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Kole C, Stefanou Ε, Karvelas N, Schizas D, Toutouzas KP. Acute and Post-Acute COVID-19 Cardiovascular Complications: A Comprehensive Review. Cardiovasc Drugs Ther 2024; 38:1017-1032. [PMID: 37209261 PMCID: PMC10199303 DOI: 10.1007/s10557-023-07465-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW The risk of cardiovascular complications due to SARS-CoV-2 are significantly increased within the first 6 months of the infection. Patients with COVID-19 have an increased risk of death, and there is evidence that many may experience a wide range of post-acute cardiovascular complications. Our work aims to provide an update on current clinical aspects of diagnosis and treatment of cardiovascular manifestations during acute and long-term COVID-19. RECENT FINDINGS SARS-CoV-2 has been shown to be associated with increased incidence of cardiovascular complications such as myocardial injury, heart failure, and dysrhythmias, as well as coagulation abnormalities not only during the acute phase but also beyond the first 30 days of the infection, associated with high mortality and poor outcomes. Cardiovascular complications during long-COVID-19 were found regardless of comorbidities such as age, hypertension, and diabetes; nevertheless, these populations remain at high risk for the worst outcomes during post-acute COVID-19. Emphasis should be given to the management of these patients. Treatment with low-dose oral propranolol, a beta blocker, for heart rate management may be considered, since it was found to significantly attenuate tachycardia and improve symptoms in postural tachycardia syndrome, while for patients on ACE inhibitors or angiotensin-receptor blockers (ARBs), under no circumstances should these medications be withdrawn. In addition, in patients at high risk after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. In this work we provide a comprehensive review on acute and post-acute COVID-19 cardiovascular complications, symptomatology, and pathophysiology mechanisms. We also discuss therapeutic strategies for these patients during acute and long-term care and highlight populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease have worse outcomes during acute SARS-CoV-2 infection and are more likely to develop cardiovascular complications during long-COVID-19.
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Affiliation(s)
- Christo Kole
- Cardiology Department, Sismanoglio General Hospital of Attica, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Εleni Stefanou
- Artificial Kidney Unit, General Hospital of Messinia, Kalamata, Greece
| | - Nikolaos Karvelas
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Krishna B, Metaxaki M, Sithole N, Landín P, Martín P, Salinas-Botrán A. Cardiovascular disease and covid-19: A systematic review. IJC HEART & VASCULATURE 2024; 54:101482. [PMID: 39189008 PMCID: PMC11345335 DOI: 10.1016/j.ijcha.2024.101482] [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] [Received: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024]
Abstract
Background Cardiovascular complications of COVID-19 are numerous and aspects of this phenomenon are not well known. The main objective of this manuscript is a systematic review of the acute and chronic cardiovascular complications secondary to COVID-19. Methods A systematic review of the literature through Medline via PubMed was conducted (2020-2024). Results There is a plethora of effects of COVID-19 on the heart in the acute setting. Here we discuss pathophysiology, myocardial infarctions, heart failure, Takotsubo Cardiomyopathy, myocardial injury, myocarditis and arrhythmias that are caused by COVID-19. Additionally, these cardiovascular injuries can linger and may be an underlying cause of some Long COVID symptoms. Conclusions Cardiovascular complications of COVID-19 are numerous and life-threatening. Long COVID can affect cardiovascular health. Microclotting induced by SARS-CoV-2 infection could be a therapeutic target for some aspects of Long Covid.
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Affiliation(s)
- B.A. Krishna
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - M. Metaxaki
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - N. Sithole
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Infectious Diseases, Cambridge University, Cambridge, United Kingdom
| | - P. Landín
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - P. Martín
- Department of Respiratory Medicine, Hospital Clínico San Carlos, Madrid, Spain
| | - A. Salinas-Botrán
- Department of Infectious Diseases, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Baig MFA, Babu AD, Herweg B, Rinde-Hoffman DA. Outcomes of Covid-19 among patients with ischemic heart disease: A propensity matched analysis. Heart Lung 2024; 68:291-297. [PMID: 39181103 DOI: 10.1016/j.hrtlng.2024.08.010] [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: 05/21/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Prior research has linked cardiovascular diseases with higher COVID-19 mortality and worse hospital outcomes, particularly in severe heart failure. Large population-based data regarding the impact of pre-existing ischemic heart disease (IHD) on COVID-19 outcomes is not well established. OBJECTIVE To study the impact of COVID-19 infection on IHD hospital mortality and other outcomes. METHODS The study included a patient cohort from the 2020 and 2021 National Inpatient Sample (NIS) database. Propensity score matching was used to match the study cohort (COVID-19 with IHD) to controls (COVID-19 without IHD) using a 1:1 matching ratio. The outcomes analyzed were in-hospital mortality, rates of acute kidney injury (AKI), acute myocardial injury (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. RESULTS A total of 2,532,652 patients met the inclusion criteria (1,199,008 females [47.3 %), predominantly Caucasian 1,456,203 (57.5 %); mean [SD] age 63, (5.4), including 29,315 (1.1 %) patients with a history of IHD. Following propensity matching, 4,772 COVID-19 patients with and without IHD were matched. IHD patients had higher rates of AMI (adjusted odds ratio (aOR) 3.75, 95 % CI 3.27-4.31, p < 0.001), cardiogenic shock (aOR 2.89, 95 % CI 1.60-5.19, p < 0.001), VT (aOR 3.26, 95 % CI 2.48-4.29, p < 0.001), and VF (aOR 2.23, 95 % CI 1.25-3.99, p < 0.001). The odds ratios of in-hospital mortality, AKI, PE, mechanical ventilation, tracheal intubation, and resource use were not significantly different. CONCLUSION A history of IHD does not impact COVID-19 mortality but increases the risk of in-hospital cardiac complications.
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Affiliation(s)
- Mirza Faris Ali Baig
- Department of Internal Medicine, Asante Three Rivers Medical Center, Grant Pass, OR, United States.
| | - Aravind Dilli Babu
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, United States
| | - Bengt Herweg
- Department of Electrophysiology, University of South Florida, Morsani College of Medicine, United States
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Akpoviroro O, Sauers NK, Uwandu Q, Castagne M, Akpoviroro OP, Humayun S, Mirza W, Woodard J. Severe COVID-19 infection: An institutional review and literature overview. PLoS One 2024; 19:e0304960. [PMID: 39163410 PMCID: PMC11335168 DOI: 10.1371/journal.pone.0304960] [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: 07/17/2023] [Accepted: 05/21/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes. METHODS A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality. RESULTS Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%. CONCLUSION Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.
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Affiliation(s)
- Ogheneyoma Akpoviroro
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Nathan Kyle Sauers
- Department of Engineering, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Myriam Castagne
- Clinical & Translational Science Institute, Boston University, Boston, Massachusetts, United States of America
| | | | - Sara Humayun
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Wasique Mirza
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Jameson Woodard
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
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Liu Y, Li D, Liang Y. Comorbidities and mortality risk in COVID-19 patients with congestive heart failure: A comprehensive analysis. Heliyon 2024; 10:e35746. [PMID: 39170371 PMCID: PMC11336877 DOI: 10.1016/j.heliyon.2024.e35746] [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: 11/09/2023] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024] Open
Abstract
The COVID-19 pandemic has posed unprecedented challenges to global healthcare systems, resulting in alarming incidence and mortality rates among patients with comorbidities, including heart failure. Understanding the characteristics of heart failure and other comorbidities during the COVID-19 pandemic is crucial for effective prevention and treatment. However, the current understanding of these characteristics among different racial groups remains incomplete. In this study, we investigated a cohort of 4711 patients, classifying them into congestive heart failure (CHF) and non-CHF groups. Biomarker analysis revealed noteworthy variations in blood urea nitrogen, aspartate aminotransferase, and white blood cell levels based on the presence or absence of CHF. Stratified by three racial groups, univariate logistic regression analysis identified significant differences in multiple variables, including CHF. Subsequent univariate Cox regression and Kaplan-Meier analysis demonstrated variations in mortality factors among distinct populations, with age and comorbidity playing prominent roles. This study utilized a large-scale database to investigate the characteristics of heart failure and related variables during the COVID-19 pandemic. The findings revealed distinctive mortality risk factors among various racial groups, emphasizing the significance of customized risk assessment and management approaches for diverse populations. These findings also provide a valuable resource for the development of targeted interventions and the promotion of equitable healthcare outcomes in the context of the COVID-19 pandemic.
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Affiliation(s)
- Yi Liu
- College of Electronic Information and Optical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
- Key Laboratory of Big Data Fusion Analysis and Application of Shanxi Province, Taiyuan, 030024, China
- Intelligent Perception Engineering Technology Center of Shanxi, Taiyuan, 030024, China
| | - Dengao Li
- College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, Taiyuan, 030024, China
- Key Laboratory of Big Data Fusion Analysis and Application of Shanxi Province, Taiyuan, 030024, China
- Intelligent Perception Engineering Technology Center of Shanxi, Taiyuan, 030024, China
| | - Yuchen Liang
- Shanxi Cardiovascular Hospital, Taiyuan, 030027, China
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Lee S, Lim KR, Chun KJ, Kim BS. Long-term impacts of COVID-19 in patients with prior heart failure in Korea: A nationwide cohort study using the common data model. Medicine (Baltimore) 2024; 103:e39236. [PMID: 39093748 PMCID: PMC11296475 DOI: 10.1097/md.0000000000039236] [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: 03/03/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024] Open
Abstract
Limited data are available on the long-term prognosis and monitoring period after coronavirus disease 2019 (COVID-19) infection in the population with prior heart failure (HF). We aimed to exam the association of COVID-19 with clinical prognosis in populations with prior HF and evaluate prognosis within 30 days and 30 days to 1 year after infection. Based on insurance benefit claims sent to the Health Insurance Review and Assessment Service of Korea from January 2018 to April 2022, 9,822,577 patients were selected and converted to the Observational Medical Outcomes Partnership-common data model by the Big Data Department of Health Insurance Review and Assessment Service of Korea. In the dataset, 1,565,274 patients exhibited diagnosis of HF based on the International Statistical Classification of Diseases and Related Health Problems 10 codes. They were divided into 2 groups according to COVID-19 infection, and propensity-score-matching analysis was performed. The clinical outcome was all-cause mortality. Among the 1,565,274 patients with an HF diagnosis, 1,152,975 patients were classified into the HF with the COVID-19 group and 412,299 patients in the HF without COVID-19 group. We created 200,780 matched pairs by propensity-score-matching analysis. Within 30 days of COVID-19, the HF with COVID-19 group had a higher risk of all-cause death compared with the HF without COVID-19 group (hazard ratio [HR]: 2.19, 95% confidence interval [CI]: 2.04-2.36, P < .01). Thirty days to 1 year after COVID-19 infection, the HF with COVID-19 group exhibited a higher risk of all-cause death (HR: 2.04, 95% CI: 1.83-2.27, P < .01). In populations with prior HF, COVID-19 is associated with a higher risk of all-cause mortality within 30 days and this risk remains augmented up to 1 year after the acute phase of COVID-19. Our findings suggest that greater attention may be crucial in populations with prior HF for a prolonged period after COVID-19 infection.
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Affiliation(s)
- Seunghwa Lee
- Division of Cardiology, Department of Medicine, Wiltse Memorial Hospital, Suwon, Gyeonggi-do, South Korea
| | - Kyoung Ree Lim
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, South Korea
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Matejin S, Gregoric ID, Radovancevic R, Paessler S, Perovic V. Risk stratification and prediction of severity of COVID-19 infection in patients with preexisting cardiovascular disease. Front Microbiol 2024; 15:1422393. [PMID: 39119143 PMCID: PMC11306936 DOI: 10.3389/fmicb.2024.1422393] [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] [Received: 04/23/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is a highly contagious viral disease. Cardiovascular diseases and heart failure elevate the risk of mechanical ventilation and fatal outcomes among COVID-19 patients, while COVID-19 itself increases the likelihood of adverse cardiovascular outcomes. Methods We collected blood samples and clinical data from hospitalized cardiovascular patients with and without proven COVID-19 infection in the time period before the vaccine became available. Statistical correlation analysis and machine learning were used to evaluate and identify individual parameters that could predict the risk of needing mechanical ventilation and patient survival. Results Our results confirmed that COVID-19 is associated with a severe outcome and identified increased levels of ferritin, fibrinogen, and platelets, as well as decreased levels of albumin, as having a negative impact on patient survival. Additionally, patients on ACE/ARB had a lower chance of dying or needing mechanical ventilation. The machine learning models revealed that ferritin, PCO2, and CRP were the most efficient combination of parameters for predicting survival, while the combination of albumin, fibrinogen, platelets, ALP, AB titer, and D-dimer was the most efficient for predicting the likelihood of requiring mechanical ventilation. Conclusion We believe that creating an AI-based model that uses these patient parameters to predict the cardiovascular patient's risk of mortality, severe complications, and the need for mechanical ventilation would help healthcare providers with rapid triage and redistribution of medical services, with the goal of improving overall survival. The use of the most effective combination of parameters in our models could advance risk assessment and treatment planning among the general population of cardiovascular patients.
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Affiliation(s)
- Stanislava Matejin
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Igor D. Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Rajko Radovancevic
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Slobodan Paessler
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
| | - Vladimir Perovic
- Laboratory of Bioinformatics and Computational Chemistry, Institute of Nuclear Sciences Vinca, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Sha'ari NI, Ismail A, Abdul Aziz AF, Suddin LS, Azzeri A, Sk Abd Razak R, Mad Tahir NS. Cardiovascular diseases as risk factors of post-COVID syndrome: a systematic review. BMC Public Health 2024; 24:1846. [PMID: 38987743 PMCID: PMC11238467 DOI: 10.1186/s12889-024-19300-4] [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: 09/13/2023] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND A growing proportion of people experience incomplete recovery months after contracting coronavirus disease 2019 (COVID-19). These COVID-19 survivors develop a condition known as post-COVID syndrome (PCS), where COVID-19 symptoms persist for > 12 weeks after acute infection. Limited studies have investigated PCS risk factors that notably include pre-existing cardiovascular diseases (CVD), which should be examined considering the most recent PCS data. This review aims to identify CVD as a risk factor for PCS development in COVID-19 survivors. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist, systematic literature searches were performed in the PubMed, Scopus, and Web of Science databases from the earliest date available to June 2023. Data from observational studies in English that described the association between CVD and PCS in adults (≥ 18 years old) were included. A minimum of two authors independently performed the screening, study selection, data extraction, data synthesis, and quality assessment (Newcastle-Ottawa Scale). The protocol of this review was registered under PROSPERO (ID: CRD42023440834). RESULTS In total, 594 studies were screened after duplicates and non-original articles had been removed. Of the 11 included studies, CVD including hypertension (six studies), heart failure (three studies), and others (two studies) were significantly associated with PCS development with different factors considered. The included studies were of moderate to high methodological quality. CONCLUSION Our review highlighted that COVID-19 survivors with pre-existing CVD have a significantly greater risk of developing PCS symptomology than survivors without pre-existing CVD. As heart failure, hypertension and other CVD are associated with a higher risk of developing PCS, comprehensive screening and thorough examinations are essential to minimise the impact of PCS and improve patients' disease progression.
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Affiliation(s)
- Nur Insyirah Sha'ari
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Aniza Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia.
- Faculty of Public Health, Universitas Sumatera Utara, North Sumatra, Jalan Universitas No. 21 Kampus USU, Medan, 20155, Indonesia.
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Leny Suzana Suddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, 47000, Selangor, Malaysia
| | - Amirah Azzeri
- Department of Primary Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, Negeri Sembilan, Nilai, 71800, Malaysia
| | - Ruhana Sk Abd Razak
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Nur Syazana Mad Tahir
- Federal Government Administrative Centre, Ministry of Health Malaysia, Pusat Pentadbiran Kerajaan Persekutuan, Wilayah Persekutuan Putrajaya, Putrajaya, 62000, Malaysia
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Mathai SV, Apple SJ, Xu X, Pang L, Flatow E, Friedman A, Rios S, Benites Moya CJ, Alhuarrat MAD, Parker M, Sokol SI, Faillace RT. Differential Mortality Among Heart Failure Patients Across Different COVID-19 Surges in New York City. J Healthc Qual 2024; 46:197-202. [PMID: 38214648 DOI: 10.1097/jhq.0000000000000421] [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: 01/13/2024]
Abstract
ABSTRACT Learning from the healthcare system's response to the COVID-19 pandemic is essential to better prepare for potential future crises. We sought to assess mortality rates for patients admitted for acute decompensated heart failure (HF) and to analyze which factors demonstrated a statistically significant correlation with this primary endpoint. We performed a retrospective analysis of patients hospitalized with a primary diagnosis of acute decompensated HF within the New York City Health and Hospitals 11-hospital system across the different COVID surge periods. Mortality information was collected in 4,405 participants (mean [SD] age 70.54 [14.44] years, 1885 [42.87%] female).The highest mortality existed in the first surge (9.02%), then improved to near prepandemic levels (3.65%) in the second (3.91%) and third surges (5.94%, p < 0.0001). In-hospital mortality inversely correlated with receipt of a COVID-19 vaccination, but had no correlation with left ventricular ejection fraction or the number of vaccination doses. Mortality for acute decompensated HF patients improved after the first surge, suggesting that hospitals adequately adapted to provide quality care. As future infectious outbreaks may occur, emergency preparedness must ensure that adequate focus and resources remain for other clinical entities, such as HF, to ensure optimal care is delivered across all areas of illness.
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Manasrah N, Duhan S, Ali S, Atti L, Keisham B, Micho T, Titus A, Pandya KK, Patel NN, Uppal D, Sattar Y, AlJaroudi WA, Alraies MC. Impact of heart failure on COVID-19 patients: An insight from nationwide inpatient sample. Am J Med Sci 2024; 367:363-374. [PMID: 38417573 DOI: 10.1016/j.amjms.2024.02.011] [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: 11/05/2023] [Revised: 01/15/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Patients with COVID-19 have been reported to experience adverse cardiovascular outcomes, such as myocarditis, acute myocardial infarction, and heart failure. Among these complications, heart failure (HF) has emerged as the most common critical complication during exacerbations of COVID-19, potentially leading to increased mortality rates and poorer clinical outcomes. We aimed to investigate the in-hospital outcomes of COVID-19 patients with HF. METHODS We analyzed the Nationwide Inpatient Sample (NIS) dataset to select COVID-19 patients aged over 18 years who were hospitalized between January 1, 2020, and December 31, 2020, using ICD-10. Based on the presence of acute HF, the patients were divided into two cohorts. The clinical outcomes and complications were assessed at index admissions using STATA v.17." RESULTS 1,666,960 COVID-19 patients were hospitalized in 2020, of which 156,755 (9.4%) had associated HF. COVID-19 patients with HF had a mean age of (72.38 ± 13.50) years compared to (62.3 ± 17.67) years for patients without HF. The HF patients had a higher prevalence of hypertension, hyperlipidemia, type 2 diabetes, smoking, and preexisting cardiovascular disease. Additionally, after adjusting for baseline demographics and comorbidities, COVID-19 patients with HF had higher rates of in-hospital mortality (23.86% vs. 17.63%, p<0.001), acute MI (18.83% vs. 10.91%, p<0.001), acute stroke (0.78% vs. 0.58%, p=0.004), cardiogenic shock (2.56% vs. 0.69%, p<0.001), and sudden cardiac arrest (5.54% vs. 3.41%, p<0.001) compared to those without HF. CONCLUSION COVID-19 patients admitted with acute HF had worse clinical outcomes, such as higher mortality, myocardial infarction, cardiogenic shock, cardiac arrest, and a higher length of stay and healthcare than patients without HF.
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Affiliation(s)
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD, USA
| | - Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | - Lalitsiri Atti
- Department of Internal Medicine, Sparrow Hospital, Lansing, MI, USA
| | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD, USA
| | - Tarec Micho
- Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Krutarth K Pandya
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neel N Patel
- Department of Internal Medicine, Landmark Medical Center, Woonsocket, NY, US
| | - Dipan Uppal
- Department of Cardiology, Cleveland Clinic, Florida, US
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, USA
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Augusta University, Augusta, GA, USA
| | - M Chadi Alraies
- Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit, MI, USA.
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Srivastava A, Nalroad Sundararaj S, Bhatia J, Singh Arya D. Understanding long COVID myocarditis: A comprehensive review. Cytokine 2024; 178:156584. [PMID: 38508059 DOI: 10.1016/j.cyto.2024.156584] [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: 12/29/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
Infectious diseases are a cause of major concern in this twenty-first century. There have been reports of various outbreaks like severe acute respiratory syndrome (SARS) in 2003, swine flu in 2009, Zika virus disease in 2015, and Middle East Respiratory Syndrome (MERS) in 2012, since the start of this millennium. In addition to these outbreaks, the latest infectious disease to result in an outbreak is the SARS-CoV-2 infection. A viral infection recognized as a respiratory illness at the time of emergence, SARS-CoV-2 has wreaked havoc worldwide because of its long-lasting implications like heart failure, sepsis, organ failure, etc., and its significant impact on the global economy. Besides the acute illness, it also leads to symptoms months later which is called long COVID or post-COVID-19 condition. Due to its ever-increasing prevalence, it has been a significant challenge to treat the affected individuals and manage the complications as well. Myocarditis, a long-term complication of coronavirus disease 2019 (COVID-19) is an inflammatory condition involving the myocardium of the heart, which could even be fatal in the long term in cases of progression to ventricular dysfunction and heart failure. Thus, it is imperative to diagnose early and treat this condition in the affected individuals. At present, there are numerous studies which are in progress, investigating patients with COVID-19-related myocarditis and the treatment strategies. This review focuses primarily on myocarditis, a life-threatening complication of COVID-19 illness, and endeavors to elucidate the pathogenesis, biomarkers, and management of long COVID myocarditis along with pipeline drugs in detail.
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Affiliation(s)
- Arti Srivastava
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | | | - Jagriti Bhatia
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Dharamvir Singh Arya
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
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12
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Settergren C, Benson L, Shahim A, Dahlström U, Thorvaldsen T, Savarese G, Lund LH, Shahim B. Cause-specific death in heart failure across the ejection fraction spectrum: A comprehensive assessment of over 100 000 patients in the Swedish Heart Failure Registry. Eur J Heart Fail 2024; 26:1150-1159. [PMID: 38606645 DOI: 10.1002/ejhf.3230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 04/13/2024] Open
Abstract
AIM To assess cause-specific death in patients with heart failure with preserved, mildly reduced, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF). METHODS AND RESULTS Data were analysed from the Swedish Heart Failure Registry (SwedeHF) and the National Patient Register of patients enrolled in SwedeHF 2000-2021. Cox proportional hazards regression models were performed and adjusted for age, sex and time period. Among 100 584 patients (23% HFpEF, 23% HFmrEF, 53% HFrEF), median age (interquartile range) was 75 (66-82) and 36% were female. Of those who died within 5 years, most deaths were ascribed to cardiovascular (CV) causes across all ejection fraction (EF) categories. Within 5 years, HFpEF had higher adjusted risk of non-CV death (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.28-1.38, p < 0.001) and lower adjusted risk of CV death (HR 0.85, 95% CI 0.82-0.88, p < 0.001) compared to HFrEF. Ischaemic heart disease (IHD) and cancer were the most common causes of CV and non-CV death regardless of EF category. The incidence rate of CV death due to IHD was highest in HFrEF while incidence rates of CV death due to pulmonary vascular disease, stroke, valvular heart disease and atrial fibrillation increased with increasing EF. The incidence rates of non-CV deaths due to cancer, respiratory disease, and infections increased with increasing EF. CONCLUSION Cardiovascular death was more common than non-CV death across all EF categories although the risk of non-CV death within 5 years was higher with increasing EF. IHD and cancer were the most common causes of CV and non-CV deaths, respectively, regardless of EF category.
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Affiliation(s)
- Camilla Settergren
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Angiza Shahim
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Dahlström
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tonje Thorvaldsen
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Bahira Shahim
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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13
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Bilehjani E, Fakhari S, Farzin H, Tajlil A, Nader ND. Diagnosis and treatment of cardiovascular manifestations of COVID-19: a narrative review. Acta Cardiol 2024; 79:267-273. [PMID: 37606350 DOI: 10.1080/00015385.2023.2246200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was the main pathogen in the COVID-19 pandemic. This viral infection has been associated with several respiratory and non-respiratory complications contributing to a higher mortality rate, especially in patients with underlying heart diseases worldwide. Once considered a respiratory tract disease, it is now well-known that COVID-19 patients may experience a wide range of cardiac manifestations. Because of its remarkable direct and indirect effects on the cardiovascular system, herein, we examined the published literature that studied the hypothetical mechanisms of injury, manifestations, and diagnostic modalities, including changes in molecular biomarkers with a predictive value in the prognostication of the disease, as well as emerging evidence regarding the long-term cardiac complications of the disease.
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Affiliation(s)
- Eissa Bilehjani
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Solmaz Fakhari
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haleh Farzin
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Tajlil
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Nader D Nader
- Departments of Anesthesiology and Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Nkoke C, Nkouonlack C, Teuwafeu D, Gobina R, Jingi AM, Aseneh J, Enyoue S, Folefac L, Mokake DM, Verla V. Outcome of hospitalized patients with COVID-19 and predictors at the Buea Regional Hospital, South West region of Cameroon. Pan Afr Med J 2024; 47:165. [PMID: 39036024 PMCID: PMC11260058 DOI: 10.11604/pamj.2024.47.165.34572] [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: 03/30/2022] [Accepted: 02/19/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction there is a paucity of data on the epidemiology of COVID-19 infection in Cameroon with a few studies limited to big urban cities. The objective of this study was to describe the clinical characteristics and outcomes of hospitalized patients with COVID-19 at the Buea Regional Hospital, in the South West region of Cameroon. Methods this was a retrospective cross-sectional study. The medical records of hospitalized patients with COVID-19 were reviewed from 2020 to 2021. Hospitalized patients with laboratory-confirmed COVID-19 were included. Binary logistic regression was used to identify factors associated with mortality. Results two hundred and ten (210) patients were included in this cohort. There were 114 (54.7%) men. The mean age was 60±17.1 years. The common co-morbidities were hypertension (46.7%), diabetes mellitus (31%), and HIV infection (5.7%). The most common symptoms were dyspnea (93.3%), fatigue (93.8%), cough (77.6%), and fever (71.4%). The median oxygen saturation was 85% and the median respiratory rate was 24 cycles per minute. More than 80% had crackles on lung examination. Death occurred in 57 (27.1%) patients. In binary logistic regression, the factors independently associated with mortality were heart failure (aOR: 6.7, p=0.034), SBP < 100 mmHg (aOR: 8.1, p<0.001), RR > 24 cpm (aOR: 3, p=0.016), SaO2<90% (aOR: 6.2, p=0.031), blood glucose > 150mg/dL (aOR: 3.3, p=0.02), and CRP > 50 mg/L (aOR: 3.3, p=0.036). For every 1 mg/dL rise in blood glucose, the odds of death increased by 1% (p=0.011). For every 1 mg/L rise in the C-reactive protein (CRP), the odds of death increased by 1% (p=0.054). Conclusion over half of hospitalized patients with laboratory-confirmed COVID-19 infection in the South West Region of Cameroon were males. Hypertension and diabetes were common co-morbidities. More than a quarter of these patients died. Furthermore, having heart failure, low systolic blood pressure (SBP), low oxygen saturation, elevated respiratory rate, high CRP and blood glucose levels on admission were associated with poor prognosis.
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Affiliation(s)
- Clovis Nkoke
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Buea Regional Hospital, Buea, Cameroon
| | - Cyrille Nkouonlack
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Buea Regional Hospital, Buea, Cameroon
| | - Denis Teuwafeu
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Buea Regional Hospital, Buea, Cameroon
| | - Ronald Gobina
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Buea Regional Hospital, Buea, Cameroon
| | | | | | | | | | - Divine Martin Mokake
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Buea Regional Hospital, Buea, Cameroon
| | - Vincent Verla
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
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15
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Bilal MI, Gajjar R, Bobba A, Zabel KM, Davis MG, Nasrullah A, Gangu K, Sheikh AB, Yadav N. Assessing 30-day readmissions and outcomes in acute heart failure patients with concurrent COVID-19: A nationwide study during the 2020 pandemic. Curr Probl Cardiol 2024; 49:102246. [PMID: 38048854 DOI: 10.1016/j.cpcardiol.2023.102246] [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: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Acute heart failure (HF) is a significant cause of readmission and mortality, particularly within 30 days post-discharge. The interplay between COVID-19 and HF is still being studied. METHODS This retrospective study utilized The National Readmission Database to examine outcomes and predictors among patients with COVID-19 and concomitant acute HF between January 1, 2020, and November 31, 2020. 53,336 index hospitalizations and 8,158 readmissions were included. The primary outcome was the 30-day all-cause readmission rate. Predictor variables included patient demographics, medical comorbidities and discharge disposition. RESULTS The primary outcome was 21.2 %. COVID-19 infection was the most predominant all-cause reason for acute HF readmission (24.7 %). Hypertensive heart disease with chronic kidney disease was the most prevalent cardiac cause (7.7 %). Mortality rate during index hospitalization was significantly higher compared to readmission. CONCLUSIONS The highlighted prevalent complications, comorbidities, and demographics driving readmissions offer valuable insights to improve outcomes in this population.
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Affiliation(s)
| | - Rohan Gajjar
- Department of Internal Medicine, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Aniesh Bobba
- Department of Cardiology, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Kenneth M Zabel
- Department of Internal Medicine, University of New Mexico Health System, Albuquerque, NM, USA
| | - Monique G Davis
- Department of Internal Medicine, University of New Mexico Health System, Albuquerque, NM, USA
| | - Adeel Nasrullah
- Department of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg PA, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health System, 1 University of New Mexico, Albuquerque, NM, 87131, MSC10-55501, NM, USA.
| | - Neha Yadav
- Department of Cardiology, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
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16
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Matta A, Ohlmann P, Nader V, Levai L, Kang R, Carrié D, Roncalli J. A review of the conservative versus invasive management of ischemic heart failure with reduced ejection fraction. Curr Probl Cardiol 2024; 49:102347. [PMID: 38103822 DOI: 10.1016/j.cpcardiol.2023.102347] [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: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
Heart failure is increasing in terms of prevalence, morbidity, and mortality rates. Clinical trials and studies are focusing on heart failure as it is the destiny end-stage for several cardiovascular disorders. Recently, medical therapy has dramatically progressed with novel classes of medicines providing better quality of life and survival outcomes. However, heart failure remains a heavy impactful factor on societies and populations. Current guidelines from the American and European cardiac societies are not uniform with respect to the class and level of treatment recommendations for coronary artery disease patients with heart failure and reduced ejection fraction. The discrepancy among international recommendations, stemming from the lack of evidence from adequately powered randomized trials, challenges physicians in choosing the optimal strategy. Hybrid therapy including optimal medical therapy with revascularization strategies are commonly used for the management of ischemic heart failure. Coronary artery bypass graft (CABG) has proved its efficacy on improving long term outcome and prognosis while no large randomized clinical trials for percutaneous coronary intervention (PCI) are still available. Regardless of the lack of data and recommendations, the trends of performing PCI in ischemic heart failure prevailed over CABG whereas lesion complexity, chronic total occlusion and complete revascularization achievement are limiting factors. Lastly, regenerative medicine seems a promising approach for advanced heart failure enhancing cardiomyocytes proliferation, reverse remodeling, scar size reduction and cardiac function restoration.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France.
| | - Patrick Ohlmann
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
| | - Vanessa Nader
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France
| | - Laszlo Levai
- Department of Cardiology, Civilian Hospital of Colmar, Colmar, France
| | - Ryeonshi Kang
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
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17
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Espiritu AI, Pilapil JCA, Aherrera JAM, Sy MCC, Anlacan VMM, Villanueva EQI, Jamora RDG. Outcomes of patients with COVID-19 and coronary artery disease and heart failure: findings from the Philippine CORONA study. BMC Res Notes 2024; 17:14. [PMID: 38178236 PMCID: PMC10768280 DOI: 10.1186/s13104-023-06677-5] [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: 10/01/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) and coronary artery disease (CAD) or heart failure (HF) are more likely to have poor outcomes. This study aimed to determine the characteristics and outcomes of COVID-19 patients with CAD/HF across various institutions in the Philippines. METHODS We utilized the data from the Philippine CORONA Study and compared the outcomes of admitted COVID-19 patients with CAD/HF versus those without. The Student's t test, Mann-Whitney U test, binary logistic regression and multivariate regression analysis were utilized. Odds ratios (OR) and Kaplan-Meier curves were generated. RESULTS We included a total of 512 patients with COVID-19 had CAD/HF and 10,369 were without. CAD/HF was significantly associated with COVID severity, all-cause mortality, death from cardiac causes, respiratory failure, and prolonged hospitalization. After adjusting for confounders, the presence of CAD/HF was still associated with death from a cardiac cause (OR 2.22, 95% CI 1.49-3.3, p < 0.01). CONCLUSIONS The presence of CAD or HF was significantly associated with severity of COVID disease, all-cause mortality, death from cardiac causes, respiratory failure, and prolonged hospitalization.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - John Christopher A Pilapil
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jaime Alfonso M Aherrera
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Marie Charmaine C Sy
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Veeda Michelle M Anlacan
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Emilio Q Iii Villanueva
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
- Institute for Neurosciences, St. Luke's Medical Center, Global City, Philippines.
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18
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Dai S, Cao T, Shen H, Zong X, Gu W, Li H, Wei L, Huang H, Yu Y, Chen Y, Ye W, Hua F, Fan H, Shen Z. Landscape of molecular crosstalk between SARS-CoV-2 infection and cardiovascular diseases: emphasis on mitochondrial dysfunction and immune-inflammation. J Transl Med 2023; 21:915. [PMID: 38104081 PMCID: PMC10725609 DOI: 10.1186/s12967-023-04787-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND SARS-CoV-2, the pathogen of COVID-19, is a worldwide threat to human health and causes a long-term burden on the cardiovascular system. Individuals with pre-existing cardiovascular diseases are at higher risk for SARS-CoV-2 infection and tend to have a worse prognosis. However, the relevance and pathogenic mechanisms between COVID-19 and cardiovascular diseases are not yet completely comprehended. METHODS Common differentially expressed genes (DEGs) were obtained in datasets of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) infected with SARS-CoV-2 and myocardial tissues from heart failure patients. Further GO and KEGG pathway analysis, protein-protein interaction (PPI) network construction, hub genes identification, immune microenvironment analysis, and drug candidate predication were performed. Then, an isoproterenol-stimulated myocardial hypertrophy cell model and a transverse aortic constriction-induced mouse heart failure model were employed to validate the expression of hub genes. RESULTS A total of 315 up-regulated and 78 down-regulated common DEGs were identified. Functional enrichment analysis revealed mitochondrial metabolic disorders and extensive immune inflammation as the most prominent shared features of COVID-19 and cardiovascular diseases. Then, hub DEGs, as well as hub immune-related and mitochondria-related DEGs, were screened. Additionally, nine potential therapeutic agents for COVID-19-related cardiovascular diseases were proposed. Furthermore, the expression patterns of most of the hub genes related to cardiovascular diseases in the validation dataset along with cellular and mouse myocardial damage models, were consistent with the findings of bioinformatics analysis. CONCLUSIONS The study unveiled the molecular networks and signaling pathways connecting COVID-19 and cardiovascular diseases, which may provide novel targets for intervention of COVID-19-related cardiovascular diseases.
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Affiliation(s)
- Shiyu Dai
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Ting Cao
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Han Shen
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Xuejing Zong
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Wenyu Gu
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Hanghang Li
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Lei Wei
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Haoyue Huang
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Yunsheng Yu
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Yihuan Chen
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Wenxue Ye
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Fei Hua
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Hongyou Fan
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China.
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19
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Zaheer K, Goncalves B, Ramalingam A, Rabbani NUA, Sayyed R, Nawab A, Puri R, Williams CJ, Mansoor K. Association of New-Onset Atrial Fibrillation With All-Cause Mortality in COVID-19 Patients. Cureus 2023; 15:e49785. [PMID: 38058521 PMCID: PMC10697182 DOI: 10.7759/cureus.49785] [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: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
Background The COVID-19 pandemic has brought about unprecedented global health challenges, with its impact extending beyond respiratory manifestations to encompass cardiovascular complications, including arrhythmias. Dysrhythmias in COVID-19 are multifactorial, ranging from direct myocardial insult due to the cytokine storm to metabolic derangements. Objective In this study, we aim to examine the incidence of new-onset atrial fibrillation and to study its association with all-cause mortality of COVID-19. Methods A cross-sectional study was conducted at Cabell Huntington Hospital, West Virginia, utilizing electronic medical records of COVID-19 patients from 2020 to 2021. Inclusion criteria comprised patients aged >18 years with COVID-19 diagnosis and cardiac arrhythmias during hospitalization. Logistic regression analysis was employed to examine the relationship between demographic and clinical variables and in-hospital mortality. Results Of the 264 eligible patients, those aged >66 years had lower odds of in-hospital mortality (p < 0.001), while gender, ejection fraction, and diabetes mellitus did not significantly predict mortality. Atrial fibrillation (p = 0.011) and heart failure (p = 0.030) were associated with increased odds of mortality, while hypertension showed no significant predictive power (p = 0.791). Conclusion This study highlights the significance of atrial fibrillation and heart failure as predictors of in-hospital mortality in COVID-19 patients. Our findings underscore the importance of recognizing and managing arrhythmias in COVID-19 and call for further research on the mechanisms and long-term effects of these cardiac complications in the context of the pandemic. These insights can guide clinical practice and interventions to optimize patient outcomes.
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Affiliation(s)
- Kamran Zaheer
- Department of Internal Medicine, St. Mary's Medical Center, Huntington, USA
| | - Bruno Goncalves
- Department of Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Archana Ramalingam
- Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Noor Ul Ann Rabbani
- Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Rameez Sayyed
- Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Athar Nawab
- Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Raghav Puri
- Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Charles J Williams
- Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Kanaan Mansoor
- Department of Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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20
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Cao Q, Du X, Jiang XY, Tian Y, Gao CH, Liu ZY, Xu T, Tao XX, Lei M, Wang XQ, Ye LL, Duan DD. Phenome-wide association study and precision medicine of cardiovascular diseases in the post-COVID-19 era. Acta Pharmacol Sin 2023; 44:2347-2357. [PMID: 37532784 PMCID: PMC10692238 DOI: 10.1038/s41401-023-01119-1] [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: 04/07/2023] [Accepted: 05/29/2023] [Indexed: 08/04/2023] Open
Abstract
SARS-CoV-2 infection causes injuries of not only the lungs but also the heart and endothelial cells in vasculature of multiple organs, and induces systemic inflammation and immune over-reactions, which makes COVID-19 a disease phenome that simultaneously affects multiple systems. Cardiovascular diseases (CVD) are intrinsic risk and causative factors for severe COVID-19 comorbidities and death. The wide-spread infection and reinfection of SARS-CoV-2 variants and the long-COVID may become a new common threat to human health and propose unprecedented impact on the risk factors, pathophysiology, and pharmacology of many diseases including CVD for a long time. COVID-19 has highlighted the urgent demand for precision medicine which needs new knowledge network to innovate disease taxonomy for more precise diagnosis, therapy, and prevention of disease. A deeper understanding of CVD in the setting of COVID-19 phenome requires a paradigm shift from the current phenotypic study that focuses on the virus or individual symptoms to phenomics of COVID-19 that addresses the inter-connectedness of clinical phenotypes, i.e., clinical phenome. Here, we summarize the CVD manifestations in the full clinical spectrum of COVID-19, and the phenome-wide association study of CVD interrelated to COVID-19. We discuss the underlying biology for CVD in the COVID-19 phenome and the concept of precision medicine with new phenomic taxonomy that addresses the overall pathophysiological responses of the body to the SARS-CoV-2 infection. We also briefly discuss the unique taxonomy of disease as Zheng-hou patterns in traditional Chinese medicine, and their potential implications in precision medicine of CVD in the post-COVID-19 era.
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Affiliation(s)
- Qian Cao
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Xin Du
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Xiao-Yan Jiang
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Yuan Tian
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Chen-Hao Gao
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Zi-Yu Liu
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Ting Xu
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Xing-Xing Tao
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Ming Lei
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Xiao-Qiang Wang
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Lingyu Linda Ye
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China.
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China.
- Key Laboratory of Autoimmune Diseases and Precision Medicie, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750001, China.
| | - Dayue Darrel Duan
- Center for Phenomics of Traditional Chinese Medicine, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China.
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China.
- Key Laboratory of Autoimmune Diseases and Precision Medicie, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750001, China.
- The Department of Pharmacology, University of Nevada Reno School of Medicine, Reno, NV, 89557, USA.
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21
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Hashem A, Khalouf A, Mohamed MS, Nayfeh T, Elkhapery A, Elbahnasawy M, Rai D, Deshwal H, Feitell S, Balla S. COVID-19 Infection Is Associated With Increased In-Hospital Mortality and Complications in Patients With Acute Heart Failure: Insight From National Inpatient Sample (2020). J Intensive Care Med 2023; 38:1068-1077. [PMID: 37350092 PMCID: PMC10291223 DOI: 10.1177/08850666231182380] [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: 02/02/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
Introduction: Patients with acute heart failure (AHF) exacerbation are susceptible to complications in the setting of COVID-19 infection. Data regarding the clinical outcomes of COVID-19 in patients admitted with AHF is limited. Methods: We used the national inpatient sample database by utilizing ICD-10 codes to identify all hospitalizations with a diagnosis of AHF in 2020. We classified the sample into AHF with COVID-19 infection versus those without COVID-19. Primary outcome was in-hospital mortality. Secondary outcomes were acute myocardial infarction, need for pressors, mechanical cardiac support, cardiogenic shock, and cardiac arrest. Also, we evaluated for acute pulmonary embolism (PE), bacterial pneumonia, need for a ventilator, and acute kidney injury (AKI). Results: We identified a total of 694,920 of AHF hospitalizations, 660,463 (95.04%) patients without COVID-19 and 34,457 (4.96%) with COVID-19 infection. For baseline comorbidities, diabetes mellitus, chronic heart failure, ESRD, and coagulopathy were significantly higher among AHF patients with COVID-19 (P < .01). While CAD, prior MI, percutaneous coronary intervention, and coronary artery bypass graft, atrial fibrillation, chronic obstructive pulmonary disease, and peripheral vascular disease were higher among those without COVID-19. After adjustment for baseline comorbidities, in-hospital mortality (aOR 5.08 [4.81 to 5.36]), septic shock (aOR 2.54 [2.40 to 2.70]), PE (aOR 1.75 [1.57 to 1.94]), and AKI (aOR 1.33 [1.30 to 1.37]) were significantly higher among AHF with COVID-19 patients. The mean length of stay (5 vs 7 days, P < .01) and costs of hospitalization ($42,143 vs $60,251, P < .01) were higher among AHF patients with COVID-19 infection. Conclusion: COVID-19 infection in patients with AHF is associated with significantly higher in-hospital mortality, need for mechanical ventilation, septic shock, and AKI along with higher resource utilization. Predictors for mortality in AHF patients during the COVID-19 pandemic, COVID-19 infection, patients with end-stage heart failure, and atrial fibrillation. Studies on the impact of vaccination against COVID-19 in AHF patients are needed.
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Affiliation(s)
- Anas Hashem
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | - Amani Khalouf
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | | | - Tarek Nayfeh
- Evidence-based medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Ahmed Elkhapery
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | | | - Devesh Rai
- Department of Cardiology, Rochester General Hospital, Sands-Constellation Heart Institute, Rochester, NY, USA
| | - Himanshu Deshwal
- Department of Pulmonary, Sleep and Critical Care Medicine, West Virginia University, Morgantown, WV, USA
| | - Scott Feitell
- Department of Cardiology, Rochester General Hospital, Sands-Constellation Heart Institute, Rochester, NY, USA
| | - Sudarshan Balla
- Department of Cardiovascular Disease, West Virginia University – Health Sciences Campus, Morgantown, WV, USA
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22
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Hrycek E, Walawska-Hrycek A, Hamankiewicz M, Milewski K, Nowakowski P, Buszman P, Żurakowski A. The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes. J Clin Med 2023; 12:5899. [PMID: 37762840 PMCID: PMC10532337 DOI: 10.3390/jcm12185899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This multicenter retrospective study with a control group was designed to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the outcomes of patients with myocardial infarction (MI). METHODS A total of 129 patients with COVID-19 who were treated for MI were included in this study. The control group comprised 129 comparable patients without SARS-CoV-2 infection. The in-hospital, out-of-hospital, and overall mortality were analyzed. RESULTS A total of thirty-one (24%) patients died in the study group, and two (1.6%) patients died in the control group (OR = 20.09; CI: 4.69-85.97; p < 0.001). Similar results were observed in all analyzed patient subgroups. Multivariable Cox regression analysis confirmed the significant influence of SARS-CoV-2 infection on in-hospital outcomes (HR: 8.48459; CI: 1.982-36.320; p = 0.004). Subanalysis of the groups with COVID-19 plus ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) revealed comparable mortality rates: 14 (21.12%) patients in the NSTEMI group and 17 (26.98%) patients in the STEMI subgroup died (OR: 1.3; CI: 0.56-3.37; p = 0.45). During out-of-hospital observation, no differences in mortality were observed (OR: 0.77; CI: 0.11-4.07; p = 0.73). CONCLUSIONS SARS-CoV-2 infection affects the in-hospital outcomes of patients with both MI and COVID-19, regardless of MI type (STEMI vs. NSTEMI).
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Affiliation(s)
- Eugeniusz Hrycek
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| | - Anna Walawska-Hrycek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | | | - Krzysztof Milewski
- American Heart of Poland, Armii Krajowej 101, 43-316 Bielsko-Biała, Poland
| | - Przemysław Nowakowski
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Vascular Surgery, Faculty of Medical Sciences, University of Technology, Rolna 43, 40-555 Katowice, Poland
| | - Piotr Buszman
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
- American Heart of Poland, Armii Krajowej 101, 43-316 Bielsko-Biała, Poland
| | - Aleksander Żurakowski
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
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23
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Zhou S, Zhang A, Liao H, Liu Z, Yang F. Pathological Interplay and Clinical Complications between COVID-19 and Cardiovascular Diseases: An Overview in 2023. Cardiology 2023; 149:60-70. [PMID: 37586358 PMCID: PMC11251668 DOI: 10.1159/000533359] [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: 05/06/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) involves all organs of the body, of which the interaction with cardiovascular diseases is the most important. SUMMARY Numerous studies have reported that COVID-19 patients complicated with cardiovascular comorbidities (hypertension, coronary heart disease, chronic heart failure (HF), cerebrovascular disease) are more likely to develop into critical illness and have higher mortality. Conversely, COVID-19 may also cause myocardial injury in patients through various pathological mechanisms such as direct virus attack on cardiomyocytes, overactivation of immune response, microthrombus formation, which may lead to fatal acute ST-segment elevation myocardial infarction, arrhythmia, acute worsening of chronic HF, etc. In addition, the symptoms of the so-called long-COVID may remain in some patients who survived the acute viral infection. Positional tachycardia has been widely reported, and cardiovascular autonomic disorders are thought to play a pathogenic role. KEY MESSAGE The review summarizes the interaction between COVID-19 and cardiovascular disease in terms of pathological mechanism, clinical features, and sequelae. Therapeutic and rehabilitation programs after COVID-19 infection are compiled and need to be further standardized in the future.
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Affiliation(s)
- Sufeng Zhou
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anchen Zhang
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Liao
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhebo Liu
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feiyan Yang
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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24
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Sokolski M, Kalużna-Oleksy M, Tycińska A, Jankowska EA. Telemedicine in Heart Failure in the COVID-19 and Post-Pandemic Era: What Have We Learned? Biomedicines 2023; 11:2222. [PMID: 37626719 PMCID: PMC10452788 DOI: 10.3390/biomedicines11082222] [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: 07/02/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Numerous studies showed that patients with heart failure (HF) and COVID-19 are at high risk of in-hospital complications and long-term mortality. Changes in the organisation of the medical system during the pandemic also worsened access to standard procedures, increasing the general mortality in HF and forcing the systems to be reorganised with the implementation and development of telemedical technologies. The main challenges for HF patients during the pandemic could be solved with new technologies aimed to limit the risk of SARS-CoV-2 transmission, optimise and titrate the therapy, prevent the progression and worsening of HF, and monitor patients with acute HF events in the course of and after COVID-19. Dedicated platforms, phone calls or video conferencing and consultation, and remote non-invasive and invasive cardiac monitoring became potential tools used to meet the aforementioned challenges. These solutions showed to be effective in the model of care for patients with HF and undoubtedly will be developed after the experience of the pandemic. However, the multitude of possibilities requires central coordination and collaboration between institutes with data protection and cost reimbursement to create effective mechanisms in HF management. It is crucial that lessons be learned from the pandemic experience to improve the quality of care for HF patients.
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Affiliation(s)
- Mateusz Sokolski
- Institute of Heart Disease, Wrocław University Hospital, Wroclaw Medical University, 50-556 Wrocław, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Marta Kalużna-Oleksy
- Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Agnieszka Tycińska
- Department of Cardiology, Medical University of Bialystok, 15-089 Białystok, Poland
| | - Ewa A. Jankowska
- Institute of Heart Disease, Wrocław University Hospital, Wroclaw Medical University, 50-556 Wrocław, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
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25
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Barreiro-Pérez M, Pastor Pueyo P, Raposeiras-Roubín S, Montero Corominas D, Uribarri A, Eiros Bachiller R, Rozado Castaño J, García-Cuenllas Álvarez L, Serratosa Fernández L, Domínguez F, Pascual Figal D. Myocarditis related SARS-CoV-2 infection or vaccination: an expert consensus statement on its diagnosis and management. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:555-563. [PMID: 36914023 PMCID: PMC10008093 DOI: 10.1016/j.rec.2023.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 03/13/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revealed several cardiovascular complications, including myocarditis caused by SARS-CoV-2 infection (COVID-19) or after messenger RNA vaccine administration. Because of the high prevalence of COVID-19, the expansion of vaccination programs, and the appearance of new information on myocarditis in these contexts, there is a need to condense the knowledge acquired since the start of the pandemic. To meet this need, this document was drafted by the Myocarditis Working Group of the Heart Failure Association of the Spanish Society of Cardiology, with the collaboration of the Spanish Agency for Medicines and Health Products (AEMPS). The document aims to address the diagnosis and treatment of cases of myocarditis associated with SARS-CoV-2 infection or messenger RNA vaccine administration.
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Affiliation(s)
- Manuel Barreiro-Pérez
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, Spain.
| | - Pablo Pastor Pueyo
- Unidad de Cardiología Clínica y Cuidados Agudos Cardiovasculares, Hospital Universitario Arnau de Vilanova, Lleida, Spain; Institut de Reserca Biomèdica Lleida (IRB-Lleida), Lleida, Spain. https://twitter.com/@PolSheperd
| | - Sergio Raposeiras-Roubín
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, Spain. https://twitter.com/@S_Raposeiras
| | - Dolores Montero Corominas
- División de Farmacoepidemiología y Farmacovigilancia, Departamento de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain. https://twitter.com/@Auribarri
| | - Rocío Eiros Bachiller
- Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain. https://twitter.com/@reirosbachiller
| | - José Rozado Castaño
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. https://twitter.com/@rozado_jose
| | | | - Luis Serratosa Fernández
- Unidad de Cardiología del Deporte, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Cardiología del Deporte, Centro de Medicina Deportiva Olympia Quirónsalud, Madrid, Spain. https://twitter.com/@LSerratosa
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain. https://twitter.com/@fernidom
| | - Domingo Pascual Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. https://twitter.com/@DomingoPascualF
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26
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Barreiro-Pérez M, Pastor Pueyo P, Raposeiras-Roubín S, Montero Corominas D, Uribarri A, Eiros Bachiller R, Rozado Castaño J, García-Cuenllas Álvarez L, Serratosa Fernández L, Domínguez F, Pascual Figal D. [Myocarditis related SARS-CoV-2 infection or vaccination: an expert consensus statement on its diagnosis and management]. Rev Esp Cardiol 2023; 76:555-563. [PMID: 36743295 PMCID: PMC9884510 DOI: 10.1016/j.recesp.2023.01.010] [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] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revealed several cardiovascular complications, including myocarditis caused by SARS-CoV-2 infection (COVID-19) or after messenger RNA vaccine administration. Because of the high prevalence of COVID-19, the expansion of vaccination programs, and the appearance of new information on myocarditis in these contexts, there is a need to condense the knowledge acquired since the start of the pandemic. To meet this need, this document was drafted by the Myocarditis Working Group of the Heart Failure Association of the Spanish Society of Cardiology, with the collaboration of the Spanish Agency for Medicines and Health Products (AEMPS). The document aims to address the diagnosis and treatment of cases of myocarditis associated with SARS-CoV-2 infection or messenger RNA vaccine administration.
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Affiliation(s)
- Manuel Barreiro-Pérez
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Pablo Pastor Pueyo
- Unidad de Cardiología Clínica y Cuidados Agudos Cardiovasculares, Hospital Universitario Arnau de Vilanova, Lleida, España
- Institut de Reserca Biomèdica Lleida (IRB-Lleida), Lleida, España
| | - Sergio Raposeiras-Roubín
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Dolores Montero Corominas
- División de Farmacoepidemiología y Farmacovigilancia, Departamento de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Sanitarios, Madrid, España
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Rocío Eiros Bachiller
- Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - José Rozado Castaño
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Luis Serratosa Fernández
- Unidad de Cardiología del Deporte, Hospital Universitario Quirónsalud Madrid, Madrid, España
- Unidad de Cardiología del Deporte, Centro de Medicina Deportiva Olympia Quirónsalud, Madrid, España
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Domingo Pascual Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
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27
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Gryglewska-Wawrzak K, Cienkowski K, Cienkowska A, Banach M, Bielecka-Dabrowa A. The Role of Multidisciplinary Approaches in the Treatment of Patients with Heart Failure and Coagulopathy of COVID-19. J Cardiovasc Dev Dis 2023; 10:245. [PMID: 37367410 PMCID: PMC10299062 DOI: 10.3390/jcdd10060245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a severe respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Heart failure (HF) is associated with a worse prognosis for patients with this viral infection, highlighting the importance of early detection and effective treatment strategies. HF can also be a consequence of COVID-19-related myocardial damage. To optimise the treatment of these patients, one needs to understand the interactions between this disease and viruses. Until now, the validity of the screening for cardiovascular complications after COVID-19 has not been confirmed. There were also no patients in whom such diagnostics seemed appropriate. Until appropriate recommendations are made, diagnosis procedures must be individualised based on the course of the acute phase and clinical symptoms reported or submitted after COVID-19. Clinical phenomena are the criteria for determining the recommended test panel. We present a structured approach to COVID-19 patients with heart involvement.
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Affiliation(s)
- Katarzyna Gryglewska-Wawrzak
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93338 Lodz, Poland; (M.B.); (A.B.-D.)
| | | | - Alicja Cienkowska
- Faculty of Biology and Environmental Protection, University of Lodz, 90136 Lodz, Poland;
| | - Maciej Banach
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93338 Lodz, Poland; (M.B.); (A.B.-D.)
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90419 Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93338 Lodz, Poland; (M.B.); (A.B.-D.)
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90419 Lodz, Poland
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29
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Adejumo AC, Yakovchenko V, Morgan TR, Spoutz P, Chia L, Bajaj JS, Chang MF, Dominitz JA, Rogal SS. The road to pandemic recovery: Tracking COVID-19's impact on cirrhosis care and outcomes among 111,558 Veterans. Hepatology 2023; 77:2016-2029. [PMID: 36705024 DOI: 10.1097/hep.0000000000000306] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/24/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AIMS This study aimed to evaluate quarterly trends in process and health outcomes among Veterans with cirrhosis and assess the factors associated with cirrhosis outcomes before and during the COVID-19 pandemic. APPROACH RESULTS US Veterans with cirrhosis were identified using the Veterans Health Administration Corporate Data Warehouse. Quarterly measures were evaluated from September 30, 2018, through March 31, 2022, including twice yearly screening for hepatocellular carcinoma (HCC-6), new HCC, surveillance for or treatment of esophageal varices, variceal bleeding, all-cause hospitalization, and mortality. Joinpoint analyses were used to assess the changes in trends over time. Logistic regression models were used to identify the demographic and medical factors associated with each outcome over time. Among 111,558 Veterans with cirrhosis with a mean Model for End-stage Liver Disease-Sodium of 11±5, rates of HCC-6 sharply declined from a prepandemic peak of 41%, to a nadir of 28%, and rebounded to 36% by March 2022. All-cause mortality did not significantly change over the pandemic, but new HCC diagnosis, EVST, variceal bleeding, and all-cause hospitalization significantly declined over follow-up. Quarterly HCC diagnosis declined from 0.49% to 0.38%, EVST from 50% to 41%, variceal bleeding from 0.15% to 0.11%, and hospitalization from 9% to 5%. Rurality became newly, significantly associated with nonscreening over the pandemic (aOR for HCC-6=0.80, 95% CI 0.74 to 0.86; aOR for EVST=0.95, 95% CI 0.90 to 0.997). CONCLUSIONS The pandemic continues to impact cirrhosis care. Identifying populations at the highest risk of care disruptions may help to address ongoing areas of need.
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Affiliation(s)
- Adeyinka C Adejumo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, USA
| | - Patrick Spoutz
- Pharmacy Benefits Management, Veterans Integrated Service Network 20, Vancouver, Washington, USA
| | - Linda Chia
- Pharmacy Benefits Management, Veterans Integrated Service Network 8, Bay Pines, Florida, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
- VA Richmond Health Care System, Richmond, Virginia, USA
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Health Care System, Portland, Oregon, USA
| | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Shari S Rogal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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30
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Boulos PK, Freeman SV, Henry TD, Mahmud E, Messenger JC. Interaction of COVID-19 With Common Cardiovascular Disorders. Circ Res 2023; 132:1259-1271. [PMID: 37167359 PMCID: PMC10171313 DOI: 10.1161/circresaha.122.321952] [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] [Indexed: 05/13/2023]
Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.
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Affiliation(s)
- Peter K. Boulos
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Scott V. Freeman
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (E.M.)
| | - John C. Messenger
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
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31
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van der Klaauw AA, Horner EC, Pereyra-Gerber P, Agrawal U, Foster WS, Spencer S, Vergese B, Smith M, Henning E, Ramsay ID, Smith JA, Guillaume SM, Sharpe HJ, Hay IM, Thompson S, Innocentin S, Booth LH, Robertson C, McCowan C, Kerr S, Mulroney TE, O'Reilly MJ, Gurugama TP, Gurugama LP, Rust MA, Ferreira A, Ebrahimi S, Ceron-Gutierrez L, Scotucci J, Kronsteiner B, Dunachie SJ, Klenerman P, Park AJ, Rubino F, Lamikanra AA, Stark H, Kingston N, Estcourt L, Harvala H, Roberts DJ, Doffinger R, Linterman MA, Matheson NJ, Sheikh A, Farooqi IS, Thaventhiran JED. Accelerated waning of the humoral response to COVID-19 vaccines in obesity. Nat Med 2023; 29:1146-1154. [PMID: 37169862 PMCID: PMC10202802 DOI: 10.1038/s41591-023-02343-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/07/2023] [Indexed: 05/13/2023]
Abstract
Obesity is associated with an increased risk of severe Coronavirus Disease 2019 (COVID-19) infection and mortality. COVID-19 vaccines reduce the risk of serious COVID-19 outcomes; however, their effectiveness in people with obesity is incompletely understood. We studied the relationship among body mass index (BMI), hospitalization and mortality due to COVID-19 among 3.6 million people in Scotland using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) surveillance platform. We found that vaccinated individuals with severe obesity (BMI > 40 kg/m2) were 76% more likely to experience hospitalization or death from COVID-19 (adjusted rate ratio of 1.76 (95% confidence interval (CI), 1.60-1.94). We also conducted a prospective longitudinal study of a cohort of 28 individuals with severe obesity compared to 41 control individuals with normal BMI (BMI 18.5-24.9 kg/m2). We found that 55% of individuals with severe obesity had unquantifiable titers of neutralizing antibody against authentic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus compared to 12% of individuals with normal BMI (P = 0.0003) 6 months after their second vaccine dose. Furthermore, we observed that, for individuals with severe obesity, at any given anti-spike and anti-receptor-binding domain (RBD) antibody level, neutralizing capacity was lower than that of individuals with a normal BMI. Neutralizing capacity was restored by a third dose of vaccine but again declined more rapidly in people with severe obesity. We demonstrate that waning of COVID-19 vaccine-induced humoral immunity is accelerated in individuals with severe obesity. As obesity is associated with increased hospitalization and mortality from breakthrough infections, our findings have implications for vaccine prioritization policies.
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Affiliation(s)
- Agatha A van der Klaauw
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Emily C Horner
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Pehuén Pereyra-Gerber
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sarah Spencer
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Bensi Vergese
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- NIHR Cambridge Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Miriam Smith
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Elana Henning
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Isobel D Ramsay
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jack A Smith
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Iain M Hay
- Babraham Institute, Babraham Research Campus, Cambridge, UK
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Sam Thompson
- Babraham Institute, Babraham Research Campus, Cambridge, UK
| | | | - Lucy H Booth
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Colin McCowan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Steven Kerr
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Maria A Rust
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Alex Ferreira
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Soraya Ebrahimi
- Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lourdes Ceron-Gutierrez
- Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jacopo Scotucci
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Barbara Kronsteiner
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Susanna J Dunachie
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Adrian J Park
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Rubino
- Department of Diabetes, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - Abigail A Lamikanra
- NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hannah Stark
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lise Estcourt
- NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - David J Roberts
- NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rainer Doffinger
- Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Nicholas J Matheson
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - I Sadaf Farooqi
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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Hansen MP, Stewart SL, Ensign C, Puckett CM, Caviness S. Virtual Group Appointments Improve Outcomes in Veterans with Heart Failure During a Global Pandemic: A Quality Improvement Project. Creat Nurs 2023; 29:223-228. [PMID: 37800731 DOI: 10.1177/10784535231195490] [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] [Indexed: 10/07/2023]
Abstract
This report on a quality improvement initiative describes a multi-professional approach to improving self-care behaviors and reducing hospitalizations in Veterans with heart failure (HF) by implementing virtual group appointments. Patients with HF are more susceptible to complications related to COVID-19 infection, creating the need for alternative communication methods for patient education during the social isolation and reduced health-care resources brought on by the global pandemic. From March 2020 to June 2021, 57 Veterans participated in 1 of 12 group appointments at the VA Portland Health Care System in Portland, Oregon. Each group was led by a multi-professional team who provided education on self-care behaviors, nutrition, medications, and mental health impacts of HF. Chart reviews and pre-/post-self-care behavior questionnaires showed that the virtual group HF appointments were associated with a decrease in hospitalizations, compared to previous data with the same population, and self-reported self-care behaviors improved from pre- to post-questionnaire. Group appointments offer a unique educational and motivational experience for those with HF and provide the ability to engage with each other during challenging times.
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Affiliation(s)
- Mary P Hansen
- Department of Cardiology, Veterans Health Administration, Portland, OR, USA
| | - Shannon L Stewart
- Department of Cardiology, Veterans Health Administration, Portland, OR, USA
| | - Christine Ensign
- Department of Cardiology, Veterans Health Administration, Portland, OR, USA
| | - Carrie M Puckett
- Department of Cardiology, Veterans Health Administration, Portland, OR, USA
| | - Sarah Caviness
- Department of Cardiology, Veterans Health Administration, Portland, OR, USA
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33
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Salas Jarque J, Moreno Díaz J, Bustos Morell C, Pereira Boan J, Durán Portella A, Ruiz Montes F, Velilla Marco J. [Corticoid treatment and SARS-CoV-2 variants: two independent factors associated with COVID-19 mortality in a Spanish regional hospital]. An Sist Sanit Navar 2023; 46:e1017. [PMID: 37203319 PMCID: PMC10205026 DOI: 10.23938/assn.1017] [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: 07/12/2022] [Revised: 08/08/2022] [Accepted: 10/26/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Pandemic inter-wave hospital admissions and COVID-19-related mortality rates vary greatly. Some of the factors that may be playing part in this are the profile of the patients, viral variants, pharmacological treatments, or preventive measures. This work aimed to analyze the factors associated with mortality in COVID-19 patients admitted to hospital during 2020-2021. METHODS Retrospective cohort study with COVID-19 patients admitted to Hospital de Barbastro (Spain) during 2020-2021. Data were collected from the Spanish Conjunto Mínimo Básico de Datos and microbiology and electronic prescription records. RESULTS During the study period, 908 patients were consecutively admitted for COVID-19 (median age 70 years, 57.2% males); 162 (17.8%) patients died. We identified seven successive epidemiological waves. The following variables significantly associated to higher mortality: age, arterial hypertension, chronic renal failure, dementia, chronic obstructive pulmonary disease, heart failure, prior stroke, Charlson index, and wave 2; wave 4 was associated to greater survival. The multivariate analysis showed that age (OR=1.11; 95% CI: 1.09-1.14), chronic obstructive pulmonary disease (OR=2.33; 95% CI: 1.18-4.57), wave 2 (OR=2.57; 95% CI: 1.10-6.00), and wave 3 (OR=2.94; 95% CI: 1.17-7.38) associated with higher mortality. Glucocorticoid treatment was the only protective factor (OR=0.29; 95%CI: 0.14-0.62). CONCLUSIONS This study confirms the therapeutic utility of glucocorticoids to reduce in-hospital mortality due to COVID-19. Heterogeneous mortality rates between the different COVID-19 waves suggest a direct role of viral variants as determinants of lethality, regardless of the patient's history.
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34
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Louis DW, Saad M, Vijayakumar S, Ilyas S, Kokkirala A, Aronow HD. The Cardiovascular Manifestations of COVID-19. Heart Fail Clin 2023; 19:153-161. [PMID: 36863807 PMCID: PMC9973545 DOI: 10.1016/j.hfc.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure (HF), and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular manifestations of COVID-19, and cardiovascular complications associated with COVID-19 vaccination.
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Affiliation(s)
- David W. Louis
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Marwan Saad
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Shilpa Vijayakumar
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Suleman Ilyas
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Aravind Kokkirala
- United States Department of Veterans Affairs Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA
| | - Herbert D. Aronow
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA,Corresponding author. 593 Eddy Street, RIH APC 730, Providence, RI 02903
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35
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Isath A, Malik A, Bandyopadhyay D, Goel A, Hajra A, Dhand A, Lanier GM, Fonarow GC, Lavie CJ, Gass AL. COVID-19, Heart Failure Hospitalizations, and Outcomes: A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101541. [PMID: 36529234 PMCID: PMC9754747 DOI: 10.1016/j.cpcardiol.2022.101541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Heart Failure (HF) patients are at a higher risk of adverse events associated with Coronavirus disease 2019 (COVID-19). Large population-based reports of the impact of COVID-19 on patients hospitalized with HF are limited. The National Inpatient Sample database was queried for HF admissions during 2020 in the United States (US), with and without a diagnosis of COVID-19 based on ICD-10-CM U07. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Multivariate logistic regression analysis was used to identify predictors of mortality. A weighted total of 1,110,085 hospitalizations for HF were identified of which 7,905 patients (0.71%) had a concomitant diagnosis of COVID-19. After propensity matching, HF patients with COVID-19 had higher rate of in-hospital mortality (8.2% vs 3.7%; odds ratio [OR]: 2.33 [95% confidence interval [CI]: 1.69, 3.21]; P< 0.001), cardiac arrest (2.9% vs 1.1%, OR 2.21 [95% CI: 1.24,3.93]; P<0.001), and pulmonary embolism (1.0% vs 0.4%; OR 2.68 [95% CI: 1.05, 6.90]; P = 0.0329). During hospitalizations for HF, COVID-19 was also found to be an independent predictor of mortality. Further, increasing age, arrythmias, and chronic kidney disease were independent predictors of mortality in HF patients with COVID-19. COVID-19 is associated with increased in-hospital mortality, longer hospital stays, higher cost of hospitalization and increased risk of adverse outcomes in patients admitted with HF.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | - Akshay Goel
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Adrija Hajra
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Abhay Dhand
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Gregg M. Lanier
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Gregg C. Fonarow
- Department of Cardiology, University of California Los Angeles Medical Center, Los Angeles, CA
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Alan L. Gass
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY,Corresponding author: Alan L. Gass, MD, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
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Henry TD. Cardiovascular Effects of COVID-19. Heart Fail Clin 2023; 19:xi-xiii. [PMID: 36863819 PMCID: PMC9910013 DOI: 10.1016/j.hfc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Alharbi A, Alfatlawi H, Mohamed A, Mhanna M, Mahmoud M, Elsheik R, Moukarbel G, Assaly R. Outcomes of Heart Failure Related Hospitalizations During the COVID-19 Pandemic. Cureus 2023; 15:e36935. [PMID: 37131573 PMCID: PMC10148956 DOI: 10.7759/cureus.36935] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The incidence and prevalence of heart failure (HF) in the United States has steadily increased in the past few decades. Similarly, the United States has experienced an increase in HF-related hospitalizations which has added to the burden of a resource-stretched healthcare system. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic in 2020, hospitalizations due to the COVID-19 infection sky-rocketed further exacerbating the burden on both patient health and the healthcare system. The focus of this study is to examine how a secondary COVID-19 diagnosis affects the outcome of HF patients, and how a pre-existing diagnosis of heart failure impacts the outcomes of patients hospitalized with COVID-19 infection. METHODS This was a retrospective observational study of adult patients hospitalized with heart failure and COVID-19 infection in the United States in the years 2019 and 2020. Analysis was conducted using the National Inpatient Sample (NIS) database of the Healthcare Utilization Project (HCUP). The total number of patients included in this study from the NIS database 2020 was 94,745. Of those, 93,798 had heart failure without a secondary diagnosis of COVID-19; 947 had heart failure along with a secondary diagnosis of COVID-19. The primary outcome of our study was in-hospital mortality, length of stay, total hospital charges and time from admission to right heart catheterization, which were compared between the two cohorts. Results: Our main study findings are that mortality in HF patients with secondary diagnosis of COVID-19 infection was not statistically different compared to those who were without a secondary diagnosis of COVID-19. Our study findings also showed that length of stay (LOS) and hospital costs in HF patients who had a secondary diagnosis of COVID-19 were not statistically different compared to those who did not have the secondary diagnosis. Time from admission to right heart catheterization (RHC) in HF patients who had a secondary diagnosis of COVID-19 was shorter in heart failure with reduced ejection fraction (HFrEF) but not in heart failure preserved ejection fraction (HFpEF) compared to those without secondary diagnoses of COVID-19. Finally, when evaluating hospital outcomes for patients admitted with COVID-19 infection, we found that inpatient mortality increased significantly when they had a pre-existing diagnosis of heart failure. CONCLUSION The COVID-19 pandemic significantly impacted hospitalization outcomes for patients admitted with heart failure. The time from admission to right heart catheterization was significantly shorter in patients admitted with heart failure reduced ejection fraction who also had a secondary diagnosis of COVID-19 infection. When evaluating hospital outcomes for patients admitted with COVID-19 infection, we found that inpatient mortality increased significantly when they had a pre-existing diagnosis of heart failure. Length of hospital stay and hospital charges also were higher for patients with COVID-19 infection who had pre-existing heart failure. Further studies should focus not just on how medical comorbidities like COVID-19 infection, affect outcomes of heart failure but also on how overall strains on the healthcare system, such as pandemics, may affect the management of conditions such as heart failure.
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Bashir H, Yildiz M, Cafardi J, Bhatia A, Garcia S, Henry TD, Chung ES. A Review of Heart Failure in patients with COVID-19. Heart Fail Clin 2023; 19:e1-e8. [PMID: 37169437 PMCID: PMC9988711 DOI: 10.1016/j.hfc.2023.03.002] [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] [Indexed: 03/09/2023]
Abstract
The interplay of COVID-19 and heart failure is complex and involves direct and indirect effects. Patients with existing heart failure develop more severe COVID-19 symptoms and have worse clinical outcomes. Pandemic-related policies and protocols have negatively affected care for cardiovascular conditions and established hospital protocols, which is particularly important for patients with heart failure.
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Affiliation(s)
- Hanad Bashir
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA. https://twitter.com/HanadBashirMD
| | - Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA
| | - John Cafardi
- Infectious Disease Department, The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA
| | - Ankit Bhatia
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA. https://twitter.com/AKBhatiaMD
| | - Santiago Garcia
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA. https://twitter.com/HenrytTimothy
| | - Eugene S Chung
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Christ Hospital Health Network, 2139 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA.
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Effects of underlying heart failure on outcomes of COVID-19; a systematic review and meta-analysis. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:6-27. [PMID: 36453439 DOI: 10.2478/rjim-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Indexed: 12/03/2022]
Abstract
Background: The risk for worse outcomes of COVID-19 (Coronavirus 2019 disease) is higher in patients with cardiac conditions. In this study, we aim to investigate the risks of COVID-19-induced conditions in cases with underlying heart failure. Methods: We systematically searched PubMed, Scopus, Ovid, ProQuest, Web of Science, and the Cochrane library, to collect the English language articles that investigated patients with underlying heart failure who get infected by COVID-19. The second version of comprehensive meta-analysis (CMA.2) software was used to conduct the meta-analysis. Results: From 5997 publications, our eligibility criteria were met by 27 studies. Overall, outcomes investigated in all studies include but are not limited to mortality rate, length of hospitalization, need for Intensive care unit (ICU) admission, need for mechanical ventilation, and major cardiovascular conditions. Regarding mortality heart failure patients were more susceptible to death (OR:2.570, 95%CI: 2.085 to 3.169; p-value:<0.001). Also in heart failure patients, the risk of mechanical ventilation was higher (OR:1.707, 95%CI: 1.113 to 2.617; p-value: 0.014). Conclusion: Pre-existing heart failure is associated with the increased risk of mortality and the need for mechanical ventilation while getting infected with COVID-19. Finding an answer to determine the risk of hospitalization, length of stay, readmission rate, and multiorgan failure is necessary for further development of preventive care and making a plan for providing optimal healthcare facilities for these patients.
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Casipit BA, Al-Sudani H, Khan A, Akuna E, Amanullah A. Retrospective analyses of the outcomes among hospitalized liver cirrhosis patients with heart failure and COVID-19 infection: Insight from the National Inpatient Sample. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100271. [PMID: 36817018 PMCID: PMC9916131 DOI: 10.1016/j.ahjo.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/04/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Background There is paucity of data regarding the impact of Coronavirus Disease 2019 (COVID-19) infection on the outcomes of hospitalized liver cirrhosis (LC) patients with heart failure (HF). Methods Utilizing the 2020 National Inpatient Sample (NIS) Database, we conducted a retrospective cohort study to investigate the outcomes of hospitalized LC patients with HF and COVID-19 infection, looking at its impact on in-hospital mortality, risk for acute kidney injury (AKI) and length of stay (LOS). Results We identified a total of 10,810 hospitalized LC patients with HF, of which 1.39 % (n = 150/10,810) had COVID-19 infection. Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, COVID-19 infection among hospitalized LC patients with HF was found to be an independent predictor of overall in-hospital mortality (aOR 3.73; 95 % CI, 1.58-8.79; p = 0.00) and risk for AKI (aOR 3.06; 95 % CI, 1.27-7.37; p = 0.01) compared to those without COVID-19 infection. However, there were comparable rates of LOS among LC patients with HF regardless of COVID-19 infection status. Moreover, AKI was found to be an independent predictor of longer LOS (coefficient 4.40, 95 % CI 3.26-5.38; p = 0.00). On subgroup analysis, diastolic HF was found to be associated with increased risk for in-hospital mortality (aOR 6.54; 95 % CI, 2.02-21.20; p = 0.00), development of AKI (aOR 3.33; 95 % CI, 1.12-9.91; p = 0.03) and longer LOS (coefficient 4.30, 95 % CI 0.79-9.45; p = 0.03). Conclusion Concomitant COVID-19 infection among hospitalized LC patients with HF was associated with higher risk for in-hospital mortality and AKI but did not significantly affect hospital LOS.
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Affiliation(s)
- Bruce Adrian Casipit
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hussein Al-Sudani
- Department of Medicine, Einstein Medical Center Montgomery, East Norriton, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ahmer Khan
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Emmanuel Akuna
- Department of Cardiovascular Diseases, Einstein Medical Center Philadelphia, Philadelphia, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aman Amanullah
- Department of Cardiovascular Diseases, Einstein Medical Center Philadelphia, Philadelphia, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Nasrullah A, Gangu K, Cannon HR, Khan UA, Shumway NB, Bobba A, Sagheer S, Chourasia P, Shuja H, Avula SR, Shekhar R, Sheikh AB. COVID-19 and Heart Failure with Preserved and Reduced Ejection Fraction Clinical Outcomes among Hospitalized Patients in the United States. Viruses 2023; 15:v15030600. [PMID: 36992309 PMCID: PMC10053519 DOI: 10.3390/v15030600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Heart failure exacerbations impart significant morbidity and mortality, however, large- scale studies assessing outcomes in the setting of concurrent coronavirus disease-19 (COVID-19) are limited. We utilized National Inpatient Sample (NIS) database to compare clinical outcomes in patients admitted with acute congestive heart failure exacerbation (CHF) with and without COVID-19 infection. A total of 2,101,980 patients (Acute CHF without COVID-19 (n = 2,026,765 (96.4%) and acute CHF with COVID-19 (n = 75,215, 3.6%)) were identified. Multivariate logistic regression analysis was utilized to compared outcomes and were adjusted for age, sex, race, income level, insurance status, discharge quarter, Elixhauser co-morbidities, hospital location, teaching status and bed size. Patients with acute CHF and COVID-19 had higher in-hospital mortality compared to patients with acute CHF alone (25.78% vs. 5.47%, adjust OR (aOR) 6.3 (95% CI 6.05–6.62, p < 0.001)) and higher rates of vasopressor use (4.87% vs. 2.54%, aOR 2.06 (95% CI 1.86–2.27, p < 0.001), mechanical ventilation (31.26% vs. 17.14%, aOR 2.3 (95% CI 2.25–2.44, p < 0.001)), sudden cardiac arrest (5.73% vs. 2.88%, aOR 1.95 (95% CI 1.79–2.12, p < 0.001)), and acute kidney injury requiring hemodialysis (5.56% vs. 2.94%, aOR 1.92 (95% CI 1.77–2.09, p < 0.001)). Moreover, patients with heart failure with reduced ejection fraction had higher rates of in-hospital mortality (26.87% vs. 24.5%, adjusted OR 1.26 (95% CI 1.16–1.36, p < 0.001)) with increased incidence of vasopressor use, sudden cardiac arrest, and cardiogenic shock as compared to patients with heart failure with preserved ejection fraction. Furthermore, elderly patients and patients with African-American and Hispanic descents had higher in-hospital mortality. Acute CHF with COVID-19 is associated with higher in-hospital mortality, vasopressor use, mechanical ventilation, and end organ dysfunction such as kidney failure and cardiac arrest.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66103, USA
| | - Harmon R. Cannon
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Umair A. Khan
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Nichole B. Shumway
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Aneish Bobba
- Department of Medicine, John H Stronger Hospital, Cook County, Chicago, IL 60612, USA
| | - Shazib Sagheer
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA 22401, USA
| | - Hina Shuja
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Sindhu Reddy Avula
- Department of Interventional Cardiology, Division of Cardiology, University of Kansas, St. Francis Campus, Kansas City, KS 66606, USA
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
- Correspondence: ; Tel.: +1-5052724661
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Vosko I, Zirlik A, Bugger H. Impact of COVID-19 on Cardiovascular Disease. Viruses 2023; 15:508. [PMID: 36851722 PMCID: PMC9962056 DOI: 10.3390/v15020508] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection with the novel severe acute respiratory distress syndrome corona virus 2 (SARS-CoV-2). Until now, more than 670 million people have suffered from COVID-19 worldwide, and roughly 7 million death cases were attributed to COVID-19. Recent evidence suggests an interplay between COVID-19 and cardiovascular disease (CVD). COVID-19 may serve as a yet underappreciated CVD risk modifier, including risk factors such as diabetes mellitus or arterial hypertension. In addition, recent data suggest that previous COVID-19 may increase the risk for many entities of CVD to an extent similarly observed for traditional cardiovascular (CV) risk factors. Furthermore, increased CVD incidence and worse clinical outcomes in individuals with preexisting CVD have been observed for myocarditis, acute coronary syndrome, heart failure (HF), thromboembolic complications, and arrhythmias. Direct and indirect mechanisms have been proposed by which COVID-19 may impact CVD and CV risk, including viral entry into CV tissue or by the induction of a massive systemic inflammatory response. In the current review, we provide an overview of the literature reporting an interaction between COVID-19 and CVD, review potential mechanisms underlying this interaction, and discuss preventive and treatment strategies and their interference with CVD that were evaluated since the onset of the COVID-19 pandemic.
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Affiliation(s)
| | | | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria
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Kelly SC, Thorne PK, Leary EV, Emter CA. Sex and diet, but not exercise, alter cardiovascular ACE2 and TMPRSS2 mRNA levels in aortic banded swine. J Appl Physiol (1985) 2023; 134:482-489. [PMID: 36656980 PMCID: PMC9942911 DOI: 10.1152/japplphysiol.00736.2022] [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] [Indexed: 01/21/2023] Open
Abstract
SARS-COV-2, or COVID-19, is a respiratory virus that enters tissues via the angiotensin-converting enzyme 2 (ACE2) receptor and is primed and activated by transmembrane protease, serine 2 (TMPRSS2). An interesting dichotomy exists regarding the preventative/therapeutic effects of exercise on COVID-19 infection and severity. Although exercise training has been shown to increase ACE2 receptor levels (increasing susceptibility to COVID-19 infection), it also lowers cardiovascular risk factors, systemic inflammation, and preserves normal renin-angiotensin system axis equilibrium, which is considered to outweigh any enhanced risk of infection by decreasing disease severity. The goal of this study was to determine the effects of chronic exercise training, sex, and Western diet on ACE2 and TMPRSS2 mRNA levels in preclinical swine models of heart failure. We hypothesized chronic exercise training and male sex would increase ACE2 and TMPRSS2 mRNA levels. A retrospective analysis was conducted in previously completed studies including: 1) sedentary and exercise-trained aortic banded male, intact Yucatan mini-swine (n = 6 or 7/group); 2) ovariectomized and/or aortic banded female, intact Yucatan mini-swine (n = 5-8/group); and 3) lean control or Western diet-fed aortic banded female, intact Ossabaw swine (n = 4 or 5/group). Left ventricle, right ventricle, and coronary vascular tissue were evaluated using qRT-PCR. A multivariable regression analysis was used to determine differences between exercise training, sex, and Western diet. Chronic exercise training did not alter ACE2 or TMPRSS2 level regardless of intensity. ACE2 mRNA was altered in a tissue-specific manner due to sex and Western diet. TMPRSS2 mRNA was altered in a tissue-dependent manner due to sex, Western diet, and pig species. These results highlight differences in ACE2 and TMPRSS2 mRNA regulation in an experimental setting of preclinical heart failure that may provide insight into the risk of cardiovascular complications of SARS-COV-2 infection.NEW & NOTEWORTHY This retrospective analysis evaluated the impact of exercise, sex, and diet on ACE2 and TMPRSS2 mRNA levels in preclinical swine heart failure models. Unlike normal exercise intensities, exercise training of an intensity tolerable to a patient with heart failure had no influence on ACE2 or TMPRSS2 mRNA. In a tissue-specific manner, ACE2 mRNA levels were altered due to sex and Western diet, whereas TMPRSS2 mRNA levels were sensitive to sex, Western diet, and pig species.
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Affiliation(s)
- Shannon C. Kelly
- 1Department of Biomedical Sciences, https://ror.org/02ymw8z06University of Missouri, Columbia, Missouri,2NextGen Precision Health Institute, University of Missouri, Columbia, Missouri
| | - Pamela K. Thorne
- 1Department of Biomedical Sciences, https://ror.org/02ymw8z06University of Missouri, Columbia, Missouri,2NextGen Precision Health Institute, University of Missouri, Columbia, Missouri
| | - Emily V. Leary
- 3Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Craig A. Emter
- 1Department of Biomedical Sciences, https://ror.org/02ymw8z06University of Missouri, Columbia, Missouri,2NextGen Precision Health Institute, University of Missouri, Columbia, Missouri
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Ostrowska M, Kasprzak M, Stolarek W, Grzelakowska K, Kryś J, Kubica A, Adamski P, Podhajski P, Navarese EP, Anielska-Michalak E, Matuszewska-Brycht O, Curzytek A, Dudek A, Gromadziński L, Grzelakowski P, Kamiński L, Kleinrok A, Kostkiewicz M, Koziński M, Król P, Kulawik T, Minczew G, Mindykowski M, Pawlak A, Prokopczuk J, Skonieczny G, Sobkowicz B, Sowiński S, Stankala S, Szymański P, Wester A, Wilczewski P, Bartuś S, Budaj A, Gajda R, Gąsior M, Gruchała M, Drożdż J, Jaguszewski M, Jankowski P, Legutko J, Lesiak M, Leszek P, Mitkowski P, Nessler J, Tomaszuk-Kazberuk A, Tycińska A, Zdrojewski T, Kaźmierczak J, Kubica J. Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: A subanalysis of the COV-HF-SIRIO 6 study. Cardiol J 2023; 30:344-352. [PMID: 36651570 PMCID: PMC10287078 DOI: 10.5603/cj.a2023.0002] [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: 09/07/2022] [Revised: 10/24/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. METHODS The present research is a subanalysis of a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). RESULTS Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). CONCLUSIONS A greater reduction in hospital admissions in 2020 vs. 2019, higher rates of patients brought by ambulance together with lower rates of self-referrals and higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths were observed in cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones.
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Affiliation(s)
| | - Michał Kasprzak
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Wioleta Stolarek
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Jacek Kryś
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Aldona Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Adamski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | | | - Edyta Anielska-Michalak
- Department of Cardiology, Marian Zyndram-Kościałkowski Ministry of Interior and Administration Hospital, Białystok, Poland
| | - Oliwia Matuszewska-Brycht
- Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
| | - Andrzej Curzytek
- Department of Cardiology, Hospital of the Ministry of Interior and Administration, Rzeszów, Poland
| | - Aneta Dudek
- 1st Department of Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Paweł Grzelakowski
- Department of Cardiology and Cardiac Surgery, 10th Military Hospital and Polyclinic, Bydgoszcz, Poland
| | - Leszek Kamiński
- Department of Cardiology Independent Public Healthcare in Przeworsk, Poland
| | | | | | - Marek Koziński
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Paweł Król
- Department of Cardiology, Tertiary Care Hospital, Ciechanow, Poland
| | - Tomasz Kulawik
- Department of Cardiology, Masovian Rehabilitation Center, Pruszkow, Poland
| | - Gleb Minczew
- Department of Cardiology, District Hospital, Tuchola, Poland
| | - Marcin Mindykowski
- Department of Cardiology, Dr. Emil Warmiński Tertiary Care Municipal Hospital, Bydgoszcz, Poland
| | - Agnieszka Pawlak
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Janusz Prokopczuk
- Department of Cardiology, Polish Hospitals, Kedzierzyn Kozle, Poland
| | - Grzegorz Skonieczny
- Department of Cardiology and Intensive Cardiac Care Unit, District Polyclinic Hospital, Torun, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University in Bialystok, Poland
| | - Sergiusz Sowiński
- Department of Cardiology and Cardiac Intensive Care, Tertiary Care Municipal Hospital, Torun, Poland
| | - Sebastian Stankala
- Cardiology Subdivision of Heart Failure, St. Elizabeth Hospital, Biala, Poland
| | - Paweł Szymański
- Department of Cardiology, Interventional Cardiology and Electrophysiology with Cardiac Intensive Care Unit, Tertiary Care Hospital in Grudziadz, Poland
| | - Andrzej Wester
- 1st Department of Physiology, Institute of Medical Sciences, University of Opole, Poland
- Cardiology Center, SCANMED SA,, Kluczbork, Poland
| | | | - Stanisław Bartuś
- 2nd Department of Cardiology, Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Robert Gajda
- Department of Kinesiology and Health Prevention, Jan Dlugosz University in Czestochowa, Poland
- Gajda-Med District Hospital, Pultusk, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Faculty of Medicine in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdansk, Poland
| | - Jarosław Drożdż
- Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
| | | | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemysław Leszek
- Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland
| | | | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Tomasz Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Poland
| | | | - Jacek Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Arutyunov GP, Tarlovskaya EI, Arutyunov AG, Lopatin YM. Impact of heart failure on all-cause mortality in COVID-19: findings from the Eurasian International Registry. ESC Heart Fail 2022; 10:1013-1024. [PMID: 36519220 PMCID: PMC9878039 DOI: 10.1002/ehf2.14243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS To study all-cause mortality in patients hospitalized with COVID-19 with or without chronic heart failure (CHF) during hospitalization and at 3 and 6 months of follow-up. METHODS AND RESULTS The international registry Analysis of Comorbid Disease Dynamics in Patients with SARS-CoV-2 Infection (ACTIV) was conducted at 26 centres in seven countries: Armenia, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russian Federation, and Uzbekistan. The primary endpoints were in-hospital all-cause mortality and all-cause mortality at 3 and 6 months of follow-up. Of the 5616 patients hospitalized with COVID-19, 917 (16.3%) had CHF. Total in-hospital mortality was 7.6%. In-hospital mortality was higher in patients with CHF than in patients without a history of CHF [17.7% vs. 4.0%, P < 0.001; odds ratio (OR) 4.614, 95% confidence interval (CI) 3.633-5.859; P < 0.001]. The risk of in-hospital all-cause mortality correlated significantly with the severity of CHF; specifically, the risk of in-hospital all-cause mortality was greater for patients in New York Heart Association functional classes III and IV (OR 6.124, 95% CI 4.538-8.266; P < 0.001 vs. patients without CHF) than for patients in functional classes I and II (OR 2.446, 95% CI 1.831-3.267, P < 0.001 vs. patients without CHF). The risk of mortality in patients with ischemic CHF was 58% higher than in patients with non-ischaemic CHF [OR 1.58 (95% CI 1.05-2.45), P = 0.030]. In the first 3 months of follow-up, the all-cause mortality rate in patients with CHF was 10.32%, compared with 1.83% in patients without CHF (P < 0.001). At 6 months of follow-up, NYHA classes II-IV was a strong risk factor for all-cause mortality [OR 5.343 (95% CI 2.717-10.508); P < 0.001]. CONCLUSIONS Hospitalized COVID-19 patients with CHF have an increased risk of in-hospital all-cause mortality, which remains high 6 months after discharge.
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Affiliation(s)
- Gregory P. Arutyunov
- Department of Internal DiseasesPirogov Russian National Research Medical UniversityMoscowRussia
| | - Ekaterina I. Tarlovskaya
- Department of Therapy and CardiologyPrivolzhsky Research Medical UniversityNizhny NovgorodRussia
| | - Alexander G. Arutyunov
- Department of Internal DiseasesPirogov Russian National Research Medical UniversityMoscowRussia
| | - Yury M. Lopatin
- Department of Cardiology and Cardiothoracic SurgeryVolgograd State Medical UniversityVolgogradRussia
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DEFILIPPIS ERSILIAM, ALLEN LARRYA, BHATT ANKEETS, JOSEPH SUSAN, KITTLESON MICHELLE, VARDENY ORLY, DRAZNER MARKH, LALA ANURADHA. Vaccines, Antibodies and Donors: Varying Attitudes and Policies Surrounding COVID-19 and Heart Transplantation. J Card Fail 2022; 28:1727-1732. [PMID: 35718306 PMCID: PMC9212876 DOI: 10.1016/j.cardfail.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are varied opinions in the United States regarding many aspects of care related to COVID-19. The purpose of this study was to examine the opinions of health care personnel and the policies of heart transplant centers concerning practices for the prevention and treatment of COVID-19 in donors and recipients of heart transplants. METHODS Two anonymous, electronic web-based surveys were developed: 1 was administered to health care personnel through a mailing list maintained by the Heart Failure Society of America (HFSA); another was administered to U.S. medical adult and pediatric heart transplant (HT) program directors. Individual and group e-mails were sent with an embedded link to the respective surveys in February 2022. RESULTS A total of 176 individuals (8.6%) responded to the survey administered through the HFSA. Of medical directors of transplant programs, 78 (54% response rate) completed a separate survey on their centers' policies. Although 95% (n = 167) of individuals indicated vaccination against COVID-19 should be required prior to HT, only 67% (n = 52) of centers mandated that practice. Similarly, 61% of individuals thought vaccination should be required prior to HT for caregivers, but only 13% of transplant centers mandated caregiver vaccination. Of the centers, 63% reported considering donors despite histories of recent COVID-19 infection (within 3 months), and 47% considered donors with current positive polymerase chain reaction tests. Regarding post-transplant care, only 22% of programs routinely measured antibodies to COVID-19, and 71% used tixagevimab/cilgavimab (Evusheld) for pre-exposure prophylaxis. CONCLUSIONS There were significant differences between individual preferences and centers' practices with respect to COVID-19 management of candidates for and recipients of HT. Additionally, there was wide variation in policies among centers, reflecting the need for further study to inform consistent guidance and recommendations across centers to optimize equitable care for this high-risk patient population.
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Affiliation(s)
- ERSILIA M. DEFILIPPIS
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - LARRY A. ALLEN
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - ANKEET S. BHATT
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - SUSAN JOSEPH
- Department of Cardiology, University of Maryland Medical Center, Baltimore, Maryland
| | - MICHELLE KITTLESON
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - ORLY VARDENY
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis, Minnesota
| | - MARK H. DRAZNER
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - ANURADHA LALA
- Zena and Michael A. Wiener Cardiovascular Institute & Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, New York,Reprint requests: Anuradha Lala, MD. The Zena and Michael A. Wiener Cardiovascular Institute, and Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1030, New York, New York 10029
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Salinas-Botrán A, Méndez-Bailón M, Pérez-Belmonte LM. Reply to "On the heart failure diagnosis. Is it enough with physical examination?". Rev Clin Esp 2022; 222:622. [PMID: 35842409 DOI: 10.1016/j.rceng.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Affiliation(s)
- A Salinas-Botrán
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria delHospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - M Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria delHospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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Ye X, Huang C, Wei Y, Li ST, Yan VK, Yiu KH, Tse HF, Ma T, Qin X, Chui CS, Lai FT, Li X, Wan EY, Wong CK, Wong IC, Chan EW. Safety of BNT162b2 or CoronaVac COVID-19 vaccines in patients with heart failure: A self-controlled case series study. THE LANCET REGIONAL HEALTH: WESTERN PACIFIC 2022; 30:100630. [PMCID: PMC9638810 DOI: 10.1016/j.lanwpc.2022.100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
Background COVID-19 vaccines are important for patients with heart failure (HF) to prevent severe outcomes but the safety concerns could lead to vaccine hesitancy. This study aimed to investigate the safety of two COVID-19 vaccines, BNT162b2 and CoronaVac, in patients with HF. Methods We conducted a self-controlled case series analysis using the data from the Hong Kong Hospital Authority and the Department of Health. The primary outcome was hospitalization for HF and the secondary outcomes were major adverse cardiovascular events (MACE) and all hospitalization. We identified patients with a history of HF before February 23, 2021 and developed the outcome event between February 23, 2021 and March 31, 2022 in Hong Kong. Incidence rate ratios (IRR) were estimated using conditional Poisson regression to evaluate the risks following the first three doses of BNT162b2 or CoronaVac. Findings We identified 32,490 patients with HF, of which 3035 were vaccinated and had a hospitalization for HF during the observation period (BNT162b2 = 755; CoronaVac = 2280). There were no increased risks during the 0–13 days (IRR 0.64 [95% confidence interval 0.33–1.26]; 0.94 [0.50–1.78]; 0.82 [0.17–3.98]) and 14–27 days (0.73 [0.35–1.52]; 0.95 [0.49–1.84]; 0.60 [0.06–5.76]) after the first, second and third doses of BNT162b2. No increased risks were observed for CoronaVac during the 0–13 days (IRR 0.60 [0.41–0.88]; 0.71 [0.45–1.12]; 1.64 [0.40–6.77]) and 14–27 days (0.91 [0.63–1.32]; 0.79 [0.46–1.35]; 1.71 [0.44–6.62]) after the first, second and third doses. We also found no increased risk of MACE or all hospitalization after vaccination. Interpretation Our results showed no increased risk of hospitalization for HF, MACE or all hospitalization after receiving BNT162b2 or CoronaVac vaccines in patients with HF. Funding The project was funded by a Research Grant from the 10.13039/501100005407Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (Ref. No. COVID19F01). F.T.T.L. (Francisco T.T. Lai) and I.C.K.W. (Ian C.K. Wong)'s posts were partly funded by the D24H; hence this work was partly supported by AIR@InnoHK administered by Innovation and Technology Commission.
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Affiliation(s)
- Xuxiao Ye
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Caige Huang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Silvia T.H. Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent K.C. Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Tiantian Ma
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Xiwen Qin
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Celine S.L. Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco T.T. Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Y.F. Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos K.H. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C.K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
- Corresponding author. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy General Office, L02-56 2/F Laboratory Block LKS, Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam Hong Kong SAR, China.
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
- Corresponding author. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy General Office, L02-56 2/F Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam Hong Kong SAR, China.
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George S, Cunningham LC, Nelson DP, Horstmanshof DA, Long JW, El Banayosy AM. Outcomes of COVID-19 in heart failure, LVAD, and heart transplant patients in an advanced heart failure practice. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 24:100223. [PMID: 36345551 PMCID: PMC9630293 DOI: 10.1016/j.ahjo.2022.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/14/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Background Patients with heart failure face increased morbidity and mortality when infected with COVID-19. The objective of this study was to evaluate the outcomes of patients with Heart Failure (HF), Left Ventricular Assist Devices (LVADs), or Heart Transplants (HTx) diagnosed with COVID-19 within an advanced HF practice. Methods Out of 2635 patients followed, 96 patients were diagnosed with COVID-19 between March 2020 and January 2021. Median hospital length of stay (LOS), requirement for mechanical ventilation (MV), and mortality rate were evaluated. Results The distribution of COVID-19 among the 96 patients was: HF = 43 (45 %), LVAD = 16 (17 %) and HTx = 37 (38 %). Among 43 HF patients, 5 (12 %) died, 18 (42 %) required hospitalization with an LOS of 7 days, 5 (12 %) required ICU and 4 (9 %) required MV. Of the 16 LVAD patients, 2 (13 %) died, 8 (50 %) required hospitalization with an LOS of 11 days, 3 (19 %) required ICU and 3 (19 %) required MV. Among 37 HTx patients, 7 (19 %) died, 23 (62 %) required hospitalization with an LOS of 9 days, 6 (16 %) required ICU and 6 (16 %) required MV. Conclusion This report is among the first to describe the impact of COVID-19 on a diverse advanced HF practice. It highlights the risks associated with COVID-19 faced by the HF, LVAD and HTx patients. A 90-day mortality rate of 19 % with HTx patients acquiring COVID-19 is ominous as is a mortality rate of 12 % each for HF and LVAD patients. This clinical impact should serve as a reminder of unique challenges with these populations.
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Affiliation(s)
- Susan George
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, United States of America
| | - Luke C Cunningham
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, United States of America
| | - David P Nelson
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, United States of America
| | - Douglas A Horstmanshof
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, United States of America
| | - James W Long
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, United States of America
| | - Ahmed M El Banayosy
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, United States of America
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50
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DePace NL, Colombo J. Long-COVID Syndrome and the Cardiovascular System: A Review of Neurocardiologic Effects on Multiple Systems. Curr Cardiol Rep 2022; 24:1711-1726. [PMID: 36178611 PMCID: PMC9524329 DOI: 10.1007/s11886-022-01786-2] [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] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Long-COVID syndrome is a multi-organ disorder that persists beyond 12 weeks post-acute SARS-CoV-2 infection (COVID-19). Here, we provide a definition for this syndrome and discuss neuro-cardiology involvement due to the effects of (1) angiotensin-converting enzyme 2 receptors (the entry points for the virus), (2) inflammation, and (3) oxidative stress (the resultant effects of the virus). RECENT FINDINGS These effects may produce a spectrum of cardio-neuro effects (e.g., myocardial injury, primary arrhythmia, and cardiac symptoms due to autonomic dysfunction) which may affect all systems of the body. We discuss the symptoms and suggest therapies that target the underlying autonomic dysfunction to relieve the symptoms rather than merely treating symptoms. In addition to treating the autonomic dysfunction, the therapy also treats chronic inflammation and oxidative stress. Together with a full noninvasive cardiac workup, a full assessment of the autonomic nervous system, specifying parasympathetic and sympathetic (P&S) activity, both at rest and in response to challenges, is recommended. Cardiac symptoms must be treated directly. Cardiac treatment is often facilitated by treating the P&S dysfunction. Cardiac symptoms of dyspnea, chest pain, and palpitations, for example, need to be assessed objectively to differentiate cardiac from neural (autonomic) etiology. Long-term myocardial injury commonly involves P&S dysfunction. P&S assessment usually connects symptoms of Long-COVID to the documented autonomic dysfunction(s).
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Affiliation(s)
- Nicholas L. DePace
- Franklin Cardiovascular Associates, PA – Autonomic Dysfunction and POTS Center, Sicklerville, NJ USA
- Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA USA
- Neuro-Cardiology Research Corporation, LLC, Wilmington, DE USA
| | - Joe Colombo
- Franklin Cardiovascular Associates, PA – Autonomic Dysfunction and POTS Center, Sicklerville, NJ USA
- Neuro-Cardiology Research Corporation, LLC, Wilmington, DE USA
- CTO and Sr. Medical Director, Physio PS, Inc, Atlanta, GA USA
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