NHSE/I have today published guidance on the provision of cardiology services during the Covid-19 pandemic, with the input and endorsement of BCS & BCIS. There is no doubt that providing care for infected patients is going to dominate our working lives for the next few weeks and quite possibly considerably longer. Accepting this, it is important to bear in mind that while there is no specific treatment for Covid-19, there are life threatening cardiac conditions which cardiologists do know how to treat and for which we have well organised and effective care pathways. We must not lose sight of this fact in the effort to do everything possible for patients severely ill from viral infection. A case in point is PPCI for STEMI. We have a national PPCI programme because there is very strong evidence that it is a more effective treatment than thrombolysis. Patients undergoing PPCI via the radial approach have significantly higher rates of reperfusion, better left ventricular function, fewer complications and are more likely to have a short, uncomplicated hospital stay. The short term investment in getting that patient to a catheter lab without delay is repaid rapidly and permanently. By contrast, giving thrombolysis may seem lower risk, but the clinical dilemmas raised in those (?25%) who fail thrombolysis, in terms of whether they then do go to the cath lab, but also the higher rates of heart failure etc, mean that this is not necessarily an easier option. Our personal view is that this means that PPCI must remain the standard of care for STEMI during the pandemic and that strenuous efforts need to be made to made to preserve PPCI services and to make them as efficient and as effective as possible. There are likely to be situations where it will prove impossible to provide timely PPCI and a patient needs to be thrombolysed but this should not be a default response and remain the exception rather than the rule. We also acknowledge the critical importance of having appropriate PPE available for cath lab staff, and we are actively lobbying about this on behalf of our members.
Finally, we hope that these guidelines are helpful. We wish members of BCS/BCIS our very best wishes at this time of challenge and stress… we KNOW that you will be up to the task.
Nick Curzen Simon Ray
British Cardiovascular Intervention Society British Cardiovascular Society
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