An Interview With Charlotte Roberts, ACNP-BC (Part 3 of the COVID-19 Interview Series)
Editor's Note: In recognition of our non-physician providers who contribute so much to the day-to-day management and, ultimately the outcomes, of high-risk and routine cardiac patients, I invited Charlotte Roberts, a nurse practitioner who has extensive experience in managing critical cardiac care, often while supporting medical and cardiovascular trainees in a university environment. These professionals with distinct "in the trenches" experience have played a significant role in shaping hospital responses to the COVID-19 cardiac crises. I appreciate Cha providing her insights about the role of planning and executing care during this stressful time.
- "The usually burdensome bureaucracy has somehow melted away and allowed our researchers to fast track protocols and get much needed investigational drugs to patients. The job obviously isn't over, but we are more and more prepared to fight this every day."
George W. Vetrovec, MD, MACC: Based on your experience in coronary care units, how have the COVID-19 preparations and actual treatment of cases compared with other major health issues?
Charlotte Roberts, ACNP-BC: This is like nothing I have ever experienced before. In the beginning, the list of unknowns was so daunting. How many patients would we have? Would we have enough supplies? Could we adequately respond to the volume and acuity? All the while, we were incredibly concerned about how we would protect our staff. We were basing our preparations on the experience that was being shared with us from Northern Italy and Washington state, which included much caution about the cardiovascular complications of COVID-19. All in all, I think we prepared as best we could. And thankfully, to date, Virginia Commonwealth University has been able to keep up with the volume of cases that has presented to us.
Vetrovec: What are your thoughts about how practitioners and personnel have adapted to the challenges of the circumstances?
Roberts: I am really proud of the job we have done. Early on, we identified a need to create discussion forums where we could begin to identify potential clinical presentations that we could address proactively. Advanced planning for every possible scenario was our goal. How would we handle the ST-segment elevation myocardial infarction (STEMI) population and other patients who might present without adequate COVID-19 screening? How would we manage high-risk clinical situations such as cardiac arrest in this patient population with a goal of optimizing outcomes and at the same time protect our staff? Many of these discussions required immediate action, and new strategies were often designed, reviewed, and approved in less than an afternoon. We have had lengthy discussion about the "new normal" of our practice. I am in awe of the resiliency of the staff as they have faced so much change and so much uncertainty.
Vetrovec: Nationally and internationally, there is documentation of decreased incidence of STEMI, likely reflected in the greater incidence of out-of-hospital cardiac arrest and death not completely accounted for by COVID-19. What have you observed?
Roberts: We have seen the same. The reduction in STEMI presentations is jarring. My biggest concern is that people have been reluctant to come to the hospital for fear of contracting the virus. This may become evident in days and weeks to come if we are suddenly seeing an increase in heart failure and/or arrhythmia admissions.
Vetrovec: What other observations would you like to share with our readers?
Roberts: We have gained so much insight into this disease in such a short period of time. The amazing mobilization and intellectual sharing that has occurred has been inspirational. The same holds true for how rapidly we have been able to get clinical trials up and running. The usually burdensome bureaucracy has somehow melted away and allowed our researchers to fast track protocols and get much needed investigational drugs to patients. The job obviously isn't over, but we are more and more prepared to fight this every day.1,2
Vetrovec: Thanks so much. I really appreciate your time and insight. Know we are all in this together, and we respect all you and your colleagues have gone through and continue to experience.
- Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574-81.
- Cook DJ, Marshall JC, Fowler RA. Critical Illness in Patients With COVID-19: Mounting an Effective Clinical and Research Response. JAMA 2020;April 6:[Epub ahead of print].
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: COVID-19, severe acute respiratory syndrome coronavirus 2, Coronavirus, Coronavirus Infections, ST Elevation Myocardial Infarction, Incidence, Coronary Care Units, Out-of-Hospital Cardiac Arrest, Drugs, Investigational, Uncertainty, Goals, Arrhythmias, Cardiac, Heart Failure, Coronary Angiography
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