Results of the CorCOVID LATAM study
By Roxana Tabakman
During the first months of the pandemic, one in three patients (31.5%) reported problems obtaining their medications, 17% reported having stopped taking some medication, and 46.4% of patients had no contact with their doctors, according to the results of CorCOVID LATAM.
The observational study in 4,216 cardiometabolic patients from Latin America describes the situation they experienced during the first months of quarantine, and presents an alert and starting point for interventions.
Treatment discontinuation was more frequent among patients with established cardiovascular disease, who are considered at higher risk. Among patients who regularly engaged in physical activity, the majority (61.3%) reported having done less than usual. Adherence to a healthy diet was reported by only one in seven (14.7%), and 11.3% of volunteers who identified themselves as alcohol consumers admitted to increasing their intake.
If this situation persists, in patients with chronic conditions ( diabetes , high blood pressure and coronary artery disease), the restrictions associated with the pandemic could generate a greater risk of complications in the short and medium term.
Likewise, one third present severe depression , according to the subgroup of the study , CorCOVID Latam Psy. [ 1 ] The most frequent symptoms were anhedonia (79.4%), psychomotor changes (64%) and sleep disorders (61.6%).
Results… expected?
"We expected the change in habits. What caught our attention were the difficulties in accessing and discontinuing medications and the psychological impact," the project leader, Dr. Ricardo Lopez Santi, told Medscape in Spanish .
Symptoms of major depression were detected in 1,590 people (37.71% of the sample). It was more frequent in women, patients taking more than five medications per day, with poor treatment adherence, low levels of physical activity, and low consumption of fruits and vegetables. One limitation of the study is the lack of information on the baseline characteristics of the sample before the pandemic restrictions.
“Many patients did not receive adequate follow-up, which would have been justifiable in 2020, but not in 2021. Now we know where the risk lies: in the lack of adequate contact with patients, difficulty of access, treatment abandonment, and symptoms of major depression that went undetected. If we know that these are the weak points, the actions taken to address the second wave should focus on these aspects,” added Dr. Lopez Santi.
"With the work already accepted for publication in the Global Heart Journal, we have a moral obligation to share the information so that action can be taken urgently," he stressed.
Thirty-eight questions, 13 countries
The CorCOVID LATAM study is an initiative of the Inter-American Society of Cardiology (SIAC), which brings together the cardiology societies of the continent, in which 66 researchers from 13 countries participated (Argentina, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, Dominican Republic and Venezuela).
The inclusion criterion was any adult patient with cardiovascular (hypertension, coronary, myocardial, valvular or pericardial disease) or metabolic (metabolic syndrome, obesity, dyslipidemia, diabetes) pathology without evidence of present or past COVID-19. [ 2 ]
A 38-question survey was conducted to examine patient behavior over the past 30 days. Volunteers responded by July 15th, some during in-person visits, others by phone or videoconference. Half (50.9%) of the 4,216 patients were male.
The CorCOVID Latam Psy study used the diagnostic criteria for major depression from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which requires the presence of symptoms for a period of at least two weeks. [ 3 ] A positive response to one of the main criterion questions and three or more positive responses to additional criteria were considered as major depression.
"The study is very well designed, with a specific population and a significant number of participants. There are many studies in which electronic means are efficient in detecting symptoms, and the researchers conducted direct interviews, which strengthens the study," Dr. Marcelo Cetkovich, medical director and head of the Department of Psychiatry at the Institute of Cognitive Neurology (INECO), who was not involved in the study, told Medscape in Spanish .
Dr. Cetkovich noted that the data confirms "that what we detect early develops into major depressive syndrome," referring to research published by his team in the Journal of Affective Disorders , which identified symptoms of depression and anxiety in the first week of quarantine in Argentina in more than a third of the sample studied (n = 10,053). [ 4 ] "Now we await the mental health epidemic that was predicted from the beginning," the specialist added.
Depression may be strongly associated with increased cardiovascular risk factors, metabolic syndrome, and an increased burden of cardiovascular disease. It should be considered in daily clinical practice, especially during periods of chronic or prolonged stress, such as that related to COVID-19. [ 1 ]
An alert for the region
The actions must be tailored to each healthcare model. The group understands that the three core actions should consist of ensuring patient follow-up, ensuring the provision of medications, and establishing support pathways, added Dr. López.
"We want to issue the alert as soon as possible through the media and scientific societies so that it reaches the ministries and secretariats of health," said Dr. López.
“For this to happen, patients must be registered, their contact information updated, and we shouldn't wait for patients to request it, because it's very likely that many will be left without any kind of supervision. And when the health system is the one providing medications to chronic patients, it should guarantee them for longer periods. And we should also consider mental health interventions, perhaps telemedicine consultations,” Dr. López pointed out.
An anticipatory strategy is required to prevent the clinical worsening of cardiometabolic patients. Failure to adequately follow up with patients is a missed opportunity.