Abstract
The coronavirus disease-19 (COVID-19) pandemic has forced hospitals to prioritize COVID-19 patients, restrict resources, and cancel all non-urgent elective cardiac procedures. Clinical visits have only been facilitated for emergency purposes. Fewer patients have been admitted to the hospital for both ST-segment elevation myocardial infarctions (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI) and a profound decrease in heart failure services has been reported. A similar reduction in the patient presentation is seen for ischemic heart disease, decompensated heart failure, and endocarditis. Cardiovascular services, including catheterization, primary percutaneous coronary intervention (PPCI), cardiac investigations such as electrocardiograms (ECGs), exercise tolerance test (ETT), dobutamine stress test, computed tomography (CT) angiography, transesophageal echocardiography (TOE) have been reported to have declined and performed on a priority basis. The long-term implications of this decline have been discussed with major concerns of severe cardiac complications and vulnerabilities in cardiac patients. The pandemic has also had psychological impacts on patients causing them to avoid seeking medical help. This review discusses the effects of the COVID-19 pandemic on the provision of various cardiology services and aims to provide strategies to restore cardiovascular services including structural changes in the hospital to make up for the reduced staff personnel, the use of personal protective equipment in healthcare workers, and provides alternatives for high-risk cardiac imaging, cardiac interventions, and procedures. Implementation of the triage system, risk assessment scores, and telemedicine services in patients and their adaptation to the cardiovascular department have been discussed.
Highlights
The coronavirus disease-19 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initially originated in the city of Wuhan, China in December 2019
Even if personal protective equipment is worn for intubations, one study found that unexposed skin and hair can still be contaminated [19]
This delay was due to the COVID-19 screening tests that are mandatory for all patients according to the protocol set by the National Health Commission (NHC) [32]
Summary
The coronavirus disease-19 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initially originated in the city of Wuhan, China in December 2019. Owning to the rapid transmissibility rate of the virus, the outbreak spread across international borders affecting nearly 218 countries and territories worldwide. It was soon declared as a pandemic by the World Health Organization (WHO) on 11th March 2020 [1]. There have been suggestions to prioritize and triage cardiac patients which would potentially reduce the patient load and the risk of exposure to healthcare workers. This can be possible through the use of telemedicine, which enables specialists to timely evaluate patients [4]. We have discussed the massive impact of the pandemic on various cardiology services and proposed solutions to minimize the disruptions in the services
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