key: cord-0836354-qmoc1imb
authors: Sozzi, Fabiola B.; Belmonte, Marta; Schiavone, Marco; Canetta, Ciro; Blasi, Francesco
title: Considerations on cardiac patients during Covid‐19 outbreak
date: 2020-07-12
journal: Echocardiography
DOI: 10.1111/echo.14790
sha: 85dd89021e0f21860c3e497d9a1cfc9161d5bc8c
doc_id: 836354
cord_uid: qmoc1imb

nan

The ongoing coronavirus disease (Covid-19) pandemic has challenged globalized society to cope with the adoption of revolutionary healthcare measures. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) not only causes viral pneumonia but also acute myocardial injury and chronic damage to the cardiovascular system. 1 Currently, treating patients with cardiovascular disease (CVD) has become more challenging. A network of "hub" and "spoke" centers based on a system of specialized Covid-19 referral hospitals has been organized, in order to guarantee optimal medical care for patients with cardiac and noncardiac emergencies. Indeed, in Lombardy, Italy (the epicenter of the European outbreak), the STelevation myocardial infarction (STEMI) regional network has been rearranged, reducing by more than 75% the number of previous "hub" centers with 24 hours a day-7 days a week capacity to perform primary percutaneous coronary interventions (PCI), with 13 hospitals acting as "hubs" and other 42 acting as "spokes". The issue is amplified by the uncertain trend of this pandemic and by the unpredictable duration of the lockdown in some countries.

Moreover, the limited mobility measures and the weak integration between hospitals and territorial medicine, especially in high-risk areas, constitute an additional concern. The most vulnerable Covid-19-free subjects, such as patients with chronic cardiac disorders (ie, heart failure), have not routinely been followed-up in the hospital facilities during the pandemic. A rapid reorganization of cardiac services and practical guidance on how to manage chronic patients are needed in the shortest time. Telemedicine and telecardiology, integrated with the traditional management, appear to be precious tools for this emergent medical model, focused on the interplay between social, economic, environmental, and clinical factors. The flexible use of telematic devices, now available for teleconsultation and/or remote monitoring, allows the creation of integrated and personalized management programs that are effective and efficient. Indeed, in order to minimize risks of in-hospital SARS-CoV-2 spreading, telemedicine should be adopted whenever possible, especially for frail and older patients. Telemedicine is crucial during this viral outbreak, preventing patients' health from deteriorating because of mistreated CVD while coping with the high infectious risks. 3 Furthermore, telerehabilitation should be considered as an option for patients dis- 

Severe acute respiratory syndrome coronavirus-2 infection has major implications for the cardiovascular system. Given the decrease in new Covid-19 cases worldwide, now, we are approaching the so-called "Phase 2" that represents a challenge that is leading to a gradual return to pre-Covid-19 life. The epidemiological and clinical situation is rapidly evolving and routine clinical practice depends on institutions and local availability. We expect a continue and progressive update of the recommendations, which serve as general framework in cardiac patients. Marco Schiavone https://orcid.org/0000-0003-0720-3380

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