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The stent crisis: cardiologists warn that the shortage has worsened and that "we are going to go back 50 years" in the care of heart attacks


Highlights: Argentine College of Interventional Cardioangiologists issues harsh statement. Says that the authorities do not respond to them and that the shortage of supplies is already affecting the emergency departments. In Argentina "more than 70,000 angioplasties are performed per year, of which between 23 and 25% are emergencies," says Martín Cisneros, president of CACI. Rescheduling is constant: there are delays of up to three weeks to get a stent, even if you have the highest prepaid plan.

The Argentine College of Interventional Cardioangiologists issued a harsh statement. He says that the authorities do not respond to them and that the shortage of supplies is already affecting the emergency departments.

While a large part of the country's economy seems to have put decision-making on hold until we see what happens to the dollar on December 10, the day of Javier Milei's inauguration as President, a transversally dollarized sector seems to have reached the limit of that wait.

The shortage of health supplies exacerbated the delay in the specialty of cardiology, which is highly detrimental to patients waiting for everything from a preventive study to a life-threatening operation.

As happened last week with the warning about possible shortages in dialysis centers, which puts at risk the sessions of 30,000 people in 300 national institutions, this Tuesday it was the turn of cardiology.

The lack of these supplies and contrast liquids that are used for angioplasties, MRIs, CT scans and other catheterization studies has plagued this medical specialty for months, as Clarín had warned weeks ago. Today, the activity is in agony due to the "stent crisis".

The meetings with the Ministry of Commerce and the Ministry of Health of the Nation, at the time demanded by the sector to avoid "0 stock" and guarantee the continuity of interventions, were useless. This is how the Argentine College of Interventional Cardioangiologists (CACI) describes it, which in the last few hours released a statement.

"The situation, far from beginning to be resolved, remains unchanged. The authorities did not show that they had listened to the majority claim of the different medical societies that represent a sector that is seriously affected by a situation that puts at risk the quality of patient care, especially those cases with risk to life, as is the case with cardiovascular diseases," said Martín Cisneros in the text. President of CACI.

The interventional cardioangiologist later explained to Clarín that in Argentina "more than 70,000 angioplasties are performed per year, of which between 23 and 25% are emergencies, heart attacks."

In addition to these cases of on-call care, Cisneros clarifies that the stent crisis affects scheduled surgeries, which is no small thing "because these patients must be operated on quickly."

Rescheduling is constant: there are delays of up to three weeks to get a stent, even if you have the highest prepaid plan.

Stent or go back 50 years

Stents are the devices used in angioplasty to sustain blocked blood flow. "They're all imported. There are many brands, there are those made in the United States, Germany, India and China," says Cisneros.

Catheters, also in short supply, are introduced into the arteries, and carry a third input in supply crisis: contrast liquids, which stain these pathways and guide procedures.

"Emergency care is in crisis, whether for coronary infarctions or other cardiological and cerebrovascular conditions. Instead of concentrating on performing the procedure, we have to be aware of getting the minimum supplies necessary for its performance and, many times, work in very precarious conditions," added Juan José Fernández, also an interventional cardioangiologist and vice president of the CACI, in the statement.

"Not being able to act in the coronary emergency with the performance of a primary angioplasty or with neurointerventionism, or with a stroke, can have very serious consequences such as an increase in disability associated with the episode or directly an increase in mortality," Cisneros remarks.

"50 years ago, the only resource to treat heart attack and vascular obstructions was coronary bypass. Today there are minimally invasive revascularization procedures, such as angioplasty, which allow the patient to return home during the day or after a night of hospitalization, and resume their usual tasks in less than a week. But many times we find that we lack fundamental elements to carry them out. We are about to go back 50 years in the care of heart attacks," says Marcelo Halac, secretary of CACI.

There are already several chambers and medical societies that denounce that there was no "more than momentary" solution to the clamp on imports of inputs or raw materials to manufacture them in Argentina. Nor to the indiscriminate increase in costs due to these restrictions.

No progress was made in the promised "trickle-down" release of dollars for the purchase of products in a critical state of stock, something that the Health Ministry announced on October 31 in a statement in which it highlighted the creation of a shortage traffic light, to establish priorities. Something that never happened.

With authorities leaving after the defeat in the runoff, doctors now say they haven't even answered the phone for weeks.

A speciality hit by several crises

Low cardiologists' fees and delays in payments by the health system are part of the overall crisis of the health system, which includes shortages of medical supplies.

The combination of factors puts at risk the care of patients with cardiovascular diseases, the leading cause of death in Argentina.

Alejandro Palacios, former president of CACI, illustrates the situation with an image: "Medicine is neglected." It separates doctors – "who often work without the minimum necessary resources" – and focuses on the authorities, "who must ensure that they provide a quality service to the population".

Largely due to this lack of prioritization of health, "many professionals emigrate or travel abroad to do on-call and internships in neighboring countries, receiving salaries far above those offered in Argentina," he said.

As happens with the doctors from Mendoza who cross into Chile to be paid in dollars. Those who practice this style of health migration, as pediatricians had already remarked to this newspaper some time ago, are called "swallow specialists".

According to the latest Vital Statistics report of the Directorate of Health Statistics and Information (DEIS), in 2021 107,403 deaths were registered in our country due to circulatory system conditions, including hypertensive, ischemic heart disease, heart failure, cerebrovascular diseases, atherosclerosis and other diseases of the heart and circulatory system.

Overall, this group of pathologies directly related to cardiovascular health is equivalent to 1 in 4 deaths (26.1%) due to known causes in our territory.


Source: clarin

All life articles on 2023-12-05

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