Geographic variation in COVID-19 hospital admissions in France: a population-based study

The impact of various environmental, socio-economic, and epidemiological factors on COVID-19 transmission and severity is well-known. However, there is little evidence about the respective role of these factors at the population-level at a national scale. The objective was to identify the environmental and contextual factors that influenced the spread and the severity of COVID-19 at the French department level during the first national lockdown. We performed a national, population-based, retrospective analysis. The cumulative rate of patients admitted for COVID-19 to any public or private acute care hospital from March 31st, 2020 to May 25, 2020 was modelled at the ‘departement’ (hereafter county) level. We used spatial regression models to quantify the aggregated effect of population health status, air pollution, meteorological, and socioeconomic factors. 57,356 patients were admitted to an acute care facility for COVID-19 over the period of interest. At the county level, the age and sex-standardized rate of admission ranged from 0.07 to 3.24 admissions per 1,000 people. After adjustment on the pre-lockdown COVID-19 hospital admission rate, the standardized cumulative rate hospital admission for COVID-19 during the period of interest was significantly and positively associated with the prevalence of diabetes, with the prevalence of mental conditions, and with high cumulative exposure to atmospheric ozone values. It was significantly and negatively associated with high cumulative exposure to ultraviolet radiation. These results suggest that several population-based epidemiological and meteorological factors could have played a role in COVID-19 spread in France. They provide potentially useful insights to design and implement geographically differentiated public health policies.

Prevalence, severity and clinical correlates of left ventricular diastolic dysfunction in patients hospitalized with acute cardiac decompensation – a sub-study from the Acute Heart Failure

Background

To date, there are few prospective studies which characterize left ventricular diastolic dysfunction (LVDD) in patients with acute heart failure (AHF) using contemporary echo- and Doppler-techniques and take heart failure (HF) phenotype into account. Furthermore, prevalence and clinical correlates of different degrees of LVDD are unknown.

Purpose

To determine prevalence and echo characteristics of LVDD and identify clinical and biomarker correlates in patients hospitalized for AHF with either preserved (HFpEF, LVEF ≥50%) or reduced (HFrEF, LVEF <50%) LV systolic function.

Methods

The AHF Registry Würzburg enrols consecutive patients hospitalized for AHF. For the current analysis, patients with complete high-quality echo- and Doppler studies performed during the index hospitalization allowing for full quantitative analysis were eligible. Left ventricular ejection fraction (LVEF) was determined using Simpson's biplane method. LVDD was graded according to 2016 ESC recommendations based on the E/A-ratio and markers of left ventricular (LV) filling pressure: E/E'-ratio, LA volume, and estimated systolic pulmonary artery pressure (sPAP, derived from peak tricuspid regurgitant flow velocity and estimated right atrial pressure). E/A-ratio <0.8 or E/A-ratio 0.8–2.0 without evidence of increased LV filling pressure was classified as LVDD°I, an E/A-ratio between 0.8–2.0 with evidence of elevated filling pressure as LVDD°II, and an E/A-ratio >2.0 as LVDD°III. LVDD prevalence rates were determined overall and in patients with HFrEF and HFpEF, respectively. Furthermore, other echocardiographic, clinical, and biomarker characteristics were studied.

Results

Overall, 155 patients were eligible (37.4% female, mean age 71.6±12.0 years, LVEF 45.7±17.8%, 49.7% HFpEF, 50.3% HFrEF). Most patients (83.9%) had Doppler evidence of increased filling pressures, with either LVDD°II (48.4%, LVEF 48.6±18.6%) or LVDD°III (35.5%, LVEF 40.3±15.4%). Overall, HFrEF-patients had higher rates of LVDD°III (47.4 vs 23.4%, p=0.002), while HFpEF-patients had higher rates of LVDD°II (58.4 vs 38.5%, p=0.013) (Figure). LVDD°I was present in only 16.1% of all patients (HFpEF: n=14, HFrEF: n=11, LVEF 48.9±15.4%). Compared to patients with LVDD°II-III, this subgroup had lower E/E'-ratio (11.7 vs 19.5 p<0.001), sPAP (30.9±15.8 vs 44±12.5 mmHg, p<0.001) and LA volume index (36.4±17.67 vs 53.5±21.0 ml/m2, p<0.001). Furthermore, NT-proBNP-levels were lower (median [IQR] 2236 [1336; 5204] vs 4125 [2390; 4125] pg/ml, p=0.042) and heart failure (HF) history shorter (56.0 vs 33.1% HF known <1 year, p=0.029).

Conclusion

Among patients hospitalized for AHF, the majority had significant LVDD, irrespective of LVEF. However, LVDD°II was more common in HFpEF, whereas HFrEF patients had more LVDD°III. Furthermore, the small subgroup with LVDD°I had less severe sPAP elevation, lower LA volume and NT-proBNP and a shorter HF history indicating a less advanced HF stage.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Bundesministerium für Bildung und Forschung