Business as Usual at Some Cath Labs, But Providers Still On Guard

Interventional cardiologists offered a glimpse of what returning to normal looks like in countries that are currently beating back COVID-19.

"Here in 2021, at this point where all our staff are vaccinated, all our patients are vaccinated, the only difference in our clinical practice is that we continue to test every patient for COVID," said Ehtisham Mahmud, MD, of the University of California San Diego, (UCSD), during a panel discussion at Society for Cardiovascular Angiography and Interventions (SCAI) virtual meeting.

Coronavirus cases are trending down in the U.S., where nearly 40% of adults have been fully vaccinated. Mahmud noted that cath labs have returned to business as usual for 6-8 months already at UCSD.

Similarly, things are looking up in the U.K., which has had a successful immunization program.

There, "COVID cases are virtually non-existent," said Mamas Mamas, BMBCh, DPhil, of Keele University in England. "I haven't seen a COVID patient in hospital now for a couple of weeks."

But is the pandemic really over for places with access to vaccines?

"I'm not sure it is. We're hearing some hotspots of double and triple mutants in the U.K., and so to my mind it's watchful waiting," Mamas said.

Many countries are still in the throes of loss and suffering due to COVID. An overwhelmed India now holds the record for new coronavirus cases in a day. The situation is so dire that travel to the U.S. from India will be restricted starting May 4.

"I think it's deceptive," said Celina Yong, MD, of Stanford University School of Medicine in California. "You walk around the hospital, and it feels like things are getting back to normal. But the world is such a small place. And even if it's better in my hometown, if it's still getting worse around the world; the chance of it being spread, once we let down our guard, I think is still a possibility."

For some, the immediate problem seems to be the backlog of cases. During the early phase of the pandemic, people were more afraid of that catching COVID from the hospital than having a heart attack, a SCAI consumer survey found. Emergency department and cath lab volumes plummeted, which translated into late-presenting ST-segment elevation MI (STEMI) cases and increased mortality.

"This is Israel's issue now because we succeeded in the vaccinations quite early ... It's not directly the virus, it's the backlog of cases. We try to do our best but it's not easy," said Danny Dvir, MD, of Shaare Zedek Medical Centre and Hebrew University in Jerusalem.

Dvir said he is not working 7 days a week to get through the backlog, and "it will be sad if we get there."

"But the days are long ... and we try to stratify patients and try to select the patients that need our help earlier than others. And it's not easy to decide who are the patients that need to come earlier. And I must say that when we lose a patient on the waiting list, it's really sad for all of us," he said.

Recently, investigators reported from the NACMI registry that primary percutaneous coronary intervention (PCI) was the preferred treatment of COVID-positive STEMI patients in North America, in line with the current guidance.

Enrollment in NACMI is ongoing, and investigators are hoping to expand it to South America, according to incoming SCAI President Timothy Henry, MD, of The Christ Hospital Health Network in Cincinnati. His group is also aiming to look at regional differences in STEMI care, changes over the course of the pandemic, and long-term outcomes of enrolled patients.

Even with registries like NACMI, however, there are missing pieces in the understanding of how COVID affected -- and continues to affect -- people with heart disease.

"We're studying the patients in the hospital. But those are the ones who actually made it. And what about the ones who are suffering at home? We haven't reached out to them yet in the right way. And I worry about when they're going to show up, what that might be down the road. And what we're going to do then," said Yong.

"And so, in my future efforts, and I hope all of ours, we'll try to figure out how we can reach and understand the patients who are not in front of our doorstep already," she said.

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