Cardiology referral during the COVID-19 pandemic

• Published in: Clinics (São Paulo, Brazil) Vol. 76; p. e3538
• Main Authors: Santorio, Nathalia Conci, Cardozo, Francisco Akira Malta, Miada, Rodrigo Freddi, Pitta, Fabio Grunspun, Tavares, Caio de Assis Moura, Habrum, Fabio Cetinic, Pinesi, Henrique Trombini, Magalhães, Iuri Resedá, Menezes, Maria Clara Saad, Caramelli, Bruno, Calderaro, Daniela
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-01-2021; Faculdade de Medicina / USP; Elsevier España
• Subjects: Cardiology Referral; Cardiology Training; COVID-19; MEDICINE, GENERAL & INTERNAL; Myocardial Injury; Original; Referral; COVID-19; Myocardial Injury; Cardiology Training; Referral; Cardiology Referral
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2021/e3538

This study presents the cardiology referral model adopted at the University of São Paulo-Hospital das Clínicas complex during the initial period of the coronavirus disease (COVID-19) pandemic, main reasons for requesting a cardiologic evaluation, and clinical profile of and prognostic predictors in patients with COVID-19.
In this observational study, data of all cardiology referral requests between March 30, 2020 and July 6, 2020 were collected prospectively. A descriptive analysis of the reasons for cardiologic evaluation requests and the most common cardiologic diagnoses was performed. A multivariable model was used to identify independent predictors of in-hospital mortality among patients with COVID-19.
Cardiologic evaluation was requested for 206 patients admitted to the ICHC-COVID. A diagnosis of COVID-19 was confirmed for 180 patients. Cardiologic complications occurred in 77.7% of the patients. Among these, decompensated heart failure was the most common complication (38.8%), followed by myocardial injury (35%), and arrhythmias, especially high ventricular response atrial fibrillation (17.7%). Advanced age, greater need of ventilatory support on admission, and pre-existing heart failure were independently associated with in-hospital mortality.
A hybrid model combining in-person referral with remote discussion and teaching is a viable alternative to overcome COVID-19 limitations. Cardiologic evaluation remains important during the pandemic, as patients with COVID-19 frequently develop cardiovascular complications or decompensation of the underlying heart disease.