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Ye M, Vena JE, Shen-Tu G, Johnson JA, Eurich DT. Reduced incidence of diabetes during the COVID-19 pandemic in Alberta: A time-segmented longitudinal study of Alberta's Tomorrow Project. Diabetes Obes Metab 2024; 26:1244-1251. [PMID: 38131246 DOI: 10.1111/dom.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
AIM To characterize the impact of the COVID-19 pandemic on diabetes diagnosis using data from Alberta's Tomorrow Project (ATP), a population-based cohort study of chronic diseases in Alberta, Canada. MATERIALS AND METHODS The ATP participants who were free of diabetes on 1 April 2018 were included in the study. A time-segmented regression model was used to compare incidence rates of diabetes before the COVID-19 pandemic, during the first two COVID-19 states of emergency, and in the period when the state of emergency was relaxed, after adjusting for seasonality, sociodemographic factors, socioeconomic status, and lifestyle behaviours. RESULTS Among 43 705 ATP participants free of diabetes (65.5% females, age 60.4 ± 9.5 years in 2018), the rate of diabetes was 4.75 per 1000 person-year (PY) during the COVID-19 pandemic (up to 31 March 2021), which was 32% lower (95% confidence interval [CI] 21%, 42%; p < 0.001) than pre-pandemic (6.98 per 1000 PY for the period 1 April 2018 to 16 March 2020). In multivariable regression analysis, the first COVID-19 state of emergency (first wave) was associated with an 87.3% (95% CI -98.6%, 13.9%; p = 0.07) reduction in diabetes diagnosis; this decreasing trend was sustained to the second COVID-19 state of emergency and no substantial rebound (increase) was observed when the COVID-19 state of emergency was relaxed. CONCLUSIONS The COVID-19 public health emergencies had a negative impact on diabetes diagnosis in Alberta. The reduction in diabetes diagnosis was likely due to province-wide health service disruptions during the COVID-19 pandemic. Systematic plans to close the post-COVID-19 diagnostic gap are required in diabetes to avoid substantial downstream sequelae of undiagnosed disease.
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Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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2
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Williams C, Shang D. Telehealth for Chronic Disease Management Among Vulnerable Populations. J Racial Ethn Health Disparities 2024; 11:1089-1096. [PMID: 37052797 PMCID: PMC10100602 DOI: 10.1007/s40615-023-01588-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
Chronic diseases disproportionately affect patients in low-income minority groups who traditionally use in-person healthcare services. COVID-19 disrupted their routines and limited options for people to receive care; this could exacerbate health inequities. The study examined telehealth chronic disease management among low-income minority groups. We used Florida Medicaid claims data from March to December 2020 and the American Consumer Survey to examine the study objectives. Data were analyzed using Linear and Logistic Regression. We retrieved claim records of 52,904 unique patients; 31,999 were female and 49% of the sample had at least one telehealth visit. Medicaid patients were 8% less likely to use telehealth and 21% more likely to have audio visits when compared to Medicare patients. The analyses suggest that Non-Hispanic Black patients and individuals with a lack of education experience significant health inequities. People with chronic obstructive pulmonary disease (5%) and heart failure (14%) were less likely to use telehealth than patients with diabetes. Telehealth will continue to be a health delivery option; thus we recommend that strategies are enacted to educate, and resources are provided to promote equity among Non-Hispanic Black patients. Without priority attention to people among low-income minority populations, health inequities will continue to plague this community.
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Affiliation(s)
- Cynthia Williams
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, 32801, USA.
| | - Di Shang
- Coggin College of Business, University of North Florida, Jacksonville, FL, 32224, USA
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3
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Stowell JR, Henry MB, Pugsley P, Edwards J, Burton H, Norquist C, Katz ED, Koenig BW, Indermuhle S, Subbian V, Ghaderi H, Akhter M. Impact of the COVID-19 Pandemic on Emergency Department Encounters in a Major Metropolitan Area. J Emerg Med 2024; 66:e383-e390. [PMID: 38278682 DOI: 10.1016/j.jemermed.2023.10.007] [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: 05/27/2023] [Revised: 08/21/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The end of 2019 marked the emergence of the COVID-19 pandemic. Public avoidance of health care facilities, including the emergency department (ED), has been noted during prior pandemics. OBJECTIVE This study described pandemic-related changes in adult and pediatric ED presentations, acuity, and hospitalization rates during the pandemic in a major metropolitan area. METHODS The study was a cross-sectional analysis of ED visits occurring before and during the pandemic. Sites collected daily ED patient census; monthly ED patient acuity, as the Emergency Severity Index (ESI) score; and disposition. Prepandemic ED visits occurring from January 1, 2019 through December 31, 2019 were compared with ED visits occurring during the pandemic from January 1, 2020 through March 31, 2021. The change in prepandemic and pandemic ED volume was found using 7-day moving average of proportions. RESULTS The study enrolled 83.8% of the total ED encounters. Pandemic adult and pediatric visit volume decreased to as low as 44.7% (95% CI 43.1-46.3%; p < 0.001) and 22.1% (95% CI 19.3-26.0%; p < 0.001), respectively, of prepandemic volumes. There was also a relative increase in adult and pediatric acuity (ESI level 1-3) and the admission percentage for adult (20.3% vs. 22.9%; p < 0.01) and pediatric (5.1% vs. 5.6%; p < 0.01) populations. CONCLUSIONS Total adult and pediatric encounters were reduced significantly across a major metropolitan area. Patient acuity and hospitalization rates were relatively increased. The development of strategies for predicting ED avoidance will be important in future pandemics.
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Affiliation(s)
- Jeffrey R Stowell
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Michael B Henry
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Paul Pugsley
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Jennifer Edwards
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Heather Burton
- Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Craig Norquist
- Department of Emergency Medicine, HonorHealth, Scottsdale, Arizona
| | - Eric D Katz
- Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Banner Medical Group, Phoenix, Arizona
| | - B Witkind Koenig
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona; EMPower Emergency Physicians, Scottsdale, Arizona
| | | | - Vignesh Subbian
- College of Engineering, The University of Arizona, Tucson, Arizona
| | - Hamid Ghaderi
- College of Engineering, The University of Arizona, Tucson, Arizona
| | - Murtaza Akhter
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona; Kendall Regional Medical Center, Department of Emergency Medicine, HCA Healthcare, Miami, Florida; Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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4
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Slotman E, Fransen HP, van Laarhoven HWM, van den Beuken-van Everdingen MHJ, Tjan-Heijnen VCG, Huijben AMT, Jager A, van Zuylen L, Kuip EJM, van der Linden YM, Raijmakers NJH, Siesling S. Reduction in potentially inappropriate end-of-life hospital care for cancer patients during the COVID-19 pandemic: A retrospective population-based study. Palliat Med 2024; 38:140-149. [PMID: 38142283 PMCID: PMC10798006 DOI: 10.1177/02692163231217373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life cancer care during the pandemic. AIM To investigate potentially inappropriate end-of-life hospital care for cancer patients before and during the COVID-19 pandemic. DESIGN Retrospective population-based cohort study using data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Potentially inappropriate care in the last month of life (chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission or hospital death) was compared between four COVID-19 periods and corresponding periods in 2018/2019. PARTICIPANTS A total of 112,919 cancer patients (⩾18 years) who died between January 2018 and May 2021 were included. RESULTS Fewer patients received potentially inappropriate end-of-life care during the COVID-19 pandemic compared to previous years, especially during the first COVID-19 peak (22.4% vs 26.0%). Regression analysis showed lower odds of potentially inappropriate end-of-life care during all COVID-19 periods (between OR 0.81; 95% CI 0.74-0.88 and OR 0.92; 95% CI 0.87-0.97) after adjustment for age, sex and cancer type. For the individual indicators, fewer patients experienced multiple or long hospitalizations, intensive care unit admission or hospital death during the pandemic. CONCLUSIONS Cancer patients received less potentially inappropriate end-of-life care during the COVID-19 pandemic. Because several factors may have contributed, it is unclear whether this reflects better quality care. However, these findings raise important questions about what pandemic-induced changes in care practices can help provide appropriate end-of-life care for future patients in the context of increasing patient numbers and limited resources.
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Affiliation(s)
- Ellis Slotman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Hanneke WM van Laarhoven
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Vivianne CG Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Auke MT Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien JM Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud Medical Center, Nijmegen, The Netherlands
| | - Yvette M van der Linden
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Natasja JH Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
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5
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study. Front Public Health 2023; 11:1251020. [PMID: 38169852 PMCID: PMC10759216 DOI: 10.3389/fpubh.2023.1251020] [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: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs). Methods We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates. Results Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year. Conclusion This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - David T. Zhu
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Douglas Manuel
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Therese A. Stukel
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- ICES, Ottawa, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Melanie Chin
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Claire E. Kendall
- ICES, Ottawa, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- The Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Andrea S. Gershon
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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6
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Cullen LA, Grange Z, Antal K, Waugh L, Alsina MS, Gibbons CL, MacDonald LE, Robertson C, Cameron JC, Stockton D, O'Leary MC. COVID-19 vaccine safety in Scotland - background rates of adverse events of special interest. Public Health 2023; 224:1-7. [PMID: 37688806 DOI: 10.1016/j.puhe.2023.08.006] [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: 02/08/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES Mass COVID-19 vaccination commenced in December 2020 in Scotland. Monitoring vaccine safety relies on accurate background incidence rates (IRs) for health outcomes potentially associated with vaccination. This study aimed to quantify IRs in Scotland of adverse events of special interest (AESI) potentially associated with COVID-19 vaccination. STUDY DESIGN AND METHODS IRs and 95% confidence intervals (CIs) for 36 AESI were calculated retrospectively for the pre-COVID-19 pandemic period (01 January 2015-31 December 2019) and the COVID-19 pandemic period (01 April 2020-30 November 2020), with age-sex stratification, and separately by calendar month and year. Incident cases were determined using International Classification of Diseases-10th Revision (ICD-10)-coded hospitalisations. RESULTS Prepandemic population-wide IRs ranged from 0.4 (0.3-0.5 CIs) cases per 100,000 person-years (PYRS) for neuromyelitis optica to 478.4 (475.8-481.0 CIs) cases per 100,000 PYRS for acute renal failure. Pandemic population-wide IRs ranged from 0.3 (0.2-0.5 CIs) cases per 100,000 PYRS for Kawasaki disease to 483.4 (473.2-493.7 CIs) cases per 100,000 PYRS for acute coronary syndrome. All AESI IRs varied by age and sex. Ten AESI (acute coronary syndrome, acute myocardial infarction, angina pectoris, heart failure, multiple sclerosis, polyneuropathies and peripheral neuropathies, respiratory failure, rheumatoid arthritis and polyarthritis, seizures and vasculitis) had lower pandemic than prepandemic period IRs overall. Only deep vein thrombosis and pulmonary embolism had a higher pandemic IR. CONCLUSION Lower pandemic IRs likely resulted from reduced health-seeking behaviours and healthcare provision. Higher IRs may be associated with SARS-CoV-2 infections. AESI IRs will facilitate future vaccine safety studies in Scotland.
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Affiliation(s)
- L A Cullen
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - Z Grange
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - K Antal
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - L Waugh
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - M S Alsina
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - C L Gibbons
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | | | - C Robertson
- University of Strathclyde and Public Health Scotland, Glasgow, UK.
| | - J C Cameron
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - D Stockton
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - M C O'Leary
- Public Health Scotland, Glasgow, Edinburgh, UK.
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B JP, S R, P MP, A J, K V, Das MK, K S, N S, Ezhilan J, Agarwal R, P R V, Choudhary AH, C B M, Malviya A, Gopi A, V K C, Joseph S, Goyal KK, John JF, Bansal S, S H, Nagula P, Joseph J, Bagawat A, Seth S, Shah U, Goel PK, Asokan PK, Sethi KK, Sharma S, Banerji LGA, Sikdar S, Agarwala M, Chandra S, Bharti B, Ashraf SM, Srivastava S, Kesavamoorthy B, Bali HK, Sarma D, Jain RK, Dani SI, Natesh BH, Chakraborty RN, Gupta V, Khanna NN, Mukhopadhyay D, Mandal S, Majumder B, L S, Girish MP, Das D, Devasia T, Vajifdar B, Bhatia T, Abdullah Z, Sharma S, Kumar S, Lincy M, Naik N, Kahali D, Sinha DP, Dastidar DG, Wander GS, Yadav R, Tewari S, Bhandari S, Chandra Rath P, Bang VH, Roy D, Banerjee P, Shanmugasundaram S, Zachariah G. Impact of COVID-19 on heart failure hospitalization and outcome in India - A cardiological society of India study (CSI-HF in COVID 19 times study - "The COVID C-HF study"). Indian Heart J 2023; 75:370-375. [PMID: 37652199 PMCID: PMC10568052 DOI: 10.1016/j.ihj.2023.08.004] [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: 06/23/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. METHODS Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. RESULTS Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. CONCLUSION The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.
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Affiliation(s)
- Jayagopal P B
- Lakshmi Hospital, Chittur Road, Palakkad, Kerala, India.
| | - Ramakrishnan S
- All India Institute of Medical Sciences, New Delhi, India
| | - Mohanan P P
- West Fort Hi-Tech Hospital, Thrissur, Kerala, India
| | - Jabir A
- Lisie Hospital, Kochi, Kerala, India
| | - Venugopal K
- Pushpagiri Medical College, Thiruvalla, Kerala, India
| | - M K Das
- Birla Heart Research Centre and the Calcutta Medical Research Institute (CMRI), Kolkata, India
| | - Santhosh K
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, India
| | - Syam N
- District Hospital, Kollam, Kerala, India
| | - J Ezhilan
- Madras Medical Mission, Chennai, India
| | | | | | | | - Meena C B
- SMS Hospital, Jaipur, Rajasthan, India
| | | | - Arun Gopi
- Metromed International Cardiac Centre, Calicut, Kerala, India
| | | | - Stigi Joseph
- Little Flower Hospital & Research Centre, Angamaly, Kochi, Kerala, India
| | | | - John F John
- Baby Memorial Hospital, Calicut, Kerala, India
| | - Sandeep Bansal
- Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | | | | | | | - Sandeep Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - P K Asokan
- Fathima Hospital, Kozhikode, Kerala, India
| | - K K Sethi
- Delhi Heart & Lung Institute, Delhi, India
| | | | | | | | | | | | | | - S M Ashraf
- Sahakarana Hridayalaya, Pariyaram Medical College, Kannur, Kerala, India
| | | | | | | | | | | | | | - B H Natesh
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - Vivek Gupta
- Indraprastha Apollo Hospitals, New Delhi, India
| | | | | | - Subroto Mandal
- Ubuntu Heart & Super Speciality Hospital, Ubbuntu, Bhopal, India
| | | | - Sridhar L
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | | | - Tom Devasia
- Kasturba Medical College Manipal, Karnataka, India
| | - Bhavesh Vajifdar
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | - Zia Abdullah
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Mathew Lincy
- Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Dhiman Kahali
- M Birla Heart Research Centre, Kolkata, West Bengal, India
| | | | | | | | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - Debabrata Roy
- N H Rabindranatha Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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8
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Louis DW, Saad M, Vijayakumar S, Ilyas S, Kokkirala A, Aronow HD. The Cardiovascular Manifestations of COVID-19. Heart Fail Clin 2023; 19:153-161. [PMID: 36863807 PMCID: PMC9973545 DOI: 10.1016/j.hfc.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure (HF), and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular manifestations of COVID-19, and cardiovascular complications associated with COVID-19 vaccination.
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Affiliation(s)
- David W. Louis
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Marwan Saad
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Shilpa Vijayakumar
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Suleman Ilyas
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Aravind Kokkirala
- United States Department of Veterans Affairs Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA
| | - Herbert D. Aronow
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA,Corresponding author. 593 Eddy Street, RIH APC 730, Providence, RI 02903
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9
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Yousufuddin M, Yamani MH, Kashani KB, Zhu Y, Wang Z, Seshadri A, Blocker KR, Peters JL, Doss JM, Karam D, Khandelwal K, Sharma UM, Dudenkov DV, Mehmood T, Pagali SR, Nanda S, Abdalrhim AD, Cummings N, Dugani SB, Smerina M, Prokop LJ, Keenan LR, Bhagra S, Jahangir A, Bauer PR, Fonarow GC, Murad MH. Characteristics, Treatment Patterns, and Clinical Outcomes After Heart Failure Hospitalizations During the COVID-19 Pandemic, March to October 2020. Mayo Clin Proc 2023; 98:31-47. [PMID: 36603956 PMCID: PMC9489984 DOI: 10.1016/j.mayocp.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare clinical characteristics, treatment patterns, and 30-day all-cause readmission and mortality between patients hospitalized for heart failure (HF) before and during the coronavirus disease 2019 (COVID-19) pandemic. PATIENTS AND METHODS The study was conducted at 16 hospitals across 3 geographically dispersed US states. The study included 6769 adults (mean age, 74 years; 56% [5033 of 8989] men) with cumulative 8989 HF hospitalizations: 2341 hospitalizations during the COVID-19 pandemic (March 1 through October 30, 2020) and 6648 in the pre-COVID-19 (October 1, 2018, through February 28, 2020) comparator group. We used Poisson regression, Kaplan-Meier estimates, multivariable logistic, and Cox regression analysis to determine whether prespecified study outcomes varied by time frames. RESULTS The adjusted 30-day readmission rate decreased from 13.1% (872 of 6648) in the pre-COVID-19 period to 10.0% (234 of 2341) in the COVID-19 pandemic period (relative risk reduction, 23%; hazard ratio, 0.77; 95% CI, 0.66 to 0.89). Conversely, all-cause mortality increased from 9.7% (645 of 6648) in the pre-COVID-19 period to 11.3% (264 of 2341) in the COVID-19 pandemic period (relative risk increase, 16%; number of admissions needed for one additional death, 62.5; hazard ratio, 1.19; 95% CI, 1.02 to 1.39). Despite significant differences in rates of index hospitalization, readmission, and mortality across the study time frames, the disease severity, HF subtypes, and treatment patterns remained unchanged (P>0.05). CONCLUSION The findings of this large tristate multicenter cohort study of HF hospitalizations suggest lower rates of index hospitalizations and 30-day readmissions but higher incidence of 30-day mortality with broadly similar use of HF medication, surgical interventions, and devices during the COVID-19 pandemic compared with the pre-COVID-19 time frame.
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Affiliation(s)
| | | | | | - Ye Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ashok Seshadri
- Division of Psychiatry, Mayo Clinic Health System, Austin, MN
| | - Katherine R Blocker
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Jessica L Peters
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Jewell M Doss
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Dhauna Karam
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | - Kanika Khandelwal
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN
| | | | - Daniel V Dudenkov
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Tahir Mehmood
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sanjeev Nanda
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Nichole Cummings
- Division of Hospital Internal Medicine, St. Cloud Hospital, St. Cloud, MN
| | - Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Michael Smerina
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | | | - Sumit Bhagra
- Division of Endocrinology, Mayo Clinic Health System, Austin, MN
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, CA
| | - Mohammad Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Preventive and Occupational Medicine, Mayo Clinic, Rochester, MN
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10
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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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11
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Guidolin K, Catton J, Rubin B, Bell J, Marangos J, Munro-Heesters A, Stuart-McEwan T, Quereshy F. Ethical decision making during a healthcare crisis: a resource allocation framework and tool. JOURNAL OF MEDICAL ETHICS 2022; 48:504-509. [PMID: 34021059 PMCID: PMC8142675 DOI: 10.1136/medethics-2021-107255] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp down decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions.
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Affiliation(s)
- Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Barry Rubin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Bell
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | | | - Ann Munro-Heesters
- University Health Network, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada
| | | | - Fayez Quereshy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
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12
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Lau VI, Dhanoa S, Cheema H, Lewis K, Geeraert P, Lu D, Merrick B, Vander Leek A, Sebastianski M, Kula B, Chaudhuri D, Agarwal A, Niven DJ, Fiest KM, Stelfox HT, Zuege DJ, Rewa OG, Bagshaw SM. Non-COVID outcomes associated with the coronavirus disease-2019 (COVID-19) pandemic effects study (COPES): A systematic review and meta-analysis. PLoS One 2022; 17:e0269871. [PMID: 35749400 PMCID: PMC9231780 DOI: 10.1371/journal.pone.0269871] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As the Coronavirus Disease-2019 (COVID-19) pandemic continues, healthcare providers struggle to manage both COVID-19 and non-COVID patients while still providing high-quality care. We conducted a systematic review/meta-analysis to describe the effects of the COVID-19 pandemic on patients with non-COVID illness and on healthcare systems compared to non-pandemic epochs. METHODS We searched Ovid MEDLINE/EMBASE/Cochrane Database of Systematic Reviews/CENTRAL/CINAHL (inception to December 31, 2020). All study types with COVID-pandemic time period (after December 31, 2019) with comparative non-pandemic time periods (prior to December 31, 2019). Data regarding study characteristics/case-mix/interventions/comparators/ outcomes (primary: mortality; secondary: morbidity/hospitalizations/disruptions-to-care. Paired reviewers conducted screening and abstraction, with conflicts resolved by discussion. Effect sizes for specific therapies were pooled using random-effects models. Risk of bias was assessed by Newcastle-Ottawa Scale, with evidence rating using GRADE methodology. RESULTS Of 11,581 citations, 167 studies met eligibility. Our meta-analysis showed an increased mortality of 16% during the COVID pandemic for non-COVID illness compared with 11% mortality during the pre-pandemic period (RR 1.38, 95% CI: 1.28-1.50; absolute risk difference: 5% [95% CI: 4-6%], p<0.00001, very low certainty evidence). Twenty-eight studies (17%) reported significant changes in morbidity (where 93% reported increases), while 30 studies (18%) reported no significant change (very low certainty). Thirty-nine studies (23%) reported significant changes in hospitalizations (97% reporting decreases), while 111 studies (66%) reported no significant change (very low certainty). Sixty-two studies (37%) reported significant disruptions in standards-to-care (73% reporting increases), while 62 studies (37%) reported no significant change (very low certainty). CONCLUSIONS There was a significant increase in mortality during the COVID pandemic compared to pre-pandemic times for non-COVID illnesses. When significant changes were reported, there was increased morbidity, decreased hospitalizations and increased disruptions in standards-of-care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020201256 (Sept 2, 2020).
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Affiliation(s)
- Vincent Issac Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Sumeet Dhanoa
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Harleen Cheema
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Geeraert
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - David Lu
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Benjamin Merrick
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Aaron Vander Leek
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Orientated Research Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Kula
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Dipayan Chaudhuri
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, General Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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13
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Cardiovasc Res 2022; 118:1618-1666. [PMID: 34864876 PMCID: PMC8690236 DOI: 10.1093/cvr/cvab343] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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14
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Cowie MR, Mourilhe-Rocha R, Chang HY, Volterrani M, Ban HN, de Albuquerque DC, Chung E, Fonseca C, Lopatin Y, Serrano JAM, Mircheva L, Moncada-Paz GA, Pagava Z, Reyes EB, Saldarriaga C, Schwartzmann P, Leng DSK, Trivi M, Yotov YT, Zieroth S. The impact of the COVID-19 pandemic on heart failure management: Global experience of the OPTIMIZE heart failure care network. Int J Cardiol 2022; 363:240-246. [PMID: 35750302 PMCID: PMC9217066 DOI: 10.1016/j.ijcard.2022.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
During the COVID-19 pandemic, reductions in heart failure (HF) hospitalizations have been widely reported, and there is an urgent need to understand how HF care has been reorganized in countries with different infection levels, vaccination rates and healthcare services. The OPTIMIZE Heart Failure Care program has a global network of investigators in 42 countries, with first-hand experience of the impact of the pandemic on HF management in different care settings. The national coordinators were surveyed to assess: 1) the challenges of the COVID-19 pandemic for continuity of HF care, from both a hospital and patient perspective; 2) the organizational changes enacted to ensure continued HF care; and 3) lessons learned for the future of HF care. Contributions were obtained from 37 national coordinators in 29 countries. We summarize their input, highlighting the issues raised and using the example of three very different settings (Italy, Brazil, and Taiwan) to illustrate the similarities and differences across the OPTIMIZE program.
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Affiliation(s)
- Martin R Cowie
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust, and School of Cardiovascular Medicine and Sciences, Faculty of Lifesciences & Medicine, King's College London, London, UK.
| | - Ricardo Mourilhe-Rocha
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maurizio Volterrani
- Department of Cardiovascular and Respiratory Sciences, Scientific Institute for Research, Hospitalization and Health Care (IRCCS) San Raffaele Roma, Rome, Italy
| | - Ha Ngoc Ban
- Ho Chi Minh City Heart Institute, Ho Chi Minh City, Viet Nam
| | | | - Edward Chung
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - Cândida Fonseca
- Heart Failure Clinic, Department of Internal Medicine, São Francisco Xavier Hospital, and NOVA Medical School, Faculty of Medical Sciences, NOVA University, Lisbon, Portugal
| | - Yuri Lopatin
- Regional Cardiology Centre, Volgograd State Medical University, Volgograd, Russian Federation
| | - José Antonio Magaña Serrano
- Division of Heart Failure and Cardiac Transplantation, Cardiology Hospital, National Medical Center "Siglo XXI", Mexican Social Security Institute, Mexico City, Mexico
| | - Lilyana Mircheva
- Second Cardiology Clinic, University Hospital St. Marina, and First Department of Internal Medicine, Medical University of Varna, Varna, Bulgaria
| | - Gustavo Adolfo Moncada-Paz
- Department of Cardiology, Honduran Social Security Institute, and Faculty of Medical Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Zurab Pagava
- Bokhua Memorial Cardiovascular Center, Tbilisi, Georgia
| | - Eugenio B Reyes
- Philippine General Hospital and Division of Cardiovascular Medicine, University of the Philippines, Manila, Philippines
| | - Clara Saldarriaga
- Department of Cardiology, Pontifical Bolivarian University and University of Antioquia, Medellín, Colombia
| | - Pedro Schwartzmann
- Unimed Hospital Ribeirão Preto and Advanced Center for Research, Teaching and Diagnosis, Ribeirão Preto, SP, Brazil
| | | | - Marcelo Trivi
- Department of Clinical Cardiology, Buenos Aires Cardiovascular Institute, Buenos Aires, Argentina
| | - Yoto Trifonov Yotov
- Second Cardiology Clinic, University Hospital St. Marina, and First Department of Internal Medicine, Medical University of Varna, Varna, Bulgaria
| | - Shelley Zieroth
- Heart Failure and Transplant Clinics, St. Boniface Hospital, and Section of Cardiology, University of Manitoba, Winnipeg, MB, Canada
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Hughes Z, Simkowski J, Mendapara P, Fink N, Gupta S, Youmans Q, Khan S, Wilcox J, Mutharasan RK. Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: A Retrospective Cohort Study (Preprint). JMIR Cardio 2022; 6:e39566. [DOI: 10.2196/39566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/13/2022] [Accepted: 11/13/2022] [Indexed: 11/15/2022] Open
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Yeh CC, Chien CY, Lee TY, Liu CH. Effect of the COVID-19 Pandemic on Emergency Department Visits of Patients with an Emergent or Urgent Diagnosis. Int J Gen Med 2022; 15:4657-4664. [PMID: 35548587 PMCID: PMC9081622 DOI: 10.2147/ijgm.s362615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose During the coronavirus disease 2019 (COVID-19) pandemic, visits to emergency department (ED) have significantly declined worldwide. The purpose of this study was to identify the trend of visits to ED for different diseases at the peak and slack stages of the epidemic. Patients and Methods This was a retrospective observational study conducted in a tertiary referral medical center in northern Taiwan. We recorded weekly ED visits for myocardial infarction with or without ST-elevation (STEMI or NSTEMI), out-of-hospital cardiac arrest (OHCA), acute stroke, and congestive heart failure from 2016 to 2021. We compared the local epidemic peak periods (calendar weeks 4–18, 2020 and calendar weeks 21–31, 2021) and its corresponding slack periods (calendar weeks 4–18, 2021 and calendar weeks 21–31, 2020) with the baseline period (2016–2019) using Mann–Whitney test to identify the difference. Results We observed a significant decline in ED visits (median [Q1, Q3]) during the epidemic for OHCA (6 [5, 7] and 5 [4, 6], p = 0.046, for baseline and peak period, respectively, in week 4–18), acute stroke (41.5 [38, 47] and 35 [28, 39], p < 0.001, in week 4–18, 40 [35, 45] and 35 [28, 40], p = 0.039, in week 21–31) and CHF (28 [24.25, 33] and 19 [12, 23], p < 0.001, in week 4–18, 18 [16, 23] and 13 [11, 16], p = 0.001, in week 21–31). Significant difference was not observed in patients with NSTEMI and STEMI in both week 4–18 and 21–31, and cardiac arrest in week 21–31. There was a rebound in ED visits in the slack period. Conclusion This study revealed that ED visits significantly declined during the COVID-19 epidemic and rebounded in the slack period. The trend was significant for acute stroke and heart failure but was relatively less prominent effect for emergent events such as cardiac arrest or myocardial infarction.
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Affiliation(s)
- Chung-Cheng Yeh
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Hsinchu, Taiwan
- Graduate Institute of Management, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hao Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Child & Adolescent Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Correspondence: Chun-Hao Liu, Department of Child & Adolescent Psychiatry, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Hsin St., Gueshan District, Taoyuan City, 333, Taiwan, Tel +886-3-3281200 #2479, Email
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17
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Patterns of home care assessment and service provision before and during the COVID-19 pandemic in Ontario, Canada. PLoS One 2022; 17:e0266160. [PMID: 35353856 PMCID: PMC8966998 DOI: 10.1371/journal.pone.0266160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective was to compare home care episode, standardised assessment, and service patterns in Ontario's publicly funded home care system during the first wave of the COVID-19 pandemic (i.e., March to September 2020) using the previous year as reference. STUDY DESIGN AND SETTING We plotted monthly time series data from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient's most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models. RESULTS The March to September 2020 period was associated with significantly fewer home care admissions, discharges, and standardised assessments. Among those assessed with the interRAI Home Care assessment, significantly fewer patients received any personal support services. Among those assessed with either interRAI assessment and identified to have rehabilitation needs, significantly fewer patients received any therapy services. Among patients receiving services, patients received significantly fewer hours of personal support and fewer therapy visits per month. By September 2020, the rate of admissions and services had mostly returned to pre-pandemic levels, but completion of standardised assessments lagged behind. CONCLUSION The first wave of the COVID-19 pandemic was associated with substantial changes in Ontario's publicly funded home care system. Although it may have been necessary to prioritise service delivery during a crisis situation, standardised assessments are needed to support individualised patient care and system-level monitoring. Given the potential disruptions to home care services, future studies should examine the impact of the pandemic on the health and well-being of home care recipients and their caregiving networks.
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Hamilton B, Yadav C, Gomez D, Book KA, Motavalli L, Gronczewski C, Kempf S, Giordano N, Mastro KA. Heart failure readmission reductions during the COVID-19 pandemic. Nurs Manag (Harrow) 2022; 53:26-33. [PMID: 35383673 PMCID: PMC8986526 DOI: 10.1097/01.numa.0000824048.91690.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Behaviors, treatments, and self-management strategies used by patients and caregivers at home.
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Affiliation(s)
- Brielle Hamilton
- At Penn Medicine Princeton Health in Plainsboro, N.J., Brielle Hamilton is a nurse manager on the telemetry unit; Charul Yadav is the heart failure coordinator; Deanna Gomez is a clinical nurse on the telemetry unit; Karyn A. Book is the assistant vice president and associate CNO; Lisa Motavalli is a physician; Craig Gronczewski is the senior vice president of medical affairs and chief medical officer; Sheila Kempf is the vice president and CNO, and Kari A. Mastro is the director of practice, innovation, and research. Nicholas Giordano is an assistant professor at Nell Hodgson Woodruff School of Nursing Emory University in Atlanta, Ga
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Eur Heart J 2022; 43:1059-1103. [PMID: 34791154 PMCID: PMC8690006 DOI: 10.1093/eurheartj/ehab697] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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20
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The Impact of the COVID-19 Pandemic on Hospital Services for Patients with Cardiac Diseases: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063172. [PMID: 35328859 PMCID: PMC8953098 DOI: 10.3390/ijerph19063172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
Abstract
This study aims to assess the impact of the COVID-19 pandemic on hospital cardiac care, as assessed by performance indicators. Scoping review methodology: performance indicators were extracted to inform on changes in care during January–June 2020. Database searches yielded 6277 articles, of which 838 met the inclusion criteria. After full-text screening, 94 articles were included and 1637 indicators were retrieved. Most of the indicators that provided information on changes in the number of admissions (n = 118, 88%) signaled a decrease in admissions; 88% (n = 15) of the indicators showed patients’ delayed presentation and 40% (n = 54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signaled by 95% (n = 18) and 81% (n = 64) of the indicators, respectively. Length of stay decreased in 58% (n = 21) of the indicators, acute coronary syndromes treatment times increased in 61% (n = 65) of the indicators, and outpatient activity decreased in 94% (n = 17) of the indicators related to outpatient care. Telehealth utilization increased in 100% (n = 6). Outcomes worsened in 40% (n = 35) of the indicators, and mortality rates increased in 52% (n = 31). All phases of the pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events.
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21
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Heidenreich PA, Fonarow GC, Opsha Y, Sandhu AT, Sweitzer NK, Warraich HJ. Economic Issues in Heart Failure in the United States. J Card Fail 2022; 28:453-466. [PMID: 35085762 PMCID: PMC9031347 DOI: 10.1016/j.cardfail.2021.12.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 12/27/2022]
Abstract
The cost of heart failure care is high owing to the cost of hospitalization and chronic treatments. Heart failure treatments vary in their benefit and cost. The cost effectiveness of therapies can be determined by comparing the cost of treatment required to obtain a certain benefit, often defined as an increase in 1 year of life. This review was sponsored by the Heart Failure Society of America and describes the growing economic burden of heart failure for patients and the health care system in the United States. It also provides a summary of the cost effectiveness of drugs, devices, diagnostic tests, hospital care, and transitions of care for patients with heart failure. Many medications that are no longer under patent are inexpensive and highly cost-effective. These include angiotensin-converting enzyme inhibitors, beta-blockers and mineralocorticoid receptor antagonists. In contrast, more recently developed medications and devices, vary in cost effectiveness, and often have high out-of-pocket costs for patients.
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Affiliation(s)
- Paul A. Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, CA,VA Palo Alto Health Care System, Palo Alto, CA
| | - Gregg C. Fonarow
- Division of Cardiology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Yekaterina Opsha
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ,Saint Barnabas Medical Center, Livingston, NJ
| | - Alexander T. Sandhu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Nancy K. Sweitzer
- Division of Cardiology, University of Arizona College of Medicine, Tucson, AZ
| | - Haider J. Warraich
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA
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22
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Affiliation(s)
- David W Louis
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Marwan Saad
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Shilpa Vijayakumar
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Suleman Ilyas
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Aravind Kokkirala
- United States Department of Veterans Affairs Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
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23
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Sun LY, Wijeysundera HC, Lee DS, van Diepen S, Ruel M, Eddeen AB, Mesana TG. Derivation and validation of a clinical risk score to predict death among patients awaiting cardiac surgery in Ontario, Canada: a population-based study. CMAJ Open 2022; 10:E173-E182. [PMID: 35260467 PMCID: PMC9259465 DOI: 10.9778/cmajo.20210031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Surgical delay may result in unintended harm to patients needing cardiac surgery, who are at risk for death if their condition is left untreated. Our objective was to derive and internally validate a clinical risk score to predict death among patients awaiting major cardiac surgery. METHODS We used the CorHealth Ontario Registry and linked ICES health administrative databases with information on all Ontario residents to identify patients aged 18 years or more who were referred for isolated coronary artery bypass grafting (CABG), valvular procedures, combined CABG-valvular procedures or thoracic aorta procedures between Oct. 1, 2008, and Sept. 30, 2019. We used a hybrid modelling approach with the random forest method for initial variable selection, followed by backward stepwise logistic regression modelling for clinical interpretability and parsimony. We internally validated the logistic regression model, termed the CardiOttawa Waitlist Mortality Score, using 200 bootstraps. RESULTS Of the 112 266 patients referred for cardiac surgery, 269 (0.2%) died while awaiting surgery (118/72 366 [0.2%] isolated CABG, 81/24 461 [0.3%] valvular procedures, 63/12 046 [0.5%] combined CABG-valvular procedures and 7/3393 [0.2%] thoracic aorta procedures). Age, sex, surgery type, left main stenosis, Canadian Cardiovascular Society classification, left ventricular ejection fraction, heart failure, atrial fibrillation, dialysis, psychosis and operative priority were predictors of waitlist mortality. The model discriminated (C-statistic 0.76 [optimism-corrected 0.73]). It calibrated well in the overall cohort (Hosmer-Lemeshow p = 0.2) and across surgery types. INTERPRETATION The CardiOttawa Waitlist Mortality Score is a simple clinical risk model that predicts the likelihood of death while awaiting cardiac surgery. It has the potential to provide data-driven decision support for managing access to cardiac care and preserve system capacity during the COVID-19 pandemic, the recovery period and beyond.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont.
| | - Harindra C Wijeysundera
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Douglas S Lee
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Sean van Diepen
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Marc Ruel
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Anan Bader Eddeen
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Thierry G Mesana
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
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Kobulnik J, Wang IY, Bell C, Moayedi Y, Truong N, Sinha S. Management of Frail and Older Homebound Patients With Heart Failure: A Contemporary Virtual Ambulatory Model. CJC Open 2022; 4:47-55. [PMID: 35072027 PMCID: PMC8767131 DOI: 10.1016/j.cjco.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background Heart failure (HF) affects many patients who are older and frail, presenting multiple physical barriers to accessing specialty care in a traditional ambulatory clinic model. Here, we present an assisted virtual care model in which a home visiting nurse facilitated video visits with a HF cardiologist to follow homebound, frail, and older patients with HF. Methods This is a pragmatic, quasi-experimental, pre–post, single-centre study. It included homebound, frail, and older patients with HF from 2015 to 2019 who were followed for 1 year; in-person clinic visits were completely replaced by nurse-facilitated virtual video visits. Outcomes evaluated included annualized hospitalization rate, number of hospitalization days, and number of emergency department visits. Results A total of 49 patients were included, with a median age of 86 (83-93) years, and were followed for 1 year after enrollment. Among patients enrolled, HF with preserved ejection fraction was the most common subtype (57%). Compared to the year prior to enrollment, patients had a lower mortality-adjusted all-cause annualized hospitalization rate in the year following enrollment (2.57 vs 1.78, P < 0.0001). Compared to the year prior, the number of mortality-adjusted all-cause hospitalization days was significantly lower in the year following enrollment (27.2 vs 21.4, P < 0.0001). There was a reduction in the number of all-cause annualized emergency department visits (3.10 vs 2.27, P = 0.003). Conclusions Nurse-assisted virtual visits may be a preferable strategy for homebound, frail, and older patients with HF to receive longitudinal care. This approach may represent a plausible strategy to care for other patients with significant barriers to accessing specialized cardiac care.
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Greene A, Sapp J, Hirsch G, Sandila N, Quraishi A, El-Khateeb O, Kirkland S, Stewart R, Anderson K, Chedrawy E, Campbell S, Herman C, Goldstein J, Carter A, Andreou P, Collins A, Travers A, Parkash R. Cardiovascular Outcomes in Nova Scotia during the Early Phase of the COVID-19 Pandemic. CJC Open 2021; 4:324-336. [PMID: 34977521 PMCID: PMC8704736 DOI: 10.1016/j.cjco.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study sought to determine the impact of the pandemic response to healthcare delivery on outcomes in patients with cardiovascular disease. Methods This is a population-based cohort study performed in the province of Nova Scotia (population 979,499), between Pre-COVID (March 1, 2017 - March 16, 2020) and in-COVID (March 17, 2020 - December 31, 2020) periods. Adult patients (≥18 years) with new onset or existing cardiovascular disease were included for comparison between periods. The main outcome measures included: cardiovascular emergency department visits or hospitalizations, mortality, and out-of-hospital cardiac arrest. Results In the first month of the in-COVID period, emergency department visits (n=51,750) for cardiac symptoms decreased by 20.8% (95% CI 14.0% - 27.0%, p<0.001). Cardiovascular hospitalizations (n=20 609) declined by 48.1% (95% CI 40.4% to 54.9%, p<0.001). In-hospital mortality rate increased in patients with cardiovascular admissions in secondary care institutions by 55.1% (95%CI 10.1%-118%, p=0.013). A decline of 20.4% - 44.0% occurred in cardiovascular surgical/interventional procedures. Out-of-hospital cardiac arrests (n=5528) increased from a monthly mean of 115±15 to 136±14, beginning in May, 2020. Mortality for ambulatory patients awaiting cardiac intervention (n=14,083) increased from 0.16% (n=12501) to 2.49% (n=361) in the in-COVID period (p<0.0001). Conclusion This study demonstrates increased cardiovascular morbidity and mortality during restrictions maintained during COVID-19, in an area with low burden of COVID-19 disease. As the healthcare system recovers or enters subsequent waves of COVID-19, these findings should inform communication to the public regarding cardiovascular symptoms and policy for delivery of cardiovascular care.
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Affiliation(s)
- Alison Greene
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - John Sapp
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Greg Hirsch
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Navjot Sandila
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Ata Quraishi
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Osama El-Khateeb
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Departments of Community Health & Epidemiology and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Stewart
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Kim Anderson
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Edgar Chedrawy
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Samuel Campbell
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Christine Herman
- Division of Cardiac Surgery, Department of Surgery, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Judah Goldstein
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.,Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Alexandra Carter
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.,Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Pantelis Andreou
- Departments of Community Health & Epidemiology and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adair Collins
- Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Andrew Travers
- Division of Emergency Medical Services, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.,Emergency Health Services, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
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König S, Pellissier V, Leiner J, Hohenstein S, Ueberham L, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. Expected and observed in-hospital mortality in heart failure patients before and during the COVID-19 pandemic: Introduction of the machine learning-based standardized mortality ratio at Helios hospitals. Clin Cardiol 2021; 45:75-82. [PMID: 34951030 PMCID: PMC8799043 DOI: 10.1002/clc.23762] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Reduced hospital admission rates for heart failure (HF) and evidence of increased in-hospital mortality were reported during the COVID-19 pandemic. The aim of this study was to apply a machine learning (ML)-based mortality prediction model to examine whether the latter is attributable to differing case mixes and exceeds expected mortality rates. METHODS AND RESULTS Inpatient cases with a primary discharge diagnosis of HF non-electively admitted to 86 German Helios hospitals between 01/01/2016 and 08/31/2020 were identified. Patients with proven or suspected SARS-CoV-2 infection were excluded. ML-based models were developed, tuned, and tested using cases of 2016-2018 (n = 64,440; randomly split 75%/25%). Extreme gradient boosting showed the best model performance indicated by a receiver operating characteristic area under the curve of 0.882 (95% confidence interval [CI]: 0.872-0.893). The model was applied on data sets of 2019 and 2020 (n = 28,556 cases) and the hospital standardized mortality ratio (HSMR) was computed as the observed to expected death ratio. Observed mortality rates were 5.84% (2019) and 6.21% (2020), HSMRs based on an individual case-based mortality probability were 100.0 (95% CI: 93.3-107.2; p = 1.000) for 2019 and 99.3 (95% CI: 92.5-106.4; p = .850) for 2020. Within subgroups of age or hospital volume, there were no significant differences between observed and expected deaths. When stratified for pandemic phases, no excess death during the COVID-19 pandemic was observed. CONCLUSION Applying an ML algorithm to calculate expected inpatient mortality based on administrative data, there was no excess death above expected event rates in HF patients during the COVID-19 pandemic.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
| | | | - Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
| | - Sven Hohenstein
- Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
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Watanabe S, Shin JH, Morishita T, Takada D, Kunisawa S, Imanaka Y. Medium-Term Impact of the Coronavirus Disease 2019 Pandemic on the Practice of Percutaneous Coronary Interventions in Japan. J Atheroscler Thromb 2021; 29:1571-1587. [PMID: 34924456 PMCID: PMC9623075 DOI: 10.5551/jat.63194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims: Declines in cardiovascular diseases during the first surge of coronavirus disease 2019 (COVID-19) have been reported. With the repeating surges of COVID-19, we aim to investigate the medium-term impact of the COVID-19 pandemic on the practice of percutaneous coronary interventions (PCIs).
Methods: We performed a descriptive analysis of rates of PCIs, utilizing administrative data in Japan. Changes in the proportion of severe cases and in-hospital mortality since the start of the COVID-19 pandemic were investigated using interrupted time series (ITS) analyses.
Results: From April 2018 to February 2021, 38,696 and 28,585 cases of elective and emergency PCIs, respectively, were identified. The rates of PCIs decreased during the first and third COVID-19 surges. The ratios of monthly rates of elective PCIs to that in the corresponding months during the previous 2 years were 50.3% in May 2020 and 76.1% in January 2021. The decrease in rates of emergency PCIs was smaller than that of elective PCIs. The ITS analyses did not identify any significant changes in the proportion of severe cases and in-hospital mortality.
Conclusions: We found that the impacts of COVID-19 on PCIs were larger in the first surge than in the subsequent and larger in the elective than in the emergency; this continued over the medium-term. During the COVID-19 pandemic, in-hospital mortality of cases undertaking emergency PCIs did not change.
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Affiliation(s)
- Shusuke Watanabe
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
| | - Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
| | - Tetsuji Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
| | - Daisuke Takada
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University
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Morishita T, Takada D, Shin JH, Higuchi T, Kunisawa S, Fushimi K, Imanaka Y. Effects of the COVID-19 pandemic on heart failure hospitalizations in Japan: interrupted time series analysis. ESC Heart Fail 2021; 9:31-38. [PMID: 34913269 PMCID: PMC8788142 DOI: 10.1002/ehf2.13744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
Aims The Coronavirus Disease 2019 (COVID‐19) pandemic has had unprecedented effects on health care utilization for acute cardiovascular diseases. Although hospitalizations for acute coronary syndrome decreased during the COVID‐19 pandemic, there is a paucity of data on the trends and management of heart failure (HF) cases. Furthermore, concerns have been raised that angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase susceptibility to COVID‐19. This study aimed to elucidate changes in HF hospitalizations from the COVID‐19 state of emergency in Japan and investigated changes in the prescription of ACEIs and ARBs, and in‐hospital mortality. Methods and results We performed an interrupted time series analysis of HF hospitalizations in Japan to verify the impacts of the COVID‐19 state of emergency. Changes in the weekly volume of HF hospitalizations were taken as the primary outcome measure. Between 1 April 2018 and 4 July 2020, 109 429 HF cases required admission. After the state of emergency, an immediate decrease was observed in HF cases per week [−3.6%; 95% confidence interval (CI): −0.3% to −6.7%, P = 0.03]. There was no significant change in the prescription of ACEIs or ARBs after the state of emergency (4.2%; 95% CI: −0.3% to 8.9%, P = 0.07). The COVID‐19 pandemic had no effect on in‐hospital mortality among HF patients (5.3%; 95% CI: −4.9% to 16.6%, P = 0.32). Conclusions We demonstrated a decline in HF hospitalizations during the COVID‐19 pandemic in Japan, with no clear evidence of a negative effect on the prescription of ACEIs and ARBs or in‐hospital mortality.
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Affiliation(s)
- Tetsuji Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan.,Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
| | - Daisuke Takada
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan
| | - Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan
| | - Takuya Higuchi
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan
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Kubica J, Ostrowska M, Stolarek W, Kasprzak M, Grzelakowska K, Kryś J, Kubica A, Adamski P, Podhajski P, Navarese EP, Anielska-Michalak E, Brycht O, Curzytek A, Dudek A, Gromadziński L, Grzelakowski P, Kamiński L, Kleinrok A, Kostkiewicz M, Koziński M, Król P, Kulawik T, Minczew G, Mindykowski M, Pawlak A, Prokopczuk J, Skonieczny G, Sobkowicz B, Sowiński S, Stankala S, Szymański P, Wester A, Wilczewski P, Bartuś S, Budaj A, Gąsior M, Gruchała M, Drożdż J, Jaguszewski M, Jankowski P, Legutko J, Lesiak M, Leszek P, Mitkowski P, Nessler J, Tomaszuk-Kazberuk A, Tycińska A, Zdrojewski T, Kaźmierczak J. Impact of COVID-19 pandemic on acute heart failure admissions and mortality: a multicentre study (COV-HF-SIRIO 6 study). ESC Heart Fail 2021; 9:721-728. [PMID: 34786869 PMCID: PMC8652676 DOI: 10.1002/ehf2.13680] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Aims The coronavirus disease‐2019 (COVID‐19) pandemic has changed the landscape of medical care delivery worldwide. We aimed to assess the influence of COVID‐19 pandemic on hospital admissions and in‐hospital mortality rate in patients with acute heart failure (AHF) in a retrospective, multicentre study. Methods and results From 1 January 2019 to 31 December 2020, a total of 101 433 patients were hospitalized in 24 Cardiology Departments in Poland. The number of patients admitted due to AHF decreased by 23.4% from 9853 in 2019 to 7546 in 2020 (P < 0.001). We noted a significant reduction of self‐referrals in the times of COVID‐19 pandemic accounting 27.8% (P < 0.001), with increased number of AHF patients brought by an ambulance by 15.9% (P < 0.001). The length of hospital stay was overall similar (7.7 ± 2.8 vs. 8.2 ± 3.7 days; P = not significant). The in‐hospital all‐cause mortality in AHF patients was 444 (5.2%) in 2019 vs. 406 (6.5%) in 2020 (P < 0.001). A total number of AHF patients with concomitant COVID‐19 was 239 (3.2% of AHF patients hospitalized in 2020). The rate of in‐hospital deaths in AHF patients with COVID‐19 was extremely high accounting 31.4%, reaching up to 44.1% in the peak of the pandemic in November 2020. Conclusions Our study indicates that the COVID‐19 pandemic led to (i) reduced hospital admissions for AHF; (ii) decreased number of self‐referred AHF patients and increased number of AHF patients brought by an ambulance; and (iii) increased in‐hospital mortality for AHF with very high mortality rate for concomitant AHF and COVID‐19.
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Affiliation(s)
- Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Małgorzata Ostrowska
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Wioleta Stolarek
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Klaudyna Grzelakowska
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Jacek Kryś
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Aldona Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Piotr Adamski
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Przemysław Podhajski
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Eliano Pio Navarese
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz, 85-094, Poland
| | - Edyta Anielska-Michalak
- Department of Cardiology, Marian Zyndram-Kościałkowski Ministry of Interior and Administration Hospital, Białystok, Poland
| | - Oliwia Brycht
- II Department of Cardiology, Chair of Cardiology, Cardiac Surgery and Vascular Diseases, Medical University of Lodz, Lodz, Poland
| | - Andrzej Curzytek
- Department of Cardiology, Hospital of the Ministry of Interior and Administration, Rzeszów, Poland
| | - Aneta Dudek
- 1st Department of Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Paweł Grzelakowski
- Department of Cardiology and Cardiac Surgery, 10th Military Hospital and Polyclinic, Bydgoszcz, Poland
| | - Leszek Kamiński
- Department of Cardiology Independent Public Healthcare in Przeworsk, Przeworsk, Poland
| | - Andrzej Kleinrok
- Cardiology Department, Pope John Paul II District Hospital in Zamość, Zamosc, Poland
| | | | - Marek Koziński
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Paweł Król
- Department of Cardiology, Tertiary Care Hospital, Ciechanów, Poland
| | - Tomasz Kulawik
- Department of Cardiology, Masovian Rehabilitation Center "STOCER", Dr. Włodzimierz Roefler Hospital, Pruszków, Poland
| | - Gleb Minczew
- Department of Cardiology, District Hospital, Tuchola, Poland
| | - Marcin Mindykowski
- Department of Cardiology, Dr. Emil Warmiński Tertiary Care Municipal Hospital, Bydgoszcz, Poland
| | - Agnieszka Pawlak
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.,Mossakowski Medical Research Centre Polish Academy of Science, Warsaw, Poland
| | - Janusz Prokopczuk
- Department of Cardiology, Polish Hospitals, Kędzierzyn-Koźle, Poland
| | - Grzegorz Skonieczny
- Department of Cardiology and Intensive Cardiac Care Unit, District Polyclinic Hospital, Toruń, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University in Białystok, Białystok, Poland
| | - Sergiusz Sowiński
- Department of Cardiology and Cardiac Intensive Care, Tertiary Care Municipal Hospital, Toruń, Poland
| | - Sebastian Stankala
- Cardiology Subdivision of Heart Failure, St. Elizabeth Hospital, Biała, Poland
| | - Paweł Szymański
- Department of Cardiology, Interventional Cardiology and Electrophysiology with Cardiac Intensive Care Unit, Tertiary Care Hospital, Grudziądz, Poland
| | - Andrzej Wester
- 1st Department of Physiology, Institute of Medical Sciences, University of Opole, Cardiology Center of Kluczbork SCANMED SA, Opole, Poland
| | | | - Stanisław Bartuś
- 2nd Department of Cardiology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Faculty of Medicine in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Jarosław Drożdż
- II Department of Cardiology, Chair of Cardiology, Cardiac Surgery and Vascular Diseases, Medical University of Lodz, Lodz, Poland
| | - Miłosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Jankowski
- 1st Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemysław Leszek
- Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland
| | | | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Agnieszka Tycińska
- Department of Cardiology, Medical University in Białystok, Białystok, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
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Laing S, Johnston S. Estimated impact of COVID-19 on preventive care service delivery: an observational cohort study. BMC Health Serv Res 2021; 21:1107. [PMID: 34656114 PMCID: PMC8520349 DOI: 10.1186/s12913-021-07131-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 has caused significant healthcare service disruptions. Surgical backlogs have been estimated but not for other healthcare services. This study aims to estimate the backlog of preventive care services caused by COVID-19. METHODS This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were crudely estimated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada. RESULTS The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (- 0.3% to - 14.7%; 95% CI), colorectal cancer decreased by 8.1% (- 0.3% to - 15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (- 0.2% to - 8.7%; 95% CI). Crude estimates imply 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI) may be overdue in Ontario. Nationally the deficits may be tripled these numbers. Re-opening measures have not reversed these trends. INTERPRETATION COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.
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Affiliation(s)
- Scott Laing
- University of Ottawa Department of Family Medicine, Telfer School of Management, Ottawa, Canada.
| | - Sharon Johnston
- University of Ottawa Department of Family Medicine, Institut du Savoir Montfort, Bruyère Research Institute, Ottawa, Canada
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31
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Ploux S, Strik M, Abu-Alrub S, Ramirez FD, Buliard S, Marchand H, Picard F, Eschalier R, Haïssaguerre M, Bordachar P. Remote monitoring of patients with heart failure during the first national lockdown for COVID-19 in France. EUROPEAN HEART JOURNAL - DIGITAL HEALTH 2021; 2:487-493. [PMID: 37115642 PMCID: PMC8135567 DOI: 10.1093/ehjdh/ztab044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
Background Multiparametric remote monitoring of patients with heart failure (HF) has the potential to mitigate the health risks of lockdowns for COVID-19. Aims To compare health care use, physiological variables, and HF decompensations during one month before and during the first month of the first French national lockdown for COVID-19 among patients undergoing remote monitoring. Methods Transmitted vital parameters and data from cardiac implantable electronic devices were analyzed in 51 patients. Medical contact was defined as the sum of visits and days of hospitalization. Results The lockdown was associated with a marked decrease in cardiology medical contact (118 days before vs 26 days during, -77%, p = 0.003) and overall medical contact (180 days before vs 79 days during, -58%, p = 0.005). Patient adherence with remote monitoring was 84±21% before and 87±19% during lockdown. The lockdown was not associated with significant changes in various parameters, including physical activity (2±1 to 2±1 h/day), weight (83±16 to 83±16 kg), systolic blood pressure (121±19 to 121±18 mmHg), heart rate (68±10 to 67±10 bpm), heart rate variability (89±44 to 78±46 ms, p = 0.05), atrial fibrillation burden (84±146 vs 86±146 h/month), or thoracic impedance (66±8 to 66±9 Ω). Seven cases of HF decompensations were observed before lockdown, all but one of which required hospitalization, versus six during lockdown, all but one of which were managed remotely. Conclusions The lockdown restrictions caused a marked decrease in health care use but no significant change in the clinical status of HF patients under multiparametric remote monitoring. lay summary The first French COVID-19 lockdown had a huge detrimental impact on conventional health care use (-78% in cardiology medical contact). However the lockdown had little impact over the short-term, if any, on vital parameters and the clinical status of patients with heart failure who were adherent to multiparametric remote monitoring. This remote monitoring strategy allowed early identification and home management of most of the heart failure decompensations during the lockdown.
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Affiliation(s)
- Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Saer Abu-Alrub
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- Cardiology Department, Clermont Université, Université d’Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, H-3406, Ottawa, ON K1Y 4W7, Canada
| | - Samuel Buliard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
| | - Hugo Marchand
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
| | - François Picard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
| | - Romain Eschalier
- Cardiology Department, Clermont Université, Université d’Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
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Jayagopal PB, Abdullakutty J, Sridhar L, Nanjappa V, Joseph J, Vaidyanathan PR, Somasekhar G, Raghu TR, Srinivas BC, Chopra VK, Manjunath CN. Acute decompensated heart failure (ADHF) during COVID-19 pandemic-insights from South India. Indian Heart J 2021; 73:464-469. [PMID: 34474759 PMCID: PMC8256338 DOI: 10.1016/j.ihj.2021.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/18/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
AIM This retrospective study compares admissions and outcomes due to acute decompensated heart failure (ADHF) during the COVID-19 pandemic from 25 March to 25 July 2020 with the historical patient control who were admitted during the same period in 2019. METHODS AND RESULTS Data of the participating hospitals was collected and analysed from the ICC NHFR (Indian College of Cardiology National Heart Failure Registry) for 2019 and 2020. Total number of ADHF admissions, demographics, aetiology, co-morbid conditions and in-hospital mortality was compared and analysed. A significant decrease in the number of hospital admissions due to ADHF from 2019 to 2020 (1056 vs. 526 respectively) was noted. Incidence of admissions with <40% ejection fraction (EF) reduced in 2020 (72.4% and 80.2% in2020 and 2019)and >40% (EF) increased (27.6% and 19.8% in 2019 and 2020 respectively, p = 0.0005). Ischemic heart disease (IHD) was the most common aetiology (78.59% in 2019 and 80.98% in 2020, p = 0.268). The in-hospital mortality was numerically higher in 2020 (10%) than in 2019 (8%), but not statistically significant (p = 0.161). CONCLUSION This study from the registry shows that the incidence of ADHF admissions during COVID-19 lockdown significantly reduced compared to the previous year. Demographic patterns remained similar but patients presenting with de-novo HF increased; IHD was the most common cause. The in-hospital mortality was numerically higher during the lockdown. The impact of lockdown perhaps led to fewer hospitalisations and this is to be factored in future strategies to address health care delivery during such crises.
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Affiliation(s)
| | | | - L Sridhar
- Sri Jayadeva Institute of Cardiovascular Science and Research, Bengaluru, India
| | - Veena Nanjappa
- Sri Jayadeva Institute of Cardiovascular Sciences & Research, Mysuru, Karnataka, India
| | | | - P R Vaidyanathan
- Kuppuswami Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - G Somasekhar
- Aayush Hospitals, Vijayawada, Andhra Pradesh, India
| | - T R Raghu
- Rajarajeshwari Medical College, Kambipura, Mysore Road, Bangalore, India
| | - B C Srinivas
- Sri Jayadeva Institute of Cardiovascular Science and Research, Bengaluru, Karnataka, India
| | - V K Chopra
- Heart Failure Programme and Research, Max Super Specialty Hospital, Saket, New Delhi, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Science and Research, Bengaluru, Karnataka, India
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Muldoon KA, Denize KM, Talarico R, Boisvert C, Frank O, Harvey ALJ, Rennicks White R, Fell DB, O'Hare-Gordon MA, Guo Y, Murphy MSQ, Corsi DJ, Sampsel K, Wen SW, Walker MC, El-Chaar D. COVID-19 and perinatal intimate partner violence: a cross-sectional survey of pregnant and postpartum individuals in the early stages of the COVID-19 pandemic. BMJ Open 2021; 11:e049295. [PMID: 34045216 PMCID: PMC8728372 DOI: 10.1136/bmjopen-2021-049295] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objectives of this study were to: (1) document violent and controlling behaviours within intimate partnerships during the perinatal period; and (2) determine individual, interpersonal and household-level factors influencing the risk of perinatal intimate partner violence (IPV). DESIGN Cross-sectional survey. SETTING The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada. PARTICIPANTS Patients who gave birth at The Ottawa Hospital and were >20 days post partum between 17 March and 16 June 2020. MAIN OUTCOMES AND MEASURES Perinatal IPV was defined as regular controlling behaviours or act-based forms of emotional/physical/sexual abuse in the 12 months before pregnancy, during pregnancy and/or post partum. Log-binomial multivariable regression models were used to compute adjusted risk ratios (aRRs) and 95% CIs to identify potential risk factors for IPV: maternal age, postpartum depression, parity, increase in partner substance use and household income. RESULTS Among 216 participants, the median maternal age was 33 years (IQR: 30-36). In total, 52 (24.07%) reported some form of perinatal IPV, 37 (17.13%) reported regular controlling behaviour and 9 (4.17%) reported both. Household income below the municipal median was the strongest risk factor for perinatal IPV (aRR: 3.24, 95% CI: 1.87 to 5.59). There was no apparent association between maternal age (aRR: 0.99, 95% CI: 0.94 to 1.04), postpartum depression (aRR: 1.03, 95% CI: 1.00 to 1.07), nulliparity (aRR: 1.18, 95% CI: 0.71 to 1.97) or increases in partner substance use (aRR: 0.73, 95% CI: 0.42 to 1.25) with IPV. CONCLUSION One in four individuals in this study experienced perinatal IPV. Household income was the strongest risk factor, and surprisingly, many hypothesised risk factors (eg, mental health, partner substance use, etc) were not significantly associated with perinatal IPV in this sample. This highlights the challenges in both measuring IPV and identifying individuals exposed to perinatal IPV during the high stress of the COVID-19 pandemic.
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Affiliation(s)
- Katherine A Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn M Denize
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carlie Boisvert
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivia Frank
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Alysha L J Harvey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Yanfang Guo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kari Sampsel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Darine El-Chaar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Lee DD, Jung H, Lou W, Rauchwerger D, Chartier LB, Masood S, Sathiaseelan S, Taher AK. The Impact of COVID-19 on a Large, Canadian Community Emergency Department. West J Emerg Med 2021; 22:572-579. [PMID: 34125029 PMCID: PMC8202991 DOI: 10.5811/westjem.2021.1.50123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/26/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION As the COVID-19 pandemic unfolded, emergency departments (EDs) across the world braced for surges in volume and demand. However, many EDs experienced decreased demand even for higher acuity illnesses. In this study we sought to examine the change in utilization at a large Canadian community ED, including changes in patient demographics and presentations, as well as structural and administrative changes made in response to the pandemic. METHODS This retrospective observational study took place in Ontario, Canada, from March 17-June 30, 2020, during province-wide lockdowns in response to COVID-19. We used a control period of March 17-June 30 in 2018-2019. Differences between observed and expected values were calculated for total visits, Canadian Triage and Acuity Scale (CTAS) groups, and age groups using Fisher's exact test. Length of stay (LOS), physician initial assessment time (PIA), and top primary and admission diagnoses were also examined. RESULTS Patient visits fell to 66.3% of expected volume in the exposure period (20,901 vs 31,525, P<0.0001). CTAS-1 (highest acuity) patient volumes dropped to 86.8% of expected (P = 0.1964) while CTAS-5 (lowest acuity) patient volumes dropped to 32.4% of expected (P <0.0001). Youth (0-17), adult (18-64), and senior (65+) visits all decreased to 37.4%, 71.7%, and 72.9% of expected volumes, respectively (P <0.0001). Median PIA and median ED LOS both decreased (1.1 to 0.6 hours and 3.3 to 3.0 hours, respectively). The most common primary diagnosis in both periods was "other chest pain." Viral syndromes were more prevalent in the exposure period. The top admission diagnoses were congestive heart failure in the control period (4.8%) and COVID-19 in the study period (3.5%). CONCLUSION ED utilization changed drastically during COVID-19. Our ED responded with wide stakeholder engagement, spatial reorganization, and human resources changes informed by real-time data. Our experiences can help prepare for potential subsequent "waves" of COVID-19 and future pandemics.
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Affiliation(s)
- Daniel Dongjoo Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - David Rauchwerger
- Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada
| | - Lucas B Chartier
- University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada
| | - Sameer Masood
- University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada
| | - Seyon Sathiaseelan
- Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada.,University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,McMaster University, Department of Family Medicine, Hamilton, Ontario, Canada
| | - Ahmed Khaled Taher
- Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada.,University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada
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Shah A, Guessi M, Wali S, Ware P, McDonald M, O'Sullivan M, Posada JD, Ross H, Seto E. The Resilience of Cardiac Care Through Virtualized Services During the COVID-19 Pandemic: Case Study of a Heart Function Clinic. JMIR Cardio 2021; 5:e25277. [PMID: 33878021 PMCID: PMC8411433 DOI: 10.2196/25277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/28/2020] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
Background Virtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed people’s interest in health systems resilience, which includes how services adapt or transform in response to shocks, evidence regarding the role of virtual care technologies in health systems resilience is scarce. Objective At Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020, as a response to the pandemic. The objective of this study was to understand people’s experiences with and the barriers and facilitators of the rapid virtualization and expansion of cardiac care resulting from the pandemic. Methods A single-case study was conducted with 3 embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile, phone-based telemonitoring program at a heart function clinic in Toronto, Canada. Individual, semistructured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. Results A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and staff (n=4). The following five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces in virtual care; and (5) the inequity paradox. The motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated the absorptive and adaptive resilience of cardiac care during the COVID-19 pandemic. However, ad hoc changes to clinic roles and workflows, challenges in building relationships through remote methods, and widened inequities were barriers that threatened virtual care sustainment. Conclusions We contend that sustaining virtual care hinges upon transformative actions (rather than adaptive actions) that strengthen health systems so that they can face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators we identified, we present the lessons we learned and recommend transformations for sustaining virtual care during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Amika Shah
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Milena Guessi
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Computer Systems, Institute of Mathematics and Computer Science, University of São Paulo, São Paulo, Brazil
| | - Sahr Wali
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Patrick Ware
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Mary O'Sullivan
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Juan Duero Posada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada.,Advanced Heart Failure, Transplantation and Mechanical Circulatory Support, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Calder LA, Perry J, Yan JW, De Gorter R, Sivilotti MLA, Eagles D, Myslik F, Borgundvaag B, Émond M, McRae AD, Taljaard M, Thiruganasambandamoorthy V, Cheng W, Forster AJ, Stiell IG. Adverse Events Among Emergency Department Patients With Cardiovascular Conditions: A Multicenter Study. Ann Emerg Med 2021; 77:561-574. [PMID: 33612283 DOI: 10.1016/j.annemergmed.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE We aim to determine incidence and type of adverse events (adverse outcomes related to emergency care) among emergency department (ED) patients discharged with recent-onset atrial fibrillation, acute heart failure, and syncope. METHODS This 5-year prospective cohort study included high-acuity adult patients discharged with the 3 sentinel diagnoses from 6 tertiary care Canadian EDs. We screened all ED visits for eligibility and performed telephone interviews 14 days postdischarge to identify flagged outcomes: death, hospital admission, return ED visit, health care provider visit, and new or worsening symptoms. We created case summaries describing index ED visit and flagged outcomes, and trained emergency physicians reviewed case summaries to identify adverse events. We reported adverse event incidence and rates with 95% confidence intervals and contributing factor themes. RESULTS Among 4,741 subjects (mean age 70.2 years; 51.2% men), we observed 170 adverse events (3.6 per 100 patients; 95% confidence interval 3.1 to 4.2). Patients discharged with acute heart failure were most likely to experience adverse events (5.3%), followed by those with atrial fibrillation (2.0%) and syncope (0.8%). We noted variation in absolute adverse event rates across sites from 0.7 to 6.0 per 100 patients. The most common adverse event types were management issues, diagnostic issues, and unsafe disposition decisions. Frequent contributing factor themes included failure to recognize underlying causes and inappropriate management of dual diagnoses. CONCLUSION Among adverse events after ED discharge for patients with these 3 sentinel cardiovascular diagnoses, we identified quality improvement opportunities such as strengthening dual diagnosis detection and evidence-based clinical practice guideline adherence.
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Affiliation(s)
- Lisa A Calder
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Lawson Health Research Institute, London, Ontario, Canada
| | - Ria De Gorter
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marco L A Sivilotti
- Departments of Emergency Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Lawson Health Research Institute, London, Ontario, Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Émond
- Département de médecine Familiale et d'Urgence, Université Laval, Québec City, Quebec, Canada
| | - Andrew D McRae
- Departments of Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan J Forster
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Nan J, Zhang T, Tian Y, Song K, Li Q, Fu Q, Ma Y, Jin Z. Impact of the 2019 Novel Coronavirus Disease Pandemic on the Performance of a Cardiovascular Department in a Non-epidemic Center in Beijing, China. Front Cardiovasc Med 2021; 8:630816. [PMID: 33681305 PMCID: PMC7929980 DOI: 10.3389/fcvm.2021.630816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Knowledge of the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on the performance of a cardiovascular department in a medical referral hub center from a non-epidemic area of China is limited. Method: The data on the total number of non-emergency medical cares (including the number of out-patient clinic attendances, the number of patients who were hospitalized in non-intensive care wards, and patients who underwent elective cardiac intervention procedures) and emergency medical cares [including the number of emergency department (ED attendances) and chest pain center (CPC attendances), as well as the number of patients who were hospitalized in coronary care unit (CCU) and the number of patients who underwent emergency cardiac intervention procedures] before and during the pandemic (time before the pandemic: 20th January 2019 to 31st March 2019 and time during the pandemic: 20th January 2020 to 31st March 2020) in the Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University were collected and compared. Results: Both the non-emergency medical and emergency medical cares were affected by the pandemic. The total number of out-patient clinic attendance decreased by 44.8% and the total number of patients who were hospitalized in non-intensive care wards decreased by 56.4%. Pearson correlation analysis showed that the number of out-patient clinic attendance per day was not associated with the number of new confirmed COVID-19 cases and the cumulative number of confirmed COVID-19 patients in Beijing (r = −0.080, p = 0.506 and r = −0.071, p = 0.552, respectively). The total number of patients who underwent non-emergency cardiac intervention procedures decreased during the pandemic, although there were no statistically significant differences except for patent foramen ovale (PFO) occlusion (1.7 ± 2.9 vs. 8.3 ± 2.3, p = 0.035). As for the emergency medical cares, the ED attendances decreased by 22.4%, the total number of CPC attendances increased by 10.3%, and the number of patients who were hospitalized in CCU increased by 8.9%: these differences were not statistically significant. During the pandemic, the proportion of hospitalized patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) significantly increased (19.0 vs. 8.7%, p < 0.001; 28.8 vs. 18.0%, p < 0.001, respectively); also, the number of primary percutaneous coronary intervention (PCI) increased by 10.3%. There was no significant difference between patients before and during the pandemic regarding the age, gender, baseline and discharge medication therapy, as well as length of stay and in-hospital mortality. Conclusions: Our preliminary results demonstrate that both the non-emergency and emergency medical cares were affected by the COVID-19 pandemic even in a referral medical center with low cross-infection risk. The number of the out-patient clinic attendances not associated with the number of confirmed COVID-19 cases could be due to different factors, such as the local government contamination measures. The proportion of hospitalized patients with acute myocardial infarction increased in our center during the pandemic since other hospitals stopped performing primary angioplasty. A hub-and-spoke model could be effective in limiting the collateral damage for patients affected by cardiovascular diseases when the medical system is stressed by disasters, such as COVID-19 pandemic.
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Affiliation(s)
- Jing Nan
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yali Tian
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke Song
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qun Li
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Fu
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zening Jin
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Kendzerska T, Zhu DT, Gershon AS, Edwards JD, Peixoto C, Robillard R, Kendall CE. The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review. Risk Manag Healthc Policy 2021; 14:575-584. [PMID: 33623448 PMCID: PMC7894869 DOI: 10.2147/rmhp.s293471] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions. METHODS A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021. FINDINGS During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed. INTERPRETATION Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.
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Affiliation(s)
- Tetyana Kendzerska
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David T Zhu
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Science, Western University, London, Ontario, Canada
| | - Andrea S Gershon
- Department of Medicine, Sunnybrook Health Sciences Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cayden Peixoto
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
| | - Rebecca Robillard
- The Royal’s Institute of Mental Health Research/University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Muldoon KA, Denize KM, Talarico R, Fell DB, Sobiesiak A, Heimerl M, Sampsel K. COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors. BMC Med 2021; 19:20. [PMID: 33541357 PMCID: PMC7861965 DOI: 10.1186/s12916-020-01897-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared. METHODS Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated. RESULTS Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79-0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93-0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient's home, 40.00% assailant's home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%). CONCLUSION This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.
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Affiliation(s)
- Katherine A Muldoon
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada.
| | - Kathryn M Denize
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Agnes Sobiesiak
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
| | | | - Kari Sampsel
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
- Faculty of Medicine, Department of Emergency Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
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König S, Ueberham L, Pellissier V, Hohenstein S, Meier-Hellmann A, Thiele H, Ahmadli V, Borger MA, Kuhlen R, Hindricks G, Bollmann A. Hospitalization deficit of in- and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID-19 pandemic: Insights from the German-wide helios hospital network. Clin Cardiol 2021; 44:392-400. [PMID: 33497509 PMCID: PMC7943897 DOI: 10.1002/clc.23549] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background Treatment numbers of various cardiovascular diseases were reduced throughout the early phase of the ongoing COVID‐19 pandemic. Aim of this study was to (a) expand previous study periods to examine the long‐term course of hospital admission numbers, (b) provide data for in‐ and outpatient care pathways, and (c) illustrate changes of numbers of cardiovascular procedures. Methods and Results Administrative data of patients with ICD‐10‐encoded primary diagnoses of cardiovascular diseases (heart failure, cardiac arrhythmias, ischemic heart disease, valvular heart disease, hypertension, peripheral vascular disease) and in‐ or outpatient treatment between March, 13th 2020 and September, 10th 2020 were analyzed and compared with 2019 data. Numbers of cardiovascular procedures were calculated using OPS‐codes. The cumulative hospital admission deficit (CumAD) was computed as the difference between expected and observed admissions for every week in 2020. In total, 80 hospitals contributed 294 361 patient cases to the database without relevant differences in baseline characteristics between the studied periods. There was a CumAD of −10% to −16% at the end of the study interval in 2020 for all disease groups driven to varying degrees by both reductions of in‐ and outpatient case numbers. The number of performed interventions was significantly reduced for all examined procedures (catheter ablations: −10%; cardiac electronic device implantations: −7%; percutaneous cardiovascular interventions: −9%; cardiovascular surgery: −15%). Conclusions This study provides data on the long‐term development of cardiovascular patient care during the COVID‐19 pandemic demonstrating a significant CumAD for several cardiovascular diseases and a concomitant performance deficit of cardiovascular interventions.
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Affiliation(s)
- Sebastian König
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Laura Ueberham
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Holger Thiele
- Leipzig Heart Institute, Leipzig, Germany.,Heart Center Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Vusal Ahmadli
- Leipzig Heart Institute, Leipzig, Germany.,Heart Center Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Michael A Borger
- Leipzig Heart Institute, Leipzig, Germany.,Heart Center Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | | | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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41
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Sankaranarayanan R, Hartshorne-Evans N, Redmond-Lyon S, Wilson J, Essa H, Gray A, Clayton L, Barton C, Ahmed FZ, Cunnington C, Satchithananda DK, Murphy CL. The impact of COVID-19 on the management of heart failure: a United Kingdom patient questionnaire study. ESC Heart Fail 2021; 8:1324-1332. [PMID: 33463044 PMCID: PMC8006619 DOI: 10.1002/ehf2.13209] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022] Open
Abstract
Aims The coronavirus disease 2019 (COVID‐19) pandemic has created significant challenges to healthcare globally, necessitating rapid restructuring of service provision. This questionnaire survey was conducted amongst adult heart failure (HF) patients in the United Kingdom (UK), to understand the impact of COVID‐19 upon HF services. Methods and results The survey was conducted by the Pumping Marvellous Foundation, a UK HF patient charity. ‘Survey Monkey’ was used to disseminate the questionnaire in the Pumping Marvellous Foundation 's online patient group and in 10 UK hospitals (outpatient hospital and community HF clinics). There were 1050 responses collected (693/1050—66% women); 55% (579/1050) were aged over 60 years. Anxiety level was significantly higher regarding COVID‐19 (mean 7 ± 2.5 on anxiety scale of 0 to 10) compared with anxiety regarding HF (6.1 ± 2.4; P < 0.001). Anxiety was higher amongst patients aged ≤60 years about HF (6.3 ± 2.2 vs. 5.9 ± 2.5 in those aged >60 years; P = 0.005) and COVID‐19 (7.3 ± 2.3 vs. 6.7 ± 2.6 those aged >60 years; P < 0.001). Sixty‐five per cent of respondents (686/1050) reported disruption to HF appointments (cancellation or postponement) during the lockdown period. Thirty‐seven per cent reported disruption to medication prescription services, and Thirty‐four per cent reported inability to access their HF teams promptly. Thirty‐two per cent expressed reluctance to attend hospital (25% stated they would only attend hospital if there was no alternative, and 7% stated that they would not attend hospital at all). Conclusions The COVID‐19 pandemic has caused significant anxiety amongst HF patients regarding COVID‐19 and HF. Cancellation or postponement of scheduled clinic appointments, investigations, procedures, prescription, and monitoring services were implicated as sources of anxiety.
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Affiliation(s)
- Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Department of Cardiology, Aintree University Hospital, Liverpool, L9 7AL, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L69 3BX, UK.,National Institute for Health Research Clinical Research Network (NIHR CRN), NIHR Clinical Research Network, North West Coast, iC1 Liverpool Science Park, 131 Mount Pleasant, Liverpool, L3 5TF, UK
| | - Nick Hartshorne-Evans
- The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK
| | - Sam Redmond-Lyon
- The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK
| | - Jill Wilson
- The Pumping Marvellous Foundation (Registered Charity Number 1151848), Suite 111 Business First Millenium City Park, Millennium Road, Preston, PR2 5BL, UK
| | - Hani Essa
- Liverpool University Hospitals NHS Foundation Trust, Department of Cardiology, Aintree University Hospital, Liverpool, L9 7AL, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L69 3BX, UK.,National Institute for Health Research Clinical Research Network (NIHR CRN), NIHR Clinical Research Network, North West Coast, iC1 Liverpool Science Park, 131 Mount Pleasant, Liverpool, L3 5TF, UK
| | - Alastair Gray
- Craigavon Area Hospital, Department of Cardiology, 68 Lurgan Rd, Portadown, Craigavon, BT63 5QQ, Northern Ireland, UK
| | - Louise Clayton
- British Society for Heart Failure, 33 Cavendish Square, London, W1G 0PW, UK.,Alliance for Heart Failure, London, UK.,Department of Cardiology, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Carys Barton
- British Society for Heart Failure, 33 Cavendish Square, London, W1G 0PW, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London, W2 1NY, UK
| | - Fozia Z Ahmed
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.,School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Colin Cunnington
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.,School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | | | - Clare L Murphy
- NHS Greater Glasgow and Clyde Heart MCN Heart Failure subgroup, Scotland, UK.,Heart Failure Hub, Scotland, UK.,Department of Cardiology, Royal Alexandra and Vale of Leven Hospitals, Castlehead, Paisley, PA2 9PJ, Scotland, UK
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42
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Palazzuoli A, Ruocco G, Tecson KM, McCullough PA. Screening, detection, and management of heart failure in the SARS-CoV2 (COVID-19) pandemic. Heart Fail Rev 2021; 26:973-979. [PMID: 33405001 PMCID: PMC7786335 DOI: 10.1007/s10741-020-10068-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 12/22/2022]
Abstract
Observational studies suggest that a heart failure (HF) diagnosis carries a poor prognosis in subjects with severe SARS-CoV2 (COVID-19) infection, but it is unknown whether this association reflects direct myocardial damage due to COVID-19 or the consequence of preexisting cardiac defects and related cardiovascular disease (CVD) risk burden. Although the close relation between CVD and COVID-19 outcomes is well established, contrasting data exists about the occurrence of HF complications during COVID-19 infection. Therefore, a specific algorithm focused on diagnostic differentiation in acute patients distinguishing between acute HF and acute respiratory distress syndrome related to COVID-19 is needed. Further, several concerns exist for the management of patients with an uncertain diagnosis and acute dyspnea, the exact relationship existing between COVID-19 and HF. Therefore, the treatment for subjects with both COVID-19 and HF and which criteria may be defined for domiciliary or hospital management, remain poorly defined. Herein, we describe practices to be adopted in order to address these concerns and avoid further virus spread among patients, l and their familiars involved in such patients' care.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte Hospital, University of Siena, Siena, Italy.
| | - Gaetano Ruocco
- Cardiology Division, Regina Montis Regalis Hospital, ASL-CN1, Mondovì, Cuneo, Italy
| | - Kristen M Tecson
- Baylor University Medical Center, Baylor Heart and Vascular Hospital, Baylor Heart and Vascular Institute, M College of Medicine, Texas A&, Dallas, TX, USA
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Hospital, Baylor Heart and Vascular Institute, M College of Medicine, Texas A&, Dallas, TX, USA
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43
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Echocardiography Abnormal Findings and Laboratory Operations during the COVID-19 Pandemic at a High Volume Center in New York City. Healthcare (Basel) 2020; 8:healthcare8040534. [PMID: 33287257 PMCID: PMC7761727 DOI: 10.3390/healthcare8040534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 02/01/2023] Open
Abstract
(1) Background: This study sought to explore how the novel coronavirus (COVID-19) pandemic affected the echocardiography (TTE) laboratory operations at a high volume medical center in New York City. Changes in cardiac imaging study volume, turn-around time, and abnormal findings were analyzed and compared to a pre-pandemic period. (2) Methods: Volume of all cardiac imaging studies and TTE reports between 11 March 2020 to 5 May 2020 and the same calendar period in 2019 were retrospectively identified and compared. (3) Results: During the pandemic, our center experienced a 46.72% reduction in TTEs, 82.47% reduction in transesophageal echocardiograms, 83.16% reduction in stress echo, 70.32% reduction in nuclear tests, 46.25% reduction in calcium score, 73.91% reduction in coronary computed tomography angiography, and 87.23% reduction in cardiac magnetic resonance imaging. TTE findings were overall similar between 2020 and 2019 (all p ≥ 0.05), except for a significantly higher right ventricular systolic pressure in 2020 (39.8 ± 14.2 vs. 34.6 ± 11.2 mmHg, p = 0.012). (4) Conclusions: Despite encountering an influx of critically ill patients, our hospital center experienced a reduction in the number of cardiac imaging studies, which likely represents a change in both patient mindset and physician management approach.
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44
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König S, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network. Eur J Heart Fail 2020; 22:2190-2201. [PMID: 33135851 DOI: 10.1002/ejhf.2044] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/09/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. METHODS AND RESULTS Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March-21 May 2020) with control intervals in 2020 (1 January-12 March) and 2019 (13 March-21 May), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67-0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70-0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (P = 0.03) and 6.0% in the previous year control group (P = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality. CONCLUSION Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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45
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Norris-Grey C, Manmathan G, Pimenta D. Letter by Norris-Grey et al Regarding Article, “Multiple Vulnerabilities to Health Disparities and Incident Heart Failure Hospitalization in the REGARDS Study”. Circ Cardiovasc Qual Outcomes 2020; 13:e007389. [PMID: 33302711 PMCID: PMC7742210 DOI: 10.1161/circoutcomes.120.007389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Gavin Manmathan
- Department of Cardiology, Royal Free Hospital, London, United Kingdom
| | - Dominic Pimenta
- Department of Cardiology, Royal Free Hospital, London, United Kingdom
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46
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Implications of the COVID-19 Pandemic for Cardiovascular Disease and Risk-Factor Management. Can J Cardiol 2020; 37:722-732. [PMID: 33212203 PMCID: PMC7667463 DOI: 10.1016/j.cjca.2020.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
COVID-19 and our public health responses to the pandemic may have far-reaching implications for cardiovascular (CV) risk, affecting the general population and not only survivors of COVID-19. In this narrative review, we discuss how the pandemic may affect general CV risk for years to come and explore the mitigating potential of telehealth interventions. From a health care perspective, the shift away from in-person office visits may have led many to defer routine risk- factor management and may have had unforeseen effects on continuity of care and adherence. Fear of COVID-19 has led some patients to forego care for acute CV events. Curtailment of routine outpatient laboratory testing has likely delayed intensification of risk-factor–modifying medical therapy, and drug shortages and misinformation may have negative impacts on adherence to antihypertensive, glucose-lowering, and lipid-lowering agents. From a societal perspective, the unprecedented curtailment of social and economic activities has led to loss of income, unemployment, social isolation, decreased physical activity, and increased frequency of depression and anxiety, all of which are known to be associated with worse CV risk-factor control and outcomes. We must embrace and evaluate measures to mitigate these potential harms to avoid an epidemic of CV morbidity and mortality in the coming years that could dwarf the initial health effects of COVID-19.
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