“Critical Organizational Issues for Cardiologists in the COVID-19 Outbreak: A Frontline Experience From Milan, Italy”: this is the title of article published in Circulation (the leading scientific journal in the cardiology field) by Professor Giulio Stefanini, cardiologist and lecturer at Humanitas University, Dr. Elena Azzolini, from the Medical Health Directorate and Professor Gianluigi Condorelli, Director of the Cardiovascular Department of Humanitas.

The article was created with the intention of sharing Humanitas’ experience in the management of the COVID-19 pandemic with the international community, with particular attention to the critical organizational issues in cardiology.

As Professor Giulio Stefanini explained: “The ongoing health emergency related to the new coronavirus infection (SARS-CoV-2) has had a major impact on our hospital organization and we found ourselves having to structure our hospital activity in a different way within a very short period of time. As cardiologists, we have particularly noted some critical issues in the management and treatment of cardiovascular diseases and we believe that sharing our experience is important, considering that Lombardy is the most affected region during this emergency in Italy. We hope that our work can be useful to other countries that will soon face this pandemic”.

Management of patients with cardiovascular diseases awaiting surgery

“One of the first measures taken by the Lombardy Regional Health Service, was to reduce planned hospital admissions up to 80% in order to increase the capacity of the facilities receiving patients with COVID-19. We therefore had to postpone 80% of the planned interventional procedures. In order to do this we had to adopt a strategy of selecting the patients eligible for postponement by stratifying the risk according to various clinical factors”, explained Prof. Stefanini.

Continuing to ensure timely care for patients with acute heart attacks

“Ensuring that patients with acute myocardial infarction have promt access to treatment is a key factor. In order to treat these patients in compliance with the guidelines, but at the same time preventing their exposure to the SARS-CoV-2 virus, the Lombardy Regional Health Service has restructured the so-called AMI (Acute Myocardial Infarction) network by reducing the network’s cardiological hubs from 55 to 13 in order to optimize processes and resources. The result has been a greater number of patients in a limited number of facilities with the risk of prolonged management times,” the Professor pointed out.

Ensuring the safety of healthcare professionals

“The final aspect concerns about the safety of healthcare professionals involved in the management of patients with acute myocardial infarction who need urgent coronary-artery surgery and whose positivity to the SARS-CoV-2 virus is not always known. Unless these patients have been swabbed and have tested negatively (and therefore do not pose a risk to others), they should be managed as if they were patients with COVID-19 in order to protect healthcare professionals from the risk of infection,” the specialist specified.

“In conclusion, all resources and efforts put in place to limit the spread of SARS-CoV-2 infection and to treat patients with COVID-19, should not compromise the standard of care for the treatment of cardiovascular disease. Therefore, we think it is important to promote a close collaboration of cardiologists with other specialists involved in the management of these patients; to define pathways to properly manage the diagnosis and treatment of cardiovascular diseases in patients with COVID-19 and non-infected patients, ensuring the safety of health professionals; to strengthen cooperation among different hospitals to centralize services for the treatment of cardiovascular diseases”, concluded Professor Stefanini.