Di Tano Giuseppe, Verde Simone, Loffi Marco, De Maria Renata, Danzi Gian Battista
U.O. Cardiologia, Ospedale, ASST di Cremona.
Istituto Fisiologia Clinica CNR, Dipartimento Cardiotoracovascolare, ASST Grande Ospedale Metropolitano Niguarda, Milano.
G Ital Cardiol (Rome). 2020 Oct;21(10):750-756. doi: 10.1714/3431.34197.
During the COVID-19 pandemic, non-urgent outpatient activities were temporarily suspended. The aim of this study was to assess the impact of this measure on the management of the heart failure outpatient clinic at our institution.
We analyzed the clinical outcome of 110 chronic heart failure patients (mean age 73 ± 9 years) whose follow-up visit had been delayed.
At their last visit before the lockdown, 80.9% was in NYHA class II, had an ejection fraction of 37 ± 7%, and B-type natriuretic peptide level was moderately elevated (266 ± 138 pg/ml). All patients received loop diuretics, 97.2% beta-blockers, 64.9% an aldosterone antagonist, 60.9% sacubitril/valsartan (S/V), and 72.2% of the remaining patients were on angiotensin-converting enzyme inhibitor or valsartan therapy. Patients were contacted by phone during and at the end of the lockdown period to fix a new appointment and underwent a structured interview to assess their clinical conditions and ongoing therapy and to verify whether they had contracted SARS-CoV-2 infection. Twelve patients (13.2%) contracted COVID-19. None was hospitalized for worsening heart failure or reported defibrillator shocks and none changed autonomously the prescribed therapy. Overall, 75% of patients reported stable or improved general well-being from the last in-person visit, while 25% described subjective worsening due to the social effect of the pandemic. Unchanged body weight and blood pressure values were reported by 86% and 78.4% of patients, respectively. Lower blood pressure values compared to baseline were recorded in 15.2% of patients on conventional renin-angiotensin system inhibition vs 21% of those on S/V, one of whom had to down-titrate S/V for persistent but asymptomatic hypotension; 4 patients up-titrated S/V to 200 mg/day following phone indications.
Cancellation of scheduled follow-up visits during 3 months did not have significant negative effects in a cohort of stable patients with chronic heart failure on optimized medical therapy. Telephone support was effective in keeping connections with the patients during the lockdown, allowing appropriate management and implementation of drug therapy. In particular, patients who received S/V were not affected by delays in scheduled visits, confirming the tolerability and safety of this novel therapy in terms of both clinical and biohumoral parameters.
在新冠疫情期间，非紧急门诊活动被暂时中止。本研究旨在评估该措施对我院心力衰竭门诊管理的影响。
我们分析了110例慢性心力衰竭患者（平均年龄73±9岁）的临床结局，这些患者的随访就诊被推迟。
在封锁前的最后一次就诊时，80.9%的患者为纽约心脏协会（NYHA）II级，射血分数为37±7%，B型利钠肽水平中度升高（266±138 pg/ml）。所有患者均接受袢利尿剂治疗，97.2%接受β受体阻滞剂治疗，64.9%接受醛固酮拮抗剂治疗，60.9%接受沙库巴曲缬沙坦（S/V）治疗，其余72.2%的患者接受血管紧张素转换酶抑制剂或缬沙坦治疗。在封锁期间及结束时通过电话联系患者以确定新的预约，并进行结构化访谈以评估他们的临床状况、正在进行的治疗，并核实他们是否感染了SARS-CoV-2。12例患者（13.2%）感染了新冠病毒。没有患者因心力衰竭恶化住院或报告除颤器电击，也没有患者自主改变规定的治疗方案。总体而言，75%的患者报告自上次面对面就诊以来总体健康状况稳定或改善，而25%的患者因疫情的社会影响描述主观恶化。分别有86%和78.4%的患者报告体重和血压值未变。与基线相比，接受传统肾素-血管紧张素系统抑制剂治疗的患者中有15.2%记录到血压值降低，而接受S/V治疗的患者中有21%出现这种情况，其中1例患者因持续性但无症状的低血压不得不下调S/V剂量；4例患者根据电话指示将S/V剂量上调至每日200 mg。
在3个月内取消预定的随访就诊对一组接受优化药物治疗的稳定慢性心力衰竭患者没有显著负面影响。电话支持在封锁期间有效地与患者保持联系，允许进行适当的管理和药物治疗的实施。特别是，接受S/V治疗的患者不受预定就诊延迟的影响，从临床和生物体液参数方面证实了这种新型治疗的耐受性和安全性。
