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During the first quarantine, not only the anticipated cardiology volumes but also those needed for emergencies dropped dramatically after the total suspension of scheduled services.
This was revealed by a study carried out by VU researchers to evaluate the operation of the cardiology service during the first quarantine and the period after the quarantine, that is, from April to September-October.
Every second person got help
Professor Giedrius Davidavičius, a cardiologist at the VU Santara Clinics, who presented the main ideas about the research during the Seimas Health Affairs Committee meeting, said that most cardiology services returned to normal volumes only in September.
“During the first quarantine, the number of people who visited for outpatient health care services decreased significantly. This was especially true in April, when only one in two patients had access to a doctor. And the volume of outpatient services made a full recovery in September alone.
Delving deeper into the levels and types of services, from 45 to 60 percent. – Decrease in the number of consultations made by a secondary and tertiary level cardiologist. Of course, long-term monitoring services, the cardiovascular disease program have stopped, (…) such an important day hospital service is no longer provided, ”he said, adding that the volume of services was decreasing constantly in all municipalities at 40 -60%.
The aid needed was reduced by a quarter
G. Davidavičius noted that younger people, both cardiologists and general practitioners, did not use cardiology services in the first place.
“Although an attempt has been made to maintain immediate and urgent care, you can see that the number of patients seeking emergency care has been reduced by a quarter,” noted the doctor.
G. Davidavičius emphasized that the availability of inpatient services repeats the situation with outpatients and again only one in two patients received help. He pointed out that such important cardiac surgeries are performed in the hospital, for example, coronary artery bypass graft.
“Every month, the number of operations carried out in three medical institutions in the country varies between 250 and 300. After falling sharply in April, even in September, it did not reach the volume of procedures of last year,” he said.
There has also been a significant decrease in the number of diagnosed coronary heart disease cases compared to 2019.
More deaths at home
Although efforts were made to maintain cluster services in terms of myocardial infarction services, more than a third fewer people did not attend or were referred in April. Only in September the level of services returned to normal and was even slightly higher than last year.
G. Davidavičius pointed out that in case of myocardial infarction, mortality is 2-3 times higher without the necessary interventions.
“The mortality of the elderly is even higher if the acute infarction is treated with drugs or not,” explained the cardiologist.
Analysis of excess deaths at that time shows that cardiovascular mortality has increased in early quarantine and in the post-quarantine period.
“If we count in absolute numbers, from the beginning of January to the end of October, there would be about 700 more deaths. There has been a significant increase in deaths among men, as well as a change in the location of deaths: there are more deaths at home, ”he explained.
The fear of seeing doctors will return to the boomerang
Cardiologist of the Kaunas clinics prof. According to Jurgita Plisienė, the results we see after the first quarantine should not surprise us, because the services were suspended.
“However, I am concerned about the current situation, that what we see in the Kaunas clinics is that patients are afraid to apply. And we have free vouchers every day, you can visit the cardiologists in the Kaunas clinics this afternoon, but the patients do not apply.
For fear to return to the boomerang after a while, the number of neglected diseases, heart attacks and heart failure will increase. This, of course, primarily affects the worst performing individuals and is likely to lead to even greater deaths at that time. However, it also has an impact on the economy, because we are very aware that the heavier the patient, the more money he needs to cure him with the desired result ”, said the doctor during the meeting.
He noted that a similar situation is observed in other institutions: coupons are still available and patients are simply invited to register.
“The most important thing is that these services are currently available, at least in university hospitals,” said the doctor.
Patients walk the ways of the cross
For her part, MP Rimantė Šalaševičiūtė pointed out that often the biggest problem when seeing a doctor is for those who feel the first symptoms of the disease.
“People cannot be examined quickly due to the complicated procedure; you need to get referrals from a family doctor for initial exams, then you have to go to cardiologists. I’m talking more here about institutions in smaller municipalities. (…)
The queue of the cardiologists is two months ahead and without referral to the county hospitals or those dependent on the ministry, 5 large republican hospitals, where the patient remains within 3 or 5 days, but has to cross the paths of the cross.
So you are still frustrated because you have to wait, there is no specialist, so in the initial stage, if a patient has a problem, he refuses to help and decides to wait until the quarantine is over and he can go and fix things himself. suggested to the doctor without a referral.
Offers to validate a remote service
At that time, the president of the Lithuanian Society of Cardiology prof. Jelena Čelutkienė shared three possible and currently relevant proposals.
“One of them is the regulation of special remote cardiology services, because until now we have not had it. Until now, only GPs can officially provide that. Remote services would address the need for stable patients to receive counseling and continue their treatment.
The second suggestion would be to require another type of remote service. Just as people call an ambulance, they can call another channel when they need to be classified, who needs an emergency, who needs a planned emergency, ”he said.
The professor here also shared good practice in the UK, where there is a so-called pain in the patient’s knee in the chest.
“There are even trained specialist nurses who can understand how urgent the patient’s condition is. And then, either the patient needs urgent help, or he can be seen a few days later by a cardiologist, perhaps even without a family doctor, which in that case becomes a barrier for such unstable patients to access specialists.
The third proposal is a good practice for the Netherlands at this peak of the pandemic. They control the number of stables throughout the country and distribute the stable patients evenly in this way, maintaining other hospital care ”, suggests J. Čelutkienė.
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