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Editorial
COVID-19 pandemic and infarctions: another call to reorganise our healthcare systems
  1. Ovidio De Filippo1,
  2. Fabrizio D'Ascenzo2,
  3. Gaetano Maria Deferrari1
  1. 1 Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy
  2. 2 Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza,University of Turin, Turin, Italy
  1. Correspondence to Dr Fabrizio D'Ascenzo, Molinette, San Giovanni Battista, Torino, Italy; fabrizio.dascenzo{at}gmail.com

https://doi.org/10.1136/heartjnl-2020-317981

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    ‘Time is muscle’. It has been almost 50 years since Professor Eugene Braunwald introduced the revolutionary hypothesis that the severity and the extent of myocardial injury resulting from coronary occlusion could be radically reduced by timely interventions.1 Since that time, research has focused on the identification of sources of delays, with the aim to optimise the delivery of care to patients suffering from acute myocardial infarction (AMI), thus minimising total ischaemic time from symptom onset to reperfusion therapy. This translated to guideline recommendations establishing several goals to be met in this context, such as optimal ‘time to diagnosis’ and ‘time to reperfusion’. Healthcare systems have been promptly reorganised over the last decades according to such endorsements, mainly by implementing networks between hospitals (‘hub’ and ‘spoke’) and the definition of geographical areas of responsibility, sharing protocols based on risk stratification and transportation by trained staff in appropriately equipped ambulances. While this strategy proved to be successful in ‘peaceful times’, resulting in significant outcome improvement in patients suffering from AMI, such organisation was never tested within a benchmark ‘crisis period’ that was supposed to severely overwhelm national health systems. The COVID-19 outbreak and the consequential measures of governments to contain the pandemic (ie, ‘national lockdowns’) put a strain on the established system of cardiovascular assistance, calling into question many assumptions of our ordinary clinical practice. In this issue of Heart, Kwok and collaborators2 reported a significant reduction in primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI) following the national lockdown in England. This finding supports the pieces of evidence arising from previous studies about a relevant reduction in hospital admissions for cardiovascular issues, such as acute coronary syndromes (ACS) and heart failure, during the COVID-19 pandemic.3 …

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    Footnotes

    • Contributors ODF, FDA and GMD critically wrote the editorial together.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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