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[新型冠状病毒肺炎大流行期间重症监护病房的心血管疾病入院情况]

[Cardiovascular admissions in Intensive Care Units during COVID-19 pandemic].

作者信息

Vensentini Natalia, Zaidel Ezequiel J, Charask Adrián, Salzberg Simón, Gagliardi Juan, Perea Joaquín, Sosa Liprandi Álvaro, de Abreu Maximiliano, Mariani Javier, Tajer Carlos D

机构信息

Grupo de Estudio, Docencia e Investigación, GEDIC, Argentina. E-mail:

Hospital de Alta Complejidad El Cruce - Néstor Kirchner, Argentina.

出版信息

Medicina (B Aires). 2020;80(5):425-432.

Abstract

The COVID-19 pandemic has led to measures of social isolation, labor restrictions, a strong information campaign and the suspension of scheduled medical activities. The aim of this study was to describe the impact of these measures on the number of hospitalizations in Cardiovascular Intensive Care Units, with the hypothesis that the social behavior generated by this emergency promotes a decreased demand for medical care, even when severe cardiovascular disease is involved. We compared the number of admissions in March-April 2010-2019 versus March-April 2020, based on a prospective study including six institutions (three public and three private) that use Epi-Cardio® as a multicenter registry of cardiovascular care unit discharge. Altogether, we included 6839 patients discharged during the 11-year study period (2010-2020). The average number of patient admissions on March-April 2010-19 was 595 (CI 95%: 507-683) and decreased to 348 in 2020 (fall of 46.8%, p < 0.001). The reasons for hospitalization were classified into 11 groups and a statistically significant reduction was seen in 10 of these groups: cardiovascular surgery 72.3%, electrophysiological interventions 67.8%, non-ST acute coronary syndromes 52.6%, angioplasties 47.6%, arrhythmias 48.7%, heart failure 46%, atrial fibrillation 35.7%, ST elevation myocardial infarction 34.7%, non cardiac chest pain 31.8%, others 51.6%. Although with low prevalence, hypertensive crisis increased in 89%. The abrupt decrease observed in the number of admissions due to critical pathologies may be considered an "adverse effect" related to the measures adopted, with potentially severe consequences. This trend could be reversed by improving public communication and policy adjustment.

摘要

新冠疫情导致了社交隔离措施、劳动限制、大规模信息宣传以及常规医疗活动的暂停。本研究旨在描述这些措施对心血管重症监护病房住院人数的影响,其假设是,即使涉及严重心血管疾病,此次紧急情况引发的社会行为也会导致医疗需求下降。我们基于一项前瞻性研究,比较了2010 - 2019年3 - 4月与2020年3 - 4月的入院人数,该研究纳入了六家机构(三家公立和三家私立),这些机构使用Epi - Cardio®作为心血管监护病房出院情况的多中心登记系统。在为期11年的研究期间(2010 - 2020年),我们共纳入了6839例出院患者。2010 - 2019年3 - 4月的患者入院平均人数为595例(95%置信区间:507 - 683),2020年降至348例(下降46.8%,p < 0.001)。住院原因分为11组,其中10组出现了具有统计学意义的下降:心血管手术下降72.3%,电生理干预下降67.8%,非ST段急性冠状动脉综合征下降52.6%,血管成形术下降47.6%,心律失常下降48.7%,心力衰竭下降46%,心房颤动下降35.7%,ST段抬高型心肌梗死下降34.7%,非心源性胸痛下降31.8%,其他下降51.6%。虽然高血压危象的患病率较低,但增加了89%。因危重症导致的入院人数突然减少可能被视为与所采取措施相关的“不良影响”,可能会产生严重后果。通过改善公众沟通和政策调整,这种趋势可能会得到扭转。

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