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Lübcke J, Peters F, Acar L, Marschall U, Behrendt CA. Short Term Outcomes and Treatment Intensity of Major Cardiovascular Emergencies During the COVID-19 Pandemic in Germany. Eur J Vasc Endovasc Surg 2024; 68:82-89. [PMID: 38493960 DOI: 10.1016/j.ejvs.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/17/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE There has been a decline in hospital admission rates in many countries since the beginning of the COVID-19 pandemic. Patient selection differed from episodes before the pandemic. This study investigated changes in baseline characteristics as well as the short term mortality rate and probability of receiving an invasive procedure while considering sex disparities. METHODS Claims data provided by Germany's second largest insurance fund, BARMER, were used. Patients without COVID-19 who were treated for ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), acute limb ischaemia (ALI), and stroke between 1 January 2018 and 31 December 2021 were included. Outcomes were compared separately for both sexes between the years before the pandemic (2018/2019) and during the pandemic (2020/2021). Propensity scores with exact matching were used to balance confounders including age, drug prescriptions in the previous year, federal state, month of admission, domiciliary care, and the Elixhauser comorbidities. Short term death and probability of invasive procedures were determined using cumulative incidence functions and Cox regressions. RESULTS The cohort consisted of 140 989 hospitalisations of 122 340 individual patients (48.3% female) with 102 960 matched cases. Baseline characteristics were similar between episodes in the unmatched cohort. Earlier discharge was observed for all strata except for males with ALI or STEMI, where the probability of early discharge was unchanged. The probability of receiving an invasive procedure was increased for both sexes with ALI, NSTEMI, and STEMI but not for stroke. The analyses suggested neither a statistically significant increase of the in hospital mortality rate nor the 30 day mortality rate after the pandemic started. CONCLUSION There was no evidence for a direct or indirect impact of the pandemic on major short term hospital outcomes. While the probability of receiving an invasive procedure increased for STEMI, NSTEMI, and ALI, the overall short term mortality rate was unaffected for both sexes.
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Affiliation(s)
- Jenny Lübcke
- Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Christian-Alexander Behrendt
- Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany; Medical School Brandenburg Theodor-Fontane, Neuruppin, Germany.
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Reyes-Santias F, Reboredo-Nogueira JC, Garcia-Alvarez RM, Cinza-Sanjurjo S, Gonzalez Juanatey JR. Population-based disease-group analysis of Spanish excess mortality in the early COVID-19 pandemic period. Open Heart 2024; 11:e002568. [PMID: 38851247 PMCID: PMC11163686 DOI: 10.1136/openhrt-2023-002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND AND AIM Increased mortality during the COVID-19 pandemic is not explained exclusively by COVID-19 infection and its complications. We analysed non-COVID-19 causes of mortality in a population analysis based on data from the Spanish National Institute of Statistics. METHODS Using monthly mortality data in Spain (January 2010-December 2020), we analysed deaths associated with cancer, blood, endocrine, mental, nervous, cardiovascular, respiratory and digestive diseases and explored the COVID-19 impact using a difference-in-difference strategy. We calculated monthly interannual variations in mortality and computed percentage change in terms of the log of deaths in month h of year t minus the log of deaths in month h in the previous year t-1. RESULTS In 2020 in Spain, mortality increased 17.9% compared with 2019. COVID-19 was the leading cause of death (n=60 358), followed by ischaemic heart disease (n=29 654). Throughout 2020, monthly interannual variations in cardiovascular mortality showed an average upward trend of 1.7%, while digestive, cancer and blood diseases showed a downward trend. CONCLUSIONS During the COVID-19 pandemic in Spain in 2020, excess mortality was primarily related to cardiovascular mortality while mortality associated with digestive, cancer and blood diseases was reduced.
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Affiliation(s)
- Francisco Reyes-Santias
- University of Vigo, Vigo, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- IDIS, Santiago de Compostela, Spain
| | | | - Rosa Maria Garcia-Alvarez
- Preventive Medicine Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sergio Cinza-Sanjurjo
- IDIS, Santiago de Compostela, Spain
- Primary Care, CS Milladoiro, SERGAS, Santiago de Compostela, Spain
| | - Jose Ramon Gonzalez Juanatey
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- IDIS, Santiago de Compostela, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Previsdomini M, Perren A, Chiesa A, Kaufmann M, Pargger H, Ludwig R, Cerutti B. Changes in diagnostic patterns and resource utilisation in Swiss adult ICUs during the first two COVID-19 waves: an exploratory study. Swiss Med Wkly 2024; 154:3589. [PMID: 38579322 DOI: 10.57187/s.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND AND AIM The coronavirus disease 2019 (COVID-19) outbreak deeply affected intensive care units (ICUs). We aimed to explore the main changes in the distribution and characteristics of Swiss ICU patients during the first two COVID-19 waves and to relate these figures with those of the preceding two years. METHODS Using the national ICU registry, we conducted an exploratory study to assess the number of ICU admissions in Switzerland and their changes over time, characteristics of the admissions, the length of stay (LOS) and its trend over time, ICU mortality and changes in therapeutic nursing workload and hospital resources in 2020 and compare them with the average figures in 2018 and 2019. RESULTS After analysing 242,935 patient records from all 84 certified Swiss ICUs, we found a significant decrease in admissions (-9.6%, corresponding to -8005 patients) in 2020 compared to 2018/2019, with an increase in the proportion of men admitted (61.3% vs 59.6%; p <0.001). This reduction occurred in all Swiss regions except Ticino. Planned admissions decreased from 25,020 to 22,021 in 2020 and mainly affected the neurological/neurosurgical (-14.9%), gastrointestinal (-13.9%) and cardiovascular (-9.3%) pathologies. Unplanned admissions due to respiratory diagnoses increased by 1971 (+25.2%), and those of patients with acute respiratory distress syndrome (ARDS) requiring isolation reached 9973 (+109.9%). The LOS increased by 20.8% from 2.55 ± 4.92 days (median 1.05) in 2018/2019 to 3.08 ± 5.87 days (median 1.11 days; p <0.001), resulting in an additional 19,753 inpatient days. The nine equivalents of nursing manpower use score (NEMS) of the first nursing shift (21.6 ± 9.0 vs 20.8 ± 9.4; p <0.001), the total NEMS per patient (251.0 ± 526.8 vs 198.9 ± 413.8; p <0.01) and mortality (5.7% vs 4.7%; p <0.001) increased in 2020. The number of ICU beds increased from 979 to 1012 (+3.4%), as did the number of beds equipped with mechanical ventilators (from 773 to 821; +6.2%). CONCLUSIONS Based on a comprehensive national data set, our report describes the profound changes triggered by COVID-19 over one year in Swiss ICUs. We observed an overall decrease in admissions and a shift in admission types, with fewer planned hospitalisations, suggesting the loss of approximately 3000 elective interventions. We found a substantial increase in unplanned admissions due to respiratory diagnoses, a doubling of ARDS cases requiring isolation, an increase in ICU LOS associated with substantial nationwide growth in ICU days, an augmented need for life-sustaining therapies and specific therapeutic resources and worse outcomes.
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Affiliation(s)
- Marco Previsdomini
- Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Andreas Perren
- Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Biomedical Sciences, Università Svizzera Italiana, Lugano, Switzerland
| | - Alessandro Chiesa
- Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Mark Kaufmann
- Intensive Care Unit, Department Acute Medicine, University Hospital and University Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, Department Acute Medicine, University Hospital and University Basel, Basel, Switzerland
| | - Roger Ludwig
- Department of Intensive Care Medicine, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Emmert-Fees KMF, Luhar S, O'Flaherty M, Kypridemos C, Laxy M. Forecasting the mortality burden of coronary heart disease and stroke in Germany: National trends and regional inequalities. Int J Cardiol 2023; 393:131359. [PMID: 37757987 DOI: 10.1016/j.ijcard.2023.131359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The decline of cardiovascular disease (CVD) mortality has slowed in many countries, including Germany. We examined the implications of this trend for future coronary heart disease (CHD) and stroke mortality in Germany considering persistent mortality inequalities between former East and West Germany. METHODS We retrieved demographic and mortality data from 1991 to 2019 from the German Federal Statistical Office. Using a Bayesian age-period-cohort framework, we projected CHD and stroke mortality from 2019 to 2035, stratified by sex and German region. We decomposed annual changes in deaths into three components (mortality rates, population age structure and population size) and assessed regional inequalities with age-sex-standardized mortality ratios. RESULTS We confirmed that declines of CVD mortality rates in Germany will likely stagnate. From 2019 to 2035, we projected fewer annual CHD deaths (114,600 to 103,500 [95%-credible interval: 81,700; 134,000]) and an increase in stroke deaths (51,300 to 53,700 [41,400; 72,000]). Decomposing past and projected mortality, we showed that population ageing was and is offset by declining mortality rates. This likely reverses after 2030 leading to increased CVD deaths thereafter. Inequalities between East and West declined substantially since 1991 and are projected to stabilize for CHD but narrow for stroke. CONCLUSIONS CVD deaths in Germany likely keep declining until 2030, but may increase thereafter due to population ageing if the reduction in mortality rates slows further. East-West mortality inequalities for CHD remain stable but may converge for stroke. Underlying risk factor trends need to be monitored and addressed by public health policy.
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Affiliation(s)
- Karl M F Emmert-Fees
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany.
| | - Shammi Luhar
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin O'Flaherty
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, United Kingdom
| | - Michael Laxy
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
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Hulíková Tesárková K, Dzúrová D. Impacts of COVID-19 pandemic through decomposition of life expectancy according to leading causes and place of death in Czechia. Sci Rep 2023; 13:20731. [PMID: 38007583 PMCID: PMC10676350 DOI: 10.1038/s41598-023-47949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023] Open
Abstract
While the direct effects of the pandemic are well documented, less is known about the indirect ones, including changes in healthcare provision or human behavior. This paper aims to study the impact of indirect consequences on mortality, focusing on two leading causes (cardiovascular diseases, COVID-19) and places of death in Czechia, during the COVID-19 pandemic, one of the most severely affected European countries. The analysis was performed using data from the Czech Statistical Office and the Institute of Health Information and Statistics. The study compares annual mortality changes during three time periods: pre-pandemic (2018-2019), pandemic beginning and peaking (2020-2021), and pandemic fading (2022). Pandemic years were covered by the WHO public health emergency of international concern. Abridged life tables were computed, and Pollard's decomposition was used to calculate the contributions of causes and places of death on annual differences in life expectancy. Seasonal decomposition of monthly time series revealed an increase in cardiovascular mortality at home or in social care facilities corresponding to limitations in healthcare. While COVID-19 had a systemic negative effect on life expectancy during the pandemic, the impact of cardiovascular mortality according to place of death changed over time. This study contributes to the evidence base of systemic risks during health crises and emergency response.
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Affiliation(s)
- Klára Hulíková Tesárková
- Department of Demography and Geodemography, Faculty of Sciences, Charles University, Prague, Czechia
| | - Dagmar Dzúrová
- Department of Social Geography and Regional Development, Faculty of Sciences, Charles University, Prague, Czechia.
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Pirayesh Z, Riahi SM, Bidokhti A, Kazemi T. Evaluation of the effect of the COVID-19 pandemic on the all-cause, cause-specific mortality, YLL, and life expectancy in the first 2 years in an Iranian population-an ecological study. Front Public Health 2023; 11:1259202. [PMID: 37927873 PMCID: PMC10620308 DOI: 10.3389/fpubh.2023.1259202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Background COVID-19 pandemic resulted in excess mortality and changed the trends of causes of death worldwide. In this study, we investigate the all-cause and cause-specific deaths during the COVID-19 pandemic (2020-2022) compared to the baseline (2018-2020), considering age groups, gender, place of residence, and place of death in south Khorasan, east of Iran. Methods The present ecological study was conducted using South Khorasan Province death certificate data during 2018-2022. The number of death and all-cause and cause-specific mortality rates (per 100,000 people) were calculated and compared based on age groups, place of residence, place of death, and gender before (2018-2020) and during the COVID-19 pandemic (2020-2022). We also calculated total and cause-specific years of life lost (YLL) to death and gender-specific life expectancy at birth. Results A total of 7,766 deaths occurred from March 21, 2018, to March 20, 2020 (pre-pandemic) and 9,984 deaths from March 21, 2020, to March 20, 2022 (pandemic). The mean age at death increased by about 2 years during the COVID-19 pandemic. The mortality rate was significantly increased in the age groups 20 years and older. The most excess deaths were recorded in men, Aged more than 60 years, death at home, and the rural population. Mortality due to COVID-19 accounted for nearly 17% of deaths. The highest increase in mortality rate was observed due to endocrine and Cardiovascular diseases. Mortality rates due to the genitourinary system and Certain conditions originating in the perinatal period have decreased during the COVID-19 pandemic. The major causes of death during the pandemic were Cardiovascular diseases, COVID-19, cancer, chronic respiratory diseases, accidents, and endocrine diseases in both sexes, in rural and urban areas. Years of life lost (YLL) increased by nearly 15.0%, which was mostly due to COVID-19, life expectancy at birth has steadily declined from 2018 to202 for both genders (from 78.4 to 75). Conclusion In this study, we found that All-cause mortality increased by 25.5% during the COVID-19 pandemic, especially in men, older adult, Rural residents, and those who died at home (outside the hospital). Considering that the most common causes of death during the COVID-19 pandemic are also non-communicable diseases. It is necessary to pay attention to non-communicable diseases even during the pandemic of a serious infectious disease like COVID-19. The years of life lost also increased during the COVID-19 pandemic, which is necessary to pay attention to all age groups, especially the causes of death in young people. In most developing countries, the first cause of death of these groups is accidents.
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Affiliation(s)
- Zahra Pirayesh
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Seyed Mohammad Riahi
- Department of Community Medicine, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Bidokhti
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Toba Kazemi
- Department of Cardiology, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Xiao H, Liu F, Unger JM. Dynamic zero-COVID policy and healthcare utilization patterns in China during the Shanghai COVID-19 Omicron outbreak. COMMUNICATIONS MEDICINE 2023; 3:143. [PMID: 37821531 PMCID: PMC10567791 DOI: 10.1038/s43856-023-00375-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND In April 2022, an outbreak of the SARS-CoV-2 virus Omicron variant in Shanghai precipitated an extensive lockdown. We assessed changes in healthcare utilization during this outbreak and investigated the relationship between the stringency of mitigation strategies and disruptions in healthcare utilization. METHODS Using provincial-level data from routine health information systems covering all hospitals across Mainland China, we conducted an interrupted time series analysis to examine changes in healthcare utilization during the Shanghai outbreak. Linear regression was used to evaluate the direction and magnitude of the association between the relative changes in the move-out movement index, a proxy for the stringency in population-level mitigation strategies, and the estimated relative changes in healthcare utilization. RESULTS Overall, there were 22.9 billion outpatient visits and 1.2 billion discharged inpatients during the study period from January 2016 to May 2022, including 9.1 billion (39.7%) and 0.46 billion (38.2%) in the post-COVID-19 period (January 2020-May 2022), respectively. From March through May 2022, the outbreak resulted in an accumulative loss of 23.5 million (47%) outpatient visits and 0.6 million (55%) discharged inpatients in Shanghai, and a loss of 150.3 million (14%) outpatient visits and 3.6 million (7%) discharged inpatients in other regions. We find that for every 10-percentage point reduction in the relative change of move-out index, a 2.7 (95% CI: 2.0-3.4) percentage point decline in the relative change of outpatient visits, and a 4.3 (95% CI: 3.5-5.2) percentage points decline in the relative change of inpatient discharges. CONCLUSIONS The Shanghai COVID-19 Omicron outbreak associates with a substantial reduction in outpatient visits and inpatient discharges within Shanghai and other regions in China. The stringency of the COVID-19 lockdown policies associates with more profound reductions in healthcare utilization.
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Affiliation(s)
- Hong Xiao
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Fang Liu
- Independent Researcher, Beijing, China
| | - Joseph M Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Ushimoto T, Yao S, Nunokawa C, Murasaka K, Inaba H. Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis. Emerg Med J 2023; 40:556-563. [PMID: 37280044 PMCID: PMC10423471 DOI: 10.1136/emermed-2022-213001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/20/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Improving out-of-hospital cardiac arrest (OHCA) prognosis within the working-age population is important, but no studies have investigated the effects of COVID-19 pandemic specifically on the working-age population with OHCAs. We aimed to determine the association between the 2020 COVID-19 pandemic and OHCA outcomes and bystander resuscitation efforts among the working-age population. METHODS Prospectively collected nationwide, population-based records concerning 166 538 working-age individuals (men, 20-68 years; women, 20-62 years) with OHCA between 2017 and 2020 were assessed. We compared characteristics and outcome differences of the arrests between three prepandemic years (2017-2019) and the pandemic year 2020. The primary outcome was neurologically favourable 1-month survival (cerebral performance category 1 or 2). Secondary outcomes were bystander cardiopulmonary resuscitation (BCPR), dispatcher-assisted instruction for cardiopulmonary resuscitation (DAI-CPR), bystander-provided defibrillation (public access defibrillation (PAD)) and 1-month survival. We examined variations in bystander resuscitation efforts and outcomes among pandemic phase and regional classifications. RESULTS Among 149 300 OHCA cases, 1-month survival (2020, 11.2%; 2017-2019, 11.1% (crude OR (cOR) 1.00, 95% CI 0.97 to 1.05)) and 1-month neurologically favourable survival (7.3%-7.3% (cOR 1.00, 95% CI 0.96 to 1.05)) were unchanged; however, the neurologically favourable 1-month survival rate decreased in 12 of the most COVID-19-affected prefectures (7.2%-7.8% (cOR 0.90, 95% CI 0.85 to 0.96)), whereas it increased in 35 other prefectures (7.5%-6.6% (cOR 1.15, 95% CI 1.07 to 1.23)). Favourable outcomes decreased for OHCAs of presumed cardiac aetiology (10.3%-10.9% (cOR 0.94, 95% CI 0.90 to 0.99)) but increased for OHCAs of non-cardiac aetiology (2.5%-2.0% (cOR 1.27, 95% CI 1.12 to 1.44)). BCPR provision increased from 50.7% of arrests prepandemic to 52.3% (crude OR 1.07, 95% CI 1.04 to 1.09). Compared with 2017-2019, home-based OHCAs in 2020 increased (64.8% vs 62.3% (crude OR 1.12, 95% CI 1.09 to 1.14)), along with DAI-CPR attempts (59.5% vs 56.6% (cOR 1.13, 95% CI 1.10 to 1.15)) and multiple calls to determine a destination hospital (16.4% vs 14.5% (cOR 1.16, 95% CI 1.12 to 1.20)). PAD use decreased from 4.0% to 3.7% but only during the state of emergency period (7 April-24 May 2020) and in prefectures significantly affected by COVID-19. CONCLUSIONS Reviewing automated external defibrillator (AED) locations and increasing BCPR through DAI-CPR may help prevent pandemic-associated decreases in survival rates for patients with cardiac OHCAs.
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Affiliation(s)
- Tomoyuki Ushimoto
- Emergency Medicine, Kanazawa Medical University, Uchinada-machi, Japan
| | - Shintaro Yao
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chika Nunokawa
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kenshi Murasaka
- Emergency Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Hideo Inaba
- Emergency Medicine, Kanazawa Medical University, Uchinada-machi, Japan
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Liu SJ, Chang YZ, Hwu LJ, Ku MS. Educational Videos to Reduce Parental Rejection of Pediatric Cardiac Catheterization during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11101395. [PMID: 37239682 DOI: 10.3390/healthcare11101395] [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: 03/07/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
During the COVID-19 pandemic, people voluntarily reduced their necessary healthcare. We examined whether supplying educational digital versatile discs (DVDs) before admission can reduce parental rejection of pediatric cardiac catheterization for congenital heart disease (CHD). Parents of 70 children with CHD selected for cardiac catheterization were randomly allocated to the DVD (received pre-admission DVDs in the outpatient department; 70 parents of 35 children) or non-DVD groups (did not receive the DVDs; 70 parents of 35 children). The parents could reject the admission of their children within 7 days. Cardiac catheterization was rejected by 14 (20.0%) and 26 (37.1%) parents in the DVD and non-DVD groups, respectively (p = 0.025). Parent Perceptions of Uncertainty Scale scores were lower in the DVD (128.3 ± 8.9 points) than in the non-DVD group (134.1 ± 7.3 points; p < 0.001). Decreased uncertainty due to pre-admission DVD watching could have contributed to the increased parental willingness for cardiac catheterization. The effects of pre-admission educational DVDs were more significant among parents with a lower education, rural residence, with only one child, female child, or younger child. Offering educational DVDs to parents of children selected for cardiac catheterization for CHD may decrease the parental rejection rate of the treatment.
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Affiliation(s)
- Shu-Juan Liu
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 402367, Taiwan
| | - Yan-Zin Chang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Drug Testing Center, Department of Clinical Laboratory, Chung Shan Medical University Hospital, Taichung 402367, Taiwan
| | - Lien-Jen Hwu
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 402367, Taiwan
| | - Min-Sho Ku
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402367, Taiwan
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Thiele H, Zeymer U. The changing spectrum of cardiovascular emergencies during the COVID-19 pandemic. Herz 2023:10.1007/s00059-023-05174-6. [PMID: 37097477 PMCID: PMC10127984 DOI: 10.1007/s00059-023-05174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 04/26/2023]
Abstract
The outbreak of the COVID-19 pandemic in March 2020 influenced treatment strategies and behaviors, particularly cardiovascular emergencies, which may have led to cardiovascular collateral damage. This review article covers aspects of the changing spectrum of cardiac emergencies with a focus on acute coronary syndrome rates and cardiovascular mortality and morbidity based on a selected literature review including the most recent comprehensive meta-analyses.
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Affiliation(s)
- Holger Thiele
- Heart Center Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany
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Alharbi A, Franz A, Alfatlawi H, Wazzan M, Alsughayer A, Eltahawy E, Assaly R. Impact of COVID-19 Pandemic on the Outcomes of Acute Coronary Syndrome. Curr Probl Cardiol 2023; 48:101575. [PMID: 36584730 PMCID: PMC9793956 DOI: 10.1016/j.cpcardiol.2022.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
During the pandemic, health care resources were primarily focused on treating COVID-19 infections and its related complications, with various Clinical units were converted to COVID-19 units, This study aims to investigate the impact of the COVID-19 pandemic on the clinical course of patients who had developed acute coronary syndrome (ACS) including ST-elevation myocardial infarction (STEMI). In this large nationwide observational study utilizing National Inpatient Sample 2019 and 2020.The primary outcomes of our study were in-hospital mortality, length of stay (LOS), total hospital charges and time from admission to percutaneous coronary intervention (PCI). Using the National Inpatient Sample 2020 database we found 32,355,827 hospitalizations in 2020 and 521,484 of which had a primary diagnosis of STEMI that met our criteria. Patients with COVID-19 infection were similar in mean age, more likely to be men, were treated in the same hospital settings as those without COVID-19 and had higher rates of diabetes with chronic complications. These patients had a similar prevalence of traditional coronary artery disease risk factors including hypertension, peripheral vascular disease and obesity. There was higher inpatient mortality (adjusted odds ratios 3.10; 95% CI, 2.40-4.02; P < 0.01) and LOS (95% CI 1.07-2.25; P < 0.01) in STEMI patient with concurrent COVID-19 infection. The average time from admission to PCI was significantly higher among unstable angina (UA) and None ST-segment elevated myocardial infarction (NSTEMI) in patients with a secondary diagnosis of COVID-19 infection compared to patients without: 0.45 days (95% CI: .155-758; P < 0.01). The COVID-19 pandemic had a significant impact on the treatment of patients with ACS, resulting in increased inpatient mortality, higher costs, and longer lengths of stay. During the pandemic, for patients with UA and NSTEMI the time from admission to PCI was significantly longer in patients with a secondary diagnosis of COVID-19 compared to patients without. When comparing ACS outcomes between pre-pandemic to pandemic periods (2019 versus 2020), the 2020 data showed higher mortality, higher hospital costs, and a decrease in LOS. Finally, the time from admission to PCI was longer for UA and NSTEMI in 2020 but not for patients with STEMI.
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Affiliation(s)
| | - Allison Franz
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Halah Alfatlawi
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Mohaamed Wazzan
- Division of Cardiology, University Hospitals Cleveland Medical Center, OH
| | - Anas Alsughayer
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Ehab Eltahawy
- Department of Cardiology, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, OH,Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH
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12
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Mahabadi AA, Mincu R, Dykun I, Michel L, Küng A, Witzke O, Kill C, Buer J, Rassaf T, Totzeck M. Frequency and prognosis of CVD and myocardial injury in patients presenting with suspected COVID-19 - The CoV-COR registry. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2023; 45:101184. [PMID: 36776683 PMCID: PMC9899778 DOI: 10.1016/j.ijcha.2023.101184] [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: 12/07/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
Background The COVID-19 pandemic led to an alteration of algorithms in emergency medicine, which may influence the management of patients with similar symptoms but underlying cardiovascular diseases. We evaluated key differential diagnoses to acute COVID-19 infection and the prevalence and the prognosis of myocardial injury in patients presenting for suspected COIVD-19 infection. Methods This prospective observational study includes patients presenting with symptoms suggestive of COVID-19 infection during the pandemic. In patients without COVID-19, leading diagnoses was classified according to ICD-10. Myocardial injury was defined as elevated high-sensitivity Troponin I with at least one value above the 99th percentile upper reference limit and its prevalence together with 90-days mortality rate was compared in patients with vs without COVID-infection. Results From 497 included patients (age 62.9 ± 17.2 years, 56 % male), 314 (63 %) were tested positive on COVID-19 based on PCR-testing, while another cause of symptom was detected in 183 patients (37 %). Cardiovascular diseases were the most frequent differential diagnoses (40 % of patients without COVID-19), followed by bacterial infection (24 %) and malignancies (16 %). Myocardial injury was present in 91 patients (COVID-19 positive: n = 34, COVID-19 negative: n = 57). 90-day mortality rate was higher in patients with myocardial injury (13.4 vs 4.6 %, p = 0.009). Conclusion Cardiovascular diseases represent the most frequent differential diagnoses in patients presenting to a tertiary care emergency department with symptoms suggestive of an acute infection. Screening for cardiovascular disease is crucial in the initial evaluation of symptomatic patients during the COVID pandemic to identify patients at increased risk.Trial Registration:Clinicaltrials.gov Identifier: NCT04327479.
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Affiliation(s)
- Amir A. Mahabadi
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany,Corresponding author.
| | - Raluca Mincu
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Iryna Dykun
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Lars Michel
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Alexander Küng
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Jan Buer
- the Institute of Medical Microbiology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Tienush Rassaf
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Matthias Totzeck
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
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13
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Sticchi A, Costa F, Muscoli S, Zilio F, Buono A, Ruggiero R, Scoccia A, Caracciolo A, Licordari R, Cammalleri V, Iacovelli F, Loffi M, Scordino D, Ferro J, Rognoni A, Nava S, Albani S, Pavani M, Colaiori I, Benenati S, Pescetelli F, DE Marzo V, Borghesi M, Regazzoni V, Mannarini A, Spione F, Doronzo B, de Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Micari A, Pasceri V, Patti G, Porto I, Campo G, Colombo A, Giannini F. Symptoms-to-emergency-call timing delay in acute coronary syndrome before and during COVID-19: independent predictors and their impact on mortality. Minerva Cardiol Angiol 2023; 71:12-19. [PMID: 36305773 DOI: 10.23736/s2724-5683.22.05985-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The COVID-19 pandemic severely impacted global health. The aim of this study was to compare predictors of symptoms-to-emergency-call timing delay in acute coronary syndrome (ACS) and their impact on mortality before and during the COVID-19 outbreak. METHODS We collected sociodemographic, clinical data, procedural features, preadmission and intra-hospital outcomes of consecutive patients admitted for ACS in seventeen Italian centers from March to April 2018, 2019, and 2020. RESULTS In 2020, a 32.92% reduction in ACS admissions was observed compared to 2018 and 2019. Unstable angina, typical and atypical symptoms, and intermittent angina were identified as significant predictors of symptoms-to-emergency-call timing delay before and during the COVID-19 pandemic (P<0.005 for all the items). Differently from 2018-2019, during the pandemic, hypertension and dyspnea (P=0.002 versus P=0.490 and P=0.001 vs. P=0.761 for 2018-2019 and 2020, respectively) did not result as predictors of delay in symptoms-to-emergency-call timing. Among these predictors, only the atypical symptoms (HR 3.36; 95% CI: 1.172-9.667, P=0.024) in 2020 and the dyspnea (HR 2.64; 95% CI: 1.345-5.190, P=0.005) in 2018-2019 resulted significantly associated with higher mortality. Finally, the family attendance at the onset of the symptoms resulted in a reduction in symptoms-to-emergency-call timing (in 2020 P<0.001; CI: -1710.73; -493.19) and in a trend of reduced mortality (HR 0.31; 95% CI: 0.089-1.079, P=0.066) in 2020. CONCLUSIONS During the COVID-19 outbreak, atypical symptoms and family attendance at ACS onset were identified, respectively, as adverse and favorable predictors of symptoms-to-emergency-call timing delay and mortality.
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Affiliation(s)
- Alessandro Sticchi
- Humanitas Research Hospital IRCCS, Milan, Italy - .,Centro per la Lotta Contro L'Infarto (CLI) Foundation, Rome, Italy - .,GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Filippo Zilio
- Unit of Cardiology, Santa Chiara Hospital, Trento, Italy
| | | | - Rossella Ruggiero
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Fortunato Iacovelli
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | - Marco Loffi
- Department of Cardiology, Hospital of Cremona, Cremona, Italy
| | | | - Jayme Ferro
- UOSD Cardiology, Department of Emergency, Intensive Care and Anesthesia, Hemodynamics Laboratory, ASST Lariana, S. Anna Hospital, Como, Italy
| | | | - Stefano Nava
- Division of Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Marco Pavani
- SS Annunziata Civil Hospital, Savigliano, Cuneo, Italy
| | | | - Stefano Benenati
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Fabio Pescetelli
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Vincenzo DE Marzo
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Marco Borghesi
- Unit of Cardiology, Santa Chiara Hospital, Trento, Italy
| | | | - Antonia Mannarini
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | - Francesco Spione
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | | | | | | | - Gian B Danzi
- Department of Cardiology, Hospital of Cremona, Cremona, Italy
| | - Mario Galli
- UOSD Cardiology, Department of Emergency, Intensive Care and Anesthesia, Hemodynamics Laboratory, ASST Lariana, S. Anna Hospital, Como, Italy
| | | | | | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | | | | | - Italo Porto
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Gianluca Campo
- Cardiovascular Institute, AOU Ferrara, Cona, Ferrara, Italy
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14
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Care Disruption During COVID-19: a National Survey of Hospital Leaders. J Gen Intern Med 2023; 38:1232-1238. [PMID: 36650332 PMCID: PMC9845025 DOI: 10.1007/s11606-022-08002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused massive disruption in usual care delivery patterns in hospitals across the USA, and highlighted long-standing inequities in health care delivery and outcomes. Its effect on hospital operations, and whether the magnitude of the effect differed for hospitals serving historically marginalized populations, is unknown. OBJECTIVE To investigate the perspectives of hospital leaders on the effects of COVID-19 on their facilities' operations and patient outcomes. METHODS A survey was administered via print and electronic means to hospital leaders at 588 randomly sampled acute-care hospitals participating in Medicare's Inpatient Prospective Payment System, fielded from November 2020 to June 2021. Summary statistics were tabulated, and responses were adjusted for sampling strategy and non-response. RESULTS There were 203 responses to the survey (41.6%), with 20.7% of respondents representing safety-net hospitals and 19.7% representing high-minority hospitals. Over three-quarters of hospitals reported COVID testing shortages, about two-thirds reported staffing shortages, and 78.8% repurposed hospital spaces to intensive care units, with a slightly higher proportion of high-minority hospitals reporting these effects. About half of respondents felt that non-COVID inpatients received worsened quality or outcomes during peak COVID surges, and almost two-thirds reported worsened quality or outcomes for outpatient non-COVID patients as well, with few differences by hospital safety-net or minority status. Over 80% of hospitals participated in alternative payment models prior to COVID, and a third of these reported decreasing these efforts due to the pandemic, with no differences between safety-net and high-minority hospitals. CONCLUSIONS COVID-19 significantly disrupted the operations of hospitals across the USA, with hospitals serving patients in poverty and racial and ethnic minorities reporting relatively similar care disruption as non-safety-net and lower-minority hospitals.
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15
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Li F, Luo R, Wang XT, Jia JF, Yu XY. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia. Open Med (Wars) 2023; 18:20220621. [PMID: 36694625 PMCID: PMC9830634 DOI: 10.1515/med-2022-0621] [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: 09/28/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 01/11/2023] Open
Abstract
Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into pre-epidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onset-to-first medical contact time, door-to-needle time, door-to-balloon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak.
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Affiliation(s)
- Feng Li
- Department of Cardiology, Jieshou People’s Hospital, 339 Renmin Road, Jieshou, Fuyang, Anhui, 236500, China
| | - Rong Luo
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Xiao-Ting Wang
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Jun-Feng Jia
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
| | - Xue-Ying Yu
- Department of Cardiology, Jieshou People’s Hospital, Jieshou, Fuyang, Anhui, 236500, China
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16
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Armand TPT, Mozumder MAI, Ali S, Amaechi AO, Kim HC. Developing a Low-Cost IoT-Based Remote Cardiovascular Patient Monitoring System in Cameroon. Healthcare (Basel) 2023; 11:healthcare11020199. [PMID: 36673567 PMCID: PMC9859308 DOI: 10.3390/healthcare11020199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
(1) Background: Cameroonians are exposed to poor health services, more so citizens with cardiovascular-related diseases. The global high cost of acquiring healthcare-related technologies has prompted the government and individuals to promote the need for local research and the development of the health system. (2) Objectives: The main goal of this study is to design and develop a low-cost cardiovascular patient monitoring system (RPM) with wireless capabilities that could be used in any region of Cameroon, accessible, and very inexpensive, that are able to capture important factors, well reflecting the patient's condition and provide alerting mechanisms. (3) Method: Using the lean UX process from the Gothelf and Seiden framework, the implemented IoT-based application measures the patients' systolic, diastolic, and heart rates using various sensors, that are automated to record directly to the application database for analysis. The validity of the heuristic evaluation was examined in an ethnographic study of paramedics using a prototype of the system in their work environment. (4) Results: We obtained a system that was pre-tested on demo patients and later deployed and tested on seven real human test subjects. The users' task performances partially verified the heuristic evaluation results. (5) Conclusions: The data acquired by the sensors have a high level of accuracy and effectively help specialists to properly monitor their patients at a low cost. The proposed system maintains a user-friendliness as no expertise is required for its effective utilization.
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Affiliation(s)
| | | | - Sikandar Ali
- Institute of Digital Anti-Aging Healthcare, Inje University, Gimhae 50834, Republic of Korea
| | - Austin Oguejiofor Amaechi
- Department of Information and Communication Technology, The ICT University, Cameroon Campus, Yaoundé P.O. Box 526, Cameroon
| | - Hee-Cheol Kim
- College of AI Convergence, Institute of Digital Anti-Aging Healthcare, u-AHRC, Inje University, Gimhae 50834, Republic of Korea
- Correspondence: ; Tel.: +82-55-320-3720
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17
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Cesaro A, De Michele G, Gragnano F, Calabrò P. How has COVID-19 impacted the care of patients with acute coronary syndromes? Expert Rev Cardiovasc Ther 2023; 21:1-4. [PMID: 36534926 DOI: 10.1080/14779072.2023.2159809] [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: 12/23/2022]
Affiliation(s)
- Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Gianantonio De Michele
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Division of Cardiology, A.O.R.N. "Sant'Anna E San Sebastiano", Caserta, Italy
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18
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Lu D, Dhanoa S, Cheema H, Lewis K, Geeraert P, Merrick B, Vander Leek A, Sebastianski M, Kula B, Chaudhuri D, Basmaji J, Agrawal A, Niven D, Fiest K, Stelfox HT, Zuege DJ, Rewa OG, Bagshaw SM, Lau VI. Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:999225. [PMID: 36590965 PMCID: PMC9800609 DOI: 10.3389/fmed.2022.999225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background and aim With the Coronavirus Disease 2019 (COVID-19) pandemic continuing to impact healthcare systems around the world, healthcare providers are attempting to balance resources devoted to COVID-19 patients while minimizing excess mortality overall (both COVID-19 and non-COVID-19 patients). To this end, we conducted a systematic review (SR) to describe the effect of the COVID-19 pandemic on all-cause excess mortality (COVID-19 and non-COVID-19) during the pandemic timeframe compared to non-pandemic times. Methods We searched EMBASE, Cochrane Database of SRs, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Controlled Trials Register (CENTRAL), from inception (1948) to December 31, 2020. We used a two-stage review process to screen/extract data. We assessed risk of bias using Newcastle-Ottawa Scale (NOS). We used Critical Appraisal and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results Of 11,581 citations, 194 studies met eligibility. Of these studies, 31 had mortality comparisons (n = 433,196,345 participants). Compared to pre-pandemic times, during the COVID-19 pandemic, our meta-analysis demonstrated that COVID-19 mortality had an increased risk difference (RD) of 0.06% (95% CI: 0.06-0.06% p < 0.00001). All-cause mortality also increased [relative risk (RR): 1.53, 95% confidence interval (CI): 1.38-1.70, p < 0.00001] alongside non-COVID-19 mortality (RR: 1.18, 1.07-1.30, p < 0.00001). There was "very low" certainty of evidence through GRADE assessment for all outcomes studied, demonstrating the evidence as uncertain. Interpretation The COVID-19 pandemic may have caused significant increases in all-cause excess mortality, greater than those accounted for by increases due to COVID-19 mortality alone, although the evidence is uncertain. Systematic review registration [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020201256].
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Affiliation(s)
- David Lu
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Sumeet Dhanoa
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Harleen Cheema
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick Geeraert
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Merrick
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Aaron Vander Leek
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research Knowledge Translation Platform, University of Alberta, Edmonton, AB, Canada
| | - Brittany Kula
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Dipayan Chaudhuri
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - John Basmaji
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Arnav Agrawal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dan Niven
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Danny J. Zuege
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Oleksa G. Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Vincent I. Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
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19
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Wagener M, Boeddinghaus J, Gaemperli O, Räber L, Nietlispach F, Meier P, Muller O, Weilenmann D, Jeger R. Trends in Coronary and Structural Heart Interventions in Switzerland over the Last 16 Years and Impact of COVID-19: Insights from the National Swiss PCI Survey. J Clin Med 2022; 11:jcm11247459. [PMID: 36556075 PMCID: PMC9783484 DOI: 10.3390/jcm11247459] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Considering the global burden of cardiovascular disease, we analysed trends in interventional coronary and structural procedures over the past 16 years (2005-2021), using continuous data from the Swiss national registry. METHODS Based on a standardised questionnaire, data on coronary and structural interventions in Switzerland were assessed by the Working Group Interventional Cardiology of the Swiss Society of Cardiology (SSC). Here, we analysed the trend of annually performed interventions from 2005 to 2021 in Switzerland and the impact of the COVID-19 pandemic. RESULTS We observed a constant increase in the total number of cases (including coronary angiographies (CA) and percutaneous coronary interventions (PCI)) from 36,436 cases in 2005 to 56,555 cases in 2021 (+55%). With 18 cases in 2007, TAVI procedures have increased to 2004 cases in 2021. During the early phase of the COVID-19 pandemic in 2020, a slight decrease in CAs and PCIs of 9.15% was observed. In contrast, we did not observe an impact of the COVID-19 pandemic on the number of no TAVI procedures. Most importantly, all cause in-hospital mortality for coronary interventions before and during the peak of the COVID-19 pandemic was comparable (1.4% vs. 1.3%). CONCLUSION Over a 16-year period, we observed an upward trend in diagnostic and therapeutic procedures for coronary as well as structural heart disease, with only a small short-term impact of the COVID-19 pandemic on interventions and a similar procedure-related in-hospital-mortality in Switzerland.
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Affiliation(s)
- Max Wagener
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, 4031 Basel, Switzerland
- Department of Cardiology, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Jasper Boeddinghaus
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, 4031 Basel, Switzerland
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Oliver Gaemperli
- Department of Cardiology, Heart Clinic Hirslanden, 8032 Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland
| | - Fabian Nietlispach
- Heart Centre Im Park, Hirslanden Clinic Im Park, 8027 Zurich, Switzerland
| | - Pascal Meier
- Cantonal Hospital Freiburg, 1752 Villars-sur-Glâne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital Vaud, 1011 Lausanne, Switzerland
| | | | - Raban Jeger
- Department of Cardiology, Triemli Hospital Zurich, 8063 Zurich, Switzerland
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
- Correspondence:
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20
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Griewing S, Gremke N, Kreutz J, Schieffer B, Timmermann L, Markus B. Chronological Development of Cardiovascular Disease in Times of COVID-19: A Retrospective Analysis of Hospitalized Diseases of the Circulatory System and COVID-19 Patients of a German University Hospital. J Cardiovasc Dev Dis 2022; 9:jcdd9100325. [PMID: 36286277 PMCID: PMC9604270 DOI: 10.3390/jcdd9100325] [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] [Received: 08/30/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims at examining the chronological development of hospitalized cardiovascular and COVID-19 patients and comparing the effects on related sub-disciplines and main diagnoses for pre-pandemic (2017–2019) and pandemic (2020–2021) years in the setting of a German university maximum care provider. Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with main diagnosis of diseases of the circulatory system (nCirculatory) and COVID-19 secondary diagnosis (nCOVID-19). The cardiovascular patient collective (nCirculatory = 25,157) depicts a steady state in terms of relative yearly development of patient numbers (+0.4%, 2019–2020, +0.1%, 2020–2021). Chronological assessment points towards monthly decline during lockdowns and phases of high regional incidence of COVID-19 (i.e., 2019–2020: March −10.2%, April −12.4%, December −14.8%). Main diagnoses of congestive heart failure (+16.1% 2019/2020; +19.2% 2019/2021) and acute myocardial infarction show an increase in case numbers over the course of the whole pandemic (+15.4% 2019/2020; +9.4% 2019/2021). The results confirm negative effects on the cardiovascular care situation during the entire pandemic in the setting of a university maximum care provider. A general increase in cardiac disorders and a worrisome turn in case development of acute myocardial infarction emphasize the feared cardiovascular burden of COVID-19.
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Affiliation(s)
- Sebastian Griewing
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
- Institute for Health Care Management, General Business Administration, Philipps-University Marburg, Universitätsstraße 24, 35037 Marburg, Hessen, Germany
- Correspondence: ; Tel.: +49-172-6823779
| | - Niklas Gremke
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Julian Kreutz
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Bernhard Schieffer
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Lars Timmermann
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Birgit Markus
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
- Institute for Health Care Management, General Business Administration, Philipps-University Marburg, Universitätsstraße 24, 35037 Marburg, Hessen, Germany
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21
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Mathieu C, Pambrun E, Bénard-Laribière A, Noize P, Faillie JL, Bezin J, Pariente A. Impact of the COVID-19 pandemic and its control measures on cardiovascular and antidiabetic drugs use in France in 2020: a nationwide repeated cohort study. Eur J Epidemiol 2022; 37:1049-1059. [PMID: 36129659 PMCID: PMC9490736 DOI: 10.1007/s10654-022-00912-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/02/2022] [Indexed: 11/04/2022]
Abstract
Since pandemic start, patients may have faced difficulties in accessing to care and treatment. This study aimed at assessing the impact of COVID-19 pandemic and its control measures on the use of drugs indicated in cardiovascular prevention and diabetes mellitus in France. From 09/17/2018 to 09/20/2020, a repeated cohort analysis was performed using the French nationwide health insurance databases. The pandemic impact was assessed using time-series analyses and unobserved components model for the weekly number of patients with (i) drug dispensing, (ii) ongoing treatment, (iii) treatment initiation, (iv) treatment disruption. Overall, 14,822,132 patients with cardiovascular drug dispensings and 3,231,618 with antidiabetic ones were identified. After a sharp spike in the amount of dispensings in the week the first national lockdown was announced, the period was marked by decreased levels and trends. Altogether, the estimated impact of the pandemic on dispensings appeared limited over the lockdown period (1–3% lack in dispensings). During lockdown, the weekly numbers of treatment disruptions remained stable whereas a significant decrease in treatment initiations was observed for almost all drug classes (e.g. β-blockers initiations: − 8.9%). Conversely, the post-lockdown period showed increases in treatment disruptions especially for antihypertensive and lipid lowering drugs (e.g. statins disruptions: + 4.9%). The pandemic and associated measures had a significant impact on cardiovascular and antidiabetic drugs use in France, mostly consisting in decreases of treatment initiations over lockdown and increases in treatment disruptions afterwards. Both could result in increased morbimortality that remains to be assessed.
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Affiliation(s)
- Clément Mathieu
- Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, Case 36, Bâtiment 1A Rez-de-chaussée, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France.
| | - Elodie Pambrun
- Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, Case 36, Bâtiment 1A Rez-de-chaussée, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - Anne Bénard-Laribière
- Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, Case 36, Bâtiment 1A Rez-de-chaussée, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - Pernelle Noize
- Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, Case 36, Bâtiment 1A Rez-de-chaussée, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France.,Service de Pharmacologie Médicale, CHU de Bordeaux, Bordeaux, France
| | - Jean-Luc Faillie
- Department of Medical Pharmacology and Toxicology, CHU Montpellier University Hospital, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - Julien Bezin
- Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, Case 36, Bâtiment 1A Rez-de-chaussée, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France.,Service de Pharmacologie Médicale, CHU de Bordeaux, Bordeaux, France
| | - Antoine Pariente
- Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University Bordeaux, Case 36, Bâtiment 1A Rez-de-chaussée, 146 Rue Léo Saignat, 33076, Bordeaux Cedex, France.,Service de Pharmacologie Médicale, CHU de Bordeaux, Bordeaux, France
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22
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Boeken U, Holst T, Hettlich V, Dörge H, Böning A, Lichtenberg A. Auswirkungen der COVID-19-Pandemie auf die Herzchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022; 36:284-291. [PMID: 36158315 PMCID: PMC9490721 DOI: 10.1007/s00398-022-00539-1] [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] [Received: 01/27/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022]
Abstract
Seit Anfang des Jahres 2020 die COVID-19-Pandemie weltweit das Leben massiv beeinflusst und auch verändert hat, lassen sich naturgemäß gerade im Gesundheitssektor schwerwiegende Konsequenzen beobachten. Diese betreffen Patienten in gleichem Maß wie medizinisches Personal aller Berufsgruppen, sowohl im ambulanten als auch im stationären Bereich. Die Herzchirurgie als eine Disziplin, die wie keine zweite von der vorhandenen Kapazität auf Intensivstationen abhängig ist, war erwartungsgemäß von den Auswirkungen der Pandemie schwer betroffen. Dieser Beitrag gibt einen Überblick über die Konsequenzen für die klinische Versorgung, die Forschung und die Lehre sowie für die herzchirurgische Weiterbildung
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23
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Roth GA, Vaduganathan M, Mensah GA. Impact of the COVID-19 Pandemic on Cardiovascular Health in 2020: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:631-640. [PMID: 35926937 PMCID: PMC9341480 DOI: 10.1016/j.jacc.2022.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 10/31/2022]
Abstract
The impact of COVID-19 on the burden of cardiovascular diseases (CVD) during the early pandemic remains unclear. COVID-19 has become one of the leading causes of global mortality, with a disproportionate impact on persons with CVD. Studies of health facility admissions for CVD found significant decreases during the pandemic. Studies of hospital mortality for CVD were more variable. Studies of population-level CVD mortality differed across countries, with most showing decreases, although some revealed increases in deaths. In some countries where large increases in CVD deaths were reported in vital registration systems, misclassification of COVID-19 as CVD may have occurred. Taken together, studies suggest heterogeneous effects of the COVID-19 pandemic on CVD without large increases in CVD mortality in 2020 for a number of countries. Clinical and population science research is needed to examine the ways in which the pandemic has affected CVD burden.
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Affiliation(s)
- Gregory A Roth
- Division of Cardiology, Department of Medicine, and Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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24
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Böning A, Falk V, Gummert J, Markewitz A, Heinemann M, Beckmann A. COVID-19: retrospektive Kapazitätsanalyse in deutschen herzchirurgischen Fachabteilungen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022; 36:292-297. [PMID: 35968031 PMCID: PMC9362024 DOI: 10.1007/s00398-022-00527-5] [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: 07/07/2022] [Indexed: 12/03/2022]
Abstract
Hintergrund Um Veränderungen in der herzchirurgischen Patientenversorgung während der COVID-19-Pandemie in Deutschland zu objektivieren, hat die Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) eine strukturierte Umfrage durchgeführt. Methode An dieser Umfrage unter 79 herzchirurgischen Fachabteilungen im Juni 2021 beteiligten sich 53 Fachabteilungen. Folgende Zeitpunkte wurden der Umfrage zugrunde gelegt: 01.01.2020 als Zeitpunkt vor Beginn der COVID-19-Pandemie und der 30.04.1921 als Stichtag für die Datenerhebung. Zu diesem Zeitpunkt war die „dritte Welle“ der Pandemie in Deutschland bereits abgeflaut, und eine Rückkehr zum Routinebetrieb erschien absehbar. Ergebnis Am 01.01.2020 standen den 53 teilnehmenden herzchirurgischen Fachabteilungen dauerhaft insgesamt 800 Intensivtherapiebetten zur Verfügung. Mit Stand zum 30.04.2021 hatte sich diese Intensivbettenkapazität um 25,6 % auf 595 reduziert. Auch die Anzahl der OP für herzchirurgische Eingriffe hatte sich während der beiden ersten „Lockdowns“ in Deutschland von 207 vor der Pandemie auf 152 reduziert (−26,6 %). Während der COVID-19-Pandemie wurden stationäre Bereiche umgewidmet, sodass 50,9 % der Teilnehmer angaben, dass ärztliches Personal und in 75,5 % der teilnehmenden Fachabteilungen auch pflegerisches Personal in spezielle COVID-19-Bereiche delegiert wurde. Schlussfolgerung Seit Beginn der Coronapandemie im Januar 2020 und dem Auslauf der „dritten Welle“ im Mai 2021 hat sich die herzchirurgische Versorgung in Deutschland erheblich verändert: Dies führte durch Schließung von Intensivbetten und OP in herzchirurgischen Fachabteilungen zu erheblichen Implikationen der Patientenversorgung. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00398-022-00527-5) enthalten.
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Affiliation(s)
- Andreas Böning
- Langenbeck-Virchow-Haus, Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie, Luisenstr. 58/59, 10117 Berlin, Deutschland
- Klinik für Herz‑, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg, Rudolf-Buchheim-Str. 7, 35385 Gießen, Deutschland
| | - Volkmar Falk
- Langenbeck-Virchow-Haus, Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie, Luisenstr. 58/59, 10117 Berlin, Deutschland
| | - Jan Gummert
- Langenbeck-Virchow-Haus, Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie, Luisenstr. 58/59, 10117 Berlin, Deutschland
| | - Andreas Markewitz
- Langenbeck-Virchow-Haus, Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie, Luisenstr. 58/59, 10117 Berlin, Deutschland
| | - Markus Heinemann
- Langenbeck-Virchow-Haus, Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie, Luisenstr. 58/59, 10117 Berlin, Deutschland
| | - Andreas Beckmann
- Langenbeck-Virchow-Haus, Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie, Luisenstr. 58/59, 10117 Berlin, Deutschland
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25
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Ryu S, Kim D, Jung LY, Kim B, Lee CS. Decreased door-to-balloon time in patients with ST-segment elevation myocardial infarction during the early COVID-19 pandemic in South Korea: An observational study. Medicine (Baltimore) 2022; 101:e29596. [PMID: 35905280 PMCID: PMC9333082 DOI: 10.1097/md.0000000000029596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) resulted in a marked decrease in the number of patient visits for acute myocardial infarction and delayed patient response and intervention in several countries. This study evaluated the effect of the COVID-19 pandemic on the number of patients, patient response time (pain-to-door), and intervention time (door-to-balloon) for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI visiting a hospital in South Korea who underwent primary coronary intervention during the COVID-19 pandemic (January 29, 2020, to December 31, 2020) were compared with those in the equivalent period from 2018 to 2019. Patient response and intervention times were compared for the COVID-19 pandemic window (2020) and the equivalent period from 2018 to 2019. We observed no decrease in the number of patients with STEMI (P = .88) and NSTEMI (P = 1.00) during the COVID-19 pandemic compared to that in the previous years. Patient response times (STEMI: P = .39; NSTEMI: P = .59) during the overall COVID-19 pandemic period did not differ significantly. However, we identified a significant decrease in door-to-balloon time among patients with STEMI (14%; P < .01) during the early COVID-19 pandemic. We found that the number of patients with STEMI and NSTEMI was consistent during the COVID-19 pandemic and that no time delays in patient response and intervention occurred. However, the door-to-balloon time among patients with STEMI significantly reduced during the early COVID-19 pandemic, which could be attributed to decreased emergency care utilization during the early pandemic.
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Affiliation(s)
- Sukhyun Ryu
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Dasom Kim
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Lae Young Jung
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Baekjin Kim
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- *Correspondence: Chang-Seop Lee, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea (e-mail: )
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26
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Ghilencea LN, Chiru MR, Stolcova M, Spiridon G, Manea LM, Stănescu AMA, Bokhari A, Kilic ID, Secco GG, Foin N, Di Mario C. Telemedicine: Benefits for Cardiovascular Patients in the COVID-19 Era. Front Cardiovasc Med 2022; 9:868635. [PMID: 35935629 PMCID: PMC9347362 DOI: 10.3389/fcvm.2022.868635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022] Open
Abstract
The recent pandemic with SARS-CoV-2 raises questions worldwide regarding telemedicine for housebound patients, including those with cardiovascular conditions. The need for further investigation, monitoring and therapeutic management are advancing practical issues which had not been identified for consideration prior to the pandemic. Using the marketing assessment, we identified the needs of the patients and evaluated the future steps necessary in the short term to meet them. The research found progress made via telemedicine in monitoring and conducting minor decisions (like up-titrating the doses of different medication regimens) in patients with several cardiovascular diseases (heart failure, atrial fibrillation, high blood pressure), as there is a worldwide trend to develop new telemonitoring biosensors and devices based on implantable delivered transcatheter. The worldwide telemedicine trend encourages a switch from small and hesitating steps to a more consistent assessment of the patients, based on high technology and Interventional Cardiology. Cardiovascular telemedicine, although made a sustainable effort in managing patients' health, has many obstacles to overcome before meeting all their needs. Data security, confidentiality and reimbursement are the top priorities in developing remote Cardiology. The regulatory institutions need to play an integrative role in leading the way for defining the framework of future telemedicine activities. The SARS-CoV-2 outbreak with all its tragedy served to reinforce the message that telemedicine services can be life-saving for cardiovascular patients. Once the Covid-19 era will fade away, telemedicine is likely to remain a complementary service of standard care. There is still room to improve the remote identification and investigation of heart disease, provide an accurate diagnosis and therapeutic regimen, and update regulations and guidelines to the new realities of technological progress in the field.
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Affiliation(s)
- Liviu-Nicolae Ghilencea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- *Correspondence: Liviu-Nicolae Ghilencea
| | | | - Miroslava Stolcova
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Gabriel Spiridon
- Department and European Project Development, Institute of Scientific Research and Technological Development in Automation and Informatics, Bucharest, Romania
| | - Laura-Maria Manea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Awais Bokhari
- Department of Cardiology, Bedford Hospital NHS Foundation Trust, Bedford, United Kingdom
| | - Ismail Dogu Kilic
- Department of Cardiology, Pamukkale University Hospital, Denizli, Turkey
| | - Gioel Gabriel Secco
- Department of Interventional Cardiology and Structural Heart Disease, SS. Antonio e Biagioe Cesare Arrigo Hospital, Alessandria, Italy
| | - Nicolas Foin
- Duke-NUS Medical School, National Heart Research Institute, Singapore, Singapore
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
- Royal Brompton Hospital, NHSFT, London, United Kingdom
- Department of Cardiology, University of Florence, Florence, Italy
- Carlo Di Mario
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27
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Reichert M, Sartelli M, Weigand MA, Hecker M, Oppelt PU, Noll J, Askevold IH, Liese J, Padberg W, Coccolini F, Catena F, Hecker A. Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members. World J Emerg Surg 2022; 17:34. [PMID: 35710386 PMCID: PMC9202986 DOI: 10.1186/s13017-022-00424-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. METHODS A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. RESULTS 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. CONCLUSIONS The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.
| | | | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Hecker
- Department of Pulmonary and Critical Care Medicine, University Hospital of Giessen and Marburg Lung Center (UGMLC), University Hospital of Giessen, Giessen, Germany
| | - Philip U Oppelt
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Julia Noll
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Ingolf H Askevold
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Juliane Liese
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
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28
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Araja D, Berkis U, Murovska M. COVID-19 Pandemic-Revealed Consistencies and Inconsistencies in Healthcare: A Medical and Organizational View. Healthcare (Basel) 2022; 10:healthcare10061018. [PMID: 35742069 PMCID: PMC9223168 DOI: 10.3390/healthcare10061018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 12/17/2022] Open
Abstract
The circumstances of the Coronavirus disease caused by the SARS-CoV-2 virus (COVID-19) pandemic have had a significant impact on global and national developments, affecting the existence of society in all its expressions, as well as the lives of people themselves. In the context of the pandemic, increased attention has been focused on acute measures, but the ending of the pandemic is expected as a resolution of the related healthcare problems. However, there are several indicators that the COVID-19 pandemic might induce long-term consequences for individual and public health. Some of the consequences are inferred and predictable, but there are also areas of medicine that have been indirectly affected by the pandemic, and these consequences have not yet been sufficiently explored. This study is focused on drawing attention to some of the COVID-19 pandemic consistencies and the pandemic-revealed inconsistencies in healthcare. Content analysis and statistical analysis were applied to achieve the aim of the study. The main findings of the study address chronic disease burden (particularly, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)), healthcare governance and organizational issues, and the synergy between health policy perspectives and innovative solutions in practice. The study provides insight into the particular healthcare issues affected by the COVID-19 pandemic, such as the increase in mortality in some diagnoses besides COVID-19 and the possible emergence of a new type of resistance—vaccine-resistance—contemporaneously supporting the identification of the tendencies and currently unnoticed indirect consistencies and inconsistencies revealed by the pandemic.
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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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Routine surgeries during the COVID-19 pandemic: A French nationwide cohort study. Ann Med Surg (Lond) 2022; 77:103721. [PMID: 35531430 PMCID: PMC9065655 DOI: 10.1016/j.amsu.2022.103721] [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: 03/31/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation. Materials and method All hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents’ health-related expenses. Percentage changes between observed and expected numbers of hospital stays were calculated for each surgery in 2020 and the first half of 2021 with 95% Confidence Intervals. Expected numbers were calculated from the number in 2019 by applying an average annual change between 2015 and 2019. The type of intervention (primary operation or reoperation/revision) and/or the emergency status were also considered. Results A total of 2,153,857 hospitalizations for cataract surgery (0.6% revision), 398,213 for hip arthroplasty (10.9% revision and 26.9% in emergency), 276,607 for knee arthroplasty (8.2% revision), 471,318 for coronary angioplasty (48.7% in emergency) and 178,441 for cardiac stimulation (27.6% revision) were included. Activity was lower than expected in 2020 (cataract surgery: −21.9% [−22.5;−21.4]; hip arthroplasty: −13.4% [−14.8;−12.0]; knee arthroplasty: −24.6% [−26.1;−23.0]; coronary angioplasty: −11.2% [−12.7;−9.7]) without any catch–up in the first half of 2021 (cataract surgery: −5.0% [−5.8;−4.3]; hip arthroplasty: −9.9% [−11.6;−8.2]; knee arthroplasty: −22.0% [−24.0;−20.1]; coronary angioplasty: −12,1% [−13.9;−10.4]). Revisions and non-elective interventions also decreased but to a lesser magnitude. Cardiac stimulation activity was almost in line with expectations (−2.6% [−4.9; −0.3]/+0.6 [−2.2; +3.4]). Conclusion This study shows that there was a marked decrease in four routine surgeries compared to expectations through to at least the first half of 2021, despite the gradual national rollout of the vaccine. Hospitalizations for cataract surgery, coronary angioplasty, hip and knee arthroplasties were strongly impacted by the pandemic from 2020 until the first half of 2021, without any catch-up outside the lockdown periods and despite the gradual rollout of the national COVID-19 vaccine campaign in 2021. Definitive cardiac stimulation was the only surgery not really impacted. Optimize surgical patient care in a pandemic setting and identify ways to improve the available capacity of surgical activity.
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Rosano GMC, Celant S, Olimpieri PP, Colatrella A, Onder G, Di Lenarda A, Ambrosio G, Reboldi G, Gensini GF, Colivicchi F, Russo P. Impact of the COVID-19 pandemic on prescription of sacubitril/valsartan in Italy. Eur J Heart Fail 2022; 24:855-860. [PMID: 35303393 PMCID: PMC9087379 DOI: 10.1002/ejhf.2490] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS The present study sought to examine the effect of the COVID-19 pandemic and lockdown measures on the prescription of sacubitril/valsartan in patients with heart failure (HF) in Italy. METHODS AND RESULTS Data from Italian Medicines Agency (AIFA) monitoring registries were analysed. The sacubitril/valsartan monitoring registry is based on 6-month prescriptions. A monthly aggregation on new activations throughout the observational period was computed. From March to December 2020, the initiation of new HF patients on sacubitril/valsartan decreased by nearly 40% with prescriptions dropping to values similar to 2018 when the registry was still operated off-line. A slight increase in prescriptions was observed after the lockdown measures were lifted, but prescriptions remained constantly below the pre-lockdown period. CONCLUSION A marked and worrisome decline during the COVID-19 pandemic in the activation of a life-saving treatment such as sacubitril/valsartan was observed. This decline was clearly linked to the lockdown measures instated to counteract the COVID-19 pandemic. Upcoming studies should analyse the occurrence of new cases of HF as well as the severity of patients admitted to hospitals and their mortality compared to pre-pandemic levels.
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Affiliation(s)
| | | | | | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, University Hospital and Health Services of Trieste, Trieste, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology and CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia School of Medicine, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Altobelli E, Angeletti PM, Marzi F, D’Ascenzo F, Petrocelli R, Patti G. Impact of SARS-CoV-2 Outbreak on Emergency Department Presentation and Prognosis of Patients with Acute Myocardial Infarction: A Systematic Review and Updated Meta-Analysis. J Clin Med 2022; 11:jcm11092323. [PMID: 35566450 PMCID: PMC9102296 DOI: 10.3390/jcm11092323] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/23/2022] Open
Abstract
We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies having the same observation period for the comparison between SARS-CoV-2 outbreak in 2020 versus control period in 2019 were included. Primary endpoints were the relative variation of hospital admissions, the difference of in-hospital mortality for STEMI and NSTEMI. Secondary were: mortality according to countries, income levels and data quality; cardiogenic shock, mechanical complications, door-to-balloon time, time from symptom onset to first medical contact, left ventricular ejection fraction (LVEF) and troponin. In total, 61 observational studies with 125,346 patients were included. Compared with 2019, during the pandemic for STEMI were observed: a 24% reduction of hospitalizations with an impact on early survival (OR = 1.33 in-hospital mortality); the time from symptom onset to first medical contact was 91.31 min longer, whereas door-to-balloon time was increased (+5.44 min); after STEMI, the rate of cardiogenic shock was 33% higher; LVEF at discharge was decreased (−3.46); elevated high-sensitivity troponin levels (1.52) on admission. For NSTEMI, in the COVID-19 period, we observed a 31% reduction of hospitalizations and higher in-hospital deaths (OR = 1.34). The highest mortality rates among countries were: Italy OR = 3.71 (high income), Serbia OR = 2.15 (upper middle) and Pakistan OR = 1.69 (lower middle). Later hospital presentation was associated with larger infarctions, as well as with increased cardiogenic shock and in-hospital mortality.
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Affiliation(s)
- Emma Altobelli
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (P.M.A.); (F.M.)
- Correspondence: ; Tel.: +39-0862-434-666
| | - Paolo Matteo Angeletti
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (P.M.A.); (F.M.)
- Cardiac Surgical Intensive Care Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy
| | - Francesca Marzi
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (P.M.A.); (F.M.)
| | - Fabrizio D’Ascenzo
- Cardiovascular and Thoracic Department, Division of Cardiology, University of Turin, 10126 Turin, Italy;
| | | | - Giuseppe Patti
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy;
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Wild J, Siegrist B, Hobohm L, Münzel T, Schwanz T, Sagoschen I. Short and Concise Peer-to-Peer Teaching—Example of a Successful Antibiotic Stewardship Intervention to Increase Iv to Po Conversion. Antibiotics (Basel) 2022; 11:antibiotics11030402. [PMID: 35326866 PMCID: PMC8944614 DOI: 10.3390/antibiotics11030402] [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] [Received: 02/28/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022] Open
Abstract
Antibiotic stewardship (ABS) programs aim to combine effective treatment with minimized antibiotic-related harms. Common ABS interventions are simple and effective, but their implementation in daily practice is often difficult. The aim of our study was to investigate if a single, short, peer-to-peer teaching intervention (junior doctor to junior doctor) during clinical routine can successfully improve antibiotic prescriptions. We performed a quasi-experimental before–after study on a regular care cardiology ward at a large academic medical center in Germany. We evaluated antibiotic use metrics retrospectively and calculated defined daily doses (DDD) with the anatomical therapeutic chemical/DDD classification system of the World Health Organization. We hypothesize that the over-representative use of intravenous administration is a potentially modifiable target, which can be proven by antibiotic use metrics analysis. After a single peer-to-peer teaching session with a focus on indications for iv to po conversion, the normalized percentage of intravenous compared to oral administration significantly decreased (from 86.5 ± 50.3% to 41.4 ± 70.3%). Moreover, after the intervention, antibiotics with high oral bioavailability were no longer administered intravenously at all during the following quarter. Our results indicate that even a single peer-to-peer training session is highly effective in improving the iv to po conversion rate in the short term.
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Affiliation(s)
- Johannes Wild
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (L.H.); (T.M.); (I.S.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Correspondence:
| | - Bettina Siegrist
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (L.H.); (T.M.); (I.S.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (L.H.); (T.M.); (I.S.)
| | - Thomas Schwanz
- Institute of Medical Microbiology and Hygiene, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
| | - Ingo Sagoschen
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (L.H.); (T.M.); (I.S.)
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Fox DK, Waken RJ, Johnson DY, Hammond G, Yu J, Fanous E, Maddox TM, Joynt Maddox KE. Impact of the COVID-19 Pandemic on Patients Without COVID-19 With Acute Myocardial Infarction and Heart Failure. J Am Heart Assoc 2022; 11:e022625. [PMID: 35229615 PMCID: PMC9075301 DOI: 10.1161/jaha.121.022625] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/20/2022] [Indexed: 12/14/2022]
Abstract
Background Excess mortality from cardiovascular disease during the COVID-19 pandemic has been reported. The mechanism is unclear but may include delay or deferral of care, or differential treatment during hospitalization because of strains on hospital capacity. Methods and Results We used emergency department and inpatient data from a 12-hospital health system to examine changes in volume, patient age and comorbidities, treatment (right- and left-heart catheterization), and outcomes for patients with acute myocardial infarction (AMI) and heart failure (HF) during the COVID-19 pandemic compared with pre-COVID-19 (2018 and 2019), controlling for seasonal variation. We analyzed 27 427 emergency department visits or hospitalizations. Patient volume decreased during COVID-19 for both HF and AMI, but age, race, sex, and medical comorbidities were similar before and during COVID-19 for both groups. Acuity increased for AMI as measured by the proportion of patients with ST-segment elevation. There were no differences in right-heart catheterization for patients with HF or in left heart catheterization for patients with AMI. In-hospital mortality increased for AMI during COVID-19 (odds ratio [OR], 1.46; 95% CI, 1.21-1.76), particularly among the ST-segment-elevation myocardial infarction subgroup (OR, 2.57; 95% CI, 2.24-2.96), but was unchanged for HF (OR, 1.02; 95% CI, 0.89-1.16). Conclusions Cardiovascular volume decreased during COVID-19. Despite similar patient age and comorbidities and in-hospital treatments during COVID-19, mortality increased for patients with AMI but not patients with HF. Given that AMI is a time-sensitive condition, delay or deferral of care rather than changes in hospital care delivery may have led to worse cardiovascular outcomes during COVID-19.
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Affiliation(s)
- Daniel K. Fox
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
| | - R. J. Waken
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
| | - Daniel Y. Johnson
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
| | - Gmerice Hammond
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
| | - Jonathan Yu
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
| | - Erika Fanous
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
| | - Thomas M. Maddox
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
| | - Karen E. Joynt Maddox
- Department of MedicineCardiovascular DivisionWashington University School of MedicineSt. LouisMO
- Center for Health Economics and PolicyInstitute for Public HealthWashington University in St. LouisSt. LouisMO
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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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Sarc I, Lotric Dolinar A, Morgan T, Sambt J, Ziherl K, Gavric D, Selb J, Rozman A, Dosenovic Bonca P. Mortality, seasonal variation, and susceptibility to acute exacerbation of COPD in the pandemic year: a nationwide population study. Ther Adv Respir Dis 2022; 16:17534666221081047. [PMID: 35253548 PMCID: PMC8905064 DOI: 10.1177/17534666221081047] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Previous studies have suggested that the coronavirus disease 2019 (COVID-19) pandemic was associated with a decreased rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data on how the COVID-19 pandemic has influenced mortality, seasonality of, and susceptibility to AECOPD in the chronic obstructive pulmonary disease (COPD) population is scarce. Methods: We conducted a national population-based retrospective study using data from the Health Insurance Institute of Slovenia from 2015 to February 2021, with 2015–2019 as the reference. We extracted patient and healthcare data for AECOPD, dividing AECOPD into severe, resulting in hospitalisation, and moderate, requiring outpatient care. The national COPD population was generated based on dispensed prescriptions of inhalation therapies, and moderate AECOPD events were analysed based on dispensed AECOPD medications. We extracted data on all-cause and non-COVID mortality. Results: The numbers of severe and moderate AECOPD were reduced by 48% and 34%, respectively, in 2020. In the pandemic year, the seasonality of AECOPD was reversed, with a 1.5-fold higher number of severe AECOPD in summer compared to winter. The proportion of frequent exacerbators (⩾2 AECOPD hospitalisations per year) was reduced by 9% in 2020, with a 30% reduction in repeated severe AECOPD in frequent exacerbators and a 34% reduction in persistent frequent exacerbators (⩾2 AECOPD hospitalisations per year for 2 consecutive years) from 2019. The risk of two or more moderate AECOPD decreased by 43% in 2020. In the multivariate model, pandemic year follow-up was the only independent factor associated with a decreased risk for severe AECOPD (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.61–0.84; p < 0.0001). In 2020, non-COVID mortality decreased (−15%) and no excessive mortality was observed in the COPD population. Conclusion: In the pandemic year, we found decreased susceptibility to AECOPD across severity spectrum of COPD, reversed seasonal distribution of severe AECOPD and decreased non-COVID mortality in the COPD population.
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Affiliation(s)
- Irena Sarc
- Noninvasive Ventilation Department, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, 4204 Golnik, Slovenia Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alesa Lotric Dolinar
- Academic Unit for Mathematics, Statistics and Operations Research, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Morgan
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Joze Sambt
- Academic Unit for Mathematics, Statistics and Operations Research, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| | - Kristina Ziherl
- Noninvasive Ventilation Department, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dalibor Gavric
- The Health Insurance Institute of Slovenia, Ljubljana, Slovenia
| | - Julij Selb
- Faculty of Medicine, University of Ljubljana, Ljubljana, SloveniaUniversity Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Ales Rozman
- Faculty of Medicine, University of Ljubljana, Ljubljana, SloveniaUniversity Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Petra Dosenovic Bonca
- Academic Unit for Economics, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
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Transcatheter-based aortic valve replacement vs. isolated surgical aortic valve replacement in 2020. Clin Res Cardiol 2022; 111:924-933. [PMID: 35362737 PMCID: PMC8972898 DOI: 10.1007/s00392-022-02006-1] [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: 01/20/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Based on the results of several recent randomized trials, European and American guidelines on valvular heart disease management have substantially expanded the indications for transcatheter aortic valve implantation (TAVI). We present an all-comer data on peri-operative risk profile and in-hospital outcomes from Germany for patients treated by TAVI or isolated surgical aortic valve replacement (iSAVR) in 2020, providing an opportunity to compare study data with data from daily clinical practice. METHODS Data concerning all isolated aortic valve procedures performed in Germany in 2020 were retrieved from the mandatory nationwide quality control program. Expected mortality was calculated with the annually revised German Aortic valve score (AKL-score) based on the data of either catheter-based (AKL-CATH) or isolated surgical (AKL-CHIR) aortic valve replacement in Germany from the previous year (2019). RESULTS In 2020 21,903 TAVI procedures (20,810 transvascular (TV; vs. 2019: 22.973; - 9.4%), 1093 transapical (TA; vs. 2019: 1413; - 22.6%)) and 6144 (vs. 2019 7905; - 22.5%) iSAVR were performed in Germany. Patients who received TAVI showed a significantly higher perioperative risk profile than patients undergoing iSAVR based on older age and more severe co-morbidities. While in-hospital mortality after TAVI (2.3%) was numerically lower than in 2019 (2.5%), this difference was not significant (p = 0.11). In-hospital mortality after iSAVR was identical in 2020 and 2019 (2.8%) and thus higher than after TAVI (p = 0.003), resulting in an observed expected mortality ratio of 1.02 after TAVI and 1.05 after iSAVR. After exclusion of the emergency procedures, in-hospital mortality did not differ significantly between the groups (TAVI 2.2% vs. iSAVR 1.9%, p = 0.26). CONCLUSION Total numbers of both iSAVR and TAVI in Germany were lower in 2020 than in 2019, most likely due to the COVID-19 pandemic. However, the relative number of patients treated by TAVI as compared to iSAVR continues to increase. Despite older age and more severe comorbidities compared to patients undergoing iSAVR the in-hospital mortality after TAVI continued to decrease in 2020 and remains significantly lower than after iSAVR.
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Baudry A, Mariet AS, Benzenine E, Crespy V, Bernard C, Morgant MC, Bejot Y, Giroud M, Bouchot O, Steinmetz E, Quantin C. Cardiovascular Surgical Emergencies in France, before, during and after the First Lockdown for COVID-19 in 2020: A Comparative Nationwide Retrospective Cohort Study. Life (Basel) 2021; 11:life11111245. [PMID: 34833121 PMCID: PMC8620591 DOI: 10.3390/life11111245] [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: 10/07/2021] [Revised: 11/02/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There are still gaps regarding the impact of the nationwide lockdown on non-COVID-19 emergency hospitalizations. This study aims to describe the trends in hospitalizations for cardiovascular surgical emergencies in France, before, during and after the first lockdown. Materials and Methods: All adults admitted for mechanical complications of myocardial infarction (MI), aortic dissection, aortic aneurysm rupture, acute and critical limb ischemia, circulatory assistance, heart transplantation and major amputation were included. This retrospective cohort study used the French National Hospital Discharge database. The numbers of hospitalizations per month in 2020 were compared to the previous three years. Results: From January to September 2020, 94,408 cases of the studied conditions were reported versus 103,126 in the same period in 2019 (−8.5%). There was a deep drop in most conditions during the lockdown, except for circulatory assistance, which increased. After the lockdown, mechanical complications of MI and aortic aneurysm rupture increased, and cardiac transplantations declined compared with previous years. Conclusion: We confirmed a deep drop in most cardiovascular surgical emergencies during the lockdown. The post-lockdown period was characterized by a small over-recovery for mechanical complications of MI and aortic aneurysm rupture, suggesting that many patients were able to access surgery after the lockdown.
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Affiliation(s)
- Anna Baudry
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Anne-Sophie Mariet
- Biostatistics and Bioinformatics (DIM), University Hospital of Dijon, 21000 Dijon, France; (A.-S.M.); (E.B.)
- CIC1432, University Hospital of Dijon, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, 21000 Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital of Dijon, 21000 Dijon, France; (A.-S.M.); (E.B.)
| | - Valentin Crespy
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Chloé Bernard
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Marie-Catherine Morgant
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Yannick Bejot
- Neurology Department, University Hospital of Dijon, 21000 Dijon, France; (Y.B.); (M.G.)
- Dijon Stroke Registry (Santé Publique France–Inserm)-EA 7460 (Pathophysiology and Epidemiology of Cerebro-CardioVascular Diseases), University of Burgundy, UFBC, 21000 Dijon, France
| | - Maurice Giroud
- Neurology Department, University Hospital of Dijon, 21000 Dijon, France; (Y.B.); (M.G.)
- Dijon Stroke Registry (Santé Publique France–Inserm)-EA 7460 (Pathophysiology and Epidemiology of Cerebro-CardioVascular Diseases), University of Burgundy, UFBC, 21000 Dijon, France
| | - Olivier Bouchot
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Eric Steinmetz
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France; (A.B.); (V.C.); (C.B.); (M.-C.M.); (O.B.); (E.S.)
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital of Dijon, 21000 Dijon, France; (A.-S.M.); (E.B.)
- CIC1432, University Hospital of Dijon, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, 21000 Dijon, France
- Université Paris-Saclay, UVSQ, University of Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, 94800 Villejuif, France
- Correspondence: ; Tel.: +33-38029-3629; Fax: +33-38029-3973
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Šikić J, Planinić Z, Matišić V, Friščić T, Molnar V, Jagačić D, Vujičić L, Tudorić N, Postružin Gršić L, Ljubičić Đ, Primorac D. COVID-19: The Impact on Cardiovascular System. Biomedicines 2021; 9:1691. [PMID: 34829920 PMCID: PMC8615470 DOI: 10.3390/biomedicines9111691] [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: 09/08/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 has been circulating in population worldwide for the past year and a half, and thus a vast amount of scientific literature has been produced in order to study the biology of the virus and the pathophysiology of COVID-19, as well as to determine the best way to prevent infection, treat the patients and eliminate the virus. SARS-CoV-2 binding to the ACE2 receptor is the key initiator of COVID-19. The ability of SARS-CoV-2 to infect various types of cells requires special attention to be given to the cardiovascular system, as it is commonly affected. Thorough diagnostics and patient monitoring are beneficial in reducing the risk of cardiovascular morbidity and to ensure the most favorable outcomes for the infected patients, even after they are cured of the acute disease. The multidisciplinary nature of the fight against the COVID-19 pandemic requires careful consideration from the attending clinicians, in order to provide fast and reliable treatment to their patients in accordance with evidence-based medicine principles. In this narrative review, we reviewed the available literature on cardiovascular implications of COVID-19; both the acute and the chronic.
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Affiliation(s)
- Jozica Šikić
- Department of Cardiology, Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia; (Z.P.); (T.F.)
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
| | - Zrinka Planinić
- Department of Cardiology, Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia; (Z.P.); (T.F.)
| | - Vid Matišić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
| | - Tea Friščić
- Department of Cardiology, Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia; (Z.P.); (T.F.)
| | - Vilim Molnar
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
| | - Dorijan Jagačić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
| | - Lovro Vujičić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
| | - Neven Tudorić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
| | | | - Đivo Ljubičić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
- Clinical Hospital Dubrava, 10000 Zagreb, Croatia
| | - Dragan Primorac
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia; (V.M.); (V.M.); (D.J.); (L.V.); (N.T.); (Đ.L.); (D.P.)
- Eberly College of Science, The Pennsylvania State University, University Park, State College, PA 16802, USA
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT 06516, USA
- Medical School, University of Split, 21000 Split, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Medical School, University of Rijeka, 51000 Rijeka, Croatia
- Medical School REGIOMED, 96 450 Coburg, Germany
- Medical School, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
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Eckner D, Hofmann EM, Ademaj F, Martinovic K, Vogt F, Becher PM, Schrage B, Westermann D, Pauschinger M. Differences in the Treatment of Acute Coronary Syndrome in the Pre-COVID and COVID Era: An Analysis from Two German High-Volume Centers. J Cardiovasc Dev Dis 2021; 8:145. [PMID: 34821698 PMCID: PMC8625826 DOI: 10.3390/jcdd8110145] [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: 10/07/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic is placing a heavy burden on healthcare systems worldwide with the risk that acute cardiovascular diseases are treated too late. The present study aims to analyze patients with acute coronary syndrome in the current pandemic. A total of 966 patients (2019 n = 463, 2020 n = 503) can be evaluated. A comparison of patient care during and before the COVID-19 pandemic was made in terms of patient characteristics and pre- and in-hospital processes. Another aim is to show how many patients seek clinical care at a late stage of the disease. After Lockdown in Germany at week 12, 2020, there was a significant decrease in patients with an acute coronary syndrome (ACS), significant for STEMI cases in the first weeks after Lockdown (calendar week 13-16 2019 n = 43, 2020 n = 30; p = 0.02). The time from pain to first medical contact (time to FMC) is significantly extended during Lockdown, while internal clinical processes are unchanged. The rate of subacute myocardial infarction is numerically, but not significantly increased in calendar weeks 15, 2020 (p = 0.40) and 16 (p = 0,19). In addition, elderly patients avoid treatment for multifactorial reasons, and the longer overall pain to FMC may impact long-term mortality.
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Affiliation(s)
- Dennis Eckner
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Eva M. Hofmann
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Fadil Ademaj
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Kristinko Martinovic
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany;
- Department of Cardiac Surgery, Artemed Clinic Munich South, 81379 Munich, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
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Doblhammer G, Kreft D, Reinke C. Regional Characteristics of the Second Wave of SARS-CoV-2 Infections and COVID-19 Deaths in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10663. [PMID: 34682408 PMCID: PMC8535595 DOI: 10.3390/ijerph182010663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
(1) Background: In the absence of individual level information, the aim of this study was to identify the regional key features explaining SARS-CoV-2 infections and COVID-19 deaths during the upswing of the second wave in Germany. (2) Methods: We used COVID-19 diagnoses and deaths from 1 October to 15 December 2020, on the county-level, differentiating five two-week time periods. For each period, we calculated the age-standardized COVID-19 incidence and death rates on the county level. We trained gradient boosting models to predict the incidence and death rates by 155 indicators and identified the top 20 associations using Shap values. (3) Results: Counties with low socioeconomic status (SES) had higher infection and death rates, as had those with high international migration, a high proportion of foreigners, and a large nursing home population. The importance of these characteristics changed over time. During the period of intense exponential increase in infections, the proportion of the population that voted for the Alternative for Germany (AfD) party in the last federal election was among the top characteristics correlated with high incidence and death rates. (4) Machine learning approaches can reveal regional characteristics that are associated with high rates of infection and mortality.
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Affiliation(s)
- Gabriele Doblhammer
- Department of Economics and Social Sciences, Institute for Sociology and Demography, University of Rostock, 18057 Rostock, Germany; (D.K.); (C.R.)
- German Center for Neurodegenerative Diseases, 53127 Bonn, Germany
| | - Daniel Kreft
- Department of Economics and Social Sciences, Institute for Sociology and Demography, University of Rostock, 18057 Rostock, Germany; (D.K.); (C.R.)
- German Center for Neurodegenerative Diseases, 53127 Bonn, Germany
| | - Constantin Reinke
- Department of Economics and Social Sciences, Institute for Sociology and Demography, University of Rostock, 18057 Rostock, Germany; (D.K.); (C.R.)
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Wienbergen H, Retzlaff T, Schmucker J, Marin LAM, Rühle S, Garstka D, Osteresch R, Fach A, Hambrecht R. Impact of COVID-19 Pandemic on Presentation and Outcome of Consecutive Patients Admitted to Hospital Due to ST-Elevation Myocardial Infarction. Am J Cardiol 2021; 151:10-14. [PMID: 34049671 PMCID: PMC8075839 DOI: 10.1016/j.amjcard.2021.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/20/2022]
Abstract
Impact of COVID-19 pandemic and pandemic-related social restrictions on clinical course of patients treated for acute ST-elevation myocardial infarction (STEMI) is unclear. In the present study presentation and outcome of patients with STEMI in the year 2020 were compared with the years before in a German registry that includes all patients hospitalized for acute STEMI in a region with approximately 1 million inhabitants. In the year 2020 726 patients with STEMI were registered compared with 10.226 patients in the years 2006 to 2019 (730 ± 57 patients per year). No significant differences were observed between the groups regarding age, gender and medical history of patients. However, in the year 2020 a significantly higher rate of patients admitted with cardiogenic shock (21.9% vs 14.2%, p <0.01) and out-of-hospital cardiac arrest (OHCA) (14.3% vs 11.1%, p <0.01) was observed. The rate of patients with subacute myocardial infarction (14.3% vs 11.6%, p <0.05) was elevated in 2020. Hospital mortality increased by 52% from the years 2006 to 2019 (8.4%) to the year 2020 (12.8%, p <0.01). Only 4 patients (0.6%) with STEMI in the year 2020 had SARS-CoV-2 infection, none of those died in-hospital. In conclusion, in the year 2020 a highly significant increase of STEMI-patients admitted to hospital with advanced infarction and poor prognosis was observed. As the structure of the emergency network to treat patients with STEMI was unchanged during the study period, the most obvious reason for these changes was COVID-19 pandemic-related lockdown and the fear of many people to contact medical staff during the pandemic.
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Baumhardt M, Dreyhaupt J, Winsauer C, Stuhler L, Thiessen K, Stephan T, Markovic S, Rottbauer W, Imhof A, Rattka M. The Effect of the Lockdown on Patients With Myocardial Infarction During the COVID-19 Pandemic–A Systematic Review and Meta-Analysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:447-453. [PMID: 34114546 PMCID: PMC8383188 DOI: 10.3238/arztebl.m2021.0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/17/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The phenomenon of declining numbers of patients presenting with myocardial infarction was reported from the beginning of the COVID-19 pandemic onward. It was thought that measures introduced to stem the pandemic, such as the lockdown, contributed to this development. However, the data on hospital admissions, delay times, and mortality are not consistent. METHODS Our systematic literature review and meta-analysis embraced studies reporting the number of hospital admissions of patients with ST-segment elevation myocardial infarction (STEMI) and/or non-ST-segment elevation myocardial infarction (NSTEMI) during lockdown episodes. We also collected data on patient- and system-related delay times and on mortality. RESULTS Data from 27 studies on a total of 81 163 patients were included in our meta-analysis. We found that the number of hospital admissions of patients with myocardial infarction was significantly lower during the lockdown than before the pandemic (incidence rate ratio [IRR] = 0.516 [0.403; 0.660], I2 = 98%). This was true both for patients with STEMI (IRR = 0.620 [0.514; 0.746], I2 = 96%) and for patients with NSTEMI (IRR = 0.454 [0.354; 0.584], I2 = 96%). However, we found no significant difference in the time from hospital admission to cardiac catheterization, or in mortality, in relation to the time from symptom onset to first medical contact. CONCLUSION In this study, we have shown that the lockdown due to COVID-19 was associated with a marked decline in the number of hospital admissions of patients with myocardial infarction. As no significant effect on delay times or mortality was observed, it seems that timely medical care continued to be delivered.
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Affiliation(s)
- Michael Baumhardt
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Jens Dreyhaupt
- Institute for Epidemiology and Medical Biometrics, University of Ulm
| | - Claudia Winsauer
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Lina Stuhler
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Kevin Thiessen
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Tilman Stephan
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Sinisa Markovic
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Armin Imhof
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Manuel Rattka
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
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Covid and Cardiovascular Diseases: Direct and Indirect Damages and Future Perspective. High Blood Press Cardiovasc Prev 2021; 28:439-445. [PMID: 34173942 PMCID: PMC8233573 DOI: 10.1007/s40292-021-00464-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 infection determines a disease that predominantly affects lungs. However the cytokines storms, determined by the huge immune response to the infection, could affect also other organs and apparatus such as heart and vessels. Beyond the acute inflammation itself also hypercoagulative status has been linked to SARSCoV-2 infection and this surely relates to the increase seen in prevalence of pulmonary embolism and myocardial infarction. A number of cardiac abnormalities and pathologies have been observed, with special attention to cardiac arrhythmias and myocardial involvement. Furthermore, indirect damages determined by the reduction in acute and chronic cardiovascular care, results in a strong mortality and morbidity outcomes in cardiological patients. In this review we will summarise current knowledge on both direct and indirect cardiovascular damages determined by the SARS-CoV-2 pandemia.
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Actis Dato GM. From COVID-19 or because COVID-19? J Card Surg 2021; 36:3317-3318. [PMID: 34170578 PMCID: PMC8447011 DOI: 10.1111/jocs.15774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 05/22/2021] [Indexed: 12/26/2022]
Abstract
Infections and pandemics will condition us in an increasingly predominant way regarding diagnostic, medical, and surgical activities in all specialist areas. Particularly cardiovascular disease represents an important field also during other health crisis like COV19 pandemia. A common strategy in the future, to cohabit with pandemic events and to be able to continue an elective and not only emergency cardiac surgery program represents an imperative.
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Impact of COVID-19 on Healthcare Workers in Brazil between August and November 2020: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126511. [PMID: 34204195 PMCID: PMC8296453 DOI: 10.3390/ijerph18126511] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 01/29/2023]
Abstract
During the COVID-19 pandemic, healthcare workers (HCW) have been subjected to greater workloads. We conducted a cross-sectional online survey to assess the impact of the COVID-19 pandemic on Brazilian HCW. Data were collected between 11 August and 1 November 2020. Of the 295 respondents, 95 (32.2%) were medical doctors, 82 (27.8%) administrative staff, 53 (18.0%) nurses, 27 (9.2%) laboratory staff, and 38 (12.9%) were other staff. COVID-19-related restructuring at the health facilities was reported by 207 (70.2%) respondents, and 69 (23.4%) had their tasks changed. Preventive measures were well respected when seeing suspected patients. Overall, 167 (56.6%) HCW screened positive for anxiety and 137 (46.4%) for depression; 109 (36.9%) screened positive for both conditions. Of the 217 (73.6%) HCW who had been tested for COVID-19, at least one positive result was reported in 49 (22.6%). Following a positive COVID-19 test, 45/49 (91.8%) stopped working and stayed home. In conclusion, we found a high incidence of COVID-19 infection among Brazilian HCW with high rates of anxiety and depression despite a good self-reported adherence to COVID-19 preventive measures. As such, our study highlights the urgent need for interventions to mitigate the psychosocial risks HCW in Brazil encounter during the COVID-19 pandemic.
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Torre E, Colombo GL, Di Matteo S, Martinotti C, Valentino MC, Rebora A, Cecoli F, Monti E, Galimberti M, Di Bartolo P, Gaggioli G, Bruno GM. Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:503-518. [PMID: 34163191 PMCID: PMC8213950 DOI: 10.2147/ceor.s313577] [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: 03/30/2021] [Accepted: 05/19/2021] [Indexed: 01/14/2023] Open
Abstract
Background In Italy, the adoption of a total lockdown has generated almost total suspension of outpatient visits except for emergencies. Even after lockdown, the pandemic fear created additional barriers to access the health services. The aim of our study is to evaluate the economic impact of the lockdown for COVID-19 on public health in Italy, focusing on its effects on diabetic population. Materials and Methods We analyzed the impact of the lockdown on excess mortality and morbidity in the Italian diabetic population during 2020. The analysis was divided into several steps: a quantification of specialist visit reduction, the calculation of excess mortality in the diabetic population, the economic evaluation of the slowdown in the use of innovative diabetic therapies. Furthermore, the impact of the lockdown on the reduction of procedures and follow-up visits in diabetic population was evaluated. The overall impact of the pandemic and lockdown effects on costs and quality of life was then calculated. Results During 2020, a drop of 28% in patient access has been observed. Diabetic patients recorded a twice higher mortality value compared to general population (20.4% vs 10.2%). The analysis of market data revealed a slowdown in consumption of new antidiabetic therapies (−14%, 27% vs 41%). We estimated an expense of €26.6 million for NHS and a loss of 257 utilities in diabetic population due to the missed benefits related to slowdown in innovative antidiabetic drugs use and non-optimal follow-up and control of diabetes complications. In simulation scenarios, we also estimated an overall expenditure ranging from €38.7 to 94.0 million and a loss of 294–836 utilities. Conclusion Diabetic population paid a high tribute to pandemic and lockdown, both in terms of number of deaths and burden of diabetic complications, together with an overall deterioration of quality of life.
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Affiliation(s)
- Enrico Torre
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | | | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Alberto Rebora
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | - Francesca Cecoli
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | - Eleonora Monti
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | | | - Paolo Di Bartolo
- Diabetes Center of Ravenna, Romagna Diabetes Clinical Network, Romagna Local Health Authority, Ravenna, Italy
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Bilgin S, Meryem Atak Tel B, Taslamacioglu Duman T, Kurtkulagi O, Bakir Kahveci G, Sagdic T, Aktas G. Комплаєнс до лікування левотироксином хворих на гіпотиреоз під час пандемічної ери SARS-CoV-2. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (UKRAINE) 2021; 17:103-107. [DOI: 10.22141/2224-0721.17.2.2021.230563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Актуальність. Гіпотиреоз потребує замісної терапії левотироксином (L-T4), щоб підтримувати в пацієнтів стан еутиреозу. Кількість госпіталізацій з приводу хронічних захворювань зменшилась протягом ери COVID-19. Мета дослідження— встановити частоту госпіталізацій пацієнтів з гіпотиреозом під час пандемії COVID-19 порівняно з аналогічним періодом часу в 2019 році. Матеріали та методи. Дослідження було проведене серед пацієнтів, які звернулись у відділення внутрішньої медицини університетської лікарні Abant Izzet Baysal та отримували замісну терапію L-T4 внаслідок гіпотиреозу. 108 пацієнтів з гіпотиреозом були включені в дослідження, підписавши інформаційну згоду. Пацієнти були розділені на дві групи відповідно до прихильності до лікування: хворі, які відповідали вимогам лікування, і хворі, які не дотримувались режиму лікування. Результати. Рівень тиреотропного гормона (ТТГ) перед включенням у дослідження у групі осіб, які відповідали вимогам лікування, був вірогідно нижчим, ніж у групі хворих, які не дотримувались режиму лікування (p<0,001). При цьому рівень вільного тироксину (вТ4) серед пацієнтів першої групи був вірогідно вищим, ніж в осіб другої групи (p=0,04). Медіана нерегулярного прийому левотироксину становила 35 (10–90) днів у групі осіб, які не відповідали вимогам лікування, і 0 (0–0) днів у групі осіб, які відповідали вимогам лікування (p<0,001). Кількість днів, коли левотироксин використовувався нерегулярно, вірогідно позитивно корелювала з останнім значенням ТТГ (r=0,564, p<0,001) та негативно— з останнім значенням вT4 (r=–0,492, p<0,001). Середній об’єм еритроцитів (MCV) у хворих першої та другої груп становив 85 (69,1–97,5) та 89 (66–96,6) фл відповідно (p=0,03). Ретроспективний характер та порівняно невелика кількість досліджуваних були двома основними обмеженнями проведеного дослідження. Висновки. Дотримання режиму лікування є дуже важливим для досягнення стану еутиреозу в пацієнтів з гіпотиреозом під час пандемії COVID-19. Підвищений рівень MCV може передбачати невідповідність лікування у хворих на гіпотиреоз.
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Cannatà A, Bromage DI, McDonagh TA. The collateral cardiovascular damage of COVID-19: only history will reveal the depth of the iceberg. Eur Heart J 2021; 42:1524-1527. [PMID: 33624020 PMCID: PMC7928971 DOI: 10.1093/eurheartj/ehab097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
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Impact of the 1st and 2nd Wave of the COVID-19 Pandemic on Primary or Revision Total Hip and Knee Arthroplasty-A Cross-Sectional Single Center Study. J Clin Med 2021; 10:jcm10061260. [PMID: 33803721 PMCID: PMC8003209 DOI: 10.3390/jcm10061260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate the number of primary and revision total joint arthroplasties (TJA/rTJA) in 2020 compared to 2019. Specifically, the first and the second waves of the COVID-19 pandemic were evaluated as well as the pre-operative COVID-19 test. A cross-sectional single-center study of our prospectively maintained institutional arthroplasty registry was performed. The first COVID-19 wave and the second COVID-19 wave led to a socioeconomic lockdown in 2020. Performed surgeries, cause of revision, age, gender, and American Society of Anesthesiologists-level were analyzed. Preoperative COVID-19 testing was evaluated and nationwide COVID-19 data were compared to other countries. In 2020, there was a decrease by 16.2% in primary and revision TJAs of the hip and knee compared to 2019. We observed a reduction of 15.8% in primary TJAs and a reduction of 18.6% on rTJAs in 2020 compared to 2019. There is an incline in total hip arthroplasties (THAs) and a decline in total knee arthroplasties (TKAs) comparing 2019 to 2020. During the first wave, there was a reduction in performed primary TJAs of 86%. During the second wave, no changes were observed. This is the first study quantifying the impact of the COVID-19 pandemic on primary and revision TJAs regarding the first and second wave.
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