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Tamimi O, Tamimi F, Nisar T, Gaber AO, Lin J, Gorthi J, Gotur D. Clinical Outcomes of Heart Transplant Recipients Admitted with COVID-19 Infection in 2020: A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101996. [PMID: 37506956 DOI: 10.1016/j.cpcardiol.2023.101996] [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: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
The COVID-19 pandemic, caused by infection of the SARS-CoV-2 virus, has impacted morbidity and mortality through widespread cytokine release and aberrant immunity; the mainstay of management has been immunosuppression. The aim of our retrospective study is to determine the effects of solid-organ transplantation (SOT) on COVID-19 admissions using data from the 2020 nationwide inpatient sample (NIS). After multivariate adjustment, we found COVID-19 admission with SOT had no difference in mortality (11.5% vs 11.1%, adjusted OR: 0.99 [95% CI 0.84-1.19, P = 0.99], no difference in need for vasopressor use (2.6% vs 1.8%, adjusted OR: 1.02 [95% CI 0.73-1.44, P = 0.88]), lower odds of requiring mechanical ventilation (MV) (13.7% vs 14.8%, adjusted OR: 0.83 [95% CI 0.71-0.97, P = 0.02]), lower odds of MV within 24 hours of admission (adjusted OR: 0.60 [95% CI 0.47-0.78, P < 0.01]), increased odds of mechanical circulatory support needs (adjusted OR 3.7 [95% CI 1.2-11.7, P = 0.025]), increased odds of acute renal failure requiring renal replacement therapy (adjusted OR 1.66 [95% CI 1.29-2.15, P < 0.01]), decreased mean length of stay (7.45 days vs 7.48 days, adjusted difference: 0.8 days less, P <0.01), and no difference in mean total hospitalization charges ($91,316 vs $79,100, adjusted difference: -$2,667, P = 0.57) compared to COVID-19 admissions without SOT.
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Affiliation(s)
- Omar Tamimi
- Department of Medicine, Houston Methodist Hospital, Houston, TX.
| | - Faisal Tamimi
- Department of Medicine, Jamaica Medical Center, Queens, NY
| | - Tariq Nisar
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston TX
| | - Ahmed Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX; J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX
| | - Jiejian Lin
- Department of Medicine, Houston Methodist Hospital, Houston, TX; Division of Infectious Disease, Houston Methodist Hospital, Houston, TX
| | - Janardhana Gorthi
- Department of Medicine, Houston Methodist Hospital, Houston, TX; J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX; Division of Cardiology, Houston Methodist Hospital, Houston TX
| | - Deepa Gotur
- Department of Medicine, Houston Methodist Hospital, Houston, TX; Division of Critical Care, Houston Methodist Hospital, Houston, TX
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la Roi-Teeuw HM, van Smeden M, Geersing GJ, Klungel OH, Rutten FH, Souverein PC, van Doorn S. Incidence and individual risk prediction of post-COVID-19 cardiovascular disease in the general population: a multivariable prediction model development and validation study. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead101. [PMID: 38046622 PMCID: PMC10690016 DOI: 10.1093/ehjopen/oead101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 12/05/2023]
Abstract
Aims Previous studies suggest relatively increased cardiovascular risk after COVID-19 infection. This study assessed incidence and explored individual risk and timing of cardiovascular disease occurring post-COVID-19 in a large primary care database. Methods and results Data were extracted from the UK's Clinical Practice Research Datalink. Incidence rates within 180 days post-infection were estimated for arterial or venous events, inflammatory heart disease, and new-onset atrial fibrillation or heart failure. Next, multivariable logistic regression models were developed on 220 751 adults with COVID-19 infection before 1 December 2020 using age, sex and traditional cardiovascular risk factors. All models were externally validated in (i) 138 034 vaccinated and (ii) 503 404 unvaccinated adults with a first COVID-19 infection after 1 December 2020. Discriminative performance and calibration were evaluated with internal and external validation. Increased incidence rates were observed up to 60 days after COVID-19 infection for venous and arterial cardiovascular events and new-onset atrial fibrillation, but not for inflammatory heart disease or heart failure, with the highest rate for venous events (13 per 1000 person-years). The best prediction models had c-statistics of 0.90 or higher. However, <5% of adults had a predicted 180-day outcome-specific risk larger than 1%. These rare outcomes complicated calibration. Conclusion Risks of arterial and venous cardiovascular events and new-onset atrial fibrillation are increased within the first 60 days after COVID-19 infection in the general population. Models' c-statistics suggest high discrimination, but because of the very low absolute risks, they are insufficient to inform individual risk management.
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Affiliation(s)
- Hannah M la Roi-Teeuw
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sander van Doorn
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
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Bhandari J, Abbas AM, Alfarone JJ, Huda S, Ojha N. The Discovery of an Intracardiac Thrombus Following a Mild COVID-19 Infection: A Case Report and Review of Literature. Cureus 2023; 15:e39745. [PMID: 37398759 PMCID: PMC10310549 DOI: 10.7759/cureus.39745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) is a viral disease that predominantly affects the respiratory system, but extrapulmonary manifestations have been increasingly reported over the course of the pandemic. Common extrapulmonary manifestations include the gastrointestinal, cardiovascular, and neurological systems, such as diarrhea, rashes, loss of smell/taste, myalgia, acute kidney injury, cardiac arrhythmias, or heart failure. COVID-19 infection is associated with an increased risk of thromboembolic events, especially in the setting of severe disease. We present a case of a 42-year-old female who recently tested positive for COVID-19 infection and presented to the clinic with complaints of palpitations that started after her diagnosis. An electrocardiogram done in the clinic showed sinus rhythm, and the patient was placed on an event monitor, which showed no evidence of tachyarrhythmia. A transthoracic echocardiogram (TTE) done as part of the workup showed a large thrombus in the right ventricular outflow tract attached to the ventricular side of the pulmonic valve. The patient was started on a therapeutic dose of apixaban at 10 mg twice a day (BID) for seven days and 5 mg twice a day afterward.
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Affiliation(s)
| | - Anas M Abbas
- Medicine, Norton College of Medicine, Upstate University Hospital, Syracuse, USA
| | - John J Alfarone
- Medicine, Norton College of Medicine, Upstate University Hospital, Syracuse, USA
| | - Syed Huda
- Cardiology, Upstate University Hospital, Syracuse, USA
| | - Niranjan Ojha
- Cardiology, Upstate University Hospital, Syracuse, USA
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Vilaplana-Carnerero C, Giner-Soriano M, Dominguez À, Morros R, Pericas C, Álamo-Junquera D, Toledo D, Gallego C, Redondo A, Grau M. Atherosclerosis, Cardiovascular Disease, and COVID-19: A Narrative Review. Biomedicines 2023; 11:biomedicines11041206. [PMID: 37189823 DOI: 10.3390/biomedicines11041206] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory and degenerative process that mainly occurs in large- and medium-sized arteries and is morphologically characterized by asymmetric focal thickenings of the innermost layer of the artery, the intima. This process is the basis of cardiovascular diseases (CVDs), the most common cause of death worldwide. Some studies suggest a bidirectional link between atherosclerosis and the consequent CVD with COVID-19. The aims of this narrative review are (1) to provide an overview of the most recent studies that point out a bidirectional relation between COVID-19 and atherosclerosis and (2) to summarize the impact of cardiovascular drugs on COVID-19 outcomes. A growing body of evidence shows that COVID-19 prognosis in individuals with CVD is worse compared with those without. Moreover, various studies have reported the emergence of newly diagnosed patients with CVD after COVID-19. The most common treatments for CVD may influence COVID-19 outcomes. Thus, their implication in the infection process is briefly discussed in this review. A better understanding of the link among atherosclerosis, CVD, and COVID-19 could proactively identify risk factors and, as a result, develop strategies to improve the prognosis for these patients.
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Affiliation(s)
- Carles Vilaplana-Carnerero
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Àngela Dominguez
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Biomedical Research Consortium in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
- Department of Pharmacology, Therapeutics and Toxicology, School of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Carles Pericas
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), 08023 Barcelona, Spain
| | - Dolores Álamo-Junquera
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Quality, Process and Innovation Direction, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Health Services Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Diana Toledo
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Carmen Gallego
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Methodology, Quality and Medical Care Assessment Department, Direcció d'Atenció Primària Metropolitana Sud, Catalan Institute of Health (ICS), 08908 Barcelona, Spain
| | - Ana Redondo
- Hospital Universitario Bellvitge, Catalan Institute of Health (ICS), 08907 Barcelona, Spain
| | - María Grau
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Serra Húnter Fellow, Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
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Isath A, Malik AH, Goel A, Gupta R, Shrivastav R, Bandyopadhyay D. Nationwide Analysis of the Outcomes and Mortality of Hospitalized COVID-19 Patients. Curr Probl Cardiol 2023; 48:101440. [PMID: 36216202 PMCID: PMC9546497 DOI: 10.1016/j.cpcardiol.2022.101440] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The Coronavirus disease 2019 (COVID-19) pandemic has affected people worldwide with the United States (US) with the largest number of reported cases currently. Previous studies in hospitalized COVID-19 patients have been limited by sample size. METHODS The National Inpatient Sample database which is the largest inpatient database in the US was queried in the year 2020 for the diagnosis of COVID-19 based on ICD-10-CM U07.1 and associated outcomes. Multivariate logistic regression analysis was used to identify predictors of mortality. STATA 16.0 was used for statistical analysis. RESULTS A weighted total of 1,678,995 hospitalizations for COVID-19 were identified. Median age of admitted patients with COVID-19 was 65 year (51-77) with 47.9% female and 49.2% White. Majority of the patients admitted were >65 years of age (49.3%). Hypertension and diabetes were the most common comorbidities (64.2% and 39.5%, respectively). Overall inpatient mortality was 13.2% and increasing to 55.9% in patients requiring mechanical ventilation. Trend of inpatient mortality was significantly decreasing over the year. Predictors of inpatient mortality included age, male sex, diabetes, chronic kidney disease, heart failure, arrythmia, obesity, and coagulopathy. Despite a lower proportion of patients admitted to hospital with COVID-19, Black, Hispanic, and Native Americans were at an increased adjusted odds of inpatient mortality. Disparity was also noted in income, with low median household income associated with higher risk of mortality. CONCLUSION In the largest US cohort with >1.6 million hospitalized COVID-19 patients in 2020, overall inpatient mortality was 13.6% with significantly higher mortality in ventilated patients. Significant socioeconomic and racial disparities were present with minorities at higher odds of mortality.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA
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