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Sofi F, Dinu M, Reboldi G, Lotti S, Genovese L, Tritto I, Gensini G, Gibson CM, Ambrosio G. Worldwide impact of COVID-19 on hospital admissions for non-ST-elevation acute coronary syndromes (NSTACS): a systematic review with meta-analysis of 553 038 cases. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:265-283. [PMID: 37580157 PMCID: PMC11112522 DOI: 10.1093/ehjqcco/qcad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND How coronavirus disease 2019 (COVID-19) impacted non-ST-segment elevation acute coronary syndromes (NSTACS) is an object of controversial reports. AIM To systematically review studies reporting NSTACS hospitalizations during the COVID-19 pandemic, and analyse whether differences in COVID-19 epidemiology, methodology of report, or public health-related factors could contribute to discrepant findings. METHODS Comprehensive search (Medline, Embase, Scopus, Web of Science, Cochrane Register), of studies reporting NSTACS hospitalizations during the COVID-19 pandemic compared with a reference period, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Data were independently extracted by multiple investigators and pooled using a random-effects model. Health-related metrics were from publicly available sources, and analysed through multiple meta-regression modelling. RESULTS We retrieved 102 articles (553 038 NSTACS cases, 40 countries). During peak COVID-19 pandemic, overall incidence rate ratio (IRR) of NSTACS hospitalizations over reference period decreased (0.70, 95% confidence interval (CI) 0.66-0.75; P < 0.00001). Significant heterogeneity was detected among studies (I2 = 98%; P < 0.00001). Importantly, wide variations were observed among, and within, countries. No significant differences were observed by study quality, whereas comparing different periods within 2020 resulted in greater decrease (IRR: 0.61; CI: 0.53-0.71) than comparing 2020 vs. previous years (IRR: 0.74; CI 0.69-0.79). Among many variables, major predictors of heterogeneity were severe acute respiratory syndrome coronavirus 2 reproduction rate/country, number of hospitals queried, and reference period length; country stringency index and socio-economical indicators did not contribute significantly. CONCLUSIONS During the COVID-19 pandemic, NSTACS hospitalizations decreased significantly worldwide. However, substantial heterogeneity emerged among countries, and within the same country. Factors linked to public health management, but also to methodologies to collect results may have contributed to this heterogeneity. TRIAL REGISTRATION The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42022308159).
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Affiliation(s)
- Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - GianPaolo Reboldi
- Department of Medicine, University of Perugia School of Medicine, Perugia 06126, Italy
- Center for Clinical and Translational Research—CERICLET, University of Perugia School of Medicine, Perugia 06126, Italy
| | - Sofia Lotti
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Luca Genovese
- Department of Cardiology, IRCCS MultiMedica, Milan 20138, Italy
| | - Isabella Tritto
- Division of Cardiology, University of Perugia School of Medicine, Perugia 06126, Italy
| | | | | | - Giuseppe Ambrosio
- Center for Clinical and Translational Research—CERICLET, University of Perugia School of Medicine, Perugia 06126, Italy
- Division of Cardiology, University of Perugia School of Medicine, Perugia 06126, Italy
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Wai AKC, Yip TF, Wong YH, Chu CK, Lee T, Yu KHO, So WL, Wong JYH, Wong CKH, Ho JW, Rainer T. The Effect of the COVID-19 Pandemic on Non-COVID-19 Deaths: Population-Wide Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e41792. [PMID: 38349717 PMCID: PMC10866203 DOI: 10.2196/41792] [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: 08/09/2022] [Revised: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non-COVID-19 deaths. OBJECTIVE This study aimed to measure the impact of hospital avoidance on excess non-COVID-19 deaths in public hospitals in Hong Kong. METHODS This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. RESULTS Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non-COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non-COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non-DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. CONCLUSIONS We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences.
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Affiliation(s)
- Abraham Ka-Chung Wai
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Accident & Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Accident & Emergency, Queen Mary Hospital, Hong Kong, China (Hong Kong)
| | - Tsz Fung Yip
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yui Hang Wong
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Chun Kit Chu
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Teddy Lee
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Ken Hung On Yu
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wang Leong So
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Janet Y H Wong
- School of Nursing & Health Studies, Hong Kong Metropolitan University, Kowloon, China (Hong Kong)
| | - Carlos King-Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joshua W Ho
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Timothy Rainer
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
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3
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Castanon A, Grasic K, Chen S, Ma F, Oboli G, Bray BD, Hughes A, White M, Ahmad S, Pearson-Stuttard J. The impact of the COVID-19 pandemic on cardiovascular disease prevention and corresponding geographical inequalities in England: interrupted time series analysis. BMC Public Health 2023; 23:2443. [PMID: 38062484 PMCID: PMC10702024 DOI: 10.1186/s12889-023-17282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There has been disruption to the detection and management of those with hypertension and atrial fibrillation (AF) during the COVID-19 pandemic. This is likely to vary geographically and could have implications for future mortality and morbidity. We aimed to estimate the change in diagnosed prevalence, treatment and prescription indicators for AF and hypertension and assess corresponding geographical inequalities. METHODS Using the Quality and Outcomes Framework (2016/17 to 2021/22) and the English Prescribing Datasets (2018 to 2022), we described age standardised prevalence, treatment and prescription item rates for hypertension and AF by geography and over time. Using an interrupted time-series (ITS) analysis, we estimated the impact of the pandemic (from April 2020) on missed diagnoses and on the percentage change in medicines prescribed for these conditions. Finally, we described changes in treatment indicators against Public Health England 2029 cardiovascular risk targets. RESULTS We observed 143,822 fewer (-143,822, 95%CI:-226,144, -61,500, p = 0.001) diagnoses of hypertension, 60,330 fewer (-60,330, 95%CI: -83,216, -37,444, p = 0.001) diagnoses of AF and 1.79% fewer (-1.79%, 95%CI: -2.37%, -1.22%), p < 0.0001) prescriptions for these conditions over the COVID-19 impact period. There was substantial variation across geography in England in terms of the indirect impact of the COVID-19 pandemic on the diagnosis, prescription, and treatment rates of hypertension and AF. 20% of Sub Integrated Care Boards account for approximately 62% of all missed diagnoses of hypertension. The percentage of individuals who had their hypertension controlled fell from 75.8% in 2019/20 to 64.1% in 2021/22 and the percentage of individuals with AF who were risk assessed fell from 97.2% to 90.7%. CONCLUSIONS Hypertension and AF detection and management were disrupted during the COVID-19 pandemic. The disruption varied considerably across diseases and geography. This highlights the utility of administrative and geographically granular datasets to inform targeted efforts to mitigate the indirect impacts of the pandemic through applied secondary prevention measures.
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Affiliation(s)
- Alejandra Castanon
- Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK.
| | - Katja Grasic
- Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK
| | - Simon Chen
- Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK
| | - Florence Ma
- Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK
| | - Godspower Oboli
- Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK
| | - Benjamin D Bray
- Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK
| | - Andrew Hughes
- Office for Health Improvement and Disparities (OHID), Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Martin White
- Office for Health Improvement and Disparities (OHID), Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Shahed Ahmad
- NHS England, 133-155 Waterloo Rd, London, SE1 8UG, UK
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Djuikoue CI, Yamdeu Djonkouh W, Epie Bekolo C, Kamga Wouambo R, Carrel Founou R, Djouela Djoulako PD, Tonfak Temgoua G, Pokam BDT, Antoine-Moussiaux N, Apalata TR. Prevalence and Antibiotic Resistance Pattern of Streptococcus, Staphylococcus, Neisseria meningitidis and Enterobacteriaceae in Two Reference Hospitals of Yaoundé: An Overview before and during COVID-19 Pandemic Era. Antibiotics (Basel) 2023; 12:antibiotics12050929. [PMID: 37237832 DOI: 10.3390/antibiotics12050929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The COVID-19 pandemic led to tremendously use of antimicrobial due to the lack of proper treatment strategies, raising concerns about emergence of antimicrobial resistance (AMR). This study aimed at determining the prevalence and antibiotic resistance pattern of selected bacteria isolates in 02 referral health facilities in Yaoundé before and during the COVID-19 pandemic era. We conducted a retrospective study over a period of 03 years (from 1 January 2019 to 31 December 2021) in the bacteriology units of the Central and General Hospitals of Yaoundé, Cameroon. Data on bacteria genera (Streptococcus, Staphylococcus, Neisseria meningitidis and Enterobacteriaceae) as well as their corresponding specifics antibiotics: Cefixime, azythromycin and erythromycin were obtained from laboratory records. The global resistance rate of bacteria as well as their correlation with antibiotics according to COVID-19 pandemic era was determined and compared. For p < 0.05, the difference was statistically significant. In all, 426 bacterial strains were included. It appeared that the highest number of bacteria isolates and lowest rate of bacterial resistance were recorded during the pre-COVID-19 period in 2019 (160 isolates vs. 58.8% resistance rate). Conversely, lower bacteria strains but greater resistance burden were recorded during the pandemic era (2020 and 2021) with the lowest bacteria amount and peak of bacteria resistance registered in 2020, the year of COVID-19 onset (120 isolates vs. 70% resistance in 2020 and 146 isolates vs. 58.9% resistance in 2021). In contrast to almost all others groups of bacteria where the resistance burden was quite constant or decreasing over years, the Enterobacteriaceae exhibited greater resistance rate during the pandemic period [60% (48/80) in 2019 to 86.9% (60/69) in 2020 and 64.5% (61/95) in 2021)]. Concerning antibiotics, unlike erythromycin, azythromycin related resitance increased during the pandemic period and the resistance to Cefixim tends to decrease the year of the pandemic onset (2020) and re-increase one year therafter. A significant association was found between resistant Enterobacteriaceae strains and cefixime (R = 0.7; p = 0.0001) and also, between resistant Staphylococcus strains and erythromycin (R = 0.8; p = 0.0001). These retrospective data showed a herogeneous MDR bacteria rate and antibiotic resistance pattern over time before and during the COVID-19 pandemic era suggesting that antimicrobial resistance needs to be more closely monitored.
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Affiliation(s)
- Cecile Ingrid Djuikoue
- Department of Public Health, Faculty of Health Sciences, University of Montagnes, Bangangte 00237, Cameroon
- American Association of Microbiology (ASM), ASM Cameroon, Bangangte 00237, Cameroon
| | - Willy Yamdeu Djonkouh
- Department of Public Health, Faculty of Health Sciences, University of Montagnes, Bangangte 00237, Cameroon
- American Association of Microbiology (ASM), ASM Cameroon, Bangangte 00237, Cameroon
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang 00237, Cameroon
- Foundation of Epidemiological Surveillance of Biological Germs, Douala 00237, Cameroon
| | - Cavin Epie Bekolo
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang 00237, Cameroon
| | - Rodrigue Kamga Wouambo
- American Association of Microbiology (ASM), ASM Cameroon, Bangangte 00237, Cameroon
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, University of Leipzig, 04103 Leipzig, Germany
| | - Raspail Carrel Founou
- Department of Microbiology-Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang 00237, Cameroon
- Antimicrobial Research Unit, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durba 4001, South Africa
- Antimicrobial Resistance and Infectious Diseases (ARID), Research Institute of Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI), Yaoundé 00237, Cameroon
| | - Paule Dana Djouela Djoulako
- American Association of Microbiology (ASM), ASM Cameroon, Bangangte 00237, Cameroon
- Faculty of Medicine, Sorbonne University, 75013 Paris, France
| | - Gilder Tonfak Temgoua
- Foundation of Epidemiological Surveillance of Biological Germs, Douala 00237, Cameroon
- Deido District Hospital, Douala 00237, Cameroon
| | | | - Nicolas Antoine-Moussiaux
- Fundamental and Applied Research for Animals and Health, Faculty of Veterinary Medicine, University of Liege, 4000 Liège, Belgium
| | - Teke R Apalata
- Faculty of Health Sciences, Walter Sisulu University, Mthatha 5099, South Africa
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5
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Dale CE, Takhar R, Carragher R, Katsoulis M, Torabi F, Duffield S, Kent S, Mueller T, Kurdi A, Le Anh TN, McTaggart S, Abbasizanjani H, Hollings S, Scourfield A, Lyons RA, Griffiths R, Lyons J, Davies G, Harris D, Handy A, Mizani MA, Tomlinson C, Thygesen JH, Ashworth M, Denaxas S, Banerjee A, Sterne JAC, Brown P, Bullard I, Priedon R, Mamas MA, Slee A, Lorgelly P, Pirmohamed M, Khunti K, Morris AD, Sudlow C, Akbari A, Bennie M, Sattar N, Sofat R. The impact of the COVID-19 pandemic on cardiovascular disease prevention and management. Nat Med 2023; 29:219-225. [PMID: 36658423 DOI: 10.1038/s41591-022-02158-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/28/2022] [Indexed: 01/21/2023]
Abstract
How the Coronavirus Disease 2019 (COVID-19) pandemic has affected prevention and management of cardiovascular disease (CVD) is not fully understood. In this study, we used medication data as a proxy for CVD management using routinely collected, de-identified, individual-level data comprising 1.32 billion records of community-dispensed CVD medications from England, Scotland and Wales between April 2018 and July 2021. Here we describe monthly counts of prevalent and incident medications dispensed, as well as percentage changes compared to the previous year, for several CVD-related indications, focusing on hypertension, hypercholesterolemia and diabetes. We observed a decline in the dispensing of antihypertensive medications between March 2020 and July 2021, with 491,306 fewer individuals initiating treatment than expected. This decline was predicted to result in 13,662 additional CVD events, including 2,281 cases of myocardial infarction and 3,474 cases of stroke, should individuals remain untreated over their lifecourse. Incident use of lipid-lowering medications decreased by 16,744 patients per month during the first half of 2021 as compared to 2019. By contrast, incident use of medications to treat type 2 diabetes mellitus, other than insulin, increased by approximately 623 patients per month for the same time period. In light of these results, methods to identify and treat individuals who have missed treatment for CVD risk factors and remain undiagnosed are urgently required to avoid large numbers of excess future CVD events, an indirect impact of the COVID-19 pandemic.
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Affiliation(s)
- Caroline E Dale
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Rohan Takhar
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Raymond Carragher
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Michail Katsoulis
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | | | - Seamus Kent
- National Institute for Health and Care Excellence, London, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Thu Nguyen Le Anh
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - Hoda Abbasizanjani
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | | | | | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Gareth Davies
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Daniel Harris
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Alex Handy
- Institute of Health Informatics, University College London, London, UK
| | - Mehrdad A Mizani
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | | | - Johan H Thygesen
- Institute of Health Informatics, University College London, London, UK
| | | | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
- Health Data Research UK, London, UK
- BHF Accelerator, University College London, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
| | | | | | - Rouven Priedon
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | | | | | - Paula Lorgelly
- Department of Applied Health Research, University College London, London, UK
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Cathie Sudlow
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK.
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK.
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Buchan TA, Kugathasan L, Kobulnik J, Poon S, Runeckles K, Fan S, Ross HJ, Alba AC. Increased Mortality in Patients With Acutely Decompensated Heart Failure During the COVID-19 Pandemic in Toronto, Canada. CJC Open 2022; 4:772-781. [PMID: 35765461 PMCID: PMC9221741 DOI: 10.1016/j.cjco.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022] Open
Abstract
Background Methods Results Conclusions
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Rácz ÁO, Szabó GT, Erdei N, Győry F, Kolozsvári RV. Heart failure caused by Takayasu's arteritis in the time of COVID-19: a case report. ESC Heart Fail 2022; 9:3602-3607. [PMID: 35808997 DOI: 10.1002/ehf2.14054] [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: 01/05/2022] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
The case of a 35-year-old female with heart failure is presented, where the symptoms overlap with the heterogeneous manifestations of coronavirus disease 2019 (COVID-19). Those similarities and a recent shift in priorities during the SARS-CoV-2 pandemic delayed the recognition of acute heart failure in this patient. During the differential diagnostic process, obliterative disease was discovered in the bilateral subclavian and right renal arteries, and the latter resulted in uncontrolled hypertension, which played a significant role in the development of heart failure. The aetiology of vascular alterations turned out to be Takayasu's arteritis. Diagnosing Takayasu's arteritis is typically not straightforward due to its nonspecific signs and symptoms. Therefore, it can be concluded from our case report that the rising incidence of COVID-19 and focus on ruling out infection can potentially defer alternative, but appropriate diagnostic tests, particularly for certain conditions like rare diseases. Early identification and intervention is especially important for treating acute heart failure, whereas delay increases the risk of severe complications and mortality.
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Affiliation(s)
- Ágnes Orsolya Rácz
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Tamás Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Erdei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Győry
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rudolf Viktor Kolozsvári
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Jain V, Clarke J, Beaney T. Association between democratic governance and excess mortality during the COVID-19 pandemic: an observational study. J Epidemiol Community Health 2022; 76:jech-2022-218920. [PMID: 35768188 PMCID: PMC9271843 DOI: 10.1136/jech-2022-218920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Excess mortality has been used to assess the overall health impact of COVID-19 across countries. Democracies aim to build trust in government and enable checks and balances on decision making, which may be useful in a pandemic. But during the pandemic, they have been criticised as being hesitant to enforce restrictive public health measures. METHODS Through linking open-access datasets we constructed univariable and multivariable linear regression models investigating the association between country V-Dem Liberal Democracy Indices (LDI), representing strength of democratic governance and excess mortality rates, from January 2020 to September 2021. We adjusted for several important confounders and conducted a range of sensitivity analyses to assess the robustness of our findings. RESULTS Across 78 countries, 4.19 million deaths million excess deaths were recorded. On multivariable regression, a one-point increase in V-Dem LDI was associated with a decrease in excess mortality of 2.18 per 100 000 (p=0.004), after accounting for age, gender, wealth and universal health coverage. This association was only partially attenuated by COVID-19 vaccination rates and remained robust in all sensitivity analyses. CONCLUSIONS Democratic governance may have played an important role in mitigating the overall health impact of COVID-19 across countries. This study strengthens the case to broaden the scope of traditional pandemic risk assessment and discussions on preparedness.
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Affiliation(s)
- Vageesh Jain
- Institute for Global Health, University College London, London, UK
| | - Jonathan Clarke
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
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9
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He L, Lu F, Du X, Long D, Sang C, Tang R, Dong J, Guo M, Ma C. Impact of COVID-19 Pandemic on Hospital Admissions of Acute Coronary Syndrome: A Beijing Inpatient Database Study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 19:100335. [PMID: 34927111 PMCID: PMC8665660 DOI: 10.1016/j.lanwpc.2021.100335] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Consequences of reduced acute coronary syndrome (ACS) admissions during COVID-19 pandemic periods were reported by different countries. However, admissions, treatments, and prognosis of ACS during and after COVID-19 pandemic in Beijing, China was unknown. Methods Information on ACS admissions and heart failure (HF) admission were identified from database of Beijing Municipal Health Commission Information Center. Study period was defined as December 1, 2019 to June 30, 2020, and control period was defined as December 1, 2018 to June 30, 2019. Numbers of admission for HF during the control period, the study period, and seven months after study period were compared to evaluate the consequence of changed ACS care during the COVID-19 pandemic. Findings Admissions for ST-elevation myocardial infarction (STEMI), Non-ST-elevation myocardial infarction (Non-STEMI), and unstable angina (UAP) reduced by 38·0%, 41·0%, and 63·3% (N = 1953, 1991, 7664 between January 24, 2020 to June 30, 2020 vs. N = 3150, 3373, and 20,868 between January 24, 2019 to June 30, 2019) in study period. Percutaneous coronary intervention performed within 24 h were significantly more frequent during study period in patients with STEMI (37·9% vs. 31·7%, P<0·0001), but significantly less frequent in patients with Non-STEMI (7·9% vs. 9·5%, P = 0·049), and in patients with UAP (1·7% vs. 3·5%, P<0·0001). In-hospital mortality rates in patients with ACS were similar during the study period and the control period (3·1% vs 2·5%, P = 0·174 for STEMI; 2·7% vs 2·3%, P = 0·429 for Non-STEMI; 0·2% vs 0·1%, P = 0·222 for UAP). A fall by 23.9% for HF admissions was also observed during the seven months following the study period than equivalent period in 2019. Interpretation During COVID-19 pandemic, ACS admissions reduced significantly in Beijing; however, increase of HF admissions was not observed within seven months post-pandemic period, implying the pandemic didn't deteriorate the short-term prognosis for ACS. Funding the National Natural Science Foundation of China (82,103,904), the National Key Research and Development Program of China (Grant number: 2020YFC2004803).
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Affiliation(s)
- Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China.,Heart Health Research Center, Beijing, China.,The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Moning Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
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10
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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: 33] [Impact Index Per Article: 11.0] [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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11
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Bogos K, Kiss Z, Kerpel Fronius A, Temesi G, Elek J, Madurka I, Cselkó Z, Csányi P, Abonyi-Tóth Z, Rokszin G, Barcza Z, Moldvay J. Different Trends in Excess Mortality in a Central European Country Compared to Main European Regions in the Year of the COVID-19 Pandemic (2020): a Hungarian Analysis. Pathol Oncol Res 2021; 27:1609774. [PMID: 34257618 PMCID: PMC8262208 DOI: 10.3389/pore.2021.1609774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
Objective: This study examined cumulative excess mortality in European countries in the year of the Covid-19 pandemic and characterized the dynamics of the pandemic in different countries, focusing on Hungary and the Central and Eastern European region. Methods: Age-standardized cumulative excess mortality was calculated based on weekly mortality data from the EUROSTAT database, and was compared between 2020 and the 2016-2019 reference period in European countries. Results: Cumulate weekly excess mortality in Hungary was in the negative range until week 44. By week 52, it reached 9,998 excess deaths, corresponding to 7.73% cumulative excess mortality vs. 2016-2019 (p-value = 0.030 vs. 2016-2019). In Q1, only Spain and Italy reported excess mortality compared to the reference period. Significant increases in excess mortality were detected between weeks 13 and 26 in Spain, United Kingdom, Belgium, Netherland and Sweden. Romania and Portugal showed the largest increases in age-standardized cumulative excess mortality in the Q3. The majority of Central and Eastern European countries experienced an outstandingly high impact of the pandemic in Q4 in terms of excess deaths. Hungary ranked 11th in cumulative excess mortality based on the latest available data of from the EUROSTAT database. Conclusion: Hungary experienced a mortality deficit in the first half of 2020 compared to previous years, which was followed by an increase in mortality during the second wave of the COVID-19 pandemic, reaching 7.7% cumulative excess mortality by the end of 2020. The excess was lower than in neighboring countries with similar dynamics of the pandemic.
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Affiliation(s)
- Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Zoltan Kiss
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | | | | | - Jenő Elek
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Ildikó Madurka
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Péter Csányi
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | | | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - Judit Moldvay
- 1st Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
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12
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Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I, Banerjee A. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021; 372:n693. [PMID: 33789877 PMCID: PMC8010267 DOI: 10.1136/bmj.n693] [Citation(s) in RCA: 372] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population. DESIGN Retrospective cohort study. SETTING NHS hospitals in England. PARTICIPANTS 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records. MAIN OUTCOME MEASURES Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity. RESULTS Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). CONCLUSIONS Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.
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Affiliation(s)
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Vahé Nafilyan
- Office for National Statistics, Government Buildings, Newport, UK
| | - Thomas Maddox
- Office for National Statistics, Government Buildings, Newport, UK
| | - Ben Humberstone
- Office for National Statistics, Government Buildings, Newport, UK
| | - Ian Diamond
- Office for National Statistics, Government Buildings, Newport, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- University College London Hospitals NHS Trust, London, UK
- Barts Health NHS Trust, Royal London Hospital, London, UK
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