|Year : 2020 | Volume
| Issue : 3 | Page : 144-145
Impact of COVID-19 in the UAE cardiovascular services: A statement from emirates cardiac and emirates intensive care societies
Department of Interventional Cardiology, Al Ain and Al Noor Hospitals, United Arab Emirates University, Al Ain, United Arab Emirates
|Date of Submission||23-Aug-2020|
|Date of Acceptance||23-Aug-2020|
|Date of Web Publication||13-Oct-2020|
Prof. Abdulla Shehab
Department of Interventional Cardiology, Al Ain and Al Noor Hospitals, United Arab Emirates University, Al Ain
United Arab Emirates
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shehab A. Impact of COVID-19 in the UAE cardiovascular services: A statement from emirates cardiac and emirates intensive care societies. Heart Views 2020;21:144-5
|How to cite this URL:|
Shehab A. Impact of COVID-19 in the UAE cardiovascular services: A statement from emirates cardiac and emirates intensive care societies. Heart Views [serial online] 2020 [cited 2020 Oct 27];21:144-5. Available from: https://www.heartviews.org/text.asp?2020/21/3/144/297801
The novel coronavirus (COVID-19) pandemic has impacted everyone's life. The world is not prepared to deal with the current situation. With a devastating number of cases and fatality rates, the health-care professionals and societies are engaged in caring COVID-19 patients. The routine practice and management of patients with cardiovascular diseases particularly in patients with acute coronary syndrome (ACS) are at high priority due to higher mortality risk and the need for urgent interventions.
In order to deal with the pandemic, all the health-care service providers from government and private hospitals have collaborated to deal with COVID-19 and also ACS patients. The interventional cardiologists started to wear personal protection equipment (PPE) from the patient's arrival at emergency room to patient's discharge. It is also important to note that delay, which occurred at each stage, impacted the door-to-balloon (D2B) intervention. This delay may not be more than 10 min in normal time, as everyone sticks to their routine roles and have collaborative support in critical cardiac care.
In the UAE, the health administration was allowed to construct local guidelines in managing the patients with COVID-19 and also in other critical conditions. The Emirates Cardiac Society adopted twenty points following international guidelines, where the primary percutaneous coronary intervention (PPCI) was recommended for all patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients who did not respond to medical therapies.
The interventional cardiologists were divided into groups with structured working hours to manage ACS patients. Most of the catheterization laboratories became nonfunctional, elective procedures were stopped, and they started to use high-efficiency particulate air filters. Most government hospitals were turned into COVID-19 hospitals.
During the pandemic, 15% of the ACS patients were COVID-19 positive and are young aged, with no comorbidities, but had higher thrombosis burden.
In private hospitals, NSTEMI patients were provided with routine cardiac care and most of them were non-COVID-19 patients. Around 50% of the COVID-19 patients admitted with myocardial infarction had Type 1 coronary lesions. Moreover, elective PPCI procedures were continued and noninvasive procedures such as coronary computed tomography were prioritized.
During the pandemic, there has been a significant drop in ACS patients. This ranged from 30% to 60%. Interestingly, some asymptomatic COVID-19 patients had extremely abnormal chest X-ray findings and presented with STEMI. They received PPCI and had a favorable outcome. On the other hand, some were severely symptomatic with a high burden of thrombosis on their coronary angiograms. These required multiple aspiration devices, excess doses of anticoagulation, etc.
NSTEMI cases were initially higher but then later decreased, similar to STEMI. Pulmonary edema increased and may have been part of the COVID-19 manifestations. There were a significant number of late presentations of STEMI cases initially. We also started to witness consequences and complications in June and July 2020. Although thrombolytic therapy is the choice for highly suspected or positive cases, still PPCI remains the first choice for all cases with proper PPE and sterilization measures.
There was the adoption of telemedicine for chronic cardiac patients to manage their concern/s and to titrate their medication doses and frequencies.
Based on our intensive care society, initially, all major government hospitals have taken desperate measures to evacuate wards, stop outpatient department services, and stop all electives and extended short stay in emergency department to accommodate mild and moderate cases as well as patients under investigation until the results are out.
Many efforts were made to create COVID-19-compatible wards and extend intensive care unit (ICU) beds (beds, ventilators, and monitors). Many physicians with critical knowledge and skills in pediatric ICU, neonatal ICU, and pediatrics and medical residents became COVID-19 doctors. They had outstanding dedication and support.
The UAE intensive care experience of early ICU cases has been positive in using steroid, anticoagulation, and adequate hydration by hemodynamic monitoring. The thrombolysis in acute thrombotic disease has not been of adequate benefit. Therapeutic plasma exchange and convalescent plasma at an early stage had good outcomes. Most extubations occurred after 7 days (10 to 14 days). Depending on the patient's condition, extubation was planned. Bronchoscopy with bronchoalveolar lavage were done in some selective cases as in early planned tracheostomy to facilitate weaning from sedation. This had been found to be a successful modified strategy for ventilator management.
All cases had cardiac, liver, and kidney function monitoring while under treatment of chloroquine and antiviral agents as per the international protocol and in collaboration with multicentric studies.
Several COVID-19 patient were kept on ventilation and most were successfully treated. Currently several research works in collaboration with international bodies are on pipeline investigating the outcomes of various sugroups.
We learned the lessons in a hard way. It was a painful experience, which showed the degree of commitment and dedication of the great frontline team. Best practice was difficult to achieve as most of the released recommendations and guidelines were dissociated from reality. We learned that best practice should be based on realism, not idealism.