key: cord-0829557-s7inwr0b
authors: Cortese, Bernardo
title: Covid-19 pandemic-some cardiovascular considerations from the trench
date: 2020-05-08
journal: Am Heart J
DOI: 10.1016/j.ahj.2020.04.026
sha: dd8c4fb926e857dc8d0d08b81e0391801727c9d4
doc_id: 829557
cord_uid: s7inwr0b

nan

J o u r n a l P r e -p r o o f By April 8th, 2020, an estimated 60-70% of every human and economic resource in the healthcare system in Northern Italy had been converted to caring for patients affected by Covid-19 disease. 1 Some numbers may help to understand where we are now and where we are going. The estimated rate of short-term death from the virus ranges between 2 and 7%, depending on the number of patients tested in a specific region. A variable number of patients need hospitalization (10-40%), with an average length of stay ranging between two and three weeks; two consecutive negative tests are required before discharge. Twelve percent of patients need ICU admission. 2 Occupancy of the ICU is very fluid; during April 3-6 in Lombardy it reached between 90 and 95% of maximum occupancy. 1 On this dramatic background, cardiovascular care in these regions has been significantly affected. In Lombardy, for example, hospitals have canceled office visits and routine elective diagnostic examinations (echocardiography, stress tests, coronary CT scans, etc.). Many hospitals have canceled invasive procedures, and even in hospitals where these procedures are still taking place, the rate has dropped 80-90%. Transcatheter aortic valve implantations are currently suspended across the region except for three centers, with only a few centers performing percutaneous aortic valvuloplasty as a bridge. Given these dramatic changes in the daily activities of the cardiovascular centers, it is imperative to anticipate the impact of these measures on the hard clinical outcomes of our patients with cardiovascular disease.

On March 8 th the regional healthcare system in Northern Italy identified 13 regional hubcenters for primary PCI of ST-elevation myocardial infarction (STEMI) and 41 spoke-centers, which would be Covid-dedicated hospitals. 3 This means that the regional emergency system will

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