RESUMO
OBJECTIVES: To determine whether telehealth acceptance by parents of children with heart disease is predicted by sociodemographic and/or by parental digital literacy, and to assess parental perceptions of telehealth usability and reliability. STUDY DESIGN: We conducted a single center study comparing telehealth acceptance versus visit cancellation/rescheduling for pediatric cardiology visits during the early phase of the COVID-19 pandemic. All parent/guardians who consented to survey completion received a validated survey assessing their digital literacy. Consenting parents who accepted telehealth received an additional validated survey assessing their perceptions of telehealth usability and reliability. RESULTS: A total of 849 patients originally were scheduled for in-person visits between March 30 and May 8, 2020. Telehealth acceptance was highest among younger, publicly insured, Hispanic patients with primary diagnoses of arrhythmia/palpitations, chest pain, dysautonomia, dyslipidemia and acquired heart disease. Among parents who completed surveys, a determinant of telehealth acceptance was digital literacy. Telehealth was determined to be a usable and reliable means for health care delivery. CONCLUSION: Although the potential for inequitable selection of telehealth due to sociodemographic factors exists, we found that such factors were not a major determinant for pediatric cardiology care within a large, diverse, free-standing pediatric hospital.
Assuntos
Alfabetização Digital/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Telemedicina/organização & administração , Adolescente , COVID-19/epidemiologia , Cardiologia/organização & administração , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pandemias , Pais , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The European Society of Cardiology's 0/1-hour algorithm improves the early triage of patients towards "rule-out" or "rule-in" of non-ST-segment elevation myocardial infarction. The HEART score is a risk stratification tool for patients with undifferentiated chest pain. We sought to evaluate the performance of the European Society of Cardiology 0/1-hour algorithm and the HEART score to evaluate chest pain patients in the emergency department. METHODS: In this prospective study, we applied the European Society of Cardiology 0/1-hour algorithm and the HEART score in 1355 consecutive patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome without ST-segment elevation. Patients were followed for non-ST-segment elevation myocardial infarctions and major adverse cardiac events at 30 days: death, non-ST-segment elevation myocardial infarction, or unplanned coronary revascularization. RESULTS: The European Society of Cardiology 0/1-hour algorithm classified 921 (68.0%) patients as "rule-out" and the HEART score classified 686 (50.6%) patients as "low-risk". The 30-day incidence of non-ST-segment elevation myocardial infarctions was 0.32% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 0.29% in the HEART score "low-risk" patients (p=0.75). The rate of major adverse cardiac events was 7.7% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 1.1% in the HEART score "low-risk" patients (p<0.001). CONCLUSION: The European Society of Cardiology 0/1-hour algorithm identified more patients with low risk of non-ST-segment elevation myocardial infarctions at 30 days whereas for major adverse cardiac events, the HEART score had a greater capacity to detect low-risk patients.
Assuntos
Cardiologia/organização & administração , Dor no Peito/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Intervenção Coronária Percutânea/estatística & dados numéricos , Estudos Prospectivos , Projetos de Pesquisa , Medição de Risco , Triagem/métodos , Troponina/sangueRESUMO
Cardiovascular disease (CVD) is the principal cause of death worldwide. Noninvasive studies have been used for the evaluation of CVD. Ensuring an accurate diagnosis of CVD requires well-trained and qualified professionals. IAEA has implemented regional training courses which are mainly aimed at professionals from countries with less economic development in order to raise their professional level so that it is in accordance with international standards and thus be able to homogenize the practice of nuclear cardiology globally.
Assuntos
Cardiologia/educação , Doenças Cardiovasculares/diagnóstico por imagem , Medicina Nuclear/educação , Cardiologia/organização & administração , Humanos , Agências Internacionais , Internacionalidade , Imagem de Perfusão do Miocárdio/métodos , Medicina Nuclear/organização & administração , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sociedades Médicas , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
Pediatric cardiology and cardiovascular surgery have witnessed significant advancements over the last two decades. In spite of this progress, congenital heart disease (CHD) still remains as one of the major causes of death in infants and young children in the United States. Many patient-related and patient-independent factors influence the outcomes in patients with CHD, one of which is the geographical location. In the US-Mexico border, management and outcomes of patients with CHD are further complicated by additional problems stemming from complex interplay between two different health systems, and socioeconomic disparities. In this article, the authors evaluate the various interplaying factors and describe the difficulties facing the practicing pediatric cardiologists in a US-Mexico border city.
Assuntos
Cardiologia/organização & administração , Atenção à Saúde/organização & administração , Cardiopatias Congênitas/cirurgia , Cardiologia/legislação & jurisprudência , Atenção à Saúde/legislação & jurisprudência , Cardiopatias Congênitas/economia , Humanos , Lactente , Cooperação Internacional , México/etnologia , TexasRESUMO
Cardiovascular diseases (CVDs) are the leading cause of death in Latin America and the Caribbean (LAC) region as well as worldwide. Lifestyle, nutritional habits and the upsurge of obesity have contributed to the increase in the prevalence of CVDs in the region. The role of nuclear cardiology in the management of patients with CVDs is well established. Particularly, myocardial perfusion imaging is widely used in LAC countries and has been increasingly integrated into the healthcare systems in the region for the diagnosis of coronary artery disease, risk stratification and to guide patient management. In its role to support countries around the world to address their health needs through the peaceful applications of nuclear techniques, the International Atomic Energy Agency (IAEA) has provided assistance to the LAC region for the establishment and strengthening of the nuclear cardiology practice. To that extent, the IAEA provides support in building capacities of multidisciplinary teams of professionals, the provision of medical equipment and the promotion of communication and exchange of knowledge among the different stakeholders. In addition, the IAEA encourages the participation of nuclear medicine centers in international multi-center research studies. In this paper, we present some of the projects through which the IAEA has supported the LAC region, including regional technical cooperation projects and coordinated research projects related to cardiology within the current multimodality approach to cardiac imaging.
Assuntos
Técnicas de Imagem Cardíaca/tendências , Cardiologia/organização & administração , Doenças Cardiovasculares/diagnóstico por imagem , Medicina Nuclear/organização & administração , Cintilografia/tendências , Região do Caribe , Doença da Artéria Coronariana/diagnóstico por imagem , Países em Desenvolvimento , Humanos , Pesquisa Interdisciplinar , Agências Internacionais , Cooperação Internacional , América Latina , Imagem de Perfusão do Miocárdio , Medição de RiscoRESUMO
Resumen: Objetivos: evaluar la transferencia de adolescentes desde Cardiología Pediátrica (CP) a Cardiología de Adultos (CA) en el Hospital Dr. Hernán Henríquez de Temuco (HHHT), determinando si recibieron su primera atención en CA en la fecha requerida y si los controles se ajustaron al plazo indicado. Evaluar si la complejidad de la cardiopatía y ruralidad se asocian al cumplimiento en ambos objetivos, en los pacientes sin seguimiento adecuado. Material y Método: revisión de fichas de pacientes atendidos en CP del HHHT que, cumplida la edad requerida, fueron transferidos a CA, entre Octubre 2014 - Julio de 2017. Resultados: De 53 pacientes transferidos de CPCA, 12 (22.6%) tuvo traspaso no efectivo; de ellos, 6 presentaban complejidad moderada-alta (66,6%) y 3 eran rurales (25%). De 28 pacientes ingresados a CA, 14 (50%) tenían seguimiento inefectivo; de ellos 13 (92.6%) tenían cardiopatías de moderada-alta complejidad y 3 (21.5%) provenían de áreas rurales. Conclusiones: la transferencia de CP - CA fue inefectiva en 22.6% de los pacientes; la complejidad de la cardiopatía no se asoció al resultado de la transferencia en este grupo. En CA el seguimiento fue inefectivo en la mitad de los pacientes; de ellos, 92.8% tenían cardiopatías de moderada-alta complejidad, lo que fue estadísticamente significativo respecto de la complejidad en todos los pacientes traspasados. El domicilio no estuvo asociado a la pérdida de pacientes en la transferencia ni en el seguimiento. Estos hallazgos nos permitieron tomar medidas de mejoría en la transferencia y los controles en CA que esperamos mejoren los resultados futuros.
Abstracts: Aim: To evaluate the transfer of adolescents from Pediatric Cardiology (PC) to Adult Cardiology (AC) at Hospital Dr. Hernán Henríquez de Temuco (HHHT). We determined whether they got their first care in AC on the required date and whether controls were performed on the period prescribed. Also, to evaluate whether the complexity of cardiac disease and the patient's place of residence influenced the accomplishment of the objectives, in patients without adequate following. Material and Method: Retrospective review of clinical records of patients that were treated in PC at HHHT who, having the required age were transferred to AC, between October 2014 and July 2017. Results: Of 53 patients that were transferred from PC to AC, 12 (22.6%) had an non effective transfer; 6 of them had moderate to high complexity cardiac lesions (66.6%) and 3 lived in rural areas (25%). Of 28 patients admitted to AC, 14 (50%) had a non effective follow up and 13 (92.8%) had moderate to high complexity forms of heart disease; 3 (21.5%) came from rural areas. Conclusions: Transfer of patients from PC to AC was not effective in 22.6% of patients. The complexity of the disease was not related to the results of transfer in this group. At AC the follow-up was not effective in half the patients; from these, 92.6% had moderate to high complexity heart disease, which was significantly different from the complexity of all patients transferred. The place of residence was not relates to transfer neither to follow-up. These findings allowed us to make improvement in the transfer processes and the follow up at AC.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Pediatria/organização & administração , Cardiologia/organização & administração , Transição para Assistência do Adulto/organização & administração , Cardiopatias Congênitas/terapia , Serviço Hospitalar de Cardiologia , Transição para Assistência do Adulto/estatística & dados numéricosRESUMO
Heart failure (HF) is the leading cause of death worldwide. Efforts to decrease HF mortality rates include a multidisciplinary approach management. Although evidence suggests that this has been an optimal strategy for treating HF, the model remains not widely implanted. The current article explores the rationale behind the formation of a Heart Team in a developing country and its development despite the lack of an allocated budget.
Assuntos
Cardiologia , Insuficiência Cardíaca/terapia , Equipe de Assistência ao Paciente , Cardiologia/organização & administração , Insuficiência Cardíaca/mortalidade , Humanos , México/epidemiologiaAssuntos
Cardiologia/organização & administração , Doenças Cardiovasculares/terapia , Lista de Checagem , Atenção à Saúde/organização & administração , Depressão/terapia , Transtorno Depressivo/terapia , Psiquiatria/organização & administração , Doenças Cardiovasculares/psicologia , Comportamento Cooperativo , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Humanos , Questionário de Saúde do PacienteRESUMO
PURPOSE: Cardiac rehabilitation (CR) programs decrease morbidity and mortality rates in patients with coronary artery disease, the leading cause of death in Latin America. This study was carried out to assess the characteristics and current level of CR program implementation in South America. METHODS: We carried out a survey of CR programs that were identified using the directory of the South American Society of Cardiology and through an exhaustive search by the investigators. RESULTS: We identified 160 CR programs in 9 of the 10 countries represented in the South American Society of Cardiology and 116 of those responded to our survey. On the basis of survey results from the responding programs, we estimate that the availability of CR programs in South America is extremely low, approximately 1 CR program for every 2 319 312 inhabitants. These CR programs provided services to a median of 180 patients per year (interquartile range, 60-400) and were most commonly led by cardiologists (84%) and physical therapists (72%). Phases I, II, III, and IV CR were offered in 49%, 91%, 89%, and 56% of the centers, respectively. The most commonly perceived barrier to participation in a CR program was lack of referral from the cardiologist or primary care physician, as reported by 70% of the CR program directors. CONCLUSIONS: The number of CR programs in South America appears to be insufficient for a population with a high and growing burden of cardiovascular disease. In addition, there appears to be a significant need for standardization of CR program components and services in the region.
Assuntos
Reabilitação Cardíaca , Cardiologia/organização & administração , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Desenvolvimento de Programas , Centros de Reabilitação/estatística & dados numéricos , Idoso , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Sociedades Médicas , América do Sul/epidemiologiaRESUMO
OBJECTIVE: Latin American healthcare has a common characteristic in the way countries provide assistance to the majority of their population, often represented by limitations in investment and most frequently by assigning funds to the wrong sectors of the system, which will never reach the neediest segments of the society. We want to share some lessons learned in nearly two decades serving the poorest segments of the society, despite limited funding, through the use of communication and information technologies. MATERIALS AND METHODS: The data analyzed come from the accumulated experience in a remote rural center in southern Venezuela (La Milagrosa Health Center in Maniapure, Bolivar State) and further experience in over 20 similar rural clinics replicated from that case. The methodology has been a retrospective evaluation of results with a constantly maturing and dynamic practice at three levels of care: (1) remote (basic clinic), (2) a virtual triage center, and (3) a specialty level. RESULTS: We analyzed qualitative results on access to specialty care of previously excluded communities (populations) and the significant cost reduction (social and financial) by avoiding unnecessary travel for the majority of consulting patients. In cases needing subspecialty care that require travel, the effectiveness of such activity is optimized in time and service. CONCLUSIONS: Communication and information technologies can provide significant savings to society and improve healthcare with the use of common and relatively inexpensive consumer-level devices if used in a basic, coordinated system of services with adequate training and follow-up.
Assuntos
Serviços de Saúde Rural/organização & administração , Telemedicina/organização & administração , Cardiologia/organização & administração , Humanos , Estudos de Casos Organizacionais , Áreas de Pobreza , Atenção Primária à Saúde , Estudos Retrospectivos , VenezuelaRESUMO
OBJECTIVE: To describe our international telemedicine experience in pediatric cardiac critical care. MATERIALS AND METHODS: This is a case series of pediatric patients teleassisted from the Cardiac Intensive Care Unit (CICU) at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, to the CICU at Hospital Valle del Lili, Cali, Valle, Colombia, between March and December 2010. An attending intensivist from the CICU in Pittsburgh reviewed cases, monitored real-time vital signs, and gave formal medical advice as requested by the attending physician in Cali. The network connection is a Cisco (San Jose, CA)-based Secure Sockets Layer virtual private network via the Internet that allows access to the web-based interface of the Dräger(®) (Lübeck, Germany) physiological monitor system. The videoconferencing equipment consists of a standard component on a custom-made mobile cart that uses an APC(®) (West Kingston, RI) uninterruptible power supply for portable power and 3Com(®) (Hewlett-Packard, Palo Alto, CA) for wireless connectivity. A post-intervention survey regarding satisfaction with the telemedicine service was conducted. RESULTS: Seventy-one recommendations were given regarding 53 patients. Median age and weight were 10 months and 7.1 kg, respectively. Ventricular septal defect, transposition of the great vessels, and single ventricle accounted for most cases. The most frequent recommendations were related to surgical conduct, management of arrhythmias, and performance of cardiac catheterization studies. No technical difficulties were experienced during the monitoring of the patients. Satisfaction rates were equally high for technical and medical aspects of telemedicine service. CONCLUSIONS: Telemedicine is a feasible option for pediatric intensivists seeking experienced assistance in the management of complex cardiac patients. Real-time remote assistance may improve the medical care of pediatric cardiac patients treated in developing countries.
Assuntos
Cardiologia/instrumentação , Doenças Cardiovasculares/diagnóstico , Cuidados Críticos/organização & administração , Pediatria/instrumentação , Telemedicina/organização & administração , Adolescente , Cardiologia/organização & administração , Criança , Pré-Escolar , Colômbia , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Masculino , Pediatria/organização & administração , Pennsylvania , Estudos Retrospectivos , Telemedicina/instrumentação , Adulto JovemRESUMO
BACKGROUND AND AIMS: Two thirds of patients with an abdominal aortic aneurysm (AAA) have relevant coronary artery disease (CAD). AAAs are prevalent in up to 16% of smokers with CAD. General screening of AAA is controversial. Aim was to assess the potential of finding AAA prior to rupture among patients with known CAD. Main endpoint was whether AAA could have been found during follow-up by sonography or at other time of cardiovascular evaluation. MATERIAL AND METHODS: Retrospective study. 213 consecutive, formerly unknown emergently operated AAAs, treated emergently for symptoms (n = 91) or rupture (n = 122) (rAAA) between January 1998 and June 2005. Patient charts were analysed and primary care physicians contacted. RESULTS: At presentation, mean age was 71 (+/-9) years, twenty (9%) were female. AAA had a mean diameter of 7.6 cm. Two thirds (143) were clinically obese (BMI 27 +/-5). 137 (64%) were active smokers, 32 (15%) had diabetes, 151 (71%) were hypertensive, and 80 (38%) received statin treatment. CAD had been diagnosed in 95 (45%) 9 years earlier and followed up. Thirty-five (16%) had had myocardial infarction. Echocardiography had been performed in 52 (24%). Thirty day mortality after open surgery was 25 (21%). CONCLUSION: All patients with rAAA had been seen by a GP or cardiologist within a year prior to presentation. The cost effectiveness of selective AAA screening should be evaluated in a larger study.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Ruptura Aórtica/prevenção & controle , Doença da Artéria Coronariana/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/terapia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/etiologia , Cardiologia/organização & administração , Estudos de Coortes , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/terapia , Feminino , Medicina Geral/organização & administração , Humanos , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
On 12 January 2010, a 7.0-magnitude earthquake devastated the island nation of Haiti, leading to the world's largest humanitarian effort in over 6 decades. The catastrophe caused massive destruction of homes and buildings and overwhelmed the Haitian health care system. The United States responded immediately with a massive relief effort, sending U.S. military forces and civilian volunteers to Haiti's aid and providing a tertiary care medical center aboard the USNS COMFORT hospital ship. The COMFORT offered sophisticated medical care to a geographically isolated population and helped to transfer resource-intensive patients from other treatment facilities. Working collaboratively with the surgical staff, ancillary services, and nursing staff, internists aboard the COMFORT were integral to supporting the mission of the hospital ship and provided high-level care to the casualties. This article provides the perspective of the U.S. Navy internists who participated in the initial response to the Haitian earthquake disaster onboard the COMFORT.