COVID-19 and its impact on acute coronary syndrome in-hospital epidemiology: a multifactorial analysis from a single center Hospital in the north-east region of Italy

2021 ◽  
Author(s):  
Paolo Diego L’Angiocola ◽  
Manuel Monti
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Care ◽  
Single Center ◽  
Coronary Syndrome ◽  
North East ◽  
The North ◽  
East Region ◽  
Center Hospital ◽  
Coronary Syndromes ◽  
Cardiac Care Unit

Objectives: we analyze all possible, multifactorial correlations between COVID-19 pandemic and epidemiological in-hospital epidemiologic variations in ischemic heart disease burden. Design: we developed a simple retrospective study surveying all acute coronary syndrome cases reporting an epidemiological analysis of a single center University Italian Hospital located in northest area of Italy in the city of Gorizia, comparing data collected in a period of two months (February and March) about definite diagnosis of myocardial infarction in the years 2019 and 2020 (COVID- 19 peak exposure interval) respectively. Methods: We retrospectively analyzed data regarding the two months of February and March 2020 about admissions to our Intensive Cardiac Care Unit (ICCU) with confirmed diagnosis of acute coronary syndrome. Differences among the two study periods were assessed using the χ2 test. Statistical significances were set at p< 0.05. All analyses were conducted using IBM SPSS software version 24.0 (IBM Corp. Armonk, NY, USA). Results: we showed a remarkable decrease of acute coronary syndrome cases diagnosed and admitted to our Intensive Cardiac Care Unit when comparing the interval period between February and March 2019 to the same months of 2020 . This rate was significantly lower than either the rate during the earlier period in the same year (95% confidence interval [CI], 0.63 to 0.80; P<0.001). Conclusions: we showed an overall decrease of diagnosis of acute coronary syndromes during CODIV-19 pandemic; we relate this amount decrease of diagnosis to general underuse of cardiologic public services leading to reduced number of admissions for acute coronary syndrome cases and possibly undertreatment and death of out-of-hospital, “silenced” critical clinical cardiologic pictures due to generalized fear of COVID-19 in-hospital contagion.

scholarly journals Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e018934 ◽  
Author(s):  
Marta Viana ◽  
Andreia Borges ◽  
Carla Araújo ◽  
Afonso Rocha ◽  
Ana I Ribeiro ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Participation Rate ◽  
Coronary Syndrome ◽  
North East ◽  
The North ◽  
East Region ◽  
Cardiology Department ◽  
Long Time

ObjectivesTo estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions.DesignProspective cohort study.SettingPatients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months.ParticipantsBetween August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up.Outcome measuresReferral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians.ResultsPatients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers.ConclusionsCR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.

scholarly journals Platelet Volume Indices in Patients with Acute Coronary Syndrome

2020 ◽  
pp. 1-5
Author(s):  
Ekta Paramjit ◽  
S. Sudhamani ◽  
Anita Sharan ◽  
Sonali Pitale ◽  
Prakash Roplekar
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Care ◽  
Platelet Volume ◽  
Distribution Width ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Cardiac Care Unit

Background & Aims: Acute coronary syndrome is one of the leading causes of morbidity and mortality in the world and platelet hyperactivity with local platelet activation plays a crucial role in its genesis. As there is discrepancy regarding the significance of deranged platelet parameters, we aimed to study the role of platelet volume indices in the spectrum of coronary artery syndrome and to correlate them clinically. Study Design: The study was conducted by collecting the data of patients with Myocardial infarction from the Cardiac care unit registry along with their clinical history and investigations. Stable coronary artery cases were collected from the Catheterization Lab and compared with Age and Sex matched controls. All CBCs of the above groups were processed by a 5-part counter and the data generated was transferred to a master chart for statistical analysis. Place and Duration of study: The study was conducted in the Central Laboratory & Department of Pathology at D.Y. Patil Hospital, Navi Mumbai, India in collaboration with the Cardiac Care Unit and Catheterisation Lab of the hospital for a period of two years. Methods: A total of 122 cases were studied and grouped into 5 groups according to presentation and the platelet volume indices of these were compared with 38 matched controls and statistically analysed. Results: Mean Platelet Volume and Platelet Distribution Width of patients with ST elevation Myocardial Infarction (STEMI) and Non ST elevation Myocardial Infarction(NSTEMI) were increased marginally in number when compared to Stable Coronary Artery Disease(SCAD) and Control group, however this was not statistically significant. Platelet Large Cell Ratio (PLCR) was significantly raised in STEMI cases only (P = 0.09), so it may prove to be a better marker for the disease (P = 0.09). Platelet counts in various groups when compared with controls gave inconsistent results i.e SCAD vs Control significantly decreased (P = 0.07) and STEMI vs Control significantly increased (P = 0.01). Conclusion: The platelet volume indices in suspected acute coronary syndrome cases showed various changes, but present data failed to be diagnostically significant. However this data may later help to characterise further relationship between Acute coronary syndrome and platelet function in subsequent studies.

Bleeding and haemostasis disorders

2015 ◽  
Author(s):  
Pier Mannuccio Mannucci
Keyword(s):  
Acute Coronary Syndrome ◽  
Bleeding Complications ◽  
Cardiac Care ◽  
Preventive Strategy ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Haemostatic Agents ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Cardiac Care Unit

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drugs (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), thrombotic microangiopathies, such as thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.

scholarly journals The Effect of Warm Footbath on the Quality of Sleep on Patients with Acute Coronary Syndrome in Cardiac Care Unit

2019 ◽  
Vol 8 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Hassan Talebi Ghadicolaei ◽  
Mohammad Ali Heydary Gorji ◽  
Babak Bagheri ◽  
Jamshid Yazdani charati ◽  
Zoya Hadinejad
Keyword(s):  
Acute Coronary Syndrome ◽  
Sleep Quality ◽  
Sleep Disorders ◽  
Cardiac Care ◽  
Control Group ◽  
Quality Of Sleep ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Cardiac Care Unit

Introduction: This study aimed to determine the effect of warm footbath before bedtime on the quality of sleep on patients with acute Coronary Syndrome in Cardiac Care Unit. Methods: This study was conducted on 120 patients admitted to CCU at Mazandaran Heart Center and randomly divided into two groups of intervention and control. In the intervention group, warm footbath was performed after the second night in hospital before bed time by 41 C water for 20 minutes for three consecutive nights; in contrast, the control group did not receive anything of this sort. The next day, St Mary's Hospital Sleep Questionnaire was completed to evaluate sleep quality. Then, the obtained data were analyzed using SPSS software and Friedman, Wilcoxon exact statistical tests. Results: The quality of sleep in the first night of hospitalization was different from the third night after the intervention in both groups and the improvement process of sleep quality was observed in both groups. Most patients had moderate impairments (23-36), which had not changed during the intervention. In intervention groups, 8 patients had severe sleep disorders (greater than 37), which declined to 1 after three nights of intervention. While, in the control group this number fell from 10 patients with severe sleep disorders to 5. Warm footbath had a great positive impact on patients suffering from severe sleep disorders (P<0.05). Conclusion: Although warm footbath did not improve the quality of sleep in all patients, it reduced the number of patients who had severe sleep disturbances.

scholarly journals Effect of aromatherapy on anxiety in patients with acute coronary syndrome hospitalized in cardiac care unit

2017 ◽  
Vol 6 (2) ◽  
pp. 331 ◽  
Author(s):  
Mahmood Reza Nematollahi ◽  
Javad Bazeli ◽  
Mahdi Basiri Moghaddam ◽  
Hossein Aalami
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Care ◽  
Coronary Syndrome ◽  
Cardiac Care Unit

Bleeding and haemostasis disorders

2017 ◽  
Author(s):  
Pier Mannuccio Mannucci
Keyword(s):  
Acute Coronary Syndrome ◽  
Bleeding Complications ◽  
Cardiac Care ◽  
Preventive Strategy ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Haemostatic Agents ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Cardiac Care Unit

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drug usage (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), such thrombotic microangiopathies as thrombotic thrombocytopenic purpura and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.

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