Giovanni Esposito, Cardiology Director "Federico II": "Call 118 immediately, which activates the heart attack network with dedicated routes and without any Covid risk for the patient"
The study published in Circulation shows that compared to the same period of 2019, in Campania, in the interventional cardiology centers that joined the study, angioplasty procedures decreased by more than 30% and in some cases it reached 50% in the first two weeks of lockdown. This decrease is due to the fact that the Coronavirus pandemic did not change the incidence of cardiovascular pathologies such as acute myocardial infarction, but unfortunately it led to the reduction of 118 calls for fear, obviously, of contagion.
Acute myocardial infarction is a major cause of death globally. The SARS-Cov-2 pandemic did not change the incidence of the disease; however, there has been an alarming decrease in patients requiring medical attention for acute myocardial infarction. In the midst of the Covid-19 emergency, the Campania Region kept the entire system dedicated to time-dependent emergencies such as those related to cardiac pathologies operational: in this way it contributed to the analysis of the phenomenon through a study that was published in Circulation, one of the magazines most authoritative cardiologists in the world.
Professor Giovanni Esposito, Professor of Cardiology and Director of the UOC of Cardiology, Hemodynamics and UTIC at the AOU "Federico II" and coordinator of the study, explains: "Since the beginning of the pandemic, the appeals of the most important scientific societies have followed one another cardiology not to underestimate the symptoms of the heart attack and activate the 118, considering the hospitals of the safe places and not fearing the contagion; what is being observed, however, is a worrying decrease in the number of patients requesting help for acute myocardial infarction, not for an actual reduction of the same, as probably for the fear of contagion ".
The authors of the work collected data related to coronary angioplasty operations performed in the 4 weeks after the first confirmed case of SARS-Cov-2 infection in Campania (February 27) and compared them with those performed in the 4 weeks preceding and with those performed during the same period in 2019. Dr. Raffaele Piccolo, Medical Director and researcher in Cardiology at the Federico II University and first author of the work, explains: "In the 20 centers of interventional Cardiology in Campania who participated in the work, they are approximately 1,800 angioplasties were performed from 30 January to 26 March 2020. Since the start of the SARS-Cov-2 pandemic, we have observed a reduction in procedures of more than 30% compared to the previous period and the same period of the previous year. This reduction has been uniform across our region and has gone up to 50% in the first two weeks of lockdown ”.
The study also highlighted particular categories at higher risk of reduced access to care: "Women - adds Prof. Esposito - and subjects over the age of 55 are the subgroups in which we have observed the largest reductions in angioplasty interventions for heart attack following the spread of COVID-19. This underlines the importance of sensitizing the most vulnerable categories to the timely request for treatment, especially taking into account the fact that the rescue machine, organized in the IMA Network has not been altered in the organization even in the most difficult moments ".
The Campania region, with approximately 5,8 million inhabitants, is the third largest region in Italy and therefore represents a very representative sample of the national population (around 10%). The data from the Federico II study are also in line with those reported by other experiences in Northern Italy, most affected by the pandemic, Spain and the United States. The effect of COVID-19 on the failure to resort to medical treatment in patients with myocardial infarction therefore seems to take on a global dimension. The cardiology community appears increasingly concerned by this trend, considering that in pathologies such as heart attack the treatment is time-dependent and the success may depend strictly on the early stages of the rescue. In addition, nationwide data show that only around 30% of heart attack patients access care through 118, while most go directly to the emergency room. The call to 118 has the undoubted advantage of directly activating the infarction network, significantly reducing the time of ischemia as the emergency room is bypassed and the patient is directly transported from 118 to the operating room to perform coronary angioplasty : “In the COVID-19 era, - concludes Esposito - the call to 118 would also have the additional advantage of avoiding, in the event of a heart attack, a possible contact with other potentially infected patients in the emergency room. Now more than ever it is essential to support communication campaigns to activate the rescue chain by calling 118 in the event of symptoms of myocardial infarction ".