Scientific Research Center Suriname (SRCS), Academic Hospital Paramaribo (AZP), Suriname.
Physical Therapy Department, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.
J Natl Med Assoc. 2023 Jun;115(3):283-289. doi: 10.1016/j.jnma.2022.12.007. Epub 2023 Apr 4.
During the height of the COVID-19 pandemic, there was a worldwide reorganization of healthcare systems focusing on limiting the spread of the virus. The impact of these measures on heart failure (HF) admissions is scarcely reported in Low and Middle Income Countries (LMICs) including Suriname. We therefore assessed HF hospitalizations before and during the pandemic and call for action to improve healthcare access in Suriname through the development and implementation of telehealth strategies.
Retrospectively collected clinical (# hospitalizations per patient, in hospital mortality, comorbidities) and demographic (sex, age, ethnicity) data of people hospitalized with a primary or secondary HF discharge ICD10 code in the Academic Hospital Paramaribo (AZP) from February to December 2019 (pre-pandemic) and February to December 2020 (during the pandemic) were used for analysis. Data are presented as frequencies with corresponding percentages. T-tests were used to analyze continuous variables and the two-sample test for proportions for categorical variables.
There was an overall slight decrease of 9.1% HF admissions (N pre-pandemic:417 vs N during the pandemic: 383). Significantly less patients (18.3%, p-value<0.00) were hospitalized during the pandemic (N: 249 (65.0%)) compared to pre-pandemic (N: 348 (83.3%)), while readmissions increased statistically significantly for both readmissions within 90 days (75 (19.6%) vs 55 (13.2%), p-value = 0.01) and readmissions within 365 days (122 (31.9%) vs 70 (16.7%), p-value = 0.00) in 2020 compared to 2019. Patients admitted during the pandemic also had significantly more of the following comorbidities: hypertension (46.2% vs 30.6%, p-value = 0.00), diabetes (31.9% vs 24.9%, p-value = 0.03) anemia (12.8% vs 3.1%, p-value = 0.00), and atrial fibrillation (22.7% vs 15.1%, p-value = 0.00).
HF admissions were reduced during the pandemic while HF readmissions increased compared to the pre-pandemic period. Due to in-person consultation restrictions, the HF clinic was inactive during the pandemic period. Distance monitoring of HF patients via telehealth tools could help in reducing these adverse effects. This call for action identifies key elements (digital and health literacy, telehealth legislation, integration of telehealth tools within the current healthcare sector) needed for the successful development and implementation of these tools in LMICs.
在 COVID-19 大流行期间，全球医疗体系进行了重组，重点是限制病毒的传播。在包括苏里南在内的中低收入国家（LMICs），很少有报道这些措施对心力衰竭（HF）入院的影响。因此，我们评估了大流行前后 HF 住院情况，并呼吁通过制定和实施远程医疗策略来改善苏里南的医疗保健可及性。
回顾性收集 2019 年 2 月至 12 月（大流行前）和 2020 年 2 月至 12 月（大流行期间）在帕拉马里博学术医院（AZP）因原发性或继发性 HF 出院 ICD10 代码住院的患者的临床（#每位患者的住院次数、院内死亡率、合并症）和人口统计学（性别、年龄、族裔）数据。数据以频率和相应百分比表示。使用 t 检验分析连续变量，使用两样本检验分析分类变量。
HF 入院人数总体略有下降 9.1%（大流行前：417 例，大流行期间：383 例）。与大流行前相比，在大流行期间（N：249（65.0%））住院的患者明显减少（N：348（83.3%）），而在大流行期间，90 天内再入院（75（19.6%）比 55（13.2%），p 值<0.00）和 365 天内再入院（122（31.9%）比 70（16.7%））显著增加，p 值均为 0.01）与 2019 年相比。在大流行期间入院的患者还患有更多以下合并症：高血压（46.2%比 30.6%，p 值<0.00）、糖尿病（31.9%比 24.9%，p 值<0.03）、贫血（12.8%比 3.1%，p 值<0.00）和心房颤动（22.7%比 15.1%，p 值<0.00）。
与大流行前相比，HF 入院人数在大流行期间减少，而 HF 再入院人数增加。由于面对面咨询的限制，HF 诊所在大流行期间处于非活动状态。通过远程医疗工具对 HF 患者进行远程监测有助于减少这些不利影响。这一行动呼吁确定了中低收入国家成功开发和实施这些工具所需的关键要素（数字和健康素养、远程医疗立法、将远程医疗工具整合到当前医疗保健部门中）。
