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B JP, S R, P MP, A J, K V, Das MK, K S, N S, Ezhilan J, Agarwal R, P R V, Choudhary AH, C B M, Malviya A, Gopi A, V K C, Joseph S, Goyal KK, John JF, Bansal S, S H, Nagula P, Joseph J, Bagawat A, Seth S, Shah U, Goel PK, Asokan PK, Sethi KK, Sharma S, Banerji LGA, Sikdar S, Agarwala M, Chandra S, Bharti B, Ashraf SM, Srivastava S, Kesavamoorthy B, Bali HK, Sarma D, Jain RK, Dani SI, Natesh BH, Chakraborty RN, Gupta V, Khanna NN, Mukhopadhyay D, Mandal S, Majumder B, L S, Girish MP, Das D, Devasia T, Vajifdar B, Bhatia T, Abdullah Z, Sharma S, Kumar S, Lincy M, Naik N, Kahali D, Sinha DP, Dastidar DG, Wander GS, Yadav R, Tewari S, Bhandari S, Chandra Rath P, Bang VH, Roy D, Banerjee P, Shanmugasundaram S, Zachariah G. Impact of COVID-19 on heart failure hospitalization and outcome in India - A cardiological society of India study (CSI-HF in COVID 19 times study - "The COVID C-HF study"). Indian Heart J 2023; 75:370-375. [PMID: 37652199 PMCID: PMC10568052 DOI: 10.1016/j.ihj.2023.08.004] [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: 06/23/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. METHODS Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. RESULTS Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. CONCLUSION The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.
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Affiliation(s)
- Jayagopal P B
- Lakshmi Hospital, Chittur Road, Palakkad, Kerala, India.
| | - Ramakrishnan S
- All India Institute of Medical Sciences, New Delhi, India
| | - Mohanan P P
- West Fort Hi-Tech Hospital, Thrissur, Kerala, India
| | - Jabir A
- Lisie Hospital, Kochi, Kerala, India
| | - Venugopal K
- Pushpagiri Medical College, Thiruvalla, Kerala, India
| | - M K Das
- Birla Heart Research Centre and the Calcutta Medical Research Institute (CMRI), Kolkata, India
| | - Santhosh K
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, India
| | - Syam N
- District Hospital, Kollam, Kerala, India
| | - J Ezhilan
- Madras Medical Mission, Chennai, India
| | | | | | | | - Meena C B
- SMS Hospital, Jaipur, Rajasthan, India
| | | | - Arun Gopi
- Metromed International Cardiac Centre, Calicut, Kerala, India
| | | | - Stigi Joseph
- Little Flower Hospital & Research Centre, Angamaly, Kochi, Kerala, India
| | | | - John F John
- Baby Memorial Hospital, Calicut, Kerala, India
| | - Sandeep Bansal
- Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | | | | | | | - Sandeep Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - P K Asokan
- Fathima Hospital, Kozhikode, Kerala, India
| | - K K Sethi
- Delhi Heart & Lung Institute, Delhi, India
| | | | | | | | | | | | | | - S M Ashraf
- Sahakarana Hridayalaya, Pariyaram Medical College, Kannur, Kerala, India
| | | | | | | | | | | | | | - B H Natesh
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - Vivek Gupta
- Indraprastha Apollo Hospitals, New Delhi, India
| | | | | | - Subroto Mandal
- Ubuntu Heart & Super Speciality Hospital, Ubbuntu, Bhopal, India
| | | | - Sridhar L
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | | | - Tom Devasia
- Kasturba Medical College Manipal, Karnataka, India
| | - Bhavesh Vajifdar
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | - Zia Abdullah
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Mathew Lincy
- Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Dhiman Kahali
- M Birla Heart Research Centre, Kolkata, West Bengal, India
| | | | | | | | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - Debabrata Roy
- N H Rabindranatha Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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Yousufuddin M, Yamani MH, Kashani KB, Zhu Y, Wang Z, Seshadri A, Blocker KR, Peters JL, Doss JM, Karam D, Khandelwal K, Sharma UM, Dudenkov DV, Mehmood T, Pagali SR, Nanda S, Abdalrhim AD, Cummings N, Dugani SB, Smerina M, Prokop LJ, Keenan LR, Bhagra S, Jahangir A, Bauer PR, Fonarow GC, Murad MH. Characteristics, Treatment Patterns, and Clinical Outcomes After Heart Failure Hospitalizations During the COVID-19 Pandemic, March to October 2020. Mayo Clin Proc 2023; 98:31-47. [PMID: 36603956 PMCID: PMC9489984 DOI: 10.1016/j.mayocp.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare clinical characteristics, treatment patterns, and 30-day all-cause readmission and mortality between patients hospitalized for heart failure (HF) before and during the coronavirus disease 2019 (COVID-19) pandemic. PATIENTS AND METHODS The study was conducted at 16 hospitals across 3 geographically dispersed US states. The study included 6769 adults (mean age, 74 years; 56% [5033 of 8989] men) with cumulative 8989 HF hospitalizations: 2341 hospitalizations during the COVID-19 pandemic (March 1 through October 30, 2020) and 6648 in the pre-COVID-19 (October 1, 2018, through February 28, 2020) comparator group. We used Poisson regression, Kaplan-Meier estimates, multivariable logistic, and Cox regression analysis to determine whether prespecified study outcomes varied by time frames. RESULTS The adjusted 30-day readmission rate decreased from 13.1% (872 of 6648) in the pre-COVID-19 period to 10.0% (234 of 2341) in the COVID-19 pandemic period (relative risk reduction, 23%; hazard ratio, 0.77; 95% CI, 0.66 to 0.89). Conversely, all-cause mortality increased from 9.7% (645 of 6648) in the pre-COVID-19 period to 11.3% (264 of 2341) in the COVID-19 pandemic period (relative risk increase, 16%; number of admissions needed for one additional death, 62.5; hazard ratio, 1.19; 95% CI, 1.02 to 1.39). Despite significant differences in rates of index hospitalization, readmission, and mortality across the study time frames, the disease severity, HF subtypes, and treatment patterns remained unchanged (P>0.05). CONCLUSION The findings of this large tristate multicenter cohort study of HF hospitalizations suggest lower rates of index hospitalizations and 30-day readmissions but higher incidence of 30-day mortality with broadly similar use of HF medication, surgical interventions, and devices during the COVID-19 pandemic compared with the pre-COVID-19 time frame.
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Affiliation(s)
| | | | | | - Ye Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ashok Seshadri
- Division of Psychiatry, Mayo Clinic Health System, Austin, MN
| | - Katherine R Blocker
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Jessica L Peters
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Jewell M Doss
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Dhauna Karam
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Kanika Khandelwal
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | | | - Daniel V Dudenkov
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Tahir Mehmood
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sanjeev Nanda
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Nichole Cummings
- Division of Hospital Internal Medicine, St. Cloud Hospital, St. Cloud, MN
| | - Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Michael Smerina
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | | | - Sumit Bhagra
- Division of Endocrinology, Mayo Clinic Health System, Austin, MN
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, CA
| | - Mohammad Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Preventive and Occupational Medicine, Mayo Clinic, Rochester, MN
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Zhang H, Zhu Y, Li N, Zeng J. Update on the Value of Lung Ultrasound Examination in Acute Decompensated Heart Failure Patients with Various Left Ventricular Ejection Fraction. Rev Cardiovasc Med 2022; 23:350. [PMID: 39077125 PMCID: PMC11267337 DOI: 10.31083/j.rcm2310350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 07/31/2024] Open
Abstract
Acute decompensated heart failure (ADHF) is one of the most common causes of hospital admission for cardiovascular diseases. ADHF often affects the elderly population, is associated with high morbidity, admission rate and mortality. Pulmonary congestion (PC) is the most common cause of hospitalization among ADHF patients. Previous studies have shown that lung ultrasound (LUS) serves as a valuable tool for the evaluation of PC in patients with heart failure in terms of diagnosis, guiding of the treatment, and post-discharge monitoring. The use of LUS for ADHF is well described and already widely used in the daily clinical practice. PC might differ in ADHF patients with different left ventricular ejection fraction value and treatment options should be steadily adjusted according to the LUS-derived PC results to improve the outcome. This review summarized the value of LUS examination in patients with ADHF with preserved, mildly reduced, and reduced left ventricular ejection fraction, aiming to expand the rational use of LUS, promote the LUS-guided management and improve the outcome among patients with ADHF.
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Affiliation(s)
- Hui Zhang
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
| | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
| | - Na Li
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, 421001 Hengyang, Hunan, China
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Nath A, Sudarshan KL, Rajput GK, Mathew S, Chandrika KRR, Mathur P. A rapid assessment of the impact of coronavirus disease (COVID- 19) pandemic on health care & service delivery for noncommunicable diseases in India. Diabetes Metab Syndr 2022; 16:102607. [PMID: 36115089 PMCID: PMC9451930 DOI: 10.1016/j.dsx.2022.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIM The coronavirus disease (COVID-19) pandemic had disrupted the availability, access and utilisation of routine health care services. The present study aimed to assess the impact of COVID-19 pandemic restrictions on India's Non communicable Disease (NCD) health care service delivery. METHODS The study included existing hospitals in disease registry network of the Indian Council of Medical Research-National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru. The study participants comprised site investigators who were clinicians from many specialities, including general medicine, surgery, cancer, neurology, cardiology, and endocrinology. A standardised questionnaire was prepared to collect data on NCD health care services at the respective hospitals over three months from March to May 2020. RESULTS Out of 153 hospitals approached for the study, 106 (70%) agreed to participate. Of these, 16 hospitals fully converted for COVID-19 care were excluded from the study. Thus, data from 90 hospitals were included in the final analysis. There had been a total disruption of NCD-related healthcare services during the three months in 44% of the hospitals. In April 2020, the outpatient attendance for over one-third of the hospitals was reduced by more than 75%. Admissions for planned surgeries for cancer treatment were reduced by more than 75% for about 40% of the hospitals. Preventive activities and population-based screening for diabetes, hypertension and cancer appear to have been adversely affected, with about one-third of the hospitals reporting total disruption in April and May 2020. As many as 60% of the institutions reported adequate availability of doctors. Over 91% of the institutions had preparedness/action plans to ensure the continuity of NCD services. CONCLUSION The study shows that despite adequate human and material resources, NCD outpatient services, elective surgeries and population-based screening were severely affected. Most institutions were prepared to overcome the pandemic-imposed disruption and ensure a continuum of care for NCDs'.
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Affiliation(s)
- Anita Nath
- ICMR-National Centre for Disease Informatics and Research (Indian Council of Medical Research), Bengaluru, India.
| | | | - Gurpreet Kaur Rajput
- ICMR-National Centre for Disease Informatics and Research (Indian Council of Medical Research), Bengaluru, India.
| | - Stany Mathew
- ICMR-National Centre for Disease Informatics and Research (Indian Council of Medical Research), Bengaluru, India.
| | | | - Prashant Mathur
- ICMR-National Centre for Disease Informatics and Research (Indian Council of Medical Research), Bengaluru, India.
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Gadsden T, Downey LE, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for noncommunicable diseases in the South-East Asia region: A systematic review. THE LANCET REGIONAL HEALTH - SOUTHEAST ASIA 2022; 1:100010. [PMID: 35769108 PMCID: PMC9069231 DOI: 10.1016/j.lansea.2022.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background COVID-19 has had a profound impact on the health systems of the 11 countries of the WHO South East Asia Region. We conducted a systematic review of studies that used quantitative and comparative approaches to assess the impact of the pandemic on the service provision of four noncommunicable diseases (NCDs) (cancer, cardiovascular disease, chronic respiratory diseases, and diabetes) in the region. Methods A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2021. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist and the ROBINS-I risk of bias tool. A narrative synthesis was conducted following the ‘synthesis without meta-analysis’ reporting guidelines. Findings Two review authors independently screened 5,397 records with 31 studies included, 26 which were cross-sectional studies. Most studies (n=24, 77%) were conducted in India and 19 (61%) were single-site studies. Compared to a pre-pandemic period, 10/17 cancer studies found a >40% reduction in outpatient services, 9/14 cardiovascular disease found a reduction of 30% or greater in inpatient admissions and 2 studies found diagnoses and interventions for respiratory diseases reduced up to 78.9% and 83.0%, respectively. No eligible studies on the impact of COVID-19 on diabetes services were found. Interpretation COVID-19 has substantially disrupted the provision of essential health services for NCDs in the WHO South East Asia Region, particularly cancer and cardiovascular disease. This is likely to have serious and potentially long-term downstream impacts on health and mortality of those living with or at risk of NCDs in the region. Funding This work was supported by the WHO Sri Lanka Country Office.
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Affiliation(s)
- Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Corresponding author at: The George Institute for Global Health, 1 King St, Newtown 2041, NSW, Australia.
| | - Laura E Downey
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Victor Del Rio Vilas
- World Health Organization (WHO) South East Asia Regional Office (SEARO), New Delhi, India
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
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