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Pellegrino F, Carnevale A, Bisi R, Cavedagna D, Reverberi R, Uccelli L, Leprotti S, Giganti M. Best Practices on Radiology Department Workflow: Tips from the Impact of the COVID-19 Lockdown on an Italian University Hospital. Healthcare (Basel) 2022; 10:healthcare10091771. [PMID: 36141383 PMCID: PMC9498676 DOI: 10.3390/healthcare10091771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: The workload of the radiology department (RD) of a university hospital in northern Italy dramatically changed during the COVID-19 outbreak. The restrictive measures of the COVID-19 pandemic lockdown influenced the use of radiological services and particularly in the emergency department (ED). Methods: Data on diagnostic services from March 2020 to May 2020 were retrospectively collected and analysed in aggregate form and compared with those of the same timeframe in the previous year. Data were sorted by patient type in the following categories: inpatients, outpatients, and ED patients; the latter divided in “traumatic” and “not traumatic” cases. Results: Compared to 2019, 6449 fewer patients (−32.6%) were assisted in the RD. This decrease was more pronounced for the emergency radiology unit (ERU) (−41%) compared to the general radiology unit (−25.7%). The proportion of investigations performed for trauma appeared to decrease significantly from 14.8% to 12.5% during the COVID-19 emergency (p < 0.001). Similarly, the proportion of assisted traumatic patients decreased from 16.6% to 12.5% (p < 0.001). The number of emergency patients assisted by the RD was significantly reduced from 45% during routine activity to 39.4% in the COVID-19 outbreak (p < 0.001). Conclusion: The COVID-19 outbreak had a tremendous impact on all radiology activities. We documented a drastic reduction in total imaging volume compared to 2019 because of both the pandemic and the lockdown. In this context, investigations performed for trauma showed a substantial decrease.
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Affiliation(s)
- Fabio Pellegrino
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
- Correspondence:
| | - Aldo Carnevale
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Riccardo Bisi
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Davide Cavedagna
- Department of Radiology, Sant’Anna University Hospital Ferrara, 44124 Ferrara, Italy
| | - Roberto Reverberi
- Blood Transfusion Service, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Licia Uccelli
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Stefano Leprotti
- Department of Radiology, Sant’Anna University Hospital Ferrara, 44124 Ferrara, Italy
| | - Melchiore Giganti
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
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Padroni M, Laudisi M, Azzini C, De Vito A, Casetta I. Stroke admissions during the COVID-19 pandemic: a single-center retrospective analysis. Neurol Sci 2022; 43:5169-5174. [PMID: 35718846 PMCID: PMC9206880 DOI: 10.1007/s10072-022-06207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Background and aims The SARS-CoV-2 pandemic affected the organization of the healthcare system, and several studies analyzed the impact on hospitalization for non-COVID diseases, in particular during the first wave period. We sought to analyze the impact of the pandemic on stroke care in the province of Ferrara during a longer pandemic period and its different phases. Methods We retrospectively analyzed data of all patients with acute ischemic stroke admitted to the University Hospital of Ferrara from March 2020 to April 2021. Data were compared with nonpandemic reference periods (RP, March–April 2018 and 2019). Results We observed a 31% reduction in monthly admission rate for ischemic stroke (IRR 0.69; 95% CI 0.51–0.94) and monthly thrombolysis rate (IRR 0.3; 95% CI 0.15–0.66) during the first-COVID-wave (March–April 2020), as compared to RP. A nonsignificant difference was recorded for admission rate when comparing RP with subsequent pandemic phases, but the thrombolysis rate was confirmed reduced. A significant increase in onset to door time (OTD) was observed in the CP-I period (median 230 vs 120 in the RP; p < 0.05) with improvement in the subsequent phases but without returning to baseline. Nonsignificant differences in the thrombectomy rates were found over the study period. Conclusion These findings reflect changing patient attitudes during the COVID-19 pandemic or the success of health system and public health campaigns to reassure patients about the safety of seeking emergency care when needed, not only for more severe stroke symptoms.
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Affiliation(s)
- Marina Padroni
- Unità Operativa Di Neurologia, Azienda Ospedaliera-Universitaria Di Ferrara, via Aldo Moro 8, 44124, Ferrara, FE, Italy.
| | | | - Cristiano Azzini
- Unità Operativa Di Neurologia, Azienda Ospedaliera-Universitaria Di Ferrara, via Aldo Moro 8, 44124, Ferrara, FE, Italy
| | - Alesandro De Vito
- Unità Operativa Di Neurologia, Azienda Ospedaliera-Universitaria Di Ferrara, via Aldo Moro 8, 44124, Ferrara, FE, Italy
| | - Ilaria Casetta
- Clinica Neurologica, Università Di Ferrara, Ferrara, Italy
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Ayati A, Hosseini K, Hadizadeh A, Jalali A, Lotfi‐Tokaldany M, Milan N, Bagheri J, Ahmadi Tafti SH. Surgical coronary revascularization in patients with COVID‐19; complications and outcomes: A retrospective cohort study. Health Sci Rep 2022; 5:e751. [PMID: 35957968 PMCID: PMC9364075 DOI: 10.1002/hsr2.751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023] Open
Abstract
Background and Aims Coronary artery disease is high‐risk comorbidity of COVID‐19 infection. Nonelective coronary artery revascularization in COVID‐19 patients carries substantial risk. Therefore, it is essential to understand the risk factors and outcomes fully. This study aims to evaluate the prognosis of coronary artery bypass grafting (CABG) surgery in patients with COVID‐19. Methods This retrospective cohort study assesses 171 patients who underwent urgent and emergent CABG in Tehran Heart Center from March 2020 to September 2021. The patients were allocated to cases and controls based on COVID‐19 infection status. Demographic and clinical features, alongside the complications and outcomes, were compared between the two groups. Results According to diagnostic criteria, 62 patients were diagnosed with COVID‐19 (Case) and 109 patients had no COVID diagnosis (Control). Regarding the demographics and risk factors, hypertension was more prevalent among patients with COVID‐19 (64.5% compared to 43.1% p= 0.007). Length of hospital stay, ventilation time, and intensive care unit (ICU) stay time were significantly higher in patients infected with COVID‐19. Postoperative complications, including stroke, atrial fibrillation, pleural effusion, blood transfusion, and Inotrope use, were significantly higher in the case group. Mortality rates were also higher in COVID‐19 patients with an odds ratio of 1.53; however, this difference is not statistically significant (p: 0.44, 95% CI = 0.50–4.01). Conclusion COVID‐19 is associated with a significantly higher hospital stay, ventilation time, and ICU stay. Mortality rates are also higher, albeit insignificantly. Various postoperative complications are also higher with COVID‐19.
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Affiliation(s)
- Aryan Ayati
- Tehran Heart Center Research Institute, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Kaveh Hosseini
- Tehran Heart Center Research Institute, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Alireza Hadizadeh
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Arash Jalali
- Tehran Heart Center Research Institute, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Masoumeh Lotfi‐Tokaldany
- Tehran Heart Center Research Institute, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Nesa Milan
- Tehran Heart Center Research Institute, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Jamshid Bagheri
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Seyed Hossein Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
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Nadarajah R, Wu J, Hurdus B, Asma S, Bhatt DL, Biondi-Zoccai G, Mehta LS, Ram CVS, Ribeiro ALP, Van Spall HG, Deanfield JE, Lüscher TF, Mamas M, Gale CP. The collateral damage of COVID-19 to cardiovascular services: a meta-analysis. Eur Heart J 2022; 43:3164-3178. [PMID: 36044988 PMCID: PMC9724453 DOI: 10.1093/eurheartj/ehac227] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 07/21/2023] Open
Abstract
AIMS The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
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Affiliation(s)
- Ramesh Nadarajah
- Corresponding author. Tel: +44 113 343 3241, , Twitter @Dr_R_Nadarajah
| | - Jianhua Wu
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- School of Dentistry, University of Leeds, Leeds, UK
| | - Ben Hurdus
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samira Asma
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Laxmi S. Mehta
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C. Venkata S. Ram
- Apollo Hospitals and Medical College, Hyderabad, Telangana, India
- University of Texas Southwestern Medical School, Dallas, TX, USA
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia
| | - Antonio Luiz P. Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - John E. Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College, London, UK
| | - Thomas F. Lüscher
- Imperial College, National Heart and Lung Institute, London, UK
- Royal Brompton & Harefield Hospital, Imperial College, London, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Chris P. Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Krczal E, Hyll W. COVID-19 triggered a physically active lifestyle of people with cardiovascular diseases: Results of a small Austrian qualitative study. Front Public Health 2022; 10:947250. [PMID: 36033783 PMCID: PMC9417466 DOI: 10.3389/fpubh.2022.947250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/25/2022] [Indexed: 01/21/2023] Open
Abstract
Objective This paper explores physical activity patterns and compensation strategies of people with cardiovascular diseases. The aim is to provide insights into the factors and their relationships that may affect physical activity levels positively or negatively during the pandemic. Methods We adopted a qualitative approach with 35 participants who were purposively sampled from different provinces in Austria, including rural and urban areas. Semi-structured interviews were conducted during the second COVID-19 wave in autumn/winter 2020 and the fourth wave in autumn/winter 2021. Content analysis was applied to explore physical activity patterns, the perceived impact of the pandemic on physical activity as well as strategies adopted by participants to maintain physically active during the pandemic waves. Results Results show encouraging signs of a recovery or even increase in physical activity during the pandemic waves. The main drivers for maintaining or even increasing physical activity were intrinsic motivation and self-determined motivation relating to the pursue of individual health goals. Furthermore, analysis suggests a reinforcing effect of exercising in green natural areas by decreasing perception of effort and increasing motivation. There was also one group who experienced difficulties in adapting physical activity behaviors. Study participants who were used to exercise indoors struggled to replace accustomed activity patterns with alternatives that were not impacted by lockdown restrictions. Conclusions This study provides novel qualitative evidence on the effect of COVID-19 lockdowns on physical activity patterns of people with cardiovascular diseases. Public health interventions to enhance a physically active lifestyle during and beyond the COVID-19 pandemic are recommended to target moderate outdoor exercising and enhance adaptive capacities of people with cardiovascular diseases.
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Affiliation(s)
- Eva Krczal
- Department for Economy and Health, University for Continuing Education Krems, Krems, Austria
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Kang E, Yun J, Hwang SH, Lee H, Lee JY. The impact of the COVID-19 pandemic in the healthcare utilization in Korea: Analysis of a nationwide survey. J Infect Public Health 2022; 15:915-921. [PMID: 35872432 PMCID: PMC9265238 DOI: 10.1016/j.jiph.2022.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND COVID-19 has brought changes in daily life and increased the medical burden. This study aims to evaluate the delays in healthcare services and related factors in the general population during the COVID-19 pandemic. METHODS We took a nationally representative sample and conducted a mobile phone-based survey. The study was conducted anonymously. Of the 3377 subjects who consented to participate, a total of 2097 finished the survey. The primary outcome was respondents' experiences with delayed (1) health screenings, (2) non-urgent medical visits, (3) medical visits for chronic disease, and (4) emergency visits during the COVID-19 pandemic. RESULTS Of 2097 respondents, females, residents of the Seoul metropolitan area, those with private insurance, those without chronic diseases, smokers, and drinkers had higher risk of delays in health screening and non-urgent medical visits after adjustment. Among chronic disease patients, those who were over 60 years old (adjusted odds ratio 0.36, 95% CI 0.14-0.92) showed lower risk of delayed medical visit. Residents of the Seoul metropolitan area, those with private insurance, smokers, and drinkers were all associated with experiencing delayed health screening and non-urgent medical visits had higher risk of delays in chronic disease visits and emergent medical visits. CONCLUSIONS Delayed access to healthcare services is associated with poor outcomes and may cause different complications. Efforts are needed to prevent delays in medical use due to infectious diseases such as COVID-19. Considering the possibility of the emergence of infectious diseases, various countermeasures are needed to prevent delays in medical visit.
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Affiliation(s)
- EunKyo Kang
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do 10408, Republic of Korea; Department of Family Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do 10408, Republic of Korea
| | - Jieun Yun
- Department of Pharmaceutical Engineering, Cheongju University, 298, Daeseong-ro, Cheongwon-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Soo-Hee Hwang
- HIRA Research Institute, Health Insurance Review & Assessment Service, 60 Hyeoksin-ro, Wonju-si, Gangwon-do, 26465, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeomggi-do 13620, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jin Yong Lee
- HIRA Research Institute, Health Insurance Review & Assessment Service, 60 Hyeoksin-ro, Wonju-si, Gangwon-do, 26465, Republic of Korea; Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Health Policy and Management, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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Changes in the Incidence of Cardiovascular Diseases during the COVID-19 Pandemic in Korea. J Pers Med 2022; 12:jpm12071183. [PMID: 35887680 PMCID: PMC9319633 DOI: 10.3390/jpm12071183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
There is scarcity in the evidence addressing the indirect impact of the COVID-19 pandemic on the epidemiology of CVDs. In this study we aimed to examine possible changes in the incidence of CVDs in Korea during the COVID-19 pandemic. ICD-10 codes of six common CVDs (cerebral hemorrhage, cerebral infarction, myocardial infarction, ischemic heart disease, cardiac failure, and arrhythmia) were collected from clinical visits between January 2018 and March 2021 using the National Health Insurance service database, which stores data on all citizens of Korea (~50 million people). The number and distribution of monthly visits for CVDs were compared before and during the COVID-19 pandemic, and the differences were analyzed using the Mann–Whitney U test and Levene’s test. Our data showed similar incidences of cerebral hemorrhage and ischemic heart disease, a lower incidence of cerebral infarction, and higher incidences of myocardial infarction, cardiac failure, and arrhythmia during COVID-19. Despite statistical differences, the changes in incidences were not considered meaningful. The monthly incidences also remained similar throughout the year, without seasonal variations, both before and during the COVID-19 outbreak. This study found no significant changes in the incidences or monthly variation in CVDs due to the COVID-19 pandemic in Korea.
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Rácz ÁO, Szabó GT, Erdei N, Győry F, Kolozsvári RV. Heart failure caused by Takayasu's arteritis in the time of COVID-19: a case report. ESC Heart Fail 2022; 9:3602-3607. [PMID: 35808997 DOI: 10.1002/ehf2.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
The case of a 35-year-old female with heart failure is presented, where the symptoms overlap with the heterogeneous manifestations of coronavirus disease 2019 (COVID-19). Those similarities and a recent shift in priorities during the SARS-CoV-2 pandemic delayed the recognition of acute heart failure in this patient. During the differential diagnostic process, obliterative disease was discovered in the bilateral subclavian and right renal arteries, and the latter resulted in uncontrolled hypertension, which played a significant role in the development of heart failure. The aetiology of vascular alterations turned out to be Takayasu's arteritis. Diagnosing Takayasu's arteritis is typically not straightforward due to its nonspecific signs and symptoms. Therefore, it can be concluded from our case report that the rising incidence of COVID-19 and focus on ruling out infection can potentially defer alternative, but appropriate diagnostic tests, particularly for certain conditions like rare diseases. Early identification and intervention is especially important for treating acute heart failure, whereas delay increases the risk of severe complications and mortality.
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Affiliation(s)
- Ágnes Orsolya Rácz
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Tamás Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Erdei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Győry
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rudolf Viktor Kolozsvári
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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COVID-19 and Cardiometabolic Health: Lessons Gleaned from the Pandemic and Insights for the Next Wave. Curr Atheroscler Rep 2022; 24:607-617. [PMID: 35773565 PMCID: PMC9247906 DOI: 10.1007/s11883-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review
To review the current evidence regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiometabolic health, with a focus on strategies to help mitigate adverse effects on population health. Recent Findings Individuals with cardiometabolic disease are particularly vulnerable to worse outcomes with COVID-19 infection. In addition, the pandemic itself has had significant deleterious impact on the cardiometabolic health of the population, including declines in physical activity, increases in smoking and alcohol use, worsening blood pressure and glycemic control, and detrimental effects on mental health. Targeted interventions at the patient and community level will be needed to mitigate the long-term consequences of the COVID-19 pandemic on population cardiometabolic health. Summary The COVID-19 pandemic has worsened cardiometabolic health, but there are several opportunities and enhanced tools available to counteract these changes.
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Banfield WH, Elghawy O, Dewanjee A, Brady WJ. Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review. Am J Emerg Med 2022; 57:91-97. [PMID: 35526406 PMCID: PMC9057561 DOI: 10.1016/j.ajem.2022.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/20/2022] [Accepted: 04/11/2022] [Indexed: 10/28/2022] Open
Abstract
The novel coronavirus of 2019 (COVID-19) has resulted in a global pandemic; COVID-19 has resulted in significant challenges in the delivery of healthcare, including emergency management of multiple diagnoses, such as stroke and ST-segment myocardial infarction (STEMI). The aim of this study was to identify the impacts of the COVID-19 pandemic on emergency department care of stroke and STEMI patients. In this study a review of the available literature was performed using pre-defined search terms, inclusion criteria, and exclusion criteria. Our analysis, using a narrative review format, indicates that there was not a significant change in time required for key interventions for stroke and STEMI emergent management, including imaging (door-to-CT), tPA administration (door-to-needle), angiographic reperfusion (door-to-puncture), and percutaneous coronary intervention (door-to-balloon). Potential future areas of investigation include how emergency department (ED) stroke and STEMI care has adapted in response to different COVID-19 variants and stages of the pandemic, as well as identifying strategies used by EDs that were successful in providing effective emergency care in the face of the pandemic.
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Affiliation(s)
- W H Banfield
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - O Elghawy
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - A Dewanjee
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - W J Brady
- Department of Emergency Medicine University of Virginia Health Systems, Charlottesville, VA, United States.
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Meiwald A, Gara-Adams R, Rowlandson A, Ma Y, Watz H, Ichinose M, Scullion J, Wilkinson T, Bhutani M, Weston G, Adams EJ. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis 2022; 17:1507-1521. [PMID: 35801119 PMCID: PMC9255283 DOI: 10.2147/copd.s360983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. A comprehensive and detailed understanding of COPD care pathways from pre-diagnosis to acute care is required to understand the common barriers to optimal COPD care across diverse health systems. Methods Country-specific COPD care pathways were created for four high-income countries using international recommendations and country-specific guidelines, then populated with published epidemiological, clinical, and economic data. To refine and validate the pathways, semi-structured interviews using pre-prepared discussion guides and country-specific pathway maps were held with twenty-four primary and secondary care respiratory healthcare professionals. Thematic analysis was then performed on the interview transcripts. Results The COPD care pathway showed broad consistency across the countries. Three key themes relating to barriers in optimal COPD management were identified across the countries: journey to diagnosis, treatment, and the impact of COVID-19. Common barriers included presentation to healthcare with advanced COPD, low COPD consideration, and sub-optimal acute and chronic disease management. COVID-19 has negatively impacted disease management across the pathway but presents opportunities to retain virtual consultations. Structural factors such as insurance and short duration of appointments also impacted the diagnosis and management of COPD. Conclusion COPD is an important public health issue that needs urgent prioritization. The use of Evidenced Care Pathways with decision-makers can facilitate evidence-based decision making on interventions and policies to improve care and outcomes for patients and reduce unnecessary resource use and associated costs for the healthcare provider/payer.
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Affiliation(s)
| | | | | | - Yixuan Ma
- Aquarius Population Health, London, UK
| | - Henrik Watz
- Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Schleswig-Holstein, Germany
| | | | | | - Tom Wilkinson
- Faculty of Medicine, Southampton University, Southampton, Hampshire, UK
- Respiratory and Allergy, NIHR Southampton Biomedical Research Centre, Southampton, Hampshire, UK
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Elisabeth J Adams
- Aquarius Population Health, London, UK
- Correspondence: Elisabeth J Adams, Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK, Tel +44 (0)207 993 2930, Email
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Hangartner N, Di Gangi S, Elbl C, Senn O, Bisatz F, Fehr T. Impact of the COVID-19 pandemic on emergency outpatient consultations and admissions of non-COVID-19 patients (ECCO)—A cross-sectional study. PLoS One 2022; 17:e0269724. [PMID: 35687575 PMCID: PMC9187104 DOI: 10.1371/journal.pone.0269724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
During the first year of the COVID-19 pandemic, healthcare facilities worldwide struggled to adequately care for the increasing number of COVID-19 patients while maintaining quality of care for all other patients. The aim of this study was to investigate the displacement and underuse of non-COVID-19 patient care in a medical department of a tertiary hospital in Switzerland. In this retrospective cross-sectional study, internal medicine admissions from 2017 to 2020, emergency outpatient visits from 2019 to 2020 and COVID-19 admissions in 2020 were analyzed and compared using a regression model. Internal medicine admissions were also stratified by diagnosis. A questionnaire was used to assess the pandemic experience of local general practitioners, referring hospitals, and nursing homes. The total number of admissions decreased during the 1st and 2nd waves of the pandemic but increased between the two waves. Elective admissions decreased in 2020 compared to pre-pandemic years: they represented 25% of total admissions in 2020 versus 30% of the total admissions during 2017–2019, p <0.001. Admissions for emergency reasons increased: 71% in 2020 versus 65% in 2017–2019, p < 0.001. Emergency outpatient consultations decreased in 2020 compared to 2019, 62.77 (14.70), mean (SD), weekly visits in 2020 versus 74.13 (13.98) in 2019, p<0.001. Most general practitioners and heads of referring hospitals also reported a decrease in consultations, especially during the 1st wave of the pandemic. Mental illnesses, anxiety or burn-out were perceived in both patients and staff in general practices and nursing homes. In conclusion, the COVID-19 pandemic negatively affected the care of non-COVID-19 patients, particularly those with chronic illnesses. A shift of health care resources from non-COVID patients to COVID patients was observed. These findings could help institutions better manage such a situation in the future.
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Affiliation(s)
- Nina Hangartner
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
- * E-mail:
| | - Stefania Di Gangi
- Institute of Primary Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Elbl
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Oliver Senn
- Institute of Primary Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Fadri Bisatz
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
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Ali HJR, Little SH, Faza NN. The Pandemic and Beyond: Innovation in Cardiovascular Training to Improve Quality of Education and Trainees’ Well-being. Methodist Debakey Cardiovasc J 2022; 18:78-86. [PMID: 35734158 PMCID: PMC9165684 DOI: 10.14797/mdcvj.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hyeon-Ju R Ali
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, US
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, US
| | - Nadeen N Faza
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, US
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Čelutkienė J, Čerlinskaitė-Bajorė K, Bajoras V, Višinskienė R, Lizaitis M, Budrys P, Buivydas R, Gurevičius R, Šerpytis P, Davidavičius G. Collateral effect of the COVID-19 pandemic on cardiology service provision and cardiovascular mortality in a population-based study: COVID-COR-LT. Clin Res Cardiol 2022; 111:1130-1146. [PMID: 35552504 PMCID: PMC9095443 DOI: 10.1007/s00392-022-02033-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
Background Collateral damage of the COVID-19 pandemic on cardiovascular health is increasingly studied. This is a population-based study addressing multiple aspects of cardiovascular care during the pandemic in a country of Lithuania, in which pandemic waves were significantly different. Methods Data on cardiology outpatient care, hospitalizations and cardiovascular mortality in 2019 and 2020 were collected from Lithuanian nationwide administrative databases and registries. Weekly data and aggregated numbers of corresponding 6-week phases were analyzed comparing the numbers between 2019 and 2020. Age, sex and regional subgroup analysis was performed. Results Both cardiovascular outpatient care visits and hospitalizations decreased dramatically in 2020 compared to 2019 with a peak reduction (up to − 60% for both) during the first pandemic wave in spring of 2020. Simultaneously, cardiovascular mortality was much higher in 2020, with a pronounced peak at the end of the year compared to 2019 (up to 46%). The increase was even more staggering when analyzing home deaths, which rose up to 91% by the end of 2020. Notable differences between age groups, regions and sexes were documented. Conclusion A profound indirect damage of COVID-19 pandemic on cardiovascular care was observed in this study, with striking decreases in cardiovascular care provision and concurrent increase in cardiovascular mortality, both overall and, even more dramatically, at home. Trial registration ClinicalTrials.gov: NCT05021575 (registration date 25–08–2021, retrospectively registered). Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02033-y.
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Affiliation(s)
- Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariškių g. 2, 08661, Vilnius, Lithuania. .,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, 08661, Vilnius, Lithuania.
| | - Kamilė Čerlinskaitė-Bajorė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariškių g. 2, 08661, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, 08661, Vilnius, Lithuania
| | - Vilhelmas Bajoras
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariškių g. 2, 08661, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, 08661, Vilnius, Lithuania
| | - Rasa Višinskienė
- National Health Insurance Fund under the Ministry of Health, Europos a. 1, 09307, Vilnius, Lithuania
| | - Mindaugas Lizaitis
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, 08661, Vilnius, Lithuania
| | - Povilas Budrys
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariškių g. 2, 08661, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, 08661, Vilnius, Lithuania
| | - Romualdas Buivydas
- Health Economics Centre, P. Vileišio g. 18N-301, 10306, Vilnius, Lithuania
| | | | - Pranas Šerpytis
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariškių g. 2, 08661, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, 08661, Vilnius, Lithuania
| | - Giedrius Davidavičius
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariškių g. 2, 08661, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, 08661, Vilnius, Lithuania
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Reduction in Hospital Admissions for Cardiovascular Diseases (CVDs) during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective Study from a Southern Italian Region in the Year 2020. Healthcare (Basel) 2022; 10:healthcare10050871. [PMID: 35628008 PMCID: PMC9140652 DOI: 10.3390/healthcare10050871] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: The COVID-19 pandemic has indirect consequences for healthcare for other diseases, known as collateral damage. This situation heavily affects healthcare systems, causing changes in patterns of hospital admission. During the peak of the coronavirus disease 2019 pandemic, numerous studies reported a reduction in admissions for acute coronary syndrome. The aim of this study was to evaluate the incidence of admissions for cardiovascular diseases in Abruzzo, a region of Southern Italy, in the year 2020 and compare it to the two previous years (2018−2019). (2) Methods: This retrospective study was conducted in Abruzzo, Italy. The monthly number of admissions in the year 2020 was compared to a control period made from the average number of events that occurred in the previous two years (2018−2019). (3) Results: A global reduction in hospital admissions for all the cardiovascular diseases (CVDs) considered was observed. In particular, compared to the control period, in 2020, the number of admissions for ST-segment elevation myocardial infarction (STEMI) was lower by 34 (hospitalization rate ratio, HRR, 0.93; p < 0.001), the number of non-ST-segment-elevation myocardial infarctions (N-STEMI) was lower by 154.5 (HRR 0.89; p < 0.001), the number for acute coronary syndrome (ACS) was 340 lower (HRR 0.90; p < 0.001) and the number for heart failure (HF) was 1424.5 lower than during the control period (HRR 0.73; p < 0.001). (4) Conclusions: The results of this study show the impact of COVID-19 on admissions for CVDs, suggesting the need for strategic measures to overcome the burden of hospitalizations in future years.
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Burns SP, Fleming TK, Webb SS, Kam ASH, Fielder JDP, Kim GJ, Hu X, Hill MT, Kringle EA. Stroke Recovery During the COVID-19 Pandemic: A Position Paper on Recommendations for Rehabilitation. Arch Phys Med Rehabil 2022; 103:1874-1882. [PMID: 35533736 PMCID: PMC9072806 DOI: 10.1016/j.apmr.2022.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/02/2022]
Abstract
Health care delivery shifted and adapted with the COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus 2. Stroke care was negatively affected across the care continuum and may lead to poor community living outcomes in those who survived a stroke during the ongoing pandemic. For instance, delays in seeking care, changes in length of stays, and shifts in discharge patterns were observed during the pandemic. Those seeking care were younger and had more severe neurologic effects from stroke. Increased strain was placed on caregivers and public health efforts, and community-wide lockdowns, albeit necessary to reduce the spread of COVID-19, had detrimental effects on treatment and recommendations to support community living outcomes. The American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group Health and Wellness Task Force convened to (1) discuss international experiences in stroke care and rehabilitation and (2) review recently published literature on stroke care and outcomes during the pandemic. Based on the findings in the literature, the task force proposes recommendations and interdisciplinary approaches at the (1) institutional and societal level; (2) health care delivery level; and (3) individual and interpersonal level spanning across the care continuum and into the community.
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Affiliation(s)
- Suzanne Perea Burns
- Division of Occupational Therapy, University of New Mexico School of Medicine, Albuquerque, New Mexico.
| | - Talya K Fleming
- JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey
| | - Sam S Webb
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Alice Sau Han Kam
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | | | - Grace J Kim
- Department of Occupational Therapy, New York University, New York City, New York; Department of Rehabilitation Medicine, NYU Langone Health, New York City, New York
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Mary Thelander Hill
- Division of Occupational Therapy, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Emily A Kringle
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Effect of the First Year of COVID-19 Pandemic on Ophthalmological Practice: A Multi-Centre Italian Study with a Focus on Medico-Legal Aspects. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
During the COVID-19 era, several restrictions on surgery have been imposed to reduce the infectious risk among patients and staff and further preserve the availability of critical care resources. The aim of the study was to assess their impact on the ophthalmological practice and its medico-legal implications. A retrospective review of electronic medical records of the ophthalmological departments of the University of Cagliari (SGD) and University Magna Græcia of Catanzaro (UMG), from 16 March 2020 to 14 March 2021 (52 weeks), were compared with data from the corresponding period of the previous year. Weekly data on the number and type of diagnoses and procedures performed were collected and analysed in relation to the weekly average of the total number of COVID-19 patients in intensive care units (ICUs) and inpatients in Sardinia and Calabria. Results showed a significant decrease in cataract surgery operations by 47% and 31%, respectively, in the SGD and UMG (p < 0.05) during the second semester of the year; this drop occurred at the same time as the increase in COVID-19 patients in ICU and those hospitalised in both regions. Additionally, anterior segment surgery decreased at the UMG by 30% (p < 0.05). Vitreoretinal surgery decreased by 27% at the SGD, differently increased amount 31.5% at UMG (p < 0.05). The pandemic had a dramatic impact on elective surgery in ophthalmology, quantifying the backlog is the first step in order to understanding the measures to be taken in near future.
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Kruse MH, Durstine A, Evans DP. Effect of COVID-19 on patient access to health services for noncommunicable diseases in Latin America: a perspective from patient advocacy organizations. Int J Equity Health 2022; 21:45. [PMID: 35366886 PMCID: PMC8976438 DOI: 10.1186/s12939-022-01648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic has been felt acutely in Latin America with several countries having among the highest numbers of SARS-CoV-2 cases and related deaths. Individuals living with underlying health conditions have an increased risk of severe disease or death from COVID-19. Patient advocacy organizations often provide supportive services to these individuals and can offer a unique perspective of the patient experience. The objective of this study was to assess the effects of COVID-19 on access to health services in Latin America, as reported by patient advocacy organizations representing individuals living with autoimmune, chronic, and noncommunicable diseases. Methods A cross-sectional study was conducted in August 2020 with patient advocacy organizations in Latin America to measure perceived effects from COVID-19 and reported access to health services among individuals living with autoimmune, chronic, and noncommunicable diseases. An original, online survey was developed and deployed in Spanish and Portuguese. Univariate and bivariate analysis was conducted across two main subject areas: perceived patient effects from COVID-19 and patient access to health services. The main outcomes of analysis considered patient access to care during COVID-19 based on type of chronic illness and geographical region in Latin America. Results A total of 81 survey responses were analyzed. A majority (83%) of patient advocacy organizations reported their patients experienced delays receiving their treatment and care services; 52% experienced delays of 30 days or more. Telemedicine was considered available, but not accessible to patients (37%) and a majority (76%) of patients faced challenges with electronic prescriptions. Patients were not likely to receive a multi-month prescription from their doctor (38%) or successfully fill it at the pharmacy (26%). Conclusions According to responses from patient advocacy organizations, individuals living with noncommunicable diseases in Latin America have faced unique challenges during the COVID-19 pandemic. As countries re-evaluate their health systems, it is critical that chronic diseases are considered so that all can fully realize the right to health. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01648-x.
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Seidu S, Hambling C, Holmes P, Fernando K, Campbell NS, Davies S, Khunti K. The impact of the COVID pandemic on primary care diabetes services in the UK: A cross-sectional national survey of views of health professionals delivering diabetes care. Prim Care Diabetes 2022; 16:257-263. [PMID: 35033477 PMCID: PMC8754561 DOI: 10.1016/j.pcd.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Healthcare systems worldwide have been adversely affected by the Coronavirus disease 2019 (COVID-19) pandemic. There has been a substantial decrease in admissions for acute medical conditions with longer delays between the onset of the symptoms and hospital treatment compared to the pre-pandemic period. The impact of the COVID pandemic on primary care services is uncertain. AIM Using an online survey, we examined the impact of the COVID pandemic on primary care diabetes services in the UK. METHODS An online survey was developed by the Primary Care Diabetes Society research group and administered to healthcare and allied health professionals delivering diabetes care in the UK from January to May 2021. Descriptive statistics and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS Of the 1070 professionals surveyed, 975 (91.1%) completed the questionnaire. Most respondents were nurses or nurse practitioners (59.7%) and doctors (32.9%). The mean age of respondents was 52 years and 79% were female. The majority of respondents felt overloaded with work (71.2%) or emotionally drained at the end of a working day (79.1%) compared with the pre-pandemic period. Being a doctor and worried about infecting a family member with the Coronavirus were each associated with an increased odds of being substantially overworked or emotionally drained: (OR = 2.52; 95% CI, 1.25-5.07) and (OR = 2.05; 95% CI, 1.24-3.39), respectively. The most common consultation method used to provide diabetes care during the pandemic was telephone consultation (92.0%). Overall 79.1% of respondents felt the COVID-19 pandemic had had moderate to significant impact on their practice's ability to provide routine diabetes care; 70.6% of respondents felt the COVID-19 pandemic had had moderate to significant impact on their practice's ability to provide routine health checks or screening for type 2 diabetes and approximately half of respondents (48.3%) reported encountering mental health concerns in people with diabetes. CONCLUSIONS COVID-19 pandemic has had significant impact on the ability of healthcare professionals and their practices to deliver routine diabetes care. Failure to restore primary care provision urgently and safely to at least pre-pandemic levels in a sustainable manner may lead to emotionally drained and overworked workforce in primary care, place additional burden on the already overburdened healthcare system and worse outcomes for patients.
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Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - Clare Hambling
- Bridge Street Surgery, Bridge Street, Downham Market, Norfolk, PE38 9DH, UK
| | - Patrick Holmes
- St George's Medical Practice, Yarm Road, Middleton St George, Darlington, DL2 1BY, UK
| | - Kevin Fernando
- North Berwick Group Practice, 54 St. Baldred's Road, North Berwick, East Lothian EH39 4PU, UK
| | - Nigel S Campbell
- Lisburn Health Centre, Linenhall Street, Lisburn BT28 1LU, Northen Ireland
| | - Sarah Davies
- Woodlands Medical Centre in Ely, Cardiff CF5 4RG, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
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Breakdown of Diabetic Foot Ulcer Care during the First Year of the Pandemic in Poland: A Retrospective National Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073827. [PMID: 35409510 PMCID: PMC8997735 DOI: 10.3390/ijerph19073827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/03/2022]
Abstract
The COVID-19 pandemic revealed a breakdown of the system of DFU patient care. This retrospective national cohort study analyses the epidemiological status of DFU patients in relation to urgent and elective hospitalizations, amputation rates, and deaths in Poland from 2017 to 2019, and during 2020 when the COVID-19 pandemic began. The data were obtained from national medical records gathered by the National Health Fund (NHF). Discharge diagnoses were categorized according to ICD-10 and ICD-9 codes. Analysis of the data showed a statistically significant decrease in elective hospital admissions (from 29.6% to 26.3%, p = 0.001). There was a decrease in the percentage of hospitalizations related to limb-salvage procedures (from 79.4% to 71.3%, p = 0.001). The opposite tendency was observed among urgent hospital admissions (from 67.0% to 73.2%, p = 0.01), which was related to a significant increase in the number of minor amputations (from 3146 to 4269, p = 0.017). This rise was in parallel with the increase in the percentage of patients who died during hospitalization due to DFU (from 3.9% to 4.8%, p = 0.03). The number of deaths has not changed significantly (from 590.7 to 668.0, p = 0.26). The results of the conducted analyses confirm the negative tendencies in the medical care of patients with DFU during the first year of the pandemic in Poland. Changes in therapy schemes and stronger patient support following this period are necessary to avoid further complications in patients with DFU.
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Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain. J Clin Med 2022; 11:jcm11071752. [PMID: 35407360 PMCID: PMC8999691 DOI: 10.3390/jcm11071752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 01/18/2023] Open
Abstract
Few studies have assessed the impact of the COVID-19 pandemic on non-COVID diseases and healthcare quality. We aimed to evaluate changes in rates of hospitalisations, complications, in-hospital mortality, and readmissions among patients with non-COVID diseases during a one-year period after the pandemic onset. From March 2018 to February 2021 a retrospective observational study of hospital admissions in a university hospital in Spain was conducted. Non-COVID hospitalisations admitted through the emergency department were compared between the pre-COVID period (n = 28,622) and the COVID period (n = 11,904). We assessed rate ratios (RaR), comparing the weekly number of admissions and risk ratios (RR) to examine rates of complications, in-hospital mortality, readmissions, and severity. Statistical significance was set at p < 0.05. The weekly admission rate dropped by 20.8% during the complete lockdown. We observed significant reductions in admissions related to diseases of the respiratory system and circulatory system. Admissions for endocrine and metabolic diseases increased. The complication rates increased (RR = 1.21, 95% CI: 1.05;1.4), while in-hospital mortality rates held steady during the COVID period (RR = 1.09, 95% CI: 0.98;1.2). Hospital efforts to maintain quality and safety standards despite disruptions translated into a moderate increase in complications but not in in-hospital mortality. Reduced hospitalisations for conditions requiring timely treatment may have significant public health consequences.
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The Impact of the COVID-19 Pandemic on Hospital Services for Patients with Cardiac Diseases: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063172. [PMID: 35328859 PMCID: PMC8953098 DOI: 10.3390/ijerph19063172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
Abstract
This study aims to assess the impact of the COVID-19 pandemic on hospital cardiac care, as assessed by performance indicators. Scoping review methodology: performance indicators were extracted to inform on changes in care during January–June 2020. Database searches yielded 6277 articles, of which 838 met the inclusion criteria. After full-text screening, 94 articles were included and 1637 indicators were retrieved. Most of the indicators that provided information on changes in the number of admissions (n = 118, 88%) signaled a decrease in admissions; 88% (n = 15) of the indicators showed patients’ delayed presentation and 40% (n = 54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signaled by 95% (n = 18) and 81% (n = 64) of the indicators, respectively. Length of stay decreased in 58% (n = 21) of the indicators, acute coronary syndromes treatment times increased in 61% (n = 65) of the indicators, and outpatient activity decreased in 94% (n = 17) of the indicators related to outpatient care. Telehealth utilization increased in 100% (n = 6). Outcomes worsened in 40% (n = 35) of the indicators, and mortality rates increased in 52% (n = 31). All phases of the pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events.
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Impact of COVID-19 Pandemic on Cardiac Arrest and Emergency Care. Cardiol Clin 2022; 40:355-364. [PMID: 35851459 PMCID: PMC8960232 DOI: 10.1016/j.ccl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Kite TA, Pallikadavath S, Gale CP, Curzen N, Ladwiniec A. The Direct and Indirect Effects of COVID-19 on Acute Coronary Syndromes. Cardiol Clin 2022; 40:309-320. [PMID: 35851454 PMCID: PMC8940579 DOI: 10.1016/j.ccl.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, Gale CP, Maggioni AP, Petersen SE, Huculeci R, Kazakiewicz D, de Benito Rubio V, Ignatiuk B, Raisi-Estabragh Z, Pawlak A, Karagiannidis E, Treskes R, Gaita D, Beltrame JF, McConnachie A, Bardinet I, Graham I, Flather M, Elliott P, Mossialos EA, Weidinger F, Achenbach S. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J 2022; 43:716-799. [PMID: 35016208 DOI: 10.1093/eurheartj/ehab892] [Citation(s) in RCA: 330] [Impact Index Per Article: 165.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries. METHODS AND RESULTS Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures. CONCLUSION Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.
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Affiliation(s)
- Adam Timmis
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Panos Vardas
- Hygeia Hospitals Group, HHG, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Hugo Katus
- Department of Internal Medicine and Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Chris P Gale
- Medical Research Council Bioinformatics Centre, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aldo P Maggioni
- Research Center of Italian Association of Hospital Cardiologists (ANMCO), Florence, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Radu Huculeci
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Barbara Ignatiuk
- Division of Cardiology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | | | - Agnieszka Pawlak
- Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roderick Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Timisoara, Romania
| | - John F Beltrame
- University of Adelaide, Central Adelaide Local Health Network, Basil Hetzel Institute, Adelaide, Australia
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Ian Graham
- Tallaght University Hospital, Dublin, Ireland
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Franz Weidinger
- Department of Internal Medicine and Cardiology, Klinik Landstrasse, Vienna, Austria
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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76
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Shah N, Velez FF, Colman S, Kauffman L, Ruetsch C, Anastassopoulos K, Maricich Y. Real-World Reductions in Healthcare Resource Utilization over 6 Months in Patients with Substance Use Disorders Treated with a Prescription Digital Therapeutic. Adv Ther 2022; 39:4146-4156. [PMID: 35819569 PMCID: PMC9273919 DOI: 10.1007/s12325-022-02215-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Substance use disorders (SUDs) affect approximately 40.3 million people in the USA, yet only approximately 19% receive evidence-based treatment each year. reSET® is a prescription digital therapeutic (PDT) and the only FDA-authorized treatment for patients with cocaine, cannabis, and stimulant use disorders. This study evaluated real-world healthcare resource utilization (HCRU) and associated costs 6 months after initiation of reSET in patients with SUD. METHODS A retrospective analysis of HealthVerity PrivateSource20 data compared the 6-month incidence of all-cause hospital facility encounters and clinician services in patients treated with reSET (re-SET cohort) before (pre-index period) and after (post-index period) reSET initiation (index). Incidence was compared using incidence rate ratios (IRR). HCRU-related costs were also assessed. RESULTS The sample included 101 patients (median age 37 years, 50.5% female, 54.5% Medicaid-insured). A statistically significant decrease of 50% was observed in overall hospital encounters from pre-index to post-index (IRR 0.50; 95% CI 0.37-0.67; P < 0.001), which included inpatient stays (56% decrease; IRR 0.44; 95% CI 0.26-0.76; P = 0.003), partial hospitalizations (57% decrease; IRR 0.43; 95% CI 0.21-0.88; P = 0.021), and emergency department visits (45% decrease; IRR 0.55; 95% CI 0.38-0.80; P < 0.004). Additionally, some clinician services declined significantly including pathology and laboratory services: other (54% decrease; IRR 0.46; 95% CI 0.28-0.76; P = 0.003); pathology and laboratory services: drug assays prior to opioid medication prescription (37% decrease; IRR 0.63; 95% CI 0.41-0.96; P = 0.031); and alcohol and drug abuse: medication services (46% decrease; IRR 0.54; 95% CI 0.41-0.70; P < 0.001). Reductions in facility-encounters drove 6-month reSET per-patient cost reductions of $3591 post-index compared to pre-index. CONCLUSIONS Use of reSET by patients with SUD is associated with durable reductions in HCRU and lower healthcare costs over 6 months compared to the 6 months before PDT treatment, after adjusting for covariates, providing an economic benefit to the healthcare system.
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Affiliation(s)
- Neel Shah
- grid.487063.ePear Therapeutics, Inc. (US), Boston, MA USA
| | | | - Samuel Colman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD USA
| | - Laura Kauffman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD USA
| | | | | | - Yuri Maricich
- grid.487063.ePear Therapeutics, Inc. (US), Boston, MA USA
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77
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Afkar M, Rezanejad Asl P, Mahdavi Hezaveh A, Akrami F, Riazi-Isfahani S, Peykari N, Payab M, Moghisi A, Yousefi E, Ranjbar M, Soleymani Nejad M, Hamelmann C, Slama S, Sadegh Tabrizi J, Larijani B, Raeisi A, Ostovar A. The Effect of the COVID-19 Pandemic on Non-Communicable Disease Prevention and Management Services in the Primary Health Care System of Iran. Med J Islam Repub Iran 2022; 36:174. [PMID: 36908938 PMCID: PMC9997416 DOI: 10.47176/mjiri.36.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 03/14/2023] Open
Abstract
Background: The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran's primary healthcare system. Methods: In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14. Results: The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction. Conclusion: The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.
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Affiliation(s)
- Mehdi Afkar
- Department of Community Medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Parisa Rezanejad Asl
- Network Management Center, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Alireza Mahdavi Hezaveh
- Deputy Director of the Center for Non-communicable Disease Control & Prevention, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Forouzan Akrami
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Center for Non-communicable Disease Control & Prevention, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Sahand Riazi-Isfahani
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Moloud Payab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moghisi
- Department of Community Medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elham Yousefi
- Center for Non-communicable Disease Control & Prevention, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mansour Ranjbar
- National Professional Officer, NCDs and Mental Health Unit Head, WHO Iran
| | | | | | - Slim Slama
- Regional Adviser Noncommunicable Diseases Prevention (NCP), UHC/NCDs, WHO EMRO
| | - Jafar Sadegh Tabrizi
- Department of Health Policy and Management, School of Management and Medical Informatics Health Services, Tabriz University of Medical Sciences, Tabriz, Iran.,Network Management Center, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Bagher Larijani
- Department of Internal Medicine, School of Medicine, Director and Chief Scientific Officer, Institute, Endocrinology and Metabolism Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Deputy Chairman of the Iranian Non-communicable Diseases Committee (INCDC), Tehran, Iran
| | - Alireza Raeisi
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Deputy Minister of Health of the Ministry of Health and Medical Education, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Center for Non-communicable Disease Control & Prevention, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
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78
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Alhejily W. Impact of the COVID-19 Pandemic on Patients With Acute Coronary Syndrome: A Tertiary Center Experience With Primary Percutaneous Intervention and Early Invasive Strategy. Cureus 2021; 13:e20747. [PMID: 34976551 PMCID: PMC8711577 DOI: 10.7759/cureus.20747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on patients with acute coronary syndrome (ACS). Methods: This retrospective longitudinal cohort study analysed ACS patients admitted in a large tertiary center in 2019 (pre-pandemic) and 2020 (pandemic). The primary endpoint was mortality from myocardial infarction; secondary endpoints were death from any causes, including COVID-related complications, stroke, and coronary artery bypass graft surgery. Results: There were 489 ACS patients admitted in 2020, and 614 in 2019, representing a 21% reduction (p=0.001). Male patients comprised 73% of the patients. Only eight were polymerase chain reaction (PCR)-confirmed positive COVID-19 patients. The mean time to presentation from the time of onset of symptoms in acute ST-elevation myocardial infarction cases was 48±16 in 2020 (vs. 4±3 h in 2019); this significant delay was observed in more than 50% of patients (p=0.0001). Mortality due to ACS in 2020 doubled, with eight patients confirmed dead during or within 30 days of admission, with none of the deaths related to COVID-19. The incidence of stroke (p=0.01) and coronary artery (p=0.0001) bypass was also high in 2020. Conclusion: We found a statistically significant increase in the mortality related to myocardial infarction. Despite timely interventions, patients presented late and were worse than in the non-pandemic period.
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79
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Meza-Ramos A, Guasch E. The non-infectious effects of COVID-19 were fierce with the weakest: What lessons did we learn? IJC HEART & VASCULATURE 2021; 37:100925. [PMID: 34869826 PMCID: PMC8632598 DOI: 10.1016/j.ijcha.2021.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Aline Meza-Ramos
- Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico.,Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Guasch
- Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Cardiovascular Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERCV, Spain
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Nandhra S, Benson RA. The persistent challenges faced by vascular surgery services during the UK coronavirus pandemic: a snapshot qualitative survey. Ann R Coll Surg Engl 2021; 104:385-388. [PMID: 34860123 DOI: 10.1308/rcsann.2021.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The coronavirus (COVID-19) pandemic continues to affect the NHS. The Vascular and Endovascular Research Network (VERN) COvid Vascular sERvice (COVER) study has prospectively shown the significant global impact of the COVID-19 pandemic on vascular surgery. The aim of this study is to investigate the way in which this second wave has affected surgeons' ability to treat patients with urgent vascular conditions, using contemporaneous snapshot data from 30 UK vascular centres. METHODS This is a contemporary (18-28 January 2021) re-run of the Tier 1 COVER survey. This used closed and open questions, related to centres' provision of common vascular services, threshold for treatment, imaging, screening, staff and theatre availability, multidisciplinary team input, clinics, personal protective equipment, vaccination policies and case-backlogs. The survey was disseminated to clinicians via email. A service reduction score was calculated. RESULTS Forty-two complete responses were received from 30 vascular centres (England, Northern Ireland, Scotland and Wales). Overall, 56.7% of units are performing only urgent procedures. The threshold for abdominal aortic aneurysm (AAA) repair has increased in the majority of UK centres (60%). One in six AAA screening programmes have stopped all screening activity: 30% having a significantly reduced programme and only half running as normal. Waiting lists are increasing for AAA, lower limb revascularisation and venous disease. CONCLUSION Overall, these data suggest that vascular care in the NHS is facing unprecedented pressures due to COVID-19. Vascular stakeholders will have to urgently address these issues in the coming months. STUDY REGISTRATION NUMBER ISRCTN 80453162 (registered prospectively).
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Affiliation(s)
- S Nandhra
- Newcastle University Faculty of Medical Sciences, UK
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81
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Haki C, Deniz O. The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19. Clin Neurol Neurosurg 2021; 212:107027. [PMID: 34839154 PMCID: PMC8604567 DOI: 10.1016/j.clineuro.2021.107027] [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: 10/05/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022]
Abstract
Introduction This study aimed to investigate the impact of home quarantine in older patients without COVID-19 hospitalized due to neurological disorders. Methods We consecutively enrolled 255 elderly patients(median age: 75 years, female: 54%), including 180 (70%) in the pre-home quarantine period and 75 (30%) home quarantine period from January to May 2020 (ten weeks before and ten weeks after the March 21, 2020, lockdown for older patients in Turkey) in a tertiary referral neurological center. Results In the home quarantine period, we documented a fall in the number of neurological admissions by 58.3%, but an increased need for intensive care in older patients. Patients in the home quarantine period were younger [73 (65−91) vs 76 (65−95), p = 0.005], had worse Glasgow Coma Scores (12.3 ± 3.6 vs 13.7 ± 2.5, p = 0.007), higher in-hospital mortality rate (21.3% vs. 6.7%, p = 0.001), had a lower prevalence of comorbidities such as diabetes mellitus, hypertension, and cardiovascular disease, and chronic neurologic disease, albeit had a higher prevalence of the acute cerebrovascular disease (hemorrhagic/ ischemic stroke)(90.7% vs 78.9, p = 0.025). In this period, even there was an increase in the proportion of the patients undergoing reperfusion therapy, it wasn’t statistically significant (20.3% vs. 10.1%, p: 0.054). Multivariate analysis revealed that high NIHSS (The National Institutes of Health Stroke Scale) score (OR=1.25; p < 0.001) and hospitalization in the home quarantine period (OR=3.21; p = 0.043) were independently associated with in-hospital mortality. Conclusion Our study indicated that during the COVID-19 home quarantine period, despite a significantly fewer number of patients admitted to the hospitalization, there was a higher percentage of those hospitalized needing intensive care and an overall worse prognosis.
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Affiliation(s)
- Cemile Haki
- Neurology Clinic, Bursa City Hospital, Bursa, Turkey
| | - Olgun Deniz
- Geriatric Medicine Clinic, Palliative Care Unit, Bursa City Hospital, Bursa, Turkey.
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82
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Schmidt-Lauber C, Günster C, Huber TB, Spoden M, Grahammer F. Collateral Effects and Mortality of Kidney Transplant Recipients during the COVID-19 Pandemic. KIDNEY360 2021; 3:325-336. [PMID: 35373117 PMCID: PMC8967627 DOI: 10.34067/kid.0006472021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/16/2021] [Indexed: 01/10/2023]
Abstract
Background Collateral effects and consequences of the coronavirus disease 19 (COVID-19) pandemic on kidney transplant recipients remain widely unknown. Methods This retrospective cohort study examined changes in admission rates, incidences of diseases leading to hospitalization, in-patient procedures, and maintenance medication in long-term kidney transplant recipients with functioning graft during the early COVID-19 pandemic in Germany. Data were derived from a nationwide health insurance database. Analysis was performed from March 15 to September 30 and compared the years 2019 and 2020. Effects on mortality and adverse allograft events were compared with COVID-19-attributed effects. Results A total of 7725 patients were included in the final analysis. Admissions declined in 2020 by 17%, with the main dip during a 3-month lockdown (-31%) but without a subsequent rebound. Incidences for hospitalization did not increase for any investigated disease entities, whereas decreasing trends were noted for non-COVID-19 pulmonary and urogenital infections (incidence rate ratio 0.8, 95% CI, 0.62 to 1.03, and 0.82, 95% CI, 0.65 to 1.04, respectively). Non-COVID-19 hospital stays were 0.6 days shorter (P=0.03) and not complicated by increased dialysis, ventilation, or intensive care treatment rates. In-hospital and 90-day mortality remained stable. Incidences of severe COVID-19 requiring hospitalization was 0.09 per 1000 patient-days, and in-hospital mortality was 9%. A third (31%) of patients with calcineurin-inhibitor medication and without being hospitalized for COVID-19 reduced doses by at least 25%, which was associated with an increased allograft rejection risk (adjusted hazard ratio 1.29, 95% CI, 1.02 to 1.63). COVID-19 caused 17% of all deaths but had no significant association with allograft rejections. All-cause mortality remained stable (incidence rate ratio 1.15, 95% CI, 0.91 to 1.46), also when restricting analysis to patients with no or outpatient-treated COVID-19 (0.97, 95% CI, 0.76 to 1.25). Conclusion Despite significant collateral effects, mortality remained unchanged during the early COVID-19 pandemic. Considerable temporary reductions in admissions are safe, whereas reducing immunosuppression results in increased allograft rejection risk.
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Affiliation(s)
| | - Christian Günster
- Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Tobias B. Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melissa Spoden
- Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Florian Grahammer
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Tanaka K, Matsumoto S, Nakazawa Y, Yamada T, Sonoda K, Nagano S, Hatano T, Yamasaki R, Nakahara I, Isobe N. Delays in Presentation Time Under the COVID-19 Epidemic in Patients With Transient Ischemic Attack and Mild Stroke: A Retrospective Study of Three Hospitals in a Japanese Prefecture. Front Neurol 2021; 12:748316. [PMID: 34777220 PMCID: PMC8578818 DOI: 10.3389/fneur.2021.748316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Coronavirus Disease 2019 (COVID-19) has spread worldwide with collateral damage and therefore might affect the behavior of stroke patients with mild symptoms seeking medical attention. Methods: Patients with ischemic stroke who were admitted to hospitals within 7 days of onset were retrospectively registered. The clinical characteristics, including onset-to-door time (ODT), of patients with a transient ischemic attack (TIA)/mild stroke (National Institutes of Health Stroke Scale [NIHSS] score of ≤ 3 on admission) or moderate/severe stroke were compared between those admitted from April 2019 to March 2020 (pre-COVID-19 period) and from April to September 2020 (COVID-19 period). Multivariable regression analysis was performed to identify factors associated with the ODT. Results: Of 1,100 patients (732 men, median age, 73 years), 754 were admitted during the pre-COVID-19 period, and 346 were admitted during the COVID-19 period. The number and proportion of patients with TIA/minor stroke were 464 (61.5%) in the pre-COVID-19 period and 216 (62.4%) during the COVID-19 period. Among patients with TIA/mild stroke, the ODT was longer in patients admitted during the COVID-19 period compared with that of the pre-COVID-19 period (median 864 min vs. 508 min, p = 0.003). Multivariable analysis revealed the COVID-19 period of admission was associated with longer ODT (standardized partial regression coefficient 0.09, p = 0.003) after adjustment for age, sex, route of arrival, NIHSS score on admission, and the presence of hypertension, diabetes mellitus, and wake-up stroke. No significant change in the ODT was seen in patients with moderate/severe stroke. Conclusions: The COVID-19 epidemic might increase the ODT of patients with TIA/mild stroke.
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Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yusuke Nakazawa
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Yamada
- Department of Neurology, Murakami Karindoh Hospital, Fukuoka, Japan
| | - Kazutaka Sonoda
- Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Sukehisa Nagano
- Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan
| | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Jud P, Hackl G, Reisinger AC, Horvath A, Eller P, Stadlbauer V. Red urine and a red herring - diagnosing rare diseases in the light of the COVID-19 pandemic. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1326-1331. [PMID: 34768287 PMCID: PMC9470277 DOI: 10.1055/a-1659-4481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background
The COVID-19 pandemic has occupied the time and resources of health care professionals for more than 1 year. The risk of missed diagnoses has been discussed in the medical literature, mainly for common diseases such as cancer and cardiovascular events. However, rare diseases also need appropriate attention in times of a pandemic.
Case Report
We report a 34-year-old woman with fever, pinprick sensation in her chest and thoracic spine, and dizziness after receiving the first dose of ChAdOx1 nCoV-19 vaccination. The patient’s condition worsened with abdominal pain, red urine, and hyponatremia, needing intensive care admission. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) was diagnosed. Vaccine-induced thrombocytopenia and thrombosis were ruled out. Acute hepatic porphyria was finally diagnosed, and the patient recovered completely after treatment with hemin.
Conclusion
Currently, the focus of physicians is on COVID-19 and associated medical problems, such as vaccine side effects. However, it is important to be vigilant for other uncommon medical emergencies in medically exceptional situations that may shift our perception.
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Affiliation(s)
- Philipp Jud
- Department of Angiology, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Medical University of Graz, Graz, Austria
| | | | - Angela Horvath
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.,CBMed Center of Biomarker Research, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.,CBMed Center of Biomarker Research, Graz, Austria
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85
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Corna G, Altimare J, Favini A, Lucas L, Arias A, Stöger G, Falconi M, Pizarro R. Ischemic Anterolateral Papillary Muscle Rupture During Pandemic. Circ Cardiovasc Imaging 2021; 14:e013141. [PMID: 34743532 DOI: 10.1161/circimaging.121.013141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuliana Corna
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina
| | - Julieta Altimare
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina
| | - Agustin Favini
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina.,Cardiovascular Images Service (A.F., L.L., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina
| | - Luciano Lucas
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina.,Cardiovascular Images Service (A.F., L.L., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina
| | - Anibal Arias
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina
| | - Guillermo Stöger
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina.,Cardiovascular Surgery Department (G.S.), Hospital Italiano de Buenos Aires, Argentina
| | - Mariano Falconi
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina.,Cardiovascular Images Service (A.F., L.L., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina
| | - Rodolfo Pizarro
- Cardiology Department (G.C., J.A., A.F., L.L., A.A., G.S., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina.,Cardiovascular Images Service (A.F., L.L., M.F., R.P.), Hospital Italiano de Buenos Aires, Argentina
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86
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Yang WF, Zheng D, Cheng RCK, Pu JJ, Su YX. Identifying unmet non-COVID-19 health needs during the COVID-19 outbreak based on social media data: a proof-of-concept study in Wuhan city. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1403. [PMID: 34733955 PMCID: PMC8506784 DOI: 10.21037/atm-21-1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022]
Abstract
Background The occupancy of healthcare resources by the COVID-19 outbreak had led to the unmet health needs of non-COVID-19 diseases. We aimed to explore whether the social media information could help surveil and understand the characteristics of unmet non-COVID-19 health needs during the COVID-19 outbreak in Wuhan city. Methods This was an observational study based on social media data. The study period was set during the 3 months of the COVID-19 outbreak. Non-COVID-19 urgent and emergent health needs in Wuhan city were derived from Sina Weibo—one of China’s largest social media platforms. Lag Spearman correlation was used to investigate the epidemiological relationship between the COVID-19 outbreak and non-COVID-19 health needs. Patient’s primary diseases and needed care were annotated and categorized according to the International Classification of Diseases 11th Revision. The delay time in seeking help was calculated and compared. Results After screening 114,795 Weibo posts, a total of 229 patients with non-COVID-19 health needs were included in our study. There were significant correlations between the daily number of COVID-19 cases at a 10-day lag, deaths at a 5-day lag, and non-COVID-19 Weibo. The actual number of non-COVID-19 patients with urgent and emergent health needs was estimated to be about 6,966. Patients with non-COVID-19 health needs were skewed to those aged 50 to 70 years. The non-COVID-19 diseases were diverse, with 46.3% as non-neoplastic diseases and 53.7% as neoplasms. The most needed cares were palliative cancer care (22.7%), chemotherapy (18.8%), and critical care (17.0%). The median delay in seeking help was 3 days [interquartile range (IQR), 1 to 15 days] for acute care, and 18.5 days (IQR, 6 to 30 days) for cancer care. Conclusions Our preliminary findings in Wuhan city indicated that the social media data might provide a viable option to surveil and understand the unmet health needs during an outbreak. Those heterogeneous health needs derived from the social media data might inspire a more resilient healthcare system to address the unmet needs promptly.
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Affiliation(s)
- Wei-Fa Yang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Danping Zheng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Reynold C K Cheng
- Department of Computer Science, The University of Hong Kong, Hong Kong, China
| | - Jingya Jane Pu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yu-Xiong Su
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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87
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Babel A, Taneja R, Mondello Malvestiti F, Monaco A, Donde S. Artificial Intelligence Solutions to Increase Medication Adherence in Patients With Non-communicable Diseases. Front Digit Health 2021; 3:669869. [PMID: 34713142 PMCID: PMC8521858 DOI: 10.3389/fdgth.2021.669869] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Artificial intelligence (AI) tools are increasingly being used within healthcare for various purposes, including helping patients to adhere to drug regimens. The aim of this narrative review was to describe: (1) studies on AI tools that can be used to measure and increase medication adherence in patients with non-communicable diseases (NCDs); (2) the benefits of using AI for these purposes; (3) challenges of the use of AI in healthcare; and (4) priorities for future research. We discuss the current AI technologies, including mobile phone applications, reminder systems, tools for patient empowerment, instruments that can be used in integrated care, and machine learning. The use of AI may be key to understanding the complex interplay of factors that underly medication non-adherence in NCD patients. AI-assisted interventions aiming to improve communication between patients and physicians, monitor drug consumption, empower patients, and ultimately, increase adherence levels may lead to better clinical outcomes and increase the quality of life of NCD patients. However, the use of AI in healthcare is challenged by numerous factors; the characteristics of users can impact the effectiveness of an AI tool, which may lead to further inequalities in healthcare, and there may be concerns that it could depersonalize medicine. The success and widespread use of AI technologies will depend on data storage capacity, processing power, and other infrastructure capacities within healthcare systems. Research is needed to evaluate the effectiveness of AI solutions in different patient groups and establish the barriers to widespread adoption, especially in light of the COVID-19 pandemic, which has led to a rapid increase in the use and development of digital health technologies.
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Affiliation(s)
- Aditi Babel
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richi Taneja
- Medical Product Evaluation, Pfizer Ltd, Mumbai, India
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88
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Rusconi F, Di Fabrizio V, Puglia M, Sica M, De Santis R, Masi S, Gagliardi L. Delayed presentation of children to the emergency department during the first wave of COVID-19 pandemic in Italy: Area-based cohort study. Acta Paediatr 2021; 110:2796-2801. [PMID: 34214214 PMCID: PMC8444882 DOI: 10.1111/apa.16019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022]
Abstract
Aim To ascertain a delay in attendances to the emergency department (ED) during 2020 lockdown. Methods Area‐based cohort study on paediatric (0‐15 years) attendances resulting in hospital admission in Tuscany, Italy, in February‐May 2020, and the corresponding periods in 2018‐19. We analysed times from symptom onset to arrival, the odds of arriving late (>90th centile of time) and paediatricians’ judgements of a late presentation by logistic models. Results As expected, ED attendance fell sharply (−62%) in 2020 vs 2018‐19. As for cases studied (455 in 2020 and 1161 in 2018–19), we documented a delay in arrival to the ED in 2020 versus 2018–19 for several groups of diagnoses, namely gastroenteritis, sepsis, wounds, burns and infections overall. Time to presentation over 90th centile was also higher in 2020 (odds ratio, OR: 1.44; 95% confidence interval: 1.00, 2.06), as were paediatricians’ judgements of a late arrival (18.9% of cases in 2020 vs. 13.4% in 2018‐19; OR: 1.58; 1.14, 2.19) Conclusion In a population‐based cohort, delayed attendances to ED ascertained both subjectively and objectively convey the message to families and to paediatricians to seek hospital care in case of severe or unremitting symptoms and not to wait longer than they normally would.
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Affiliation(s)
- Franca Rusconi
- Unit of Epidemiology Meyer Children’s University Hospital Florence Italy
- Unit of Epidemiology Regional Health Agency of Tuscany Florence Italy
| | | | - Monia Puglia
- Unit of Epidemiology Regional Health Agency of Tuscany Florence Italy
| | - Michela Sica
- Unit of Epidemiology Meyer Children’s University Hospital Florence Italy
| | - Rita De Santis
- Department of Emergency Medicine and Trauma Center Meyer Children's University Hospital Florence Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center Meyer Children's University Hospital Florence Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics Versilia Hospital Viareggio Italy
- Azienda USL Toscana Nord Ovest Pisa Italy
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89
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Abstract
PURPOSE OF REVIEW This review aims to assess the global impact of the COVID-19 pandemic on the cardiovascular diseases (CVDs), trying to assess the possible future trajectory of the CVDs and their management. RECENT FINDINGS The COVID-19 pandemic has had a deleterious impact on the CV risk factors, with an increase in both sedentary and unhealthy food habits. The fear of contagion has decreased the access to the emergency systems with an increase in out-of-hospital-cardiac-arrests and late presentation of acute myocardial infarctions. The closure of the non-urgent services has delayed cardiac rehabilitation programmes and chronic clinical care. As a result of the COVID-19 pandemic impact on the population habits and on the management of CVDs, we will probably face an increase in CVD and heart failure cases. It is crucial to use all the non-traditional approaches, such as telemonitoring systems, in order to overcome the difficulties raised by the pandemic.
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Affiliation(s)
- Alessandra Pina
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, piazzale Brescia 20, 20149, Milan, Italy
| | - Silvia Castelletti
- IRCCS Istituto Auxologico Italiano, Cardiomyopathy Unit and Center for the Cardiac Arrhythmias of Genetic Origin, Department of Cardiovascular, Neural and Metabolic Sciences, piazzale Brescia 20, 20149, Milan, Italy.
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90
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Seidu S, Kunutsor SK, Cos X, Khunti K. Indirect impact of the COVID-19 pandemic on hospitalisations for cardiometabolic conditions and their management: A systematic review. Prim Care Diabetes 2021; 15:653-681. [PMID: 34083122 PMCID: PMC8162904 DOI: 10.1016/j.pcd.2021.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic crisis in health care systems worldwide. These may have significant implications for the management of cardiometabolic diseases. We conducted a systematic review of published evidence to assess the indirect impact of the COVID-19 pandemic on hospitalisations for cardiovascular diseases and their management. METHODS Studies that evaluated volume of hospitalisations for cardiometabolic conditions and their management with comparisons between the COVID-19 and pre-COVID periods were identified from MEDLINE, Embase and the reference list of relevant studies from January 2020 to 25 February 2021. RESULTS We identified 103 observational studies, with most studies assessing hospitalisations for acute cardiovascular conditions such as acute coronary syndrome, ischemic strokes and heart failure. About 89% of studies reported a decline in hospitalisations during the pandemic compared to pre-pandemic times, with reductions ranging from 20.2 to 73%. Severe presentation, less utilization of cardiovascular procedures, and longer patient- and healthcare-related delays were common during the pandemic. Most studies reported shorter length of hospital stay during the pandemic than before the pandemic (1-8 vs 2-12 days) or no difference in length of stay. Most studies reported no change in in-hospital mortality among hospitalised patients. CONCLUSION Clinical care of patients for acute cardiovascular conditions, their management and outcomes have been adversely impacted by the COVID-19 pandemic. Patients should be educated via population-wide approaches on the need for timely medical contact and health systems should put strategies in place to provide timely care to patients at high risk. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2021: CRD42021236102.
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Affiliation(s)
- Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, UK.
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Xavier Cos
- DAP_Cat Research Group, Gerencia Territorial Barcelona Ciutat, Institut Català de la Salut, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, UK
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91
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Cannata A, Watson SA, Daniel A, Giacca M, Shah AM, McDonagh TA, Scott PA, Bromage DI. Impact of the COVID-19 pandemic on in-hospital mortality in cardiovascular disease: a meta-analysis. Eur J Prev Cardiol 2021; 29:1266-1274. [PMID: 34297822 PMCID: PMC8344916 DOI: 10.1093/eurjpc/zwab119] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Aims The COVID-19 pandemic has resulted in excess mortality due to both COVID-19 directly and other conditions, including cardiovascular (CV) disease. We aimed to explore the excess in-hospital mortality, unrelated to COVID-19 infection, across a range of CV diseases. Methods and results A systematic search was performed for studies investigating in-hospital mortality among patients admitted with CV disease without SARS-CoV-2 infection compared with a period outside the COVID-19 pandemic. Fifteen studies on 27 421 patients with CV disease were included in the analysis. The average in-hospital mortality rate was 10.4% (n = 974) in the COVID-19 group and 5.7% (n = 1026) in the comparator group. Compared with periods outside the COVID-19 pandemic, the pooled risk ratio (RR) demonstrated increased in-hospital mortality by 62% during COVID-19 [95% confidence interval (CI) 1.20–2.20, P = 0.002]. Studies with a decline in admission rate >50% during the COVID-19 pandemic observed the greatest increase in mortality compared with those with <50% reduction [RR 2.74 (95% CI 2.43–3.10) vs. 1.21 (95% CI 1.07–1.37), P < 0.001]. The observed increased mortality was consistent across different CV conditions (P = 0.74 for interaction). Conclusions In-hospital mortality among patients admitted with CV diseases was increased relative to periods outside the pandemic, independent of co-infection with COVID-19. This effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period. However, studies were generally poorly conducted, and there is a need for further well-designed studies to establish the full extent of mortality not directly related to COVID-19 infection.
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Affiliation(s)
- Antonio Cannata
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Samuel A Watson
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Allen Daniel
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Mauro Giacca
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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92
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Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic. Am J Emerg Med 2021; 49:367-372. [PMID: 34246966 PMCID: PMC8254397 DOI: 10.1016/j.ajem.2021.06.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. Study This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. Results COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. Conclusions Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.
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93
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Long-Term Outcomes of Patients with Coronavirus Disease 2019 at One Year after Hospital Discharge. J Clin Med 2021; 10:jcm10132945. [PMID: 34209085 PMCID: PMC8269002 DOI: 10.3390/jcm10132945] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 12/29/2022] Open
Abstract
Background: The long-term effects of COVID-19 remain largely unclear. This study aims to investigate post-acute health consequences and mortality one year after hospital discharge. Methods: All surviving adult patients who were discharged after hospital admission due to acute COVID-19 in the first wave of the pandemic underwent a comprehensive interview. Functional assessment was performed in patients aged over 65. Clinical and hospital records were reviewed and mortality causes assessed. Results: A total of 587 patients with COVID-19 were discharged from hospital, including 266 after hospital admission and 321 from the emergency room. Mortality within the following year occurred in 34/266 (12.8%) and 10/321 (3.1%), respectively, due to causes directly or possibly related to COVID-19 in 20.5% and 25% of patients. Post-COVID-19 syndrome was assessed in 543 patients at one year from discharge. Any clinical complaint was reported by 90.1% of patients who needed hospitalization and 80.4% of those discharged from the emergency room (p = 0.002), with breathlessness (41.6%), tiredness (35.4%), ageusia (30.2%), and anosmia (26.3%) being the most common complaints. Ongoing symptoms attributed to COVID-19 were reported by 66.8% and 49.5% of patients, respectively (p < 0.001). Newly developed COPD, asthma, diabetes, heart failure, and arthritis—as well as worsening of preexisting comorbidities—were found. Conclusions: One-year mortality among survivors of acute COVID-19 was 7.5%. A significant proportion of COVID-19 patients experienced ongoing symptoms at 1 year from onset of the disease.
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94
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Miró Ò, Jiménez S, Mebazaa A, Freund Y, Burillo-Putze G, Martín A, Martín-Sánchez FJ, García-Lamberechts EJ, Alquézar-Arbé A, Jacob J, Llorens P, Piñera P, Gil V, Guardiola J, Cardozo C, Mòdol Deltell JM, Tost J, Aguirre Tejedo A, Palau-Vendrell A, LLauger García L, Adroher Muñoz M, Del Arco Galán C, Agudo Villa T, López-Laguna N, López Díez MP, Beddar Chaib F, Quero Motto E, González Tejera M, Ponce MC, González Del Castillo J. Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome. Eur Heart J 2021; 42:3127-3142. [PMID: 34164664 PMCID: PMC8344714 DOI: 10.1093/eurheartj/ehab314] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/21/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022] Open
Abstract
Aims We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. Methods and Results We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92‰). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51–9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65–1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97–2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66–4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations. Conclusions PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Alexandre Mebazaa
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP Rue Ambroise Paré, 75010 Paris, France
| | - Yonathan Freund
- Emergency Department, HôpitalPitié-Salpêtrière, Assistance Publique-Hôpitaux 18 de Paris (APHP), Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Alfonso Martín
- Emergency Department, Hospital Severo Ochoa, M-402, 8, 28914 Leganés, Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Eric Jorge García-Lamberechts
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Hospital General de Alicante, University Miguel Hernández, Calle Pintor Baeza, 11, 03010 Alicante, Spain
| | - Pascual Piñera
- Emergency Department, Hospital General Universitario Reina Sofía. Av. Intendente Jorge Palacios, 1, 30003 Murcia, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Josep Guardiola
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Carlos Cardozo
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - Josep Maria Mòdol Deltell
- Emergency Department, Hospital Universitari Germans Trias i Pujol de Badalona, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Carretera Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | - Alfons Aguirre Tejedo
- Emergency Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Anna Palau-Vendrell
- Emergency Department, Hospital Universitari Joan XXIII, Carrer Dr. Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Lluís LLauger García
- Emergency Department, Hospital Universitari de Vic, Carrer de Francesc Pla el Vigatà, 1, 08500 Vic Barcelona, Spain
| | - Maria Adroher Muñoz
- Emergency Department, Hospital Universitari de Girona Dr JosepTrueta, Avinguda de França, S/N, 17007 Girona, Spain
| | - Carmen Del Arco Galán
- Emergency Department, Hospital Universitario de la Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Teresa Agudo Villa
- Emergency Department, Hospital Universitario Severo Ochoa, M-402, 8, 28914 Leganés, Madrid, Spain
| | - Nieves López-Laguna
- Emergency Department, Clínica Universidad Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain
| | - María Pilar López Díez
- Emergency Department, Hospital Universitario de Burgos. Av. Islas Baleares, 3, 09006 Burgos, Spain
| | - Fahd Beddar Chaib
- Emergency Department, Complejo Asistencial de Soria, Paseo Sta. Bárbara, 42005 Soria, Spain
| | - Eva Quero Motto
- Emergency Department, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Matilde González Tejera
- Emergency Department, Hospital General Universitario de Elche. Carrer Almazara, 11, 03203 Elche, Alicante, Spain
| | - María Carmen Ponce
- Emergency Department, Hospital de la Vega Baja Orihuela. Carretera Orihuela - Almoradí, S/N, Orihuela, Alicante, Spain
| | - Juan González Del Castillo
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
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95
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Affiliation(s)
- Thomas Rea
- Department of Medicine General Medicine University of Washington Seattle WA.,The Division of Emergency Medical Services, Public Health Seattle & King County Seattle WA
| | - Peter J Kudenchuk
- The Division of Emergency Medical Services, Public Health Seattle & King County Seattle WA.,Department of Medicine Cardiology University of Washington Seattle WA
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96
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Schuster NA, de Breij S, Schaap LA, van Schoor NM, Peters MJL, de Jongh RT, Huisman M, Hoogendijk EO. Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam. Eur Geriatr Med 2021; 12:1075-1083. [PMID: 34046874 PMCID: PMC8159721 DOI: 10.1007/s41999-021-00514-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022]
Abstract
Aim To investigate the extent to which Dutch older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic. Findings One third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. Message Delay of routine care during the pandemic may impact morbidity and related adverse outcomes in the long term, which should be monitored in future research. Purpose Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics. Methods Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine. Results 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09–3.50; hospital OR = 1.86, 95% CI = 1.28–2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04–4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06–1.24). Conclusion About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.
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Affiliation(s)
- Noah A Schuster
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Sascha de Breij
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Mike J L Peters
- Department of Internal Medicine, Section Geriatrics, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, Section Endocrinology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands.
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97
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Rosman L, Armbruster T, Kyazimzade S, Tugaoen Z, Mazzella AJ, Deyo Z, Walker J, Machineni S, Gehi A. Effect of a virtual self-management intervention for atrial fibrillation during the outbreak of COVID-19. Pacing Clin Electrophysiol 2021; 44:451-461. [PMID: 33565642 PMCID: PMC8014277 DOI: 10.1111/pace.14188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the pandemic continues to unfold, effective, technology-based solutions are needed to help patients with atrial fibrillation (AF) maintain their health and well-being during the outbreak of COVID-19. METHODS This single-center, pilot study investigated the effects of a 4-week (eight sessions) virtual AF self-management program. Questionnaires were completed at baseline and 1 week after the intervention, and assessed AF knowledge, adherence to self-management behaviors, mental health, physical function, and disease-specific quality of life in patients with AF. Secondary outcomes included knowledge of COVID-19, intervention, acceptability, and satisfaction. RESULTS Of 68 patients who completed baseline questionnaires, 57 participated in the intervention and were included in the analysis (mean age of 73.4 ± 10.0 years, 60% male). Adherence to AF self-monitoring behaviors, including monitoring their heart rate (p < .001), heart rhythm (p = .003), and blood pressure (p = .013) were significantly improved at the end of the intervention compared with baseline. Symptom identification (p = .007) and management (p < .001) also improved. Reductions in sleep disturbance (p < .001), anxiety (p = .014), and depression (p = .046) were also observed. Misinformation and inaccurate beliefs about COVID-19 were significantly reduced at the end of the intervention compared with baseline. CONCLUSIONS This pilot study suggests that a virtual patient education program could have beneficial effects on adherence to guideline-recommend self-care of AF, emotional wellbeing, physical function, and knowledge of COVID-19 in patients with AF. Future randomized studies in larger samples are needed to determine the clinical benefits of the intervention.
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Affiliation(s)
- Lindsey Rosman
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Tiffany Armbruster
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sayyad Kyazimzade
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Zachary Tugaoen
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anthony J. Mazzella
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Zack Deyo
- Department of PharmacyUniversity of North Carolina HospitalsChapel HillNorth CarolinaUSA
- Division of Practice Advancement and Clinical EducationUniversity of North Carolina Eshelman School of PharmacyChapel HillNorth CarolinaUSA
| | - Jennifer Walker
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sriram Machineni
- Department of MedicineDivision of Endocrinology & MetabolismUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anil Gehi
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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98
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Zeymer U, Gitt A, Thiele H. [COVID-19 pandemic : Effects on clinical care of cardiovascular patients in spring 2020]. Herz 2021; 46:115-119. [PMID: 33590283 PMCID: PMC7884099 DOI: 10.1007/s00059-020-05015-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
Die COVID-19(„coronavirus disease 2019“)-Pandemie hat zu einer Fokussierung der Akutmedizin auf die Versorgung von Patienten mit SARS-CoV-2(„severe acute respiratory syndrome coronavirus type 2“)-infizierten Patienten geführt – mit Auswirkungen auf alle anderen medizinischen Gebiete. In den Monaten von März bis Mai 2020 kam es zu einem Rückgang der Krankenhausaufnahmen sowohl für elektive kardiologische Prozeduren als auch für akute kardiologische Erkrankungen. Die Anzahl von Patienten mit akutem Herzinfarkt, insbesondere mit Nicht-ST-Strecken-Hebungs-Infarkt, ist während dieser Monate zurückgegangen, und es zeigte sich auch teilweise eine Zunahme der Zeit zwischen Symptombeginn und Krankenhausaufnahme. In einigen Untersuchungen wurde auch eine Erhöhung der infarktbezogenen Mortalität beobachtet. Die Gründe sind vielfältig und beinhalten eine Furcht der Patienten vor dem Krankenhausaufenthalt mit möglicher Ansteckung mit SARS-CoV‑2, Missdeutung der Symptome und Fokussierung des Gesundheitssystems auf die Pandemie. Zusätzlich kann SARS-CoV‑2 zu einer höheren Thromboseneigung führen und damit schwerere Verläufe eines Myokardinfarkts induzieren.
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Affiliation(s)
- Uwe Zeymer
- Medizinische Klinik B und Institut für Herzinfarktforschung Ludwigshafen, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Deutschland.
| | - Anselm Gitt
- Medizinische Klinik B und Institut für Herzinfarktforschung Ludwigshafen, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Deutschland
| | - Holger Thiele
- Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.
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Alanazi MF, Alanazi ZT, Alanazi MO, Alanazi SR, Alanazi WO, Alanazi YO, Alanazi AS. Covid-19 Pandemic Effects on Orthopedic Patients: Northern Saudi Patients’ Perspectives. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/qzf4fqmf7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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