Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 +/- 17 years) compared with 1041 patients (51% male, 63 +/- 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81-0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32-0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83-1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.Cardiolog

Can cardiac [I-123] m-iodobenzylguanidine imaging be used for risk stratification of patients with acute myocardial infarction?

Vascular Biology and Interventio

The new era of chest pain evaluation in the Netherlands

Cardiolog

The role of nuclear imaging in the failing heart: myocardial blood flow, sympathetic innervation, and future applications

Ventricular Dysfunction & Heart Failur

Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic

Introduction: The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists.Hypothesis: A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity.Methods: The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands.Results: From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity.Conclusion: The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future

Coronary Artery Calcium Scoring in Cardiovascular Risk Assessment

Vascular Biology and Interventio

Impact of coronary atherosclerosis on the efficacy of radiofrequency catheter ablation for atrial fibrillation

AIMS Coronary atherosclerosis has been associated with the development of atrial fibrillation (AF). However, little is known about the impact of coronary atherosclerosis on the outcome treatment of AF. The aim of this study was to investigate the impact of coronary atherosclerosis on the efficacy of radiofrequency catheter ablation (RFCA) for AF using multi-detector row computed tomography (MDCT). METHODS In 125 consecutive patients undergoing RFCA for AF, a pre-procedural MDCT examination (coronary angiography and/or coronary calcium score) was performed to evaluate the presence and severity of coronary atherosclerosis. Furthermore, all patients underwent a comprehensive echocardiographic evaluation to measure the left atrial size and to rule out structural heart disease. After RFCA all patients were regularly evaluated at the outpatient clinic. RESULTS After a mean follow-up of 12 ± 3 months, 78 patients (62%) had maintained stable sinus rhythm and 47 patients (38%) had recurrence of AF. Left atrial volume index was a significant predictor of AF recurrence after RFCA. The presence of coronary atherosclerosis on MDCT did not influence the efficacy of RFCA for AF. CONCLUSIONS The presence of coronary atherosclerosis on MDCT is not associated with a higher risk for AF recurrence after RFCA.Cardiolog

CT Coronary Angiography Is Feasible for the Assessment of Coronary Artery Disease in Chronic Dialysis Patients, Despite High Average Calcium Scores

Nephrolog

Automatic centerline extraction of coronary arteries in coronary computed tomographic angiography

Cardiolog