key: cord-0847935-ryz1sy6f
authors: Benetti, Federico; Del Prete, Sergio H.; Glanc, Mario; Navia, Daniel
title: COVID‐19: An Argentinian perspective
date: 2021-01-24
journal: J Card Surg
DOI: 10.1111/jocs.15235
sha: ab0cbe2d23748c41a000fe55b8df8d6129589625
doc_id: 847935
cord_uid: ryz1sy6f

At the time of this writing (July 6, 2020), the mortality rate reported for COVID‐19 in Argentina was <2%. Also, the country's critical care beds are ≤63% occupied. This achievement results from the excellent coordination and action by the Argentine Ministry of Health together with the 23 provinces and the Autonomous City of Buenos Aires of the nation for now. MATERIALS AND METHODS: Regarding cardiovascular care for patients over 65 years of age, a more accurate analysis could be performed when two comparative half‐yearly periods corresponding to the years 2019 and 2020 (pandemic time) were compared. The data collected regarding this age range revealed issues that had not previously been evaluated in our country. That undoubtedly proposes a different solution for the future based on a strict scientific analysis. RESULTS: The ratio of patients who received stents to those that underwent coronary surgery was 6 to 1, while the ratio of patients who had off‐pump surgery to those that underwent minimally invasive surgery was 69 to 1. CONCLUSION: An Argentinian perspective regarding cardiovascular care is good because the country has an excellent level of qualified medical training in its cardiac surgery and interventional cardiology services, as well as healthcare infrastructure distributed throughout the country, which will undoubtedly be able to respond to the new challenges posed by the post‐pandemic period.

The healthcare system in Argentina is comprised of three subsectors.

The public sector, financed with resources from general income for a consolidated amount that is equivalent to 2.7% of GDP, caters to the entire population, especially for citizens from low-income backgrounds. The second sector is concerned with social security and is under contributory financing that amounts to 3.9% of GDP. This The country has adapted its healthcare system to the pandemic by increasing its focus on critical care services, optimizing and increasing low complexity beds for mild/moderate cases (hotel beds and construction of modular emergency hospitals), the deferral of nonurgent hospitalizations, the procurement of supplies, personal protective equipment, and the reduction of the use of hospital beds of high complexity ( (ASPO) to protect its citizens. This was understood as a strict quarantine initially arranged for 2 weeks, and was carried out in different phases according to the emergency of cases in the different provinces and some specific localities of the country. The original isolation remains in force 120 days after it began in the Buenos Aires Metropolitan Area (AMBA), so it is social confinement to the extent that is unusual. 3, 4 In the social field, the implementation of the mandatory confinement generated a significant worsening of the preceding economic conditions, leading to a drop-in activity of 11.5% as early as

Argentina is the highest in the region. 5 The national government established a series of nonsanitary initiatives to alleviate the effects of the closure of many small-and medium-sized companies, through the following: Emergency Family Income (IFE)-a monthly bonus of approximately US $140 to be received by 8,300,000 highly vulnerable people, subsidies for the payment of wages up to a maximum of US $480, allocation of credits at zero rates to low-paid independent workers, distribution of food stamps, and other subsidies to pensioners and recipients of social assistance. At present, these initiatives amount to 2.14% of GDP. 6 year. And a similar phenomenon occurs with practices of high cardiovascular complexity, be it cardiac surgeries or percutaneous intervention, with an average reduction of 59% for the former, 62% for percutaneous intervention, and 58% for angioplasties of the neck vessels, abdomen, and lower limbs. It is known that in terms of acute coronary ischemia, a drop from 40% to 60% in the opportunity for timely reperfusion treatment implies an increase in mortality of the order of 3%-5%. It is enough to consider that a marginal increase in the relative risk of death from cardiovascular causes between 10% and 15% could lead to an average excess of 8000 preventable deaths.

On the basis of information from the main solidary health financer in Argentina, the INSSJP, which provides coverage to 5 million beneficiaries, most of whom are over 65 years of age, it has been possible to cross data from the same semesters of 2019 and 2020 as well.

To break down what happened with cardiac surgical practices with and without extracorporeal circulation and interventional hemodynamics that have been carried out during the specific period of social confinement. These correspond to a total offer of 313 hemodynamic services and 170 cardiac surgery services throughout the country. In the case of TAVR, in March, April, and May, the implants fall to zero until June when they are placed. This arises from the type of scheduling practice. As a result, the need not to occupy beds, LIMA-LAD can be performed with minimal resources in a completely isolated surgical area of COVID-19, within the hospital. 12 Another option to consider for patients under these circumstances is the hybrid treatment of coronary heart disease. 13 decisions that allow patients with acute coronary disease to receive the appropriate treatment on time. About half of coronary cases are either urgent or emergent, which means they must be treated immediately. The other half are electives that can be programmed. The advantage of using minimally invasive cardiac surgery is the presence of less postoperative discomfort, faster healing times, and less risk of infections. The procedure also makes cardiac surgery possible in patients who were considered high risk for traditional surgery with extracorporeal circulation due to their age or medical history, adding to the low risk of associated percutaneous intervention. An

Argentinian perspective is good because the country has an excellent level of qualified medical training in its cardiac surgery and interventional cardiology services, as well as healthcare infrastructure distributed throughout the country, which will undoubtedly be able to respond to the new challenges posed by the post-pandemic period.

The authors confirm that the data supporting the findings of this study are available in INSSJP, Argentina.

http://orcid.org/0000-0002-8787-7926

Overview of Latin American Health Systems

Obtained from the Official Gazette of the Argentine Republic

Obtained from COVID19 Ministry of Health Daily Report

The social challenge in the days of COVID-19

Ministry of Health. Information, recommendations of the Ministry of Health of the Nation and prevention measures

Synthesis of the main fiscal economics in the framework of the Health Emergency by COVID-19

Total arterial off-pump coronary revascularization using bilateral internal thoracic arteries in triple-vessel disease: surgical technique and clinical outcomes

MINI-off-pump coronary artery bypass graft: long-term results

Minimally invasive coronary artery bypass: twenty-year experience

Minimally invasive coronary surgery (the xiphoid approach)

Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularization

COVID-19: An Argentinian perspective