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Beeks VV, Achilleos S, Quattrocchi A, Pallari CT, Critselis E, Salameh P, Rahmanian Haghighi MR, Rodriguez-Llanes JM, Ambrosio G, Artemiou A, Gabel J, Bennett CM, Cuthbertson J, Zimmermann C, Schernhammer ES, Costa AJL, de Carvalho LF, Lobato JCP, Athanasiadou M, Critchley JA, Goldsmith LP, Kandelaki L, Glushkova N, Davletov K, Semenova Y, Erzen I, Verstiuk O, Alekkou D, Polemitis A, Charalambous A, Demetriou CA. Cause-Specific Excess Mortality During the COVID-19 Pandemic (2020-2021) in 12 Countries of the C-MOR Consortium. J Epidemiol Glob Health 2024; 14:337-348. [PMID: 38775902 PMCID: PMC11176135 DOI: 10.1007/s44197-024-00242-4] [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: 10/27/2023] [Accepted: 05/09/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021. METHODS We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality. RESULTS Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021). CONCLUSIONS This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.
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Affiliation(s)
- Victoria Virginia Beeks
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
| | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Chryso Th Pallari
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Elena Critselis
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Pascale Salameh
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | | | | | - Giuseppe Ambrosio
- Department of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Andreas Artemiou
- Department of Information Technologies, University of Limassol, Limassol, Cyprus
| | - John Gabel
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Catherine Marie Bennett
- School of Health and Social Development, Institute for Health Transformation, Deakin University, Waurn Ponds, Australia
| | - Joseph Cuthbertson
- Monash University Disaster Resilience Initiative, Monash University, Melbourne, Australia
| | - Claudia Zimmermann
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Eva Susanna Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Antonio José Leal Costa
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Maria Athanasiadou
- Health Monitoring Unit, Cyprus Ministry of Health, 1 Prodromou & 17 Chilonos Street, 1448, Nicosia, Cyprus
| | | | | | - Levan Kandelaki
- Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Natalya Glushkova
- Health Research Institute, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Kairat Davletov
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Ivan Erzen
- School of Public Health, National Institute of Public Health, Ljubljana, Slovenia
| | - Olesia Verstiuk
- Department of Medical Science, University of Nicosia, Nicosia, Cyprus
| | - Dimos Alekkou
- Department of Psychology, University of Nicosia, Nicosia, Cyprus
| | | | | | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
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Kerwagen F, Riemer U, Wachter R, von Haehling S, Abdin A, Böhm M, Schulz M, Störk S. Impact of the COVID-19 pandemic on implementation of novel guideline-directed medical therapies for heart failure in Germany: a nationwide retrospective analysis. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100778. [PMID: 38023333 PMCID: PMC10652117 DOI: 10.1016/j.lanepe.2023.100778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
Background Guideline-directed medical therapy (GDMT) is the cornerstone in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) and novel substances such as sacubitril/valsartan (S/V) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated marked clinical benefits. We investigated their implementation into real-world HF care in Germany before, during, and after the COVID-19 pandemic period. Methods The IQVIA LRx data set is based on ∼80% of 73 million people covered by the German statutory health insurance. Prescriptions of S/V were used as a proxy for HFrEF. Time trends were analysed between Q1/2016 and Q2/2023 for prescriptions for S/V alone and in combination therapy with SGLT2i. Findings The number of patients treated with S/V increased from 5260 in Q1/2016 to 351,262 in Q2/2023. The share of patients with combination therapy grew from 0.6% (29 of 5260) to 14.2% (31,128 of 219,762) in Q2/2021, and then showed a steep surge up to 54.8% (192,429 of 351,262) in Q2/2023, coinciding with the release of the European Society of Cardiology (ESC) guidelines for HF in Q3/2021. Women and patients aged >80 years were treated less often with combined therapy than men and younger patients. With the start of the COVID-19 pandemic, the number of patients with new S/V prescriptions dropped by 17.5% within one quarter, i.e., from 26,855 in Q1/2020 to 22,145 in Q2/2020, and returned to pre-pandemic levels only in Q1/2021. Interpretation The COVID-19 pandemic was associated with a 12-month deceleration of S/V uptake in Germany. Following the release of the ESC HF guidelines, the combined prescription of S/V and SGLT2i was readily adopted. Further efforts are needed to fully implement GDMT and strengthen the resilience of healthcare systems during public health crises. Funding Supported by Novartis Pharma GmbH, Nuremberg, Germany.
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Affiliation(s)
- Fabian Kerwagen
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Uwe Riemer
- Medical Department, Novartis Pharma GmbH, Nuremberg, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Amr Abdin
- Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany
| | - Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- German Institute for Drug Use Evaluation (DAPI), Berlin, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
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Torti C, Olimpieri PP, Bonfanti P, Tascini C, Celant S, Tacconi D, Nicastri E, Tacconelli E, Cacopardo B, Perrella A, Buccoliero GB, Parruti G, Bassetti M, Biagetti C, Giacometti A, Erne EM, Frontuto M, Lanzafame M, Summa V, Spagnoli A, Vestri A, Di Perri G, Russo P, Palù G. Real-life comparison of mortality in patients with SARS-CoV-2 infection at risk for clinical progression treated with molnupiravir or nirmatrelvir plus ritonavir during the Omicron era in Italy: a nationwide, cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 31:100684. [PMID: 37547273 PMCID: PMC10398591 DOI: 10.1016/j.lanepe.2023.100684] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023]
Abstract
Background Comparative data on mortality in COVID-19 patients treated with molnupiravir or with nirmatrelvir plus ritonavir are inconclusive. We therefore compared all-cause mortality in community-dwelling COVID-19 patients treated with these drugs during the Omicron era. Methods Data collected in the nationwide, population-based, cohort of patients registered in the database of the Italian Medicines Agency (AIFA) were used. To increase completeness of the recorded deaths and date correctness, a cross-check with the National Death Registry provided by the Ministry of the Interior was performed. We included in this study all patients infected by SARS-CoV-2 treated within 5 days after the test date and symptom onset between February 8 and April 30, 2022. All-cause mortalities by day 28 were compared between the two treatment groups after balancing for baseline characteristics using weights obtained from a gradient boosting machine algorithm. Findings In the considered timeframe, 17,977 patients treated with molnupiravir and 11,576 patients with nirmatrelvir plus ritonavir were included in the analysis. Most patients (25,617/29,553 = 86.7%) received a full vaccine course including the booster dose. A higher crude incidence rate of all-cause mortality was found among molnupiravir users (51.83 per 100,000 person-days), compared to nirmatrelvir plus ritonavir users (22.29 per 100,000 person-days). However, molnupiravir-treated patients were older than those treated with nirmatrelvir plus ritonavir and differences between the two populations were found as far as types of co-morbidities were concerned. For this reason, we compared the weight-adjusted cumulative incidences using the Aalen estimator and found that the adjusted cumulative incidence rates were 1.23% (95% CI 1.07%-1.38%) for molnupiravir-treated and 0.78% (95% CI 0.58%-0.98%) for nirmatrelvir plus ritonavir-treated patients (adjusted log rank p = 0.0002). Moreover, the weight-adjusted mixed-effect Cox model including Italian regions and NHS centers as random effects and treatment as the only covariate confirmed a significant reduced risk of death in patients treated with nirmatrelvir plus ritonavir. Lastly, a significant reduction in the risk of death associated with nirmatrelvir plus ritonavir was confirmed in patient subgroups, such as in females, fully vaccinated patients, those treated within day 2 since symptom onset and patients without (haemato)-oncological diseases. Interpretation Early initiation of nirmatrelvir plus ritonavir was associated for the first time with a significantly reduced risk of all-cause mortality by day 28 compared to molnupiravir, both in the overall population and in patient subgroups, including those fully vaccinated with the booster dose. Funding This study did not receive funding.
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Affiliation(s)
- Carlo Torti
- Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Pier Paolo Olimpieri
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Bonfanti
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - Carlo Tascini
- Department of Medicine (DAME), Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Simone Celant
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy
| | - Danilo Tacconi
- Department of Specialised and Internal Medicine, Infectious Diseases Unit, San Donato Hospital, Arezzo, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Disease Lazzaron Spallanzani, IRCCS, Via Portuense 292, 00149, Rome, Italy
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, 37129 Verona, Italy
| | - Bruno Cacopardo
- Department of Internal and Experimental Medicine, University of Catania School of Medicine, Catania, Italy
| | - Alessandro Perrella
- Division Emerging Infectious Disease and High Contagiousness, D. Cotugno Hospital, 80131 Naples, Italy
| | | | - Giustino Parruti
- Department of Medicine, Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Carlo Biagetti
- Unit of Infectious disease Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Andrea Giacometti
- Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elke Maria Erne
- Department of Infectious Disease, Azienda Sanitaria dell’Alto Adige, Central Hospital of Bolzano, Italy
| | - Maria Frontuto
- Infectious Diseases Unit, A.O.R. San Carlo, Potenza, Italy
| | | | - Valentina Summa
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences at the Unit of Infectious Diseases, University of Torino, Amedeo di Savoia Hospital, Torino, Italy
| | - Pierluigi Russo
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy
| | - Giorgio Palù
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy
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McAlister FA, Hsu Z, Dong Y, Tsuyuki RT, van Walraven C, Bakal JA. Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory-Care Sensitive Conditions During the COVID-19 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study. J Am Heart Assoc 2023; 12:e027922. [PMID: 36734338 PMCID: PMC9973663 DOI: 10.1161/jaha.122.027922] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Because the impact of changes in how outpatient care was delivered during the COVID-19 pandemic is uncertain, we designed this study to examine the frequency and type of outpatient visits between March 1, 2019 to February 29, 2020 (prepandemic) and from March 1, 2020 to February 28, 2021 (pandemic) and specifically compared outcomes after virtual versus in-person outpatient visits during the pandemic. Methods and Results Population-based retrospective cohort study of all 3.8 million adults in Alberta, Canada. We examined all physician visits and 30- and 90-day outcomes, with a focus on those adults with the cardiovascular ambulatory-care sensitive conditions heart failure, hypertension, and diabetes. Our primary outcome was emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk of death. Although in-person outpatient visits decreased by 38.9% in the year after March 1, 2020 (10 142 184 versus 16 592 599 in the prior year), the introduction of virtual visits (7 152 147; 41.4% of total) meant that total outpatient visits increased by 4.1% in the first year of the pandemic for Albertan adults. Outpatient visit frequency (albeit 41.4% virtual, 58.6% in-person) and prescribing patterns were stable in the first year after pandemic onset for patients with the cardiovascular ambulatory-care sensitive conditions we examined, but laboratory test frequency declined by 20% (serum creatinine) to 47% (glycosylated hemoglobin). In the first year of the pandemic, virtual outpatient visits were associated with fewer subsequent emergency department visits or hospitalizations (compared with in-person visits) for patients with heart failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85-0.96] at 30 days and 0.96 [95% CI, 0.92-1.00] at 90 days), hypertension (aHR, 0.88 [95% CI, 0.85-0.91] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days), or diabetes (aHR, 0.90 [95% CI, 0.87-0.93] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days). Conclusions The adoption and rapid uptake of virtual outpatient care during the COVID-19 pandemic did not negatively impact frequency of follow-up, prescribing, or short-term outcomes, and could have potentially positively impacted some of these for adults with heart failure, diabetes, or hypertension in a setting where there was an active reimbursement policy for virtual visits. Given declines in laboratory monitoring and screening activities, further research is needed to evaluate whether long-term outcomes will differ.
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Affiliation(s)
- Finlay A. McAlister
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada,Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Zoe Hsu
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Yuan Dong
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Ross T. Tsuyuki
- Departments of Pharmacology, Medicine, and EPICORE Centre, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Carl van Walraven
- Division of General Internal MedicineOttawa Hospital and the Ottawa Health Research InstituteOttawaOntarioCanada
| | - Jeffrey A. Bakal
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada,Provincial Research Data Services, Alberta Health ServicesEdmontonAlbertaCanada
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Ambrosio G, Gensini GF, Stracci F. Virtual Outpatient Visits During COVID-19 Pandemic: So Distant, Yet So Close. J Am Heart Assoc 2023; 12:e028817. [PMID: 36734346 PMCID: PMC9973659 DOI: 10.1161/jaha.122.028817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Giuseppe Ambrosio
- Division of Cardiology, and Center for Clinical and Translational Research (CERICLET)University of Perugia School of MedicinePerugiaItaly
| | | | - Fabrizio Stracci
- Section of Public Health, and Center for Clinical and Translational Research (CERICLET)University of Perugia School of MedicinePerugiaItaly
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Xoxi E, Rumi F, Kanavos P, Dauben HP, Gutierrez-Ibarluzea I, Wong O, Rasi G, Cicchetti A. A Proposal for Value-Based Managed Entry Agreements in an Environment of Technological Change and Economic Challenge for Publicly Funded Healthcare Systems. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:888404. [PMID: 35782579 PMCID: PMC9245041 DOI: 10.3389/fmedt.2022.888404] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Managed entry agreements (MEA) represent one of the main topics of discussion between the European National Payers Authorities. Several initiatives on the subject have been organized over the past few years and the scientific literature is full of publications on the subject. There is currently little international sharing of information between payers, mainly as a result of the confidentiality issues. There are potential benefits from the mutual sharing of information, both about the existence of MEAs and on the outcomes and results. The importance of involving all the players in the decision-making process on market access for a medicinal product (MP) is that it may help to make new therapies available to patients in a shorter time. The aim of this project is to propose a new pathway of value-based MEA (VBMEA), based on the analysis of the current Italian pricing and reimbursement framework. This requires elaboration of a transparent appraisal and MEA details with at least a 24-month contract. The price of the MP is therefore valued based on the analysis of the VBMEA registries of the Italian Medicines Agency. Although the proposal focuses on the Italian context, a similar approach could also be adapted in other nations, considering the particularities of the single health technology assessment (HTA)/payer system.
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Affiliation(s)
- Entela Xoxi
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Rumi
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Filippo Rumi
| | - Panos Kanavos
- London School of Economics and Political Science, London, United Kingdom
| | - Hans-Peter Dauben
- Rheinische Fachhochschule Köln, University for Applied Science, Köln, Germany
| | - Iñaki Gutierrez-Ibarluzea
- BIOEF, Public Foundation of the Department of Health to Promote Innovation and Research in Euskadi, Bilbao, Spain
| | | | - Guido Rasi
- Clinical Trial Center, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Americo Cicchetti
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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Russo P, Tacconelli E, Olimpieri PP, Celant S, Colatrella A, Tomassini L, Palù G. Mortality in SARS-CoV-2 Hospitalized Patients Treated with Remdesivir: A Nationwide, Registry-Based Study in Italy. Viruses 2022; 14:v14061197. [PMID: 35746668 PMCID: PMC9228114 DOI: 10.3390/v14061197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 12/20/2022] Open
Abstract
Remdesivir is the first drug approved for treatment of COVID-19 but current evidence for recommending its use for the treatment of moderate-to-severe disease is still controversial among clinical guidelines. We performed a nationwide, registry-based study including all Italian hospitalized patients with COVID-19 treated with remdesivir to assess the impact of major confounders on crude 15-day and 29-day mortality. Mortality was calculated using the Kaplan–Meier estimator and the Cox proportional-hazards model was applied to analyze the risks by patient’s baseline features. In total, 16,462 patients treated with remdesivir from 29 October 2020 to 17 December 2020 were entered in the study. Crude 15-day and 29-day mortality were 7.1% (95% CI, 6.7–7.5%) and 11.7% (95% CI, 11.2–12.2%), respectively. Being treated within two days of admission reduced the risk of death by about 40% (HR 1.4, 95% CI, 1.2–1.6). Results from the largest cohort of remdesivir-treated patients suggests that mortality in SARS-CoV-2 hospitalized patients is substantially influenced by the days between SARS-CoV-2 diagnosis and drug prescription. Current recommendations and future clinical trials for remdesivir alone or in combination should carefully consider the target population and timing for best efficacy of treatment.
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Affiliation(s)
- Pierluigi Russo
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy; (P.P.O.); (S.C.); (A.C.); (L.T.)
- Correspondence: (P.R.); (G.P.); Tel.: +39-06-5978-4583 (P.R.)
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, 37129 Verona, Italy;
| | - Pier Paolo Olimpieri
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy; (P.P.O.); (S.C.); (A.C.); (L.T.)
| | - Simone Celant
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy; (P.P.O.); (S.C.); (A.C.); (L.T.)
| | - Antonietta Colatrella
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy; (P.P.O.); (S.C.); (A.C.); (L.T.)
| | - Luca Tomassini
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy; (P.P.O.); (S.C.); (A.C.); (L.T.)
| | - Giorgio Palù
- Italian Medicines Agency, Via del Tritone 181, 00187 Rome, Italy; (P.P.O.); (S.C.); (A.C.); (L.T.)
- Correspondence: (P.R.); (G.P.); Tel.: +39-06-5978-4583 (P.R.)
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Gabet A, Grave C, Tuppin P, Lesuffleur T, Guenancia C, Nguyen-Thanh V, Guignard R, Blacher J, Olié V. Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope? Front Cardiovasc Med 2022; 9:856689. [PMID: 35548431 PMCID: PMC9081923 DOI: 10.3389/fcvm.2022.856689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population. Methods For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017–2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists. Results In 2020, IRR significantly decreased for initiations of antihypertensives (−11.1%[CI95%, −11.4%;−10.8%]), lipid-lowering drugs (−5.2%[CI95%, −5.5%;−4.8%]), oral anticoagulants in atrial fibrillation (−8.6%[CI95%, −9.1%;−8.0%]), and smoking cessation medications (−50.9%[CI95%, −51.1%;−50.7%]) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women. Conclusion The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.
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Affiliation(s)
- Amélie Gabet
- Santé Publique France, Paris, France
- *Correspondence: Amélie Gabet,
| | | | | | | | | | | | | | - Jacques Blacher
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, AP-HP, Université de Paris, Paris, France
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Airoldi F, Tavano D, Ambrosio G. Stress-testing interventional cardiology organization to streamline procedures during COVID-19 pandemic, and beyond. Int J Cardiol 2022; 354:84-85. [PMID: 35235840 PMCID: PMC8882250 DOI: 10.1016/j.ijcard.2022.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Davide Tavano
- Division of Cardiology, IRCCS MultiMedica, Milan, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, and Center for Clinical and Translational Researc-CERICLET, University of Perugia School of Medicine, Perugia, Italy.
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Transcatheter aortic valve implantation during COVID-19 pandemic: An optimized model to relieve healthcare system overload. Int J Cardiol 2022; 352:190-194. [PMID: 35077726 PMCID: PMC8783646 DOI: 10.1016/j.ijcard.2022.01.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
Background The coronavirus 2019 (COVID-19) pandemic upset healthcare systems and their logistics worldwide. We sought to assess safety and effectiveness of an optimized logistics for transcatheter aortic valve implantation (TAVI) pathway developed during the COVID-19 pandemic. Methods This is a retrospective analysis. An optimized TAVI logistics based on performing TAVI work-up and procedure during the same hospitalization was used during the COVID-19 pandemic. In-hospital and 30-day outcomes of patients treated during the pandemic were compared with an historical cohort of patients undergoing TAVI with staged work-up before the pandemic within an homogeneous timeframe. Results Of 536 patients, 227 (42.4%) underwent TAVI during the COVID-19 pandemic with a reduction of 26.5% compared to the pre-pandemic period (n = 309). The median age was 81 (77–85) years and STS score was 3.4 (2.2–5.6)%. Lower rates of in-hospital major vascular complications (2.2% vs. 8.7%; p < 0.01) and life-threatening bleeding (0.4% vs. 4.2%; p = 0.01) were reported in the COVID-19 period, whereas no difference in acute kidney injury (7.0% vs. 7.4%, p = 0.85) rate was reported between COVID-19 and pre-COVID-19 periods. No difference in 30-day rates of all-cause death (4.0 vs. 4.5, p = 0.75) and of major adverse cardiovascular events (4.0 vs. 6.1, p = 0.26) were reported between COVID-19 and pre-COVID-19 periods. Conclusions The use of optimized single-hospitalization logistics for TAVI workup and procedure developed during the COVID-19 pandemic, showed to be as safe and effective as the two-stage TAVI pathway previously adopted, allowing the minimization of potential exposure to COVID-19 infection and shortening times to treatment for severely symptomatic patients.
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Sofi F, Dinu M, Reboldi G, Stracci F, Pedretti RFE, Valente S, Gensini G, Gibson CM, Ambrosio G. Worldwide differences of hospitalization for ST-segment elevation myocardial infarction during COVID-19: A systematic review and meta-analysis. Int J Cardiol 2021; 347:89-96. [PMID: 34740717 PMCID: PMC8561779 DOI: 10.1016/j.ijcard.2021.10.156] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/04/2021] [Accepted: 10/29/2021] [Indexed: 12/30/2022]
Abstract
Background Discrepant data were reported about hospital admissions for ST-segment elevation myocardial infarction (STEMI) during COVID-19 pandemic. We reviewed studies reporting STEMI hospitalizations during COVID-19 pandemic, investigating whether differences in COVID-19 epidemiology or public health-related factors could explain discrepant findings in different countries. Methods Search through MedLine, Embase, Scopus, Web-of-Science, Cochrane Register of Controlled Trials, of studies comparing STEMI admissions during COVID-19 pandemic with a reference period, without language restrictions, as registered in PROSPERO International Prospective Register of Systematic Reviews. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Data independently extracted by multiple investigators were pooled using a random-effects model. Health-related metrics were from publicly-available sources. Results We included 79 articles (111,557 STEMI cases, from 57 countries). During peak COVID-19 pandemic, overall incidence rate-ratio (IRR) of STEMI hospitalizations over reference period decreased (0.80; 95% CI 0.76–0.84; p < 0.05). Although wide variations and significant heterogeneity were detected among studies (I2 = 89%; p < 0.0001), no significant differences were observed by report methodology (survey vs registry), or observation/reference period. However, large differences emerged at country level not explained by COVID-related epidemiological data, nor by public health strategies. Instead, IRRs for STEMI admissions were inversely related to hospital bed availability in each country (p < 0.05). Conclusions During COVID-19 pandemic hospitalization for STEMI significantly decreased, although to a smaller extent than initially reported. Large variability emerged across countries, unrelated to COVID-related epidemiology or social containment measures. Disparities in healthcare organization likely contributed, indicating that proper organization of emergency medicine should be preserved during pandemics.
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Affiliation(s)
- Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - GianPaolo Reboldi
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy; Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy
| | - Fabrizio Stracci
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | | | | | | | - C Michael Gibson
- Baim Institute for Clinical Research, Harvard Medical School, Boston, MS, United States of America
| | - Giuseppe Ambrosio
- Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.
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