Cardiovascular disease and surgery amid COVID-19 pandemic

Bashir, Mohamad; Moughal, Saad

doi:10.1016/j.jvs.2020.04.479

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…After a rapid spread of SARS-CoV-2 in Italy [2] and other European regions, several countries issued strict infection control measures. Elective in-hospital procedures were widely cancelled or postponed to provide additional capacities for the treatment of COVID-patients in Germany, starting in March 2020 [3,4].…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

et al. 2020

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Aims The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany. Methods and results This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January-May 2019 (pre-COVID) to January-May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3-6.6), non-ST-segment elevation myocardial infarction (16.8-14.6), acute limb ischemia (5.1-4.6), stroke (35.0-32.5) and TIA (13.7-11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5-9.8%). Conclusions Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients' comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients' outcomes. Moritz Seiffert and Fabian J. Brunner share the first authorship.

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Section: Introductionmentioning

confidence: 99%

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

et al. 2020

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“…This case is classified as a diagnostic error due to anchoring bias, in which COVID-19 was suspected and accurate diagnosis was delayed [ 12 ]. The major reasons for this bias are the high probability of COVID-19 during pandemic and the insufficient examination to be performed due to infection control practices [ 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic delay of acute mitral regurgitation during the coronavirus disease 2019 pandemic: a case report

Kawabata¹,

Funakoshi²,

Ito³

et al. 2021

Int J Emerg Med

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Background Diagnostic errors or delays can cause serious consequences for patient safety, especially in the emergency department. Anchoring bias is one of the major factors leading to diagnostic error. During the coronavirus disease 2019 (COVID-19) pandemic, the high probability of COVID-19 in febrile patients could be a major cause of anchoring bias leading to diagnostic error. In addition, certain evaluations such as auscultation are difficult to perform on a casual basis due to the increased risk of contact infection, which lead to inadequate assessment of the patients with valvular disease. Acute mitral regurgitation (MR) could be a fatal disease in the emergency department, especially if there is a diagnostic error or delay in diagnosis. It is often reported that diagnosis can be difficult even though there is no treatment other than emergent surgery. The diagnosis of acute MR has become more difficult because coronavirus disease 2019 (COVID-19) pandemic could affect our daily practice especially in febrile patients. We report a case of a diagnostic delay of a febrile patient because of anchoring bias during the COVID-19 pandemic. Case presentation A 45-year-old man presented to the emergency department complaining of acute dyspnea and fever. Based on vital signs and computed tomography of the chest, acute pneumonia due to COVID-19 was suspected. Auscultation was avoided because of facility rule based on concern of contact infection. After admission to the intensive care unit, Doppler echocardiography revealed acute mitral regurgitation, and transesophageal echocardiography revealed mitral valve tendon rupture. After confirming the negative result for the polymerase chain reaction of severe acute respiratory syndrome coronavirus 2, mitral valvuloplasty was performed on the third day after admission. The patient was discharged 14 days after admission without complications. Conclusions In COVID-19 pandemic, anchoring bias suspecting COVID-19 among febrile patients becomes a strong heuristic factor. A thorough history and physical examination is still important in febrile patients presenting with dyspnea to ensure the correct diagnosis of acute mitral regurgitation.

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“…[2][3][4] A commonly used method is prioritizing and ranking the patients and making patient-based plans. [5,6] In this case, potential problems should be handled during this ranking process. For instance, a patient with coronary artery lesions may have a severe ischemic attack or die while waiting after the decision to delay the operation.…”

mentioning

confidence: 99%

“…Another strategy in the process of delaying diagnosis and treatment of cardiovascular diseases is to stay in touch with patients via telecommunication tools or face-to-face. [2][3][4][5][6] Moreover, to be proactive during these follow-ups (e.g. to perform an earlier operation for progressive symptoms) may minimize the potential problems caused by this delaying process.…”

mentioning

confidence: 99%

Normalization process of cardiac operations in COVID-19 pandemic

Gokalp¹

2020

Cardiovasc Surg Int

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Cardiovascular disease and surgery amid COVID-19 pandemic

Cited by 5 publications

References 14 publications

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Diagnostic delay of acute mitral regurgitation during the coronavirus disease 2019 pandemic: a case report

Normalization process of cardiac operations in COVID-19 pandemic

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