After Covid-19, heart care can no longer wait

TIME is a key factor in protecting and saving the heart. Unfortunately, in the era of Covid-19, the waiting lists have lengthened and now it is necessary to recover to cope with the many problems related to cardiovascular health, which afflict about seven and a half million people in our country. To launch the message are the experts gathered on the occasion of the conference Thinkheart 2021, scientific appointment of the Italian Society of Interventional Cardiology (GISE), also in light of the really worrying report on what happened last year.

“The Italian hemodynamics laboratories closed 2020 with a 20% reduction in activity – he explains Giuseppe Tarantini, president of the Scientific Society. At the beginning of the pandemic we had a contraction of 72% for transcatheter aortic valve replacement, 80% for the mitral clip, 91% for the closure of the left auricle and 97% for that of the patent foramen ovale. We have recovered what we can, making incredible efforts, but it is not enough. We need to break down waiting lists and reshape the relationship with the territory, on which the care of the cardiovascular patient has shifted in the last year. Telemedicine must also enter the Recovery Fund in our area ”. Among the objectives indicated by the experts in the first place there is obviously the elimination of waiting lists. A figure for everyone: for a planned coronary angioplasty intervention, for which the national average wait is around 20/25 days, now months are expected, with certainly worrying prognostic prospects.

“We also report that the waiting lists, in the face of a reduction in activity as a whole, have instead had a significant increase – says Tarantini. This tells us how much the heart of this country has suffered in the last year, between initial fear of contagion, conversion of departments and blocking of scheduled activities. We now need a National restart cardiological plan, which provides for a reorganization of the hospital-territory relationship, to promptly and appropriately manage coronary and structural cardiac pathologies. We must identify the patients most at risk, review the priority criteria in access to care, establish a territory-hospital information flow, invest in technologies, innovation and non-invasive diagnostic-therapeutic options, those that allow the patient to be brought home, in better conditions and shorter times “.

According to the data of a survey promoted among the members of the companies ARCA (Regional Associations of Outpatient Cardiologists) and ANCE (Association of Cardiology of the Territory, former National Association of Extra-hospital Cardiologists), however, trends emerge that must find an answer. “It is clear how much Covid-19 has shifted the need for care of the cardiovascular patient on the territory and, at the same time, has impacted the latter’s ability to respond in a timely manner to the requests received: for about 57% of the sample, the main barrier was the waiting time for a medical visit, followed by an increase in the number of patients on treatment (37%) – explains the president-elect GISE Giovanni Esposito. The pathologies most affected by this “shift in management” in the area concern heart failure, arterial hypertension, cardiac arrhythmias and heart disease “.

And he concludes: “Italy cannot lag behind on telemedicine, even in the field of interventional cardiology. There is an under-dimensioning of the health needs of the population, especially the elderly and frail, already so badly hit by the epidemic. Prevention has become an unpronounceable word. Already in the pre-Covid era we had denounced the inequality of access to standard care treatments. Last year we committed ourselves by producing a Covid protocol which was then shared by colleagues from all over the world, we put forward our proposals in a “Cardio Priority” Manifesto, we monitored the progress of the activity by administering surveys in all hemodynamics. I Now is the time to network, activate a Hospital-Territory cross-talk, making them dialogue through the single computer health record. Only thanks to an efficient flow of information will we be able to intervene in a timely manner on people’s cardiovascular health problems, whether or not they are on the waiting list for an interventional procedure. The National Restart Cardiology Plan must consider the greater safety and efficacy of the percutaneous approach compared to interventions that require intubation and which present a greater risk of complications and must classify procedures on structural cardiac pathologies, such as the treatment of severe aortic stenosis, as non-postponable. , mitral regurgitation and the closure of the left auricle “.