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Machowski M, Ou-Pokrzewińska A, Perzanowska-Brzeszkiewicz K, Gałecka-Nowak M, Pacho S, Jermakow M, Wójcik A, Zoruk M, Pruszczyk A, Deutsch K, Roik M, Łabyk A, Palczewski P, Pruszczyk P. Predicting Acute Cardiovascular Complications in COVID-19: Insights from a Specialized Cardiac Referral Department. Med Sci Monit 2024; 30:e942612. [PMID: 38644597 PMCID: PMC11047208 DOI: 10.12659/msm.942612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND COVID-19 increases the risk of acute cardiovascular diseases (CVDs), including acute coronary syndrome (ACS), acute pulmonary embolism (APE), and acute myocarditis (AMyo). The actual impact of CVDs on mortality of patients with COVID-19 remains unknown. This study aimed to determine whether CVDs influence the course of COVID-19 pneumonia and if they can be easily detected by using common tests and examinations. MATERIAL AND METHODS Data of 249 consecutive patients with COVID-19 hospitalized in a dedicated cardiology department were analyzed. On admission, clinical status, biomarkers, computed tomography, and bedside echocardiography were performed. RESULTS D-dimer level predicted APE (AUC=0.850 95% CI [0.765; 0.935], P<0.001) with sensitivity of 69.4% and specificity of 96.2% for a level of 4968.0 ng/mL, and NT-proBNP predicted AMyo (AUC=0.692 95% CI [0.502; 0.883], P=0.004) and showed sensitivity of 54.5%, with specificity of 86.5% for the cut-off point of 8970 pg/mL. Troponin T levels were not useful for diagnostic differentiation between CVDs. An extent of lung involvement predicted mortality (OR=1.03 95% CI [1.01;1.04] for 1% increase, P<0.001). After adjusting for lung involvement, ACS increased mortality, compared with COVID-19 pneumonia only (OR=5.27 95% CI [1.76; 16.38] P=0.003), while APE and AMyo did not affect risk for death. CONCLUSIONS D-dimer and NT-proBNP, but not troponin T, are useful in differentiating CVDs in patients with COVID-19. ACS with COVID-19 increased in-hospital mortality independently from extent of lung involvement, while coexisting APE or AMyo did not.
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Affiliation(s)
- Michał Machowski
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Aisha Ou-Pokrzewińska
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Perzanowska-Brzeszkiewicz
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Gałecka-Nowak
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Pacho
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Jermakow
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Wójcik
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Milena Zoruk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Karol Deutsch
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Łabyk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland
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Bilal MI, Gajjar R, Bobba A, Zabel KM, Davis MG, Nasrullah A, Gangu K, Sheikh AB, Yadav N. Assessing 30-day readmissions and outcomes in acute heart failure patients with concurrent COVID-19: A nationwide study during the 2020 pandemic. Curr Probl Cardiol 2024; 49:102246. [PMID: 38048854 DOI: 10.1016/j.cpcardiol.2023.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Acute heart failure (HF) is a significant cause of readmission and mortality, particularly within 30 days post-discharge. The interplay between COVID-19 and HF is still being studied. METHODS This retrospective study utilized The National Readmission Database to examine outcomes and predictors among patients with COVID-19 and concomitant acute HF between January 1, 2020, and November 31, 2020. 53,336 index hospitalizations and 8,158 readmissions were included. The primary outcome was the 30-day all-cause readmission rate. Predictor variables included patient demographics, medical comorbidities and discharge disposition. RESULTS The primary outcome was 21.2 %. COVID-19 infection was the most predominant all-cause reason for acute HF readmission (24.7 %). Hypertensive heart disease with chronic kidney disease was the most prevalent cardiac cause (7.7 %). Mortality rate during index hospitalization was significantly higher compared to readmission. CONCLUSIONS The highlighted prevalent complications, comorbidities, and demographics driving readmissions offer valuable insights to improve outcomes in this population.
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Affiliation(s)
| | - Rohan Gajjar
- Department of Internal Medicine, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Aniesh Bobba
- Department of Cardiology, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Kenneth M Zabel
- Department of Internal Medicine, University of New Mexico Health System, Albuquerque, NM, USA
| | - Monique G Davis
- Department of Internal Medicine, University of New Mexico Health System, Albuquerque, NM, USA
| | - Adeel Nasrullah
- Department of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg PA, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health System, 1 University of New Mexico, Albuquerque, NM, 87131, MSC10-55501, NM, USA.
| | - Neha Yadav
- Department of Cardiology, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
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3
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Dai S, Cao T, Shen H, Zong X, Gu W, Li H, Wei L, Huang H, Yu Y, Chen Y, Ye W, Hua F, Fan H, Shen Z. Landscape of molecular crosstalk between SARS-CoV-2 infection and cardiovascular diseases: emphasis on mitochondrial dysfunction and immune-inflammation. J Transl Med 2023; 21:915. [PMID: 38104081 PMCID: PMC10725609 DOI: 10.1186/s12967-023-04787-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND SARS-CoV-2, the pathogen of COVID-19, is a worldwide threat to human health and causes a long-term burden on the cardiovascular system. Individuals with pre-existing cardiovascular diseases are at higher risk for SARS-CoV-2 infection and tend to have a worse prognosis. However, the relevance and pathogenic mechanisms between COVID-19 and cardiovascular diseases are not yet completely comprehended. METHODS Common differentially expressed genes (DEGs) were obtained in datasets of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) infected with SARS-CoV-2 and myocardial tissues from heart failure patients. Further GO and KEGG pathway analysis, protein-protein interaction (PPI) network construction, hub genes identification, immune microenvironment analysis, and drug candidate predication were performed. Then, an isoproterenol-stimulated myocardial hypertrophy cell model and a transverse aortic constriction-induced mouse heart failure model were employed to validate the expression of hub genes. RESULTS A total of 315 up-regulated and 78 down-regulated common DEGs were identified. Functional enrichment analysis revealed mitochondrial metabolic disorders and extensive immune inflammation as the most prominent shared features of COVID-19 and cardiovascular diseases. Then, hub DEGs, as well as hub immune-related and mitochondria-related DEGs, were screened. Additionally, nine potential therapeutic agents for COVID-19-related cardiovascular diseases were proposed. Furthermore, the expression patterns of most of the hub genes related to cardiovascular diseases in the validation dataset along with cellular and mouse myocardial damage models, were consistent with the findings of bioinformatics analysis. CONCLUSIONS The study unveiled the molecular networks and signaling pathways connecting COVID-19 and cardiovascular diseases, which may provide novel targets for intervention of COVID-19-related cardiovascular diseases.
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Affiliation(s)
- Shiyu Dai
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Ting Cao
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Han Shen
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Xuejing Zong
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Wenyu Gu
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Hanghang Li
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Lei Wei
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Haoyue Huang
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Yunsheng Yu
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Yihuan Chen
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Wenxue Ye
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Fei Hua
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Hongyou Fan
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery of the First Affiliated Hospital and Institute for Cardiovascular Science, Suzhou Medical College, Soochow University, Suzhou, 215006, China.
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Boulos PK, Freeman SV, Henry TD, Mahmud E, Messenger JC. Interaction of COVID-19 With Common Cardiovascular Disorders. Circ Res 2023; 132:1259-1271. [PMID: 37167359 PMCID: PMC10171313 DOI: 10.1161/circresaha.122.321952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.
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Affiliation(s)
- Peter K. Boulos
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Scott V. Freeman
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (E.M.)
| | - John C. Messenger
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
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5
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Nasrullah A, Gangu K, Cannon HR, Khan UA, Shumway NB, Bobba A, Sagheer S, Chourasia P, Shuja H, Avula SR, Shekhar R, Sheikh AB. COVID-19 and Heart Failure with Preserved and Reduced Ejection Fraction Clinical Outcomes among Hospitalized Patients in the United States. Viruses 2023; 15:v15030600. [PMID: 36992309 PMCID: PMC10053519 DOI: 10.3390/v15030600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Heart failure exacerbations impart significant morbidity and mortality, however, large- scale studies assessing outcomes in the setting of concurrent coronavirus disease-19 (COVID-19) are limited. We utilized National Inpatient Sample (NIS) database to compare clinical outcomes in patients admitted with acute congestive heart failure exacerbation (CHF) with and without COVID-19 infection. A total of 2,101,980 patients (Acute CHF without COVID-19 (n = 2,026,765 (96.4%) and acute CHF with COVID-19 (n = 75,215, 3.6%)) were identified. Multivariate logistic regression analysis was utilized to compared outcomes and were adjusted for age, sex, race, income level, insurance status, discharge quarter, Elixhauser co-morbidities, hospital location, teaching status and bed size. Patients with acute CHF and COVID-19 had higher in-hospital mortality compared to patients with acute CHF alone (25.78% vs. 5.47%, adjust OR (aOR) 6.3 (95% CI 6.05–6.62, p < 0.001)) and higher rates of vasopressor use (4.87% vs. 2.54%, aOR 2.06 (95% CI 1.86–2.27, p < 0.001), mechanical ventilation (31.26% vs. 17.14%, aOR 2.3 (95% CI 2.25–2.44, p < 0.001)), sudden cardiac arrest (5.73% vs. 2.88%, aOR 1.95 (95% CI 1.79–2.12, p < 0.001)), and acute kidney injury requiring hemodialysis (5.56% vs. 2.94%, aOR 1.92 (95% CI 1.77–2.09, p < 0.001)). Moreover, patients with heart failure with reduced ejection fraction had higher rates of in-hospital mortality (26.87% vs. 24.5%, adjusted OR 1.26 (95% CI 1.16–1.36, p < 0.001)) with increased incidence of vasopressor use, sudden cardiac arrest, and cardiogenic shock as compared to patients with heart failure with preserved ejection fraction. Furthermore, elderly patients and patients with African-American and Hispanic descents had higher in-hospital mortality. Acute CHF with COVID-19 is associated with higher in-hospital mortality, vasopressor use, mechanical ventilation, and end organ dysfunction such as kidney failure and cardiac arrest.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66103, USA
| | - Harmon R. Cannon
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Umair A. Khan
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Nichole B. Shumway
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Aneish Bobba
- Department of Medicine, John H Stronger Hospital, Cook County, Chicago, IL 60612, USA
| | - Shazib Sagheer
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA 22401, USA
| | - Hina Shuja
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Sindhu Reddy Avula
- Department of Interventional Cardiology, Division of Cardiology, University of Kansas, St. Francis Campus, Kansas City, KS 66606, USA
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
- Correspondence: ; Tel.: +1-5052724661
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6
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Wadiwala IJ, Garg P, Alomari M, Elawady MS, Alamouti‐Fard E, Raavi L, Mateen N, Khan F, Hussain MWA, Pham SM, Jacob S. Accelerated LVAD pump thrombosis in COVID-19 patient: Case report and mini review. J Card Surg 2022; 37:5313-5319. [PMID: 36345681 PMCID: PMC9878257 DOI: 10.1111/jocs.17097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Coronavirus (COVID-19) infection exposes patients with heart failure specially who are on mechanical support to a higher risk of morbidity and mortality. AIMS To investigate the impact of COVID-19 infection on left ventricular assist device (LVAD) thrombosis in heart failure patients. MATERIALS & METHODS We searched the medical electronic records, Medline, PubMed and Cochrane databases for; (LVAD) AND (thrombosis)) AND (covid-19)) AND (heart failure). We divided cases reported into, LVAD thrombosis with COVID-19 infection and compare them with LVAD thrombosis without COVID-19 infection. Demographic data, LVAD device, presentation, treatment and outcomes were reviewed in all the LVAD thrombosis patients. RESULTS In addition to our case, 8 other cases of LVAD thrombosis associated with COVID and 9 cases of LVAD thrombosis without covid infection were found. Patients with Covid infection had worse presentation and outcomes (3 deaths VS. 1 death in non-covid group). DISCUSSION In LVAD patients, pump malfunction due to thrombus development in the inflow cannula, device body, or outflow graft can result in hemodynamic instability, hemolysis and other life-threatening complications. COVID infection significantly increases the risk of mortality in LVAD patient by accelerating the pump thrombosis due to elevated levels of endothelial protein C receptor and thrombomodulin along with procoagulants such as factor VIII, P-selectin, and von Willebrand factor. CONCLUSION Significant morbidity and mortality are attributed to LVAD thrombosis, which are exasperated by prothrombotic conditions created in COVID-19 infections.
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Affiliation(s)
- Ishaq J. Wadiwala
- Department of Cardiothoracic Surgery Research UnitMayo ClinicJacksonvilleFloridaUSA
| | - Pankaj Garg
- Department of Cardiothoracic SurgeryMayo ClinicJacksonvilleFloridaUSA
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery Research UnitMayo ClinicJacksonvilleFloridaUSA
| | - Mohamed S. Elawady
- Department of Cardiothoracic Surgery Research UnitMayo ClinicJacksonvilleFloridaUSA
| | - Emad Alamouti‐Fard
- Department of Cardiothoracic Surgery Research UnitMayo ClinicJacksonvilleFloridaUSA
| | - Lekhya Raavi
- Department of Cardiothoracic Surgery Research UnitMayo ClinicJacksonvilleFloridaUSA
| | - Nargis Mateen
- Department of Cardiothoracic Surgery Research UnitMayo ClinicJacksonvilleFloridaUSA
| | - Fazal Khan
- Department of Cardiothoracic Surgery Research UnitMayo ClinicJacksonvilleFloridaUSA
| | | | - Si M. Pham
- Department of Cardiothoracic SurgeryMayo ClinicJacksonvilleFloridaUSA
| | - Samuel Jacob
- Department of Cardiothoracic SurgeryMayo ClinicJacksonvilleFloridaUSA
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7
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D’Elia JA, Bayliss GP, Weinrauch LA. The Diabetic Cardiorenal Nexus. Int J Mol Sci 2022; 23:ijms23137351. [PMID: 35806355 PMCID: PMC9266839 DOI: 10.3390/ijms23137351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 12/10/2022] Open
Abstract
The end-stage of the clinical combination of heart failure and kidney disease has become known as cardiorenal syndrome. Adverse consequences related to diabetes, hyperlipidemia, obesity, hypertension and renal impairment on cardiovascular function, morbidity and mortality are well known. Guidelines for the treatment of these risk factors have led to the improved prognosis of patients with coronary artery disease and reduced ejection fraction. Heart failure hospital admissions and readmission often occur, however, in the presence of metabolic, renal dysfunction and relatively preserved systolic function. In this domain, few advances have been described. Diabetes, kidney and cardiac dysfunction act synergistically to magnify healthcare costs. Current therapy relies on improving hemodynamic factors destructive to both the heart and kidney. We consider that additional hemodynamic solutions may be limited without the use of animal models focusing on the cardiomyocyte, nephron and extracellular matrices. We review herein potential common pathophysiologic targets for treatment to prevent and ameliorate this syndrome.
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Affiliation(s)
- John A. D’Elia
- Kidney and Hypertension Section, E P Joslin Research Laboratory, Joslin Diabetes Center, Boston, MA 02215, USA
| | - George P. Bayliss
- Division of Organ Transplantation, Rhode Island Hospital, Providence, RI 02903, USA;
| | - Larry A. Weinrauch
- Kidney and Hypertension Section, E P Joslin Research Laboratory, Joslin Diabetes Center, Boston, MA 02215, USA
- Correspondence: ; Tel.: +617-923-0800; Fax: +617-926-5665
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8
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Alqahtani MS, Abbas M, Alsabaani A, Alqarni A, Almohiy HM, Alsawqaee E, Alshahrani R, Alshahrani S. The Potential Impact of COVID-19 Virus on the Heart and the Circulatory System. Infect Drug Resist 2022; 15:1175-1189. [PMID: 35345472 PMCID: PMC8957310 DOI: 10.2147/idr.s351318] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/08/2022] [Indexed: 12/13/2022] Open
Abstract
Heart attacks, arrhythmias, and cardiomyopathy are all linked to the 2019 coronavirus disease (COVID-19), which has been identified as a risk factor for cardiovascular disease. Nothing can be held accountable in the current state of affairs. Undiagnosed chronic systolic heart failure (CSHF) develops when the heart’s second half of the cardiac cycle does not function properly. As a result, the heart’s blood pumping function is interrupted. Stress-induced cardiomyopathy may be caused by a variety of factors inside the body (SICM). Cytokine storm and microvascular dysfunction are among the issues. There is inflammation in the heart muscle, which may lead to stress-induced cardiomyopathy. A major part of our study is going to be devoted to understanding the effects of coronavirus on the cardiovascular system and blood vessels. A lot of time and effort has been put into figuring out the health effects of radiation exposure. The heart and circulatory system are shown to be affected by the coronavirus in this research. COVID-19 is shown to influence persons with heart disease, heart failure, arrhythmias, microvascular angiopathy, and cardiac damage in this study.
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Affiliation(s)
- Mohammed S Alqahtani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia.,BioImaging Unit, Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH, U.K
| | - Mohamed Abbas
- Electrical Engineering Department, College of Engineering, King Khalid University, Abha, 61421, Saudi Arabia.,Computers and Communications Department, College of Engineering, Delta University for Science and Technology, Gamasa, 35712, Egypt
| | - Abdullah Alsabaani
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia
| | - Amjad Alqarni
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Hussain M Almohiy
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Entisar Alsawqaee
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Raghad Alshahrani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Shahd Alshahrani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
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9
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Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J 2022; 43:1157-1172. [PMID: 35176758 PMCID: PMC8903393 DOI: 10.1093/eurheartj/ehac031] [Citation(s) in RCA: 257] [Impact Index Per Article: 128.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Emerging as a new epidemic, long COVID or post-acute sequelae of coronavirus disease 2019 (COVID-19), a condition characterized by the persistence of COVID-19 symptoms beyond 3 months, is anticipated to substantially alter the lives of millions of people globally. Cardiopulmonary symptoms including chest pain, shortness of breath, fatigue, and autonomic manifestations such as postural orthostatic tachycardia are common and associated with significant disability, heightened anxiety, and public awareness. A range of cardiovascular (CV) abnormalities has been reported among patients beyond the acute phase and include myocardial inflammation, myocardial infarction, right ventricular dysfunction, and arrhythmias. Pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiac diseases which are abundant in those at risk of severe disease. In this review, we discuss the definition of long COVID and its epidemiology, with an emphasis on cardiopulmonary symptoms. We further review the pathophysiological mechanisms underlying acute and chronic CV injury, the range of post-acute CV sequelae, and impact of COVID-19 on multiorgan health. We propose a possible model for referral of post-COVID-19 patients to cardiac services and discuss future directions including research priorities and clinical trials that are currently underway to evaluate the efficacy of treatment strategies for long COVID and associated CV sequelae.
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Affiliation(s)
- Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
| | - Thomas F. Lüscher
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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10
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Keshvani N, Mehta A, Alger HM, Rutan C, Williams J, Zhang S, Young R, Alhanti B, Chiswell K, Greene SJ, DeVore AD, Yancy CW, Fonarow GC, Pandey A. Heart Failure Quality of Care and In-Hospital Outcomes During the COVID-19 Pandemic Findings from the Get With The Guidelines-Heart Failure Registry. Eur J Heart Fail 2022; 24:1117-1128. [PMID: 35289038 PMCID: PMC9087396 DOI: 10.1002/ejhf.2484] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022] Open
Abstract
Aims To assess heart failure (HF) in‐hospital quality of care and outcomes before and during the COVID‐19 pandemic. Methods and results Patients hospitalized for HF with ejection fraction (EF) <40% in the American Heart Association Get With The Guidelines©‐HF (GWTG‐HF) registry during the COVID‐19 pandemic (3/1/2020–4/1/2021) and pre‐pandemic (2/1/2019–2/29/2020) periods were included. Adherence to HF process of care measures, in‐hospital mortality, and length of stay (LOS) were compared in pre‐pandemic vs. pandemic periods and in patients with vs. without COVID‐19. Overall, 42 004 pre‐pandemic and 37 027 pandemic period patients (median age 68, 33% women, 58% White) were included without observed differences across clinical characteristics, comorbidities, vital signs, or EF. Utilization of guideline‐directed medical therapy at discharge was comparable across both periods, with rates of implantable cardioverter defibrillator (ICD) placement or prescription lower during the pandemic (vs. pre‐pandemic period). In‐hospital mortality (3.0% vs. 2.5%, p <0.0001) and LOS (mean 5.7 vs. 5.4 days, p <0.0004) were higher during the pandemic vs. pre‐pandemic. The highest in‐hospital mortality during the pandemic was observed among patients hospitalized in the Northeast region (3.4%). Among patients concurrently diagnosed with COVID‐19 (n = 549; 1.5%), adherence to ICD placement or prescription, prescription of aldosterone antagonist or angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor–neprilysin inhibitor at discharge were lower, and in‐hospital mortality (8.2% vs. 3.0%, p <0.0001) and LOS (mean 7.7 vs. 5.7 days, p <0.0001) were higher than those without COVID‐19. Conclusion Among GWTG‐HF participating hospitals, patients hospitalized for HF with reduced EF during the pandemic received similar care quality but experienced higher in‐hospital mortality than the pre‐pandemic period.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | | | | | - Stephen J Greene
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, CA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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11
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Bruno RR, Wernly B, Wolff G, Fjølner J, Artigas A, Bollen Pinto B, Schefold JC, Kindgen-Milles D, Baldia PH, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Topeli A, Elhadi M, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Flaatten H, Jung C. Association of chronic heart failure with mortality in old intensive care patients suffering from Covid-19. ESC Heart Fail 2022; 9:1756-1765. [PMID: 35274490 PMCID: PMC9065875 DOI: 10.1002/ehf2.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID‐19). This prospective international multicentre study investigates the role of pre‐existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID‐19. Methods and results Patients with pre‐existing CHF were subclassified as having ischaemic or non‐ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre‐existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5–2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5–1.5; P = 0.137]. More patients suffered from pre‐existing ischaemic than from non‐ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non‐ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9–1.0; P = 0.128). Conclusions In critically ill older COVID‐19 patients, pre‐existing CHF was not independently associated with 30 day mortality. Trial registration number: NCT04321265.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital Bern, University of Bern, Bern, Switzerland
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Heinrich Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Department of Anaesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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12
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Pérez-Belmonte LM, Sanz-Cánovas J, Salinas A, Fornie IS, Méndez-Bailón M, Gómez-Huelgas R. Corticosteroid therapy in patients with heart failure hospitalized for COVID-19: a multicenter retrospective study. Intern Emerg Med 2021; 16:2301-2305. [PMID: 34637077 PMCID: PMC8505476 DOI: 10.1007/s11739-021-02843-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Luis M Pérez-Belmonte
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Avenida de Carlos Haya, s/n, 29010, Málaga, Spain.
| | - Jaime Sanz-Cánovas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Avenida de Carlos Haya, s/n, 29010, Málaga, Spain
| | - Alejandro Salinas
- Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Iñigo Sagastagoitia Fornie
- Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Avenida de Carlos Haya, s/n, 29010, Málaga, Spain
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13
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Hebbard C, Lee B, Katare R, Garikipati VNS. Diabetes, Heart Failure, and COVID-19: An Update. Front Physiol 2021; 12:706185. [PMID: 34721055 PMCID: PMC8554151 DOI: 10.3389/fphys.2021.706185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the WHO in March 2020. As of August 2021, more than 220 countries have been affected, accounting for 211,844,613 confirmed cases and 4,432,802 deaths worldwide. A new delta variant wave is sweeping through the globe. While previous reports consistently have demonstrated worse prognoses for patients with existing cardiovascular disease than for those without, new studies are showing a possible link between SARS-CoV-2 infection and an increased incidence of new-onset heart disease and diabetes, regardless of disease severity. If this trend is true, with hundreds of millions infected, the disease burden could portend a potentially troubling increase in heart disease and diabetes in the future. Focusing on heart failure in this review, we discuss the current data at the intersection of COVID, heart failure, and diabetes, from clinical findings to potential mechanisms of how SARS-CoV-2 infection could increase the incidence of those pathologies. Additionally, we posit questions for future research areas regarding the significance for patient care.
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Affiliation(s)
- Carleigh Hebbard
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Brooke Lee
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rajesh Katare
- Department of Physiology–HeartOtago, University of Otago, Dunedin, New Zealand
| | - Venkata Naga Srikanth Garikipati
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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14
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Zuin M, Rigatelli G, Bilato C, Cervellati C, Zuliani G, Roncon L. Dyslipidaemia and mortality in COVID-19 patients: a meta-analysis. QJM 2021; 114:390-397. [PMID: 33822215 PMCID: PMC8083520 DOI: 10.1093/qjmed/hcab071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/29/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The prevalence and prognostic implications of pre-existing dyslipidaemia in patients infected by the SARS-CoV-2 remain unclear. AIM To assess the prevalence and mortality risk in COVID-19 patients with pre-existing dyslipidaemia. DESIGN Systematic review and meta-analysis. METHODS Preferred reporting items for systematic reviews and meta-analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 31 January 2021, reporting data on dyslipidaemia among COVID-19 survivors and non-survivors. The pooled prevalence of dyslipidaemia was calculated using a random-effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random-effect models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic. RESULTS Of about 18 studies, enrolling 74 132 COVID-19 patients (mean age 70.6 years), met the inclusion criteria and were included in the final analysis. The pooled prevalence of dyslipidaemia was 17.5% of cases (95% CI: 12.3-24.3%, P < 0.0001), with high heterogeneity (I2 = 98.7%). Pre-existing dyslipidaemia was significantly associated with higher risk of short-term death (OR: 1.69, 95% CI: 1.19-2.41, P = 0.003), with high heterogeneity (I2 = 88.7%). Due to publication bias, according to the Trim-and-Fill method, the corrected random-effect ORs resulted 1.61, 95% CI 1.13-2.28, P < 0.0001 (one studies trimmed). CONCLUSION Dyslipidaemia represents a major comorbidity in about 18% of COVID-19 patients but it is associated with a 60% increase of short-term mortality risk.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | - Carlo Cervellati
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
- Corresponding author: Prof. Loris Roncon MD, Department of Cardiology, Rovigo General Hospital, Viale tre Martiri, Rovigo 45100, Italy. Tel.+390425393286; Fax: +390425393597,
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15
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Essa H, Brousas S, Whybrow‐Hupptaz I, Salmon T, Sankaranarayanan R. What is the effect of lockdown upon hospitalisation because of COVID-19 amongst patients from a heart failure registry? Int J Clin Pract 2021; 75:e14425. [PMID: 34535050 PMCID: PMC8646245 DOI: 10.1111/ijcp.14425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Hani Essa
- Aintree University HospitalLiverpool University Hospitals NHS Foundation TrustLiverpoolUK
- Liverpool Centre for Cardiovascular ScienceLiverpool Heart & Chest HospitalLiverpoolUK
| | - Sophia Brousas
- Aintree University HospitalLiverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - Isabel Whybrow‐Hupptaz
- Aintree University HospitalLiverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - Thomas Salmon
- Aintree University HospitalLiverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - Rajiv Sankaranarayanan
- Aintree University HospitalLiverpool University Hospitals NHS Foundation TrustLiverpoolUK
- Liverpool Centre for Cardiovascular ScienceLiverpool Heart & Chest HospitalLiverpoolUK
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16
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Thakker RA, Abu-Jazar D, Cabello R, Pham C, Hong J, Abdelmaseih R, Elbadawi A, Albaeni A, Hasan SM, Almustafa A, Murrieta JI, Modi S, Berbarie RF, Khalife W, Chatila KF. Outcomes in Hospitalization in Patients with Heart Failure Undergoing Remote Pulmonary Artery Pressure Monitoring: A Systematic Review and Meta-Analysis of Major Trials. Curr Probl Cardiol 2021; 47:100980. [PMID: 34547344 DOI: 10.1016/j.cpcardiol.2021.100980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
Heart failure is a leading global pandemic and a cause of economic burden. Although, treatments exist to help symptomatic alleviation, patient compliance and monitoring is the basis of ensuring efficacy. With devices that allow for remote wireless PA pressure monitoring such as CardioMEMS, the inconsistency in patient reporting and factors such as symptoms and hospitalizations can be reduced. A systematic review and meta-analysis utilizing the MEDLINE, Cochrane, and Scopus database was performed to identify randomized and non-randomized clinical trials evaluating baseline characteristics and hospitalizations. Five trials for the systematic review and 2 trials for the meta-analysis meeting the inclusion and exclusion criteria were included. Baseline characteristics included an average age of 64.6 years, male predominance, mean BMI of 29.6, predominance of HFrEF, hypertension the most prevalent comorbidity, and a mean PA pressure of 27.2 mm Hg. The follow-up periods ranged from 90 days to 12 months. There was a total of 64 adverse events, mostly non-serious. Patients who underwent remote PA monitoring were less likely to be hospitalized compared with patients who did not (Odds Ratio: 0.52; 95% Confidence Interval 0.39, 0.69). Remote PA pressure monitoring allows for reduced hospitalizations. With the recent and now resurging SARS-CoV-2 pandemic, devices such as CardioMEMS can allow for heart failure patients to be managed from home to not only reduce hospitalizations but for symptom prevention and management.
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Affiliation(s)
- Ravi A Thakker
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555.
| | - Deaa Abu-Jazar
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555
| | - Rafael Cabello
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555
| | - Christine Pham
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555
| | - Jimmy Hong
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555
| | - Ramy Abdelmaseih
- Department of Internal Medicine, Ocala Regional Medical Center, Ocala, FL
| | - Ayman Elbadawi
- Division of Cardiology, Baylor College of Medicine, Houston, TX
| | - Aiham Albaeni
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
| | | | - Ahmed Almustafa
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
| | | | - Shreyas Modi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
| | - Rafic F Berbarie
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
| | - Khaled F Chatila
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX
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17
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Clinical characteristics and outcomes of patients with heart failure admitted to the intensive care unit with coronavirus disease 2019 (COVID-19): A multicenter cohort study. ACTA ACUST UNITED AC 2021; 7:100033. [PMID: 34308397 PMCID: PMC8288252 DOI: 10.1016/j.ahjo.2021.100033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 01/08/2023]
Abstract
Background Patients with underlying heart failure (HF) in the setting of COVID-19 who require admission to the intensive care unit (ICU) might present with a unique set of challenges. This study aims to extensively describe the characteristics and outcomes of patients with HF who were admitted to ICU with COVID-19. Methods We conducted a multicenter retrospective analysis for all adult patients with HF and an objectively confirmed diagnosis of COVID-19 who were admitted to ICUs between March 1 and August 31, 2020, in Saudi Arabia. Results A total of 723 critically ill patients with COVID-19 were admitted into ICUs during the study period: 59 patients with HF and 664 patients with no HF before admission to ICU. Patients with HF had statistically significant more comorbidities, including diabetes mellitus, hypertension, dyslipidemia, atrial fibrillation, and acute coronary syndrome. Moreover, higher baseline severity scores (APACHE II & SOFA score) and nutritional risk (NUTRIC score) were observed in HF patients. Overall, patients with HF had more in-hospital and ICU deaths in comparison to patients without HF: (64.3% vs. 44.6%, P-value <0.01) and (54.5% vs. 39%, P-value = 0.02), respectively. Patients with HF had a similar incidence of thrombosis, ICU length of stay, duration of mechanical ventilation, and hospital length of stay compared to patients with no HF. Conclusion In this study, patients with HF had more in-hospital and ICU deaths than patients with no HF. Thus, history of HF could be used to help direct case management during hospitalization and possibly dictate proactive COVID-19 care.
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18
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Ruge M, Gomez JMD, du Fay de Lavallaz J, Hlepas A, Rahman A, Patel P, Hoster C, Lavani P, Nair GG, Jahan N, Alan Simmons J, Rao AK, Cotts W, Williams K, Volgman AS, Marinescu K, Suboc T. Impact of pre-existing heart failure on 60-day outcomes in patients hospitalized with COVID-19. ACTA ACUST UNITED AC 2021; 4:100022. [PMID: 34151308 PMCID: PMC8204812 DOI: 10.1016/j.ahjo.2021.100022] [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] [Indexed: 12/05/2022]
Abstract
Background In the coronavirus disease 2019 (COVID-19) global pandemic, patients with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. However, the relationship between COVID-19 and heart failure (HF) is unclear, specifically whether HF is an independent risk factor for severe infection or if other accompanying comorbidities are responsible for the increased risk. Methods This is a retrospective analysis of 1331 adult patients diagnosed with COVID-19 infection between March and June 2020 admitted at Rush University System for Health (RUSH) in metropolitan Chicago, Illinois, USA. Patients with history of HF were identified by International Classification of Disease, Tenth Revision (ICD-10) code assignments extracted from the electronic medical record. Propensity score matching was utilized to control for the numerous confounders, and univariable logistic regression was performed to assess the relationship between HF and 60-day morbidity and mortality outcomes. Results The propensity score matched cohort consisted of 188 patients in both the HF and no HF groups. HF patients did not have lower 60-day mortality (OR 0.81; p = 0.43) compared to patients without HF. However, those with HF were more likely to require readmission within 60 days (OR 2.88; p < 0.001) and sustain myocardial injury defined as troponin elevation within 60 days (OR 3.14; p < 0.05). Conclusions This study highlights the complex network of confounders present between HF and COVID-19. When balanced for these numerous factors, those with HF appear to be at no higher risk of 60-day mortality from COVID-19 but are at increased risk for morbidity.
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Affiliation(s)
- Max Ruge
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Joanne Michelle D Gomez
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Jeanne du Fay de Lavallaz
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Alexander Hlepas
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Annas Rahman
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Priya Patel
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Clay Hoster
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Prutha Lavani
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Gatha G Nair
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Nusrat Jahan
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - J Alan Simmons
- Research Core, Rush University Medical Center, Chicago, IL, United States of America
| | - Anupama K Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - William Cotts
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America.,Advocate Christ Medical Center, Oaklawn, IL, United States of America
| | - Kim Williams
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | | | - Karolina Marinescu
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
| | - Tisha Suboc
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America
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19
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Bhatt AS, Jering KS, Vaduganathan M, Claggett BL, Cunningham JW, Rosenthal N, Signorovitch J, Thune JJ, Vardeny O, Solomon SD. Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19. JACC. HEART FAILURE 2021; 9:65-73. [PMID: 33384064 PMCID: PMC7833294 DOI: 10.1016/j.jchf.2020.11.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19). BACKGROUND Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications. METHODS The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression. RESULTS Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; pinteraction <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic. CONCLUSIONS Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.
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Affiliation(s)
- Ankeet S Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Karola S Jering
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan W Cunningham
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ning Rosenthal
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
| | | | - Jens J Thune
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans' Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Scott D Solomon
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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20
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Chatrath N, Kaza N, Pabari PA, Fox K, Mayet J, Barton C, Cole GD, Plymen CM. The effect of concomitant COVID-19 infection on outcomes in patients hospitalized with heart failure. ESC Heart Fail 2020; 7:4443-4447. [PMID: 33040480 PMCID: PMC7675415 DOI: 10.1002/ehf2.13059] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Patients with cardiovascular disease appear particularly susceptible to severe COVID-19 disease, but the impact of COVID-19 infection on patients with heart failure (HF) is not known. This study aimed to quantify the impact of COVID-19 infection on mortality in hospitalized patients known to have HF. METHODS AND RESULTS We undertook a retrospective analysis of all patients admitted with a pre-existing diagnosis of HF between 1 March and 6 May 2020 to our unit. We assessed the impact of concomitant COVID-19 infection on in-hospital mortality, incidence of acute kidney injury, and myocardial injury. One hundred and thirty-four HF patients were hospitalized, 40 (29.9%) with concomitant COVID-19 infection. Those with COVID-19 infection had a significantly increased in-hospital mortality {50.0% vs. 10.6%; relative risk [RR] 4.70 [95% confidence interval (CI) 2.42-9.12], P < 0.001} and were more likely to develop acute kidney injury [45% vs. 24.5%; RR 1.84 (95% CI 1.12-3.01), P = 0.02], have evidence of myocardial injury [57.5% vs. 31.9%; RR 1.81 (95% CI 1.21-2.68), P < 0.01], and be treated for a superadded bacterial infection [55% vs. 32.5%; RR 1.67 (95% CI 1.12-2.49), P = 0.01]. CONCLUSIONS Patients with HF admitted to hospital with concomitant COVID-19 infection have a very poor prognosis. This study highlights the need to regard patients with HF as a high-risk group to be shielded to reduce the risks of COVID-19 infection.
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Affiliation(s)
- Nikhil Chatrath
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Nandita Kaza
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Punam A. Pabari
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Kevin Fox
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Jamil Mayet
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Carys Barton
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Graham D. Cole
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Carla M. Plymen
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
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