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Srivastava PK, Klomhaus AM, Tehrani DM, Fonarow GC, Ziaeian B, Desai PS, Rafique A, de Lemos J, Parikh RV, Yang EH. Impact of Age and Variant Time Period on Clinical Presentation and Outcomes of Hospitalized Coronavirus Disease 2019 Patients. Mayo Clin Proc Innov Qual Outcomes 2023; 7:411-429. [PMID: 37731677 PMCID: PMC10507578 DOI: 10.1016/j.mayocpiqo.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Objective To evaluate the impact of age and COVID-19 variant time period on morbidity and mortality among those hospitalized with COVID-19. Patients and Methods Patients from the American Heart Association's Get With The Guidelines COVID-19 cardiovascular disease registry (January 20, 2020-February 14, 2022) were divided into groups based on whether they presented during periods of wild type/alpha, delta, or omicron predominance. They were further subdivided by age (young: 18-40 years; older: more than 40 years), and characteristics and outcomes were compared. Results The cohort consisted of 45,421 hospitalized COVID-19 patients (wild type/alpha period: 41,426, delta period: 3349, and omicron period: 646). Among young patients (18-40 years), presentation during delta was associated with increased odds of severe COVID-19 (OR, 1.6; 95% CI, 1.3-2.1), major adverse cardiovascular events (MACE) (OR, 1.8; 95% CI, 1.3-2.5), and in-hospital mortality (OR, 2.2; 95% CI, 1.5-3.3) when compared with presentation during wild type/alpha. Among older patients (more than 40 years), presentation during delta was associated with increased odds of severe COVID-19 (OR, 1.2; 95% CI, 1.1-1.3), MACE (OR, 1.5; 95% CI, 1.4-1.7), and in-hospital mortality (OR, 1.4; 95% CI, 1.3-1.6) when compared with wild type/alpha. Among older patients (more than 40 years), presentation during omicron associated with decreased odds of severe COVID-19 (OR, 0.7; 95% CI, 0.5-0.9) and in-hospital mortality (OR, 0.6; 95% CI, 0.5-0.9) when compared with wild type/alpha. Conclusion Among hospitalized adults with COVID-19, presentation during a time of delta predominance was associated with increased odds of severe COVID-19, MACE, and in-hospital mortality compared with presentation during wild type/alpha. Among older patients (aged more than 40 years), presentation during omicron was associated with decreased odds of severe COVID-19 and in-hospital mortality compared with wild type/alpha.
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Affiliation(s)
- Pratyaksh K. Srivastava
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - David M. Tehrani
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Boback Ziaeian
- Division of Cardiology, West Los Angeles Medical Center, Los Angeles, CA
| | - Pooja S. Desai
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Asim Rafique
- Division of Cardiology, Santa Monica UCLA Medical Center, Los Angeles, CA
| | - James de Lemos
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX
| | - Rushi V. Parikh
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Eric H. Yang
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
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Tehrani DM, Wang J, Lai P, Desai PS, Nguyen HL, Bang L, Yang EH, Vorobiof G, Nsair A, Aksoy O, Press MC, Parikh RV. Change in Invasively Measured Mean Pulmonary Artery Pressure After Transcatheter Mitral Valve Repair Is Associated With Heart Failure Readmission. Cardiol Res 2021; 12:302-308. [PMID: 34691328 PMCID: PMC8510655 DOI: 10.14740/cr1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pre-existing pulmonary hypertension is associated with poor outcomes after transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR). However, the impact of an immediate change in mean pulmonary artery pressure (ΔmPAP) following TMVr on outcomes is unknown. Methods Patients who underwent TMVr from December 2015 to February 18, 2020 at our institution for symptomatic 3-4+ MR and who had invasive hemodynamics measured immediately pre- and post-TMVR were included. Multivariate Cox regression analysis was performed to examine the association of ΔmPAP (post-TMVr - pre-TMVr mPAP) with the primary endpoint of heart failure (HF) readmission at 1 year. Secondary endpoints included all-cause mortality and the composite endpoint of HF readmission or all-cause mortality at 1 year. Results Among 55 patients, 55% were men, mean age was 72 ± 14.2 years, and mean ΔmPAP was -1.4 ± 8.2 mm Hg. Overall, HF readmission occurred in 14 (25%), death in 10 (18%), and the composite endpoint in 20 (36%) patients. In multivariable analyses, higher ΔmPAP was significantly associated with HF readmission (hazard ratio (HR) = 1.10, 95% confidence interval (CI): 1.00 - 1.21; P = 0.04). ΔmPAP was not associated with death (HR = 1.04, 95% CI: 0.96 - 1.14; P = 0.33), though there was a numerical but statistically non-significant trend towards the composite endpoint (HR = 1.06, 95% CI: 1.00 - 1.13; P = 0.06) driven by HF readmission. Conclusion Higher ΔmPAP immediately following TMVr was associated with increased HF readmission at 1 year. Larger prospective studies are needed to validate these data and further explore the utility of ΔmPAP as a novel hemodynamic parameter to predict post-TMVR outcomes.
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Affiliation(s)
- David M Tehrani
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jiexi Wang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Parntip Lai
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Pooja S Desai
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Heajung L Nguyen
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Lisa Bang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Gabriel Vorobiof
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ali Nsair
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Olcay Aksoy
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Marcella Calfon Press
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,These authors contributed equally to this article
| | - Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,These authors contributed equally to this article
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Desai PS, Fanous EJ, Tan W, Lee J, Trinh T, Rafique AM, Parikh RV, Press MC. Trajectory of Cardiac Catheterization for Acute Coronary Syndrome and Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic. Cardiol Res 2020; 12:47-50. [PMID: 33447325 PMCID: PMC7781261 DOI: 10.14740/cr1149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 01/20/2023] Open
Abstract
Background We sought to investigate the trajectory of cardiac catheterizations for acute coronary syndrome (ACS) and out-of-hospital cardiac arrest (OHCA) during the pre-isolation (PI), strict-isolation (SI), and relaxed-isolation (RI) periods of the coronavirus disease 2019 (COVID-19) pandemic at three hospitals in Los Angeles, CA, USA. Methods A retrospective analysis was conducted on adult patients undergoing urgent or emergent cardiac catheterization for suspected ACS or OHCA between January 1, 2020 and June 2, 2020 at three hospitals in Los Angeles, CA, USA. We designated January 1, 2020 to March 17, 2020 as the PI COVID-19 period, March 18, 2020 to May 5, 2020 as the SI COVID-19 period, and May 6, 2020 to June 2, 2020 as the RI COVID-19 period. Results From PI to SI, there was a significant reduction in mean weekly cases of catheterizations for non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA) (8.29 vs. 12.5, P = 0.019), with all other clinical categories trending downwards. From SI to RI, mean weekly cases of catheterizations for total ACS increased by 17%, NSTEMI/UA increased by 27%, and OHCA increased by 32%, demonstrating a “rebound effect”. Conclusions Cardiac catheterizations for ACS and NSTEMI/UA exhibited a “rebound effect” once social isolation was relaxed.
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Affiliation(s)
- Pooja S Desai
- Department of Internal Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Elias J Fanous
- Department of Internal Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Weiyi Tan
- Division of Interventional Cardiology, UCLA Medical Center, Los Angeles, CA, USA.,Division of Congenital Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - James Lee
- UCLA Cardiology Group, Henry Mayo Hospital, Valencia, CA, USA
| | - Tri Trinh
- UCLA Cardiology Group, Henry Mayo Hospital, Valencia, CA, USA
| | - Asim M Rafique
- Division of Interventional Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Rushi V Parikh
- Division of Interventional Cardiology, UCLA Medical Center, Los Angeles, CA, USA
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Deodhar KP, Desai PS, Haji KK, Pimparkar BD, Mehta JM. Hypoglycemia in alcoholics a preliminary report. J Assoc Physicians India 1974; 22:341-5. [PMID: 4413744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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