Patient with heart failure: importance to treat valvular diseases

Abstract

COVID-19 pandemic is causing an unprecedented burden on healthcare resources and this includes treatment of heart failure and valvular heart diseases (VHD). Percutaneous procedures have broadened the number of patients with VHD who could be treated. However, COVID-19 pandemic has challenged their implementation. The risk of in-hospital infection, resources reallocation, reduced access to hospital caused a substantial delay of VHD treatment with an increased risk of clinical worsening and mortality. Now, the pandemic is not ended and subsequent waves are likely. Reorganization of our healthcare resources is needed, including a proper algorithm for patients’ prioritization, based on the severity of their valve disease, their life expectancy, complexity of the intervention, and the resources available. A wider use of telemedicine for patients’ selection and follow-up and any measurement that can shorten the duration of the hospital stay must be adopted. Patients’ and healthcare staff screening for COVID-19 and all needed procedures to prevent infection will continue to be mandatory. Percutaneous procedures, compared to surgery, are associated with a lower risk of infection and a lower need for in-hospital resources, including a shorter duration of hospital stay. This may favour their adoption when the risk of viral infection is high.

Heart failure during the COVID‐19 pandemic: clinical, diagnostic, management, and organizational dilemmas

“…The pandemic has changed both routine hospital admission for HF and planned tests requiring specific skills such as heart catheterization. Interventional therapeutic procedures, such as left ventricular assist device (LVAD) and ICD/CRT implants, have been substantially delayed due to the changes in the priority of healthcare delivery 140,141 and focusing resources in patients with more urgent needing. 142,143 Transitioning to telehealth in order to reduce hospital admission may be advocated in this group of patients.…”

“…COVID‐19 pandemic caused a significant delay in treating valvular heart disease (VHD) in patients with HF. Reorganization of healthcare resources and implementation of algorithm for patients' prioritization based on the severity of their VHD, life expectancy, complexity of the intervention, and resources available have been proposed 140 . Compared with surgery, percutaneous procedures may be associated with a lower risk of COVID‐19 infection mainly due to the lower length of stay.…”

Clinical and Molecular Implications of Osteopontin in Heart Failure

“…Valvular heart disease represents one of the major causes of heart failure [ 161 ]. Osteopontin has been implicated in the regulation of mineral deposition in the cardiac valves, and alterations in osteopontin expression can lead to pathological valve changes [ 162 ].…”

Transvenous Phrenic Nerve Stimulation in Patients Who Are Difficult to Wean

“…In fact, both these cardiac diseases may lead to congestive lung pathology due to congestive heart failure, volume overload, elevated pulmonary capillary wedge pressure or excessive pulmonary blood flow. 4 The difference in maximum inspiratory pressure (MIP) despite similar diaphragmatic thickening fraction in both the arms suggests extradiaphragmatic pathologies. The change in MIP reflects the cumulative pathologies of the lung, pleura, diaphragm, chest wall and abdomen.…”

“…The exclusion of congenital heart disease and inclusion of valvular heart disease in this study is indeed surprising. In fact, both these cardiac diseases may lead to congestive lung pathology because of congestive heart failure, volume overload, elevated pulmonary capillary wedge pressure, or excessive pulmonary blood flow ( 4 ).…”