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COVID-19 : impacto no internamento do serviço de Cardiologia do CHULN
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Passados 100 anos desde a última pandemia, conhecida como Gripe Espanhola de 1918, a disseminação do novo Coronavírus SARS-COV-2 teve o seu início em Dezembro de 2019 a partir da cidade de Wuhan, China. Desde logo os sistemas de saúde depararam-se com uma sobrecarga significativa de doentes COVID-19, tendo sido necessária uma rápida reforma e reorganização dos cuidados de saúde em geral.
O objetivo deste estudo retrospetivo é a análise das mudanças do volume da atividade assistencial, dos diagnósticos, do perfil e nas características de 427 doentes internados no Serviço de Cardiologia do Centro Hospitalar Universitário Lisboa Norte na primeira e na segunda vagas da pandemia (respetivamente, nos períodos entre 19/03 e 31/05 de 2020, e 01/01 e 31/03 de 2021) e no período pré-pandémico homólogo à primeira vaga da pandemia (19/03 a 31/05 de 2019), com os seguintes diagnósticos: síndrome coronária aguda, insuficiência cardíaca, bradiarritmias, taquicardia/fibrilhação ventricular e estenose aórtica.
O principal resultado observado neste estudo foi a diminuição significativa do volume de internamentos durante a 1ª vaga (-44,8%) no conjunto dos diagnósticos estudados. No que respeita às características dos doentes houve uma tendência para o aumento do impacto e da gravidade das várias patologias, traduzindo-se por valores médios mais elevados de marcadores de lesão miocárdica, hepática e renal, e, no caso da síndrome coronária aguda, também por fração de ejeção ventricular esquerda menor.
A pandemia COVID-19 levou à modificação dos padrões anteriormente verificados, nomeadamente a redução do volume assistencial durante a 1ª vaga e a maior gravidade clínica à apresentação no serviço de urgência.
A century after the last pandemic, known as the “Spanish Flu” of 1918, the spread of the new coronavirus (SARS-COV2) began in December 2019, in the city of Wuhan, China. Therefore, health systems were overwhelmed with the significant burden of COVID-19 patients, requiring immediate changes and a fast reorganization of health care. The main purpose of this retrospective study was to analyse changes in the volume of health care activity, diagnoses, profile and characteristics of 427 non-elective patients admitted to the Cardiology Department of Centro Hospitalar Universitário Lisboa Norte during the first and the second pandemic waves (respectively, the periods between March 19th and May 31st 2020, and January 1st and March 31st 2021) and the pre-pandemic period homologous to the first wave of the pandemic (from March 19th to May 31st 2019), with the following diagnosis: acute coronary syndrome, heart failure, bradyarrythmias, ventricular tachycardia/fibrillation and aortic stenosis. The main result observed in this study was the significant decline in the volume of hospitalizations during the 1st outbreak (-44.8%) in the set of the diagnoses studied. Considering the patients’ characteristics there was a trend towards an increase in the impact and severity of the various pathologies resulting in higher mean values of myocardial, hepatic and renal injury biomarkers, and, in the case of acute coronary syndromes, to a more reduced left ventricular ejection fraction. The COVID-19 pandemic led to a modification of the previous patterns, namely to the significant reduction of the assistance volume during the first outbreak and the greater clinical severity at presentation to the emergency department.
A century after the last pandemic, known as the “Spanish Flu” of 1918, the spread of the new coronavirus (SARS-COV2) began in December 2019, in the city of Wuhan, China. Therefore, health systems were overwhelmed with the significant burden of COVID-19 patients, requiring immediate changes and a fast reorganization of health care. The main purpose of this retrospective study was to analyse changes in the volume of health care activity, diagnoses, profile and characteristics of 427 non-elective patients admitted to the Cardiology Department of Centro Hospitalar Universitário Lisboa Norte during the first and the second pandemic waves (respectively, the periods between March 19th and May 31st 2020, and January 1st and March 31st 2021) and the pre-pandemic period homologous to the first wave of the pandemic (from March 19th to May 31st 2019), with the following diagnosis: acute coronary syndrome, heart failure, bradyarrythmias, ventricular tachycardia/fibrillation and aortic stenosis. The main result observed in this study was the significant decline in the volume of hospitalizations during the 1st outbreak (-44.8%) in the set of the diagnoses studied. Considering the patients’ characteristics there was a trend towards an increase in the impact and severity of the various pathologies resulting in higher mean values of myocardial, hepatic and renal injury biomarkers, and, in the case of acute coronary syndromes, to a more reduced left ventricular ejection fraction. The COVID-19 pandemic led to a modification of the previous patterns, namely to the significant reduction of the assistance volume during the first outbreak and the greater clinical severity at presentation to the emergency department.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
COVID-19 Enfarte agudo do miocárdio Bradiarritmias Arritmias ventriculares Estenose aórtica Cardiologia