How Does SARS-CoV-2 Infection Affect Survival of Emergency Cardiovascular Patients? A Cohort Study From a German Insurance Claims Database

The Impact of the COVID-19 Pandemic on Mortality Rates From Non-Communicable Chronic Diseases in Taiwan: An Interventional Time Series Study

Objectives

To examine whether the likelihood of death from non-communicable diseases nationwide was heightened during the COVID-19 pandemic.

Methods

Data on mortality caused by seven leading non-communicable chronic diseases from 2011 to 2022 were extracted from Taiwan's Death Registry. Monthly standardized mortality rates were analyzed using an intervention time series model.

Results

The monthly mortality rate showed a significant upward trend during the pandemic in the rate of mortality due to heart diseases, diabetes, and hypertension diseases (p < 0.001). The 2021 monthly rates of mortality caused by the three diseases showed a significant increase of 4.3%, 8.2%, and 13.4%, respectively, compared to the 2020 rates and continued until the end of the study period. No upward or downward post-intervention shift was observed for malignant tumors, renal disease, and liver diseases.

Conclusion

Adverse individual behaviors and reduced health services might have raised severe concerns for patients with cardiovascular diseases and diabetes. Health promotion and medical resource allocation are crucial for patients with disadvantaged health and sociodemographic factors and related metabolic conditions during the pandemic.

Prädiktoren für die Folgen eines Schlaganfalls: eine systematische Literaturübersicht für GKV-Routinedatenanalysen

Zielsetzung Ermittlung unabhängiger Variablen (UVs) des Schlaganfallrezidivs, der Mortalität und der Kosten nach Schlaganfall oder transitorisch-ischämischer Attacke, abbildbar in Routinedaten der Gesetzlichen Krankenversicherung.

Methodik Durchführung einer systematischen Literaturrecherche in PubMed und Embase unter Anwendung festgelegter Auswahlkriterien.

Ergebnisse Von 1 982 Treffern wurden 23 eingeschlossen. Robuste UVs für Rezidiv und Mortalität waren Alter, Schlaganfalltyp, Diabetes mellitus und Vorhofflimmern. Bei Mortalität waren zudem Geschlecht, stationärer Aufnahmezeitpunkt und Stroke Unit-Behandlung relevant. Für Kosten war die Evidenzlage zu gering.

Schlussfolgerung Eine Übersicht zu UVs des Rezidivs und der Mortalität wurde gegeben. Folgestudien sollten einheitliche Ansätze hinsichtlich Schlaganfall- und Outcomedefinitionen sowie Evaluationszeiträumen wählen.

Short Term Outcomes and Treatment Intensity of Major Cardiovascular Emergencies During the COVID-19 Pandemic in Germany

OBJECTIVE

There has been a decline in hospital admission rates in many countries since the beginning of the COVID-19 pandemic. Patient selection differed from episodes before the pandemic. This study investigated changes in baseline characteristics as well as the short term mortality rate and probability of receiving an invasive procedure while considering sex disparities.

METHODS

Claims data provided by Germany's second largest insurance fund, BARMER, were used. Patients without COVID-19 who were treated for ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), acute limb ischaemia (ALI), and stroke between 1 January 2018 and 31 December 2021 were included. Outcomes were compared separately for both sexes between the years before the pandemic (2018/2019) and during the pandemic (2020/2021). Propensity scores with exact matching were used to balance confounders including age, drug prescriptions in the previous year, federal state, month of admission, domiciliary care, and the Elixhauser comorbidities. Short term death and probability of invasive procedures were determined using cumulative incidence functions and Cox regressions.

RESULTS

The cohort consisted of 140 989 hospitalisations of 122 340 individual patients (48.3% female) with 102 960 matched cases. Baseline characteristics were similar between episodes in the unmatched cohort. Earlier discharge was observed for all strata except for males with ALI or STEMI, where the probability of early discharge was unchanged. The probability of receiving an invasive procedure was increased for both sexes with ALI, NSTEMI, and STEMI but not for stroke. The analyses suggested neither a statistically significant increase of the in hospital mortality rate nor the 30 day mortality rate after the pandemic started.

CONCLUSION

There was no evidence for a direct or indirect impact of the pandemic on major short term hospital outcomes. While the probability of receiving an invasive procedure increased for STEMI, NSTEMI, and ALI, the overall short term mortality rate was unaffected for both sexes.

Influence of Clinical, Angiographic, and Developmental Characteristics and COVID-19 Severity and Vaccination Status on Young Patients with Acute Myocardial Infarction

Background

Atherosclerosis is the most common cause of ischemic cardiovascular disease (CVD). However, approximately 20%-40% of cases of acute myocardial infarction (AMI) in patients aged <50 years can be attributed to genetic factors, and coronavirus disease 2019 (COVID-19) is a risk factor for blood clots and AMI. We aimed to describe the clinical, angiographic, and developmental characteristics and COVID-19 severity and vaccination status in patients aged ≤45 years with AMI.

Methods

We retrospectively analyzed 2624 patients with AMI by reviewing the results of coronary angiography and percutaneous coronary intervention and medical reports. The study included patients aged >18 years who met the universal definition of AMI but excluded those with missing medical records or coronary angiograms.

Results

In total, 2624 patients with AMI (aged 18-85 years) were included in the study and divided into two groups based on age: ≤45 (n = 1286) and >45 years (n = 1338). Total cholesterol and triglyceride levels were significantly higher in patients aged ≤45 years (5.6 ± 2.1 and 3.2 ± 2.1 mmol/L, respectively, P < 0.007) than in those aged >45 years (6.3 ± 1.8 and 3.1 ± 2.0 mmol/L, respectively, P < 0.001). Overall, 1745 and 879 patients were unvaccinated and fully vaccinated, respectively; severe and critical COVID-19 infections were more common among unvaccinated patients in both age groups.

Conclusions

Younger patients with AMI were more likely to be smokers with no hypertension, diabetes mellitus, or previous AMI. In contrast, they were more likely to have hypercholesterolemia and hypertriglyceridemia, single-vessel disease, Type C lesions, and a history of drug-eluting stent use.

Clinical characteristics of COVID-19 associated vasculopathic diseases

Coronavirus disease 19 (COVID-19) has shown to be an infectious disease affecting not only of the respiratory system, but also cardiovascular system leading to different COVID-19-associated vasculopathies. Venous and arterial thromboembolic events have been frequently described among hospitalized patients with COVID-19 and inflammatory vasculopathic changes have also been observed. Several of the reported COVID-19 associated vasculopathies exhibit differences on epidemiology, clinical characteristics and outcome compared to non-COVID-19 types. This review focuses on the epidemiology, clinical, diagnostic and therapeutic characteristics as well as outcome data of COVID-19 associated thromboembolic events and inflammatory vasculopathies, elaborating similarities and differences with non-COVID-19 cohorts.

The impact of COVID-19 and COVID vaccination on cardiovascular outcomes

COVID-19 is an independent risk factor for cardiovascular disease. COVID-19 vaccination may prevent this, but in some cases, COVID-19 vaccination may cause myocarditis or pericarditis. Patients with COVID-19 may present with non-specific symptoms that have a cardiac origin. This review examines the cardiovascular complications of COVID-19 infection and the impact of COVID-19 vaccination. COVID-19 cardiovascular complications include myocardial injury, pericarditis, coagulopathy, myocardial infarction, heart failure, arrhythmias, and persistent post-acute risk of adverse cardiovascular outcomes. Diagnostic and referral pathways for non-specific symptoms, such as dyspnoea and fatigue, remain unclear. COVID-19 vaccination is cardioprotective overall but is associated with myopericarditis in young males, though at a lower rate than following SARS-CoV-2 infection. Increased awareness among primary care physicians of potential cardiovascular causes of non-specific post-COVID-19 symptoms, including in younger adults, such as fatigue, dyspnoea, and chest pain, is essential. We recommend full vaccination with scheduled booster doses, optimal management of cardiovascular risk factors, rapid treatment of COVID-19, and clear diagnostic, referral, and management pathways for patients presenting with non-specific symptoms to rule out cardiac complications.

Editor's Choice - Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

OBJECTIVE

To perform a scoping review of how patients with COVID-19 are affected by acute limb ischaemia (ALI) and evaluate the recommendations of the 2020 ESVS ALI Guidelines for these patients.

METHODS

Research questions were defined, and a systematic literature search was performed following the PRISMA guidelines. Abstracts and unpublished literature were not included. The definition of ALI in this review is in accordance with the ESVS guidelines.

RESULTS

Most identified papers were case reports or case series, although population based data and data from randomised controlled trials were also identified. In total, 114 unique and relevant papers were retrieved. Data were conflicting concerning whether the incidence of ALI increased, or remained unchanged, during the pandemic. Case reports and series reported ALI in patients who were younger and healthier than usual, with a greater proportion affecting the upper limb. Whether or not this is coincidental remains uncertain. The proportion of men/women affected seems unchanged. Most reported cases were in hospitalised patients with severe COVID-19. Patients with ALI as their first manifestation of COVID-19 were reported. Patients with ALI have a worse outcome if they have a simultaneous COVID-19 infection. High levels of D-dimer may predict the occurrence of arterial thromboembolic events in patients with COVID-19. Heparin resistance was observed. Anticoagulation should be given to hospitalised COVID-19 patients in prophylactic dosage. Most of the treatment recommendations from the ESVS Guidelines remained relevant, but the following were modified regarding patients with COVID-19 and ALI: 1) CTA imaging before revascularisation should include the entire aorta and iliac arteries; 2) there should be a high index of suspicion, early testing for COVID-19 infection and protective measures are advised; and 3) there should be preferential use of local or locoregional anaesthesia during revascularisation.

CONCLUSION

Although the epidemiology of ALI has changed during the pandemic, the recommendations of the ESVS ALI Guidelines remain valid. The above mentioned minor modifications should be considered in patients with COVID-19 and ALI.

A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on the delivery of vascular surgery to patients around the world. In order to conserve resources and reduce the risk of COVID-19 infection, many institutions have postponed or cancelled surgical procedures. In this scoping review, we aim to review current literature and recapitulate the significant changes in elective and emergency vascular surgery during the COVID-19 pandemic. We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. We included all articles that had reported the effects of the COVID-19 pandemic on elective or emergency vascular surgery. A total of 28 articles were included in this scoping review. We identified eight distinct themes that were relevant to our study topic. We report global, regional, and local data on vascular surgical cases. We also discuss the adoption of vascular surgery triage systems, emergence of global collaborative vascular surgery research groups, increased use of endovascular techniques and locoregional anesthesia, delayed presentation of vascular surgery conditions, and poorer outcomes of patients with chronic limb threatening ischemia. This scoping review provides a snapshot of the impact of the COVID-19 pandemic on elective and emergency vascular surgery.