Arrhythmia

Car park clinic for cardiac patients as hospitals remain ‘eerily quiet’


The cardiology team at Austin Health in Melbourne have started a Pacemaker Car Park Clinic after a worrying drop off in patients with cardiac rhythm devices attending for annual check ups.

The COVID-19 pandemic led to a 40% decrease in implantable cardiac device checks, the Cardiac Diagnostics team noted, with only 155 checks performed in June 2020 compared to 260 during the same period in 2019.

The team therefore set up a drive through clinic for pacemaker checks, which started operating in a cordoned off area of the B1 level of the Austin Hospital car park in September.

“Implantable cardiac devices such as pacemakers and defibrillators need to be regularly checked using a specialised programmer to ensure they are functioning correctly,” says Jo McKenna, Chief Cardiac Physiologist.

“The batteries in these devices have a lifecycle of 5–15 years and need to be replaced before they reach end of life.”

“The drive-through clinic will enable patients to come to the hospital and have their implantable cardiac device checked without leaving their car,” she said

“It will help alleviate fears for patients who are concerned about coming into the hospital. It will also help with social distancing in our department and decrease the foot traffic through the hospital.”

Hospital emergency departments and outpatient clinics have reported an alarming drop off in patients attending for both acute and chronic conditions, with institutions such as the Victor Chang Institute urging patients to continue to see their healthcare provider, even if through telehealth.

The fear of COVID-19 that deters cardiovascular disease patients from seeking help is described as an emerging cardiac risk, according to a commentary in JAMA Cardiology this week.

Dr Benjamin Wessler of the Division of Cardiology, Tufts Medical Center, Boston, notes that cardiology units remain “eerily quiet” in the US where there has been a 40% drop in catheterisation laboratory activation for ST-elevation myocardial infarction care, presumably due to fears of COVID-19.

“For patients with myocardial infarction who are not treated with timely reperfusion therapy, sudden death, stroke associated with left ventricular thrombus, and mechanical complications are likely to return to rates seen before the modern treatment era,” he writes.

And he warns there is early evidence that this might be occurring in New York, where emergency calls for cardiac arrests have risen substantially in the weeks since COVID-19 has overtaken the city.

“If this trend moves across the country (or globe), then morbidity and mortality associated with myocardial infarction are likely to substantially increase.”

Dr Wessler says hospitals need to shed the perception of being ‘war zones’ and redefine themselves as ‘safe zones’.

“We will thereby restore our perceived and actual ability to provide proven, life-saving treatments to patients with other deadly but reversible conditions. The urgency of this restoration is magnified by the substantial increase in the number of coronary events to be anticipated in the months to come.”

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