ABC | Volume 114, Nº6, June 2020

Viewpoint Guimarães et al. Acute coronary syndromes in the Covid era Arq Bras Cardiol. 2020; 114(6):1067-1071 depict suggestions of care pathways that can be adjusted to local hospital circumstances. For this purpose, personal protective equipment (anti-splash goggles, facial protectors, respirator masks, caps and waterproof aprons/gowns) should be available to the entire team with strict institutional routines for their use. In addition, the creation of infarction networks, supported by telemedicine, can reduce mortality and length of hospitalization. The “Mission: Lifeline STEMI Systems Accelerator” 23 program observed the impact of the implementation of infarction networks in 167 hospitals, which treated 23,498 patients with acute ST elevation myocardial infarction. It documented key processes for improved care: pre-hospital catheterization laboratory activation (62% to 91%; P<0.001), single call protocol for external unit transfer (45% - 70%; P<0.001), and direct referral to the laboratory (avoiding delays in the emergency room) (48%- 59%; P=0.002). There was also a significant reduction in the time between the first medical contact and balloon inflation (88 minutes x 98 minutes; p<0.001). The LATIN 24-28 program connected 13 tertiary hospitals to 86 emergency care units (UPAs) in Brazil. It treated more than 6,000 patients with chest pain through telemedicine. The mean time for the diagnosis of infarction was 5 minutes. Primary percutaneous coronary intervention was used in 49% of these patients, reaching an average hospital mortality of 5%. In these networks, cases assisted early follow routes that avoid emergency care and lead the patient directly to the hemodynamics room, shortening the avoidable delays, which may even prevent the need for ICU, relieving the overload of the health care system. Future Perspectives The imminent economic recession caused by COVID-19 makes it challenging to maintain the population lockdown for long. This fact may theoretically imply a greater spread of the disease or the emergence of a second wave, with real chances of overcrowding and exhausting the health system. In this sense, providing a safe environment and adequate protocols for the treatment of patients with ACS is fundamental for coping with the pandemic, both in the public and supplementary health areas. The continuous review of institutional protocol management measures are fundamental for the management of patients with COVID-19 who have ACS, as well as for those without the co-existing infection. The medical staff should always be aligned and work as multidisciplinary teams, always alert to the potential cardiac side effects of the different drugs and therapies used to treat COVID-19. Training of the care team in relation to screening, biosafety, work routes, personal protective equipment, correct donning techniques, stringent observance of the doffing processes, patient care, isolation, hygiene measures, diagnostic adequacy and therapy avoiding the exposure of the health team will be imperative. Combined with all this preparation, it is urgent to warn the population that “myocardial infarction and heart diseases do not respect the quarantine”. Dedicated campaigns such as Coração Alerta (https://coracaoalerta.com . br) sponsored by the Brazilian Society of Hemodynamics and Interventional Cardiology (SBHCI), governmental, social and community actions and spaces for this purpose in the lay media and medical literature, as never before, can save lives. A new way of living and providing care has emerged. The real final outcome of everything we are experiencing is not yet known, but what is certain is that this acute complicated situation will pass and cardiovascular pathologies, especially ACS, cannot be put in the background. Therefore, the best available management should always be available and offered. With science, wisdom and common sense we will come out stronger out of this serious situation with many teachings that will further help us to qualify our care activity for the greater good, which is the protection of life. Author Contributions Analysis and interpretation of the data and Writing of the manuscript: Guimarães RB, Falcão B, Costa RA, Lopes MACQ, Botelho RV, Petraco R, Sarmento-Leite R. Potential Conflicts of Interest Roberto Vieira Botelho is a shareholder of telemedicine companies. ITMS Telemedicine network and Conexa Saúde. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics Approval and Consent to Participate This article does not contain any studies with human participants or animals performed by any of the authors. 1070