attack made it possible to analyze the impact of the pandemic (Gettyimages)
But at the same time, “everything that the State can do helps a lot,” he said, for example assuming the role of “effectively warning which foods have the highest sugar, fat or sodium content,” he said. .
The Continuous Registry of Infarction ARGEN-AMI-ST of the SAC began to function 5 years ago and is made up of reports from some 50 medical institutions. It has included 3,815 cases, of which 627 occurred during the pandemic; Its objective is to maintain a quality control of the care processes in the face of a heart attack and allowed to analyze the impact of the pandemic, as well as to detect aspects that can be improved in the care of cardiovascular disease.
The 47th Argentine Congress of Cardiology, organized by the SAC, began today and will run until next Saturday. For three days, national and international specialists will discuss clinical cases, scientific papers will be communicated, and the latest news in technology and digital health will be announced.
It is the largest Spanish-speaking cariology congress in which cardiological societies from abroad also participate, such as the delegations of the World Heart Federation, the European Society of Cardiology, the American College of Cardiology and the American Heart Association, as well as representatives of the cardiological societies of Latin American countries, the Inter-American Society of Cardiology and the South American Society of Cardiology.
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