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Vital Signs During the COVID-19 Outbreak: A Retrospective Analysis of 19,960 Participants in Wuhan and Four Nearby Capital Cities in China. Glob Heart 2021; 16:47. [PMID: 34381669 PMCID: PMC8284499 DOI: 10.5334/gh.913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background The implications of city lockdown on vital signs during the COVID-19 outbreak are unknown. Objective We longitudinally tracked vital signs using data from wearable sensors and determined associations with anxiety and depression. Methods We selected all participants in the HUAWEI Heart Study from Wuhan and four nearby large provincial capital cities (Guangzhou, Chongqing, Hangzhou, Zhengzhou) and extracted all data from 26 December 2019 (one month before city lockdown) to 21 February 2020. Sleep duration and quality, daily steps, oxygen saturation and heart rate were collected on a daily basis. We compared the vital signs before and after the lockdown using segmented regression analysis of the interrupted time series. The depression and anxiety cases were defined as scores ≥8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A] in 727 participants who finished the survey. Results We included 19,960 participants (mean age 36 yrs, 90% men). Compared with pre-lockdown, resting heart rate dropped immediately by 1.1 bpm after city lockdown (95% confidence interval [CI]: -1.8, -0.4). Sleep duration increased by 0.5 hour (95% CI: 0.3, 0.8) but deep sleep ratio decreased by 0.9% (95% CI: -1.2, -0.6). Daily steps decreased by 3352 steps (95% CI: -4333, -2370). Anxiety and depression existed in 26% and 17% among 727 available participants, respectively, and associated with longer sleep duration (0.2 and 0.1 hour, both p < 0.001). Conclusions Lockdown of Wuhan in China was associated with an adverse vital signs profile (reduced physical activity, heart rate, and sleep quality, but increased sleep duration). Wearable devices in combination with mobile-based apps may be useful to monitor both physical and mental health. Clinical trial registration The trial is registered at Chinese Clinical Trial Registry (ChiCTR) website (ChiCTR-OOC-17014138).
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Mathew S, Fraebel C, Johnson V, Abdelgwad S, Schneider N, Müller P, Chasan R, Hamm C, Schmitt J. Cardiac arrhythmias in patients with SARS-CoV‑2 infection and effects of the lockdown on invasive rhythmological therapy. Herzschrittmacherther Elektrophysiol 2020; 32:108-113. [PMID: 33355696 PMCID: PMC7757077 DOI: 10.1007/s00399-020-00734-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022]
Abstract
Background Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, various strategies have been taken worldwide to reduce the risk of infection. As part of the amendment to the Infection Protection Act, elective medical interventions were restricted, leading to a change in patient care. However, the consequences of the lockdown on the treatment of rhythmological patients in Germany remains unclear. Objectives The aim of this study was to analyze the reduction in rhythmological interventions and the patient care situation using a nationwide survey during the first lockdown period. Methods A survey was sent to all electrophysiological centers certified by the German Society of Cardiology. Here, the treatment volume of tachycardia and bradycardia and their invasive therapy were surveyed before and during the lockdown period. Furthermore, the number of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treated at these centers and the incidence of cardiac arrhythmias was also recorded. Results Participating centers performed a total of 24,648 ablation procedures/year and represent approximately 34% (24,648/72,548) of the estimated German ablation treatments. The majority of these centers (33/40; 82.5%) were so-called primary COVID-19 hospitals (level-1). Overall, the number of ablations and pacemaker implantations were reduced by 41% and 18% respectively. Due to postponed ablation procedures and pacemaker implantations, 22/40 (55%) centers reported a worsening of clinical symptoms or early re-hospitalization of their patients. Conclusion These results demonstrate a significant decline in elective rhythmological procedures during the lockdown, as required by the German Federal Government. At the same time, however, more than half of the participating centers reported an increase in patient re-hospitalizations due to postponed procedures.
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Affiliation(s)
- Shibu Mathew
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany.
| | - Christian Fraebel
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Victoria Johnson
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Saboukh Abdelgwad
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Nikita Schneider
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Patrick Müller
- Department of cardiology, University Hospital Muenster, Muenster, Germany
| | - Ritvan Chasan
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Christian Hamm
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Joern Schmitt
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
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Reichardt P, Bollmann A, Hohenstein S, Glass B, Untch M, Reichardt A, Amrein D, Kuhlen R. Decreased Incidence of Oncology Admissions in 75 Helios Hospitals in Germany during the COVID-19 Pandemic. Oncol Res Treat 2020; 44:71-75. [PMID: 33333506 PMCID: PMC7801981 DOI: 10.1159/000512935] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022]
Abstract
Background The COVID-19 pandemic lead to a massive shutdown of social life in Germany starting in March 2020. Elective medical treatment was substantially reduced but urgent diagnostics and treatment including cancer care should not have been affected. Materials and Methods We analyzed the number of oncology admissions to 75 German Helios hospitals during 2 time periods in 2020 and compared the data with the respective periods in 2019. The study included nearly 69,000 admissions in total. Results A highly significant reduction in overall cancer admissions was seen for the early lockdown period from 13 March to 28 April 2020 compared to the same period in 2019. After an official communication advising the health system to return to normal practice on 29 April 2020, we again found a highly significant difference in admissions compared to the respective time in the previous year. Subgroup analysis shows a significant impact of age >75 years, high hospital volume, and intermediate or high COVID-19 case volume in the federal states. Gender had no impact on admission numbers. The effects and significance levels were comparable in nearly all different diagnostic subgroups according to the ICD codes. Conclusions For cancer diagnosis and treatment, we found a statistically significant decrease in hospital admissions in the range of 10–20% for both study periods in comparison to the previous year.
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Affiliation(s)
- Peter Reichardt
- Department of Oncology and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany,
| | - Andreas Bollmann
- Heart Center Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Sven Hohenstein
- Heart Center Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Bertram Glass
- Department of Oncology and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Michael Untch
- Department of Oncology and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Daniel Amrein
- Department of Oncology and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
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König S, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network. Eur J Heart Fail 2020; 22:2190-2201. [PMID: 33135851 DOI: 10.1002/ejhf.2044] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/09/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. METHODS AND RESULTS Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March-21 May 2020) with control intervals in 2020 (1 January-12 March) and 2019 (13 March-21 May), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67-0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70-0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (P = 0.03) and 6.0% in the previous year control group (P = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality. CONCLUSION Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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Bracun V, Boer RA. Transforming heart failure and cardio‐oncology care during COVID‐19. ESC Heart Fail 2020; 7:3278-3280. [PMID: 32946205 PMCID: PMC7537306 DOI: 10.1002/ehf2.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Valentina Bracun
- University Medical Center Groningen, University of Groningen Department of Cardiology, AB 31, Hanzeplein 1 Groningen 9713 GZ The Netherlands
| | - Rudolf A. Boer
- University Medical Center Groningen, University of Groningen Department of Cardiology, AB 31, Hanzeplein 1 Groningen 9713 GZ The Netherlands
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Koshy AN, Murphy AC, Farouque O, Ramchand J, Burrell LM, Yudi MB. Renin-angiotensin system inhibition and risk of infection and mortality in COVID-19: a systematic review and meta-analysis. Intern Med J 2020; 50:1468-1474. [PMID: 33191600 PMCID: PMC7753674 DOI: 10.1111/imj.15002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the causative agent of COVID‐19, enters human cells by binding of its viral protein to the aminopeptidase angiotensin‐converting enzyme 2 (ACE2). This has led to speculation whether treatment with renin–angiotensin system (RAS) inhibitors was associated with an increased likelihood of a positive test for COVID‐19 and risk of mortality. Aims We performed a systematic review and meta‐analysis to investigate whether RAS inhibitors increased the likelihood of a positive test or death/severe illness in patients with COVID‐19. Methods A systematic search of MEDLINE, PubMed and EMBASE was conducted for studies stratified by the use of angiotensin‐converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). Pooled analysis was performed using a random‐effects model. Results Seven trials of 73 122 patients were included. Overall, 16 624 (22.7%) patients had a positive COVID‐19 test and 7892 (10.8%) were on a RAS inhibitor. RAS inhibitors were not associated with higher likelihood of a positive COVID‐19 test result (odds ratio (OR) 0.97 (95% CI 0.97–1.05, P = 0.48) with low heterogeneity. This was comparable when stratifying by use of each medication class. The use of RAS inhibitors was also not associated with mortality or severe illness (OR 0.89, 95% CI 0.73–1.07, P = 0.21) with moderate heterogeneity. Conclusion Use of ACEI or ARB was not associated with a heightened susceptibility for a positive diagnosis of COVID‐19. Furthermore, they were not associated with increased illness severity or mortality due to COVID‐19. Randomised controlled trials are needed to address definitively the potential benefits or harms of RAS inhibitors in patients with COVID‐19.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jay Ramchand
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Heart and Vascular Institute, Cleveland Clinic Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Louise M Burrell
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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