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Øvrebotten T, Tholin B, Berge K, Myhre PL, Stavem K. Cardiac events and procedures following COVID-19 compared with other pneumonias: a national register study. Open Heart 2025; 12:e002914. [PMID: 39904555 PMCID: PMC11795400 DOI: 10.1136/openhrt-2024-002914] [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: 09/03/2024] [Accepted: 12/30/2024] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Studies have shown an increased risk of cardiac disease following COVID-19, but how it compares to pneumonia of other etiologies is unclear. AIMS To determine the incidence and HRs of cardiac disease in patients hospitalised with COVID-19 compared with other viral or bacterial pneumonias. METHODS Using nationwide registry data, we estimated the incidence of cardiac events after hospitalisation with COVID-19 (n=2082) in February to November 2020 vs hospitalisation with viral (n=9018) or bacterial (n=29 339) pneumonia in 2018-2019. We defined outcomes using ICD-10 codes for incident myocarditis, acute myocardial infarction, atrial fibrillation/flutter, heart failure, ischaemic heart disease, other cardiac disease and total cardiac disease (any heart condition). We used Cox regression and logistic regression for analysis. RESULTS Patients with COVID-19 had a mean (SD) age of 60 (18) years, compared with 69 (19) years for viral and 72 (17) years for bacterial pneumonia. Those with COVID-19 were more often male and had fewer comorbidities and fewer prior hospitalisations. Patients with COVID-19 had a lower hazard of new-onset cardiac disease compared with viral (HR 0.79 [95%CI 0.66 to 0.93]) and bacterial pneumonia (HR 0.66 [95%CI 0.57 to 0.78]), adjusted for age, sex, comorbidity, hospital admission prior year and respiratory support. Results were similar when including recurrent events. CONCLUSION Patients hospitalised with COVID-19 had a lower hazard of new-onset cardiac disease during the first 9 months after hospitalisation compared with patients with other viral or bacterial pneumonias after adjusting for multiple possible confounders. However, there may still be residual confounding from other or unknown factors.
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Affiliation(s)
- Tarjei Øvrebotten
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, Oslo, Norway
| | - Birgitte Tholin
- University of Oslo, Oslo, Norway
- Østfold Hospital Kalnes, Grålum, Norway
| | - Kristian Berge
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, Oslo, Norway
| | - Peder Langeland Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, Oslo, Norway
| | - Knut Stavem
- University of Oslo, Oslo, Norway
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Shapiro S, Majert J, Obeidalla A, Clift A, Havord S, Jebamani A, Matejtschuk C, Clarke P, Lasserson D. Same-day emergency care: a retrospective observational study of the incidence and predictors of venous thromboembolism following hospital-based acute ambulatory medical care. J Thromb Haemost 2025; 23:97-107. [PMID: 39798971 DOI: 10.1016/j.jtha.2024.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 09/10/2024] [Accepted: 09/11/2024] [Indexed: 01/15/2025]
Abstract
BACKGROUND Same-day emergency care (SDEC) is an expanding area of hospital acute medical care. It aims to minimize delays and manage medical emergency patients within the same day, enabling hospitalization to be avoided; the expectation is that the patients would have required inpatient hospitalization in the absence of the SDEC service. Venous thromboembolism (VTE) prevention is a key medical inpatient safety measure. Whether VTE prevention should be considered for SDEC patients is unknown. OBJECTIVES To examine the incidence and predictors of VTE diagnosed within 90 days of SDEC assessment. METHODS Data were obtained from electronic health records of people who received SDEC at our hospital during a 5-year period (April 2016 to March 2021). RESULTS There were 40 045 attendance episodes by 33 715 individuals. Median age was 60 years (IQR, 41.0-76.0 years), and 55.2% were women. Three hundred forty-nine patients (0.9%) developed a VTE within 90 days of SDEC. Increased risk of VTE was associated with age more than 60 years, prior malignancy (adjusted odds ratio [OR], 4.12; 95% CI, 3.19-5.32; P < .0001), history of diseases of the circulatory system (adjusted OR, 2.92; 95% CI, 2.27-3.76; P < .0001), and having 1 or more additional SDEC attendances within 30 days (adjusted OR, 4.61; 95% CI, 3.65-5.82; P < .0001). In the 90 days prior to VTE diagnosis, 36.6% of patients had a separate inpatient admission in addition to SDEC. There was no association with completion of an electronic VTE risk assessment (adjusted OR, 0.96; 95% CI, 0.76-1.20). CONCLUSION The incidence of VTE following SDEC is similar to that reported for symptomatic VTE in traditional medical inpatients without thromboprophylaxis.
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Affiliation(s)
- Susan Shapiro
- Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
| | - Jeannette Majert
- Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, United Kingdom
| | - Abubaker Obeidalla
- Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Alex Clift
- Department of Informatics, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Havord
- Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Angelin Jebamani
- Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Charlotte Matejtschuk
- Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Penney Clarke
- Department of Haematology, Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Daniel Lasserson
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Garratt AM, Stavem K. COVID-19 and self-reported health of the Norwegian adult general population: A longitudinal study 3 months before and 9 months into the pandemic. PLoS One 2024; 19:e0312201. [PMID: 39446847 PMCID: PMC11500952 DOI: 10.1371/journal.pone.0312201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 10/02/2024] [Indexed: 10/26/2024] Open
Abstract
The COVID-19 pandemic had a global impact on daily lives, and this study aimed to assess the effects on broader aspects of health in the general population of Norway. This population-based cohort study assessed changes in health of the Norwegian general population from 3 months before to 9 months during the COVID-19 pandemic. Sampling was based on the results of Norwegian surveys designed for collecting general population norms for health measurement instruments. In December 2019, 12,790 randomly selected adults aged ≥18 years received a postal questionnaire. The 3,200 respondents received a similar follow-up postal questionnaire including the EQ-5D-5L, PROMIS-29 instruments, and questions about respondents having or having had COVID-19. Score changes were compared to estimates for the minimal important change (MIC) and age-related change. Association of instrument change scores with baseline characteristics, health problems, and having had COVID-19 was determined using multivariable linear regression. Of 3101 respondents with unchanged addresses, 2423 (78.1%) responded to the second survey. For all respondents, EQ VAS and PROMIS-29 scores for 6 of 8 domains were slightly poorer (p<0.01) than before COVID-19, and the mean change was below the MIC. In multivariable analyses, the greatest number of poorer outcomes were associated with being female, 18-29 years, or ≥80 years of age (p<0.01); > MIC for ≥ 80 years of age and EQ-5D index, PROMIS-29 physical function and social participation. Respondents who had COVID-19 had poorer outcomes for PROMIS-29 social participation (> MIC). Those reporting COVID-19 in their partner/family and not themselves, had poorer outcomes for PROMIS-29 anxiety and social participation. About 9 months into the COVID-19 pandemic, EQ-5D-5L and PROMIS-29 domain scores showed slightly poorer health in the Norwegian adult general population compared to 1 year earlier in the same respondents. The overall changes were less than expected for age-related change. Relatively poor outcomes defined as important, included general health and social participation for the elderly, and the latter for those having had COVID-19. In conclusion, this study found no evidence for a decline in important aspects of adult general population health in Norway that might be attributed to the pandemic at approximately 9 months.
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Affiliation(s)
- Andrew M. Garratt
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Knut Stavem
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Medical Division, Department of Pulmonary Medicine, Akershus University Hospital, Nordbyhagen, Norway
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Sultan MA, Kong Y, Story C, Caterson H, Dix C, Gad F, Dhaliwal JS, Dunkley S, Jo H, van Hal S, Passam F. Thrombo-inflammatory response in hospitalised patients with COVID-19: a single institution experience. Intern Med J 2024; 54:43-53. [PMID: 37926861 DOI: 10.1111/imj.16285] [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: 05/17/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Severe COVID-19 causes acute inflammation, which is complicated by venous thromboembolism events (VTE). However, it is unclear if VTE risk has evolved over time since the COVID-19 outbreak. AIMS To determine markers of thrombo-inflammation and rates of symptomatic VTE in patients hospitalised for COVID-19 in a metropolitan hospital in Sydney, Australia. METHODS A retrospective, single-centre, cohort study was performed by reviewing electronic medical records of consecutive patients admitted to Royal Prince Alfred Hospital between March 2020 and September 2021. This period included three waves of COVID-19 outbreaks in Australia with the ancestral, alpha and delta variants. Standard coagulation assays and inflammatory markers were recorded over 4 weeks. RESULTS A total of 205 patients were consecutively admitted during the study period. Activated partial thromboplastin time, neutrophil count and C-reactive protein (CRP) were significantly increased in patients hospitalised in the intensive care unit (ICU) compared with non-ICU patients. The use of anti-inflammatory medication increased in 2021 compared with 2020. The mortality rate was 7.3% in our cohort. Ninety-four per cent of patients received anticoagulation with 6.3% of patients developing VTE. CONCLUSION We observed lower rates of VTE compared to the internationally reported rate for the same period. We conclude that in the setting of controlled hospital admission rate and standard anticoagulation guidelines, COVID-19 resulted in similar thrombo-inflammatory response and VTE rates over the first 1.5 years of the pandemic.
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Affiliation(s)
- Muhammad Ahmed Sultan
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine Health, University of Sydney, Sydney, New South Wales, Australia
| | - Yvonne Kong
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Chloe Story
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Harriet Caterson
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Caroline Dix
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Fady Gad
- Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jagpreet Singh Dhaliwal
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine Health, University of Sydney, Sydney, New South Wales, Australia
| | - Scott Dunkley
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Helen Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Freda Passam
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine Health, University of Sydney, Sydney, New South Wales, Australia
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