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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura I Ferrer G, Quadros A, Milewski M, Scotto Di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, De Simone C, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Arpad L, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martínez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo-Silbermann S, Ordoñez S, Arat Özkan A, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Bessonov I, Zoni R, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Bellemain-Appaix A, Pessah G, Cortese G, Parodi G, Burgadha MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. SARS-CoV-2 Positivity, Stent Thrombosis, and 30-day Mortality in STEMI Patients Undergoing Mechanical Reperfusion. Angiology 2023; 74:987-996. [PMID: 36222189 DOI: 10.1177/00033197221129351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older (P = .002), less often active smokers (P = .002), and hypercholesterolemic (P = .006), they presented more often later than 12 h (P = .037), more often to the hub and were more often in cardiogenic shock (P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow (P = .029) and more thrombectomy (P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy Division of Cardiology, Ospedale Nuovo Galeazzi, Milan, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brasil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore
| | | | - Gerard Roura I Ferrer
- Interventional Cardiology Unit, Heart Disease Institute. Hospital Universitari de Bellvitge, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
- Technical Medical Centre, Health Technologies and Services Research, University of Twente, Enschede, Netherlands
| | | | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta
| | | | - Ciro De Simone
- Division of Cardiology, Clinica Villa Dei Fiori, Acerra, Italy
| | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio", Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Lux Arpad
- Maastricht University Medical Center, Utrecht, Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria Delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Hospital Garcia de Orta, Cardiology Department, Pragal, Almada, Portugal
| | | | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Alev Arat Özkan
- Cardiology Institute, Instanbul University, Instanbul, Turkey
| | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Konstantopoulion Hospital, Athens, Greece
| | | | | | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Argentina
| | | | | | | | - Carlos E Uribe
- Carlos E Uribe, Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | | | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Guido Parodi
- Division of Cardiology, Ospedale di Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Belgium
| | | | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, Brescia, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Italy
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Di Marco M, Miano N, Marchisello S, Coppolino G, L’Episcopo G, Scilletta S, Spichetti C, Torre S, Scicali R, Zanoli L, Gaudio A, Castellino P, Piro S, Purrello F, Di Pino A. Indirect Effects of the COVID-19 Pandemic on In-Hospital Outcomes among Internal Medicine Departments: A Double-Center Retrospective Study. J Clin Med 2023; 12:5304. [PMID: 37629346 PMCID: PMC10455112 DOI: 10.3390/jcm12165304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
The coronavirus disease 19 (COVID-19) emergency led to rearrangements of healthcare systems with a significant impact on those internal medicine departments that had not been converted to COVID-19 wards. A reduced number of departments, indeed, had to cope with the same number of patients along with a lack of management of patients' chronic diseases. We conducted a retrospective study aimed at examiningthe consequences of the COVID-19 pandemic on internal medicine departments that were not directly managing COVID-19 patients. Data from 619 patients were collected: 247 subjects hospitalized in 2019 (pre-COVID-19 era), 178 in 2020 (COVID-19 outbreak era) and 194 in 2021 (COVID-19 ongoing era). We found that in 2020 in-hospital mortality was significantly higher than in 2019 (17.4% vs. 5.3%, p = 0.009) as well as length of in-hospital stay (LOS) (12.7 ± 6.8 vs. 11 ± 6.2, p = 0.04). Finally, we performed a logistic regression analysis of the major determinants of mortality in the entire study population, which highlighted an association between mortality, being bedridden (β = 1.4, p = 0.004), respiratory failure (β = 1.5, p = 0.001), glomerular filtration rate (β = -0.16, p = 0.03) and hospitalization in the COVID-19 outbreak era (β = 1.6, p = 0.005). Our study highlights how the COVID-19 epidemic may have caused an increase in mortality and LOS even in patients not directly suffering from this infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (M.D.M.); (N.M.); (S.M.); (G.C.); (G.L.); (S.S.); (C.S.); (S.T.); (R.S.); (L.Z.); (A.G.); (P.C.); (S.P.); (F.P.)
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Abstract
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.
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Affiliation(s)
- Thiemo Greistorfer
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria.
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Alharbi A, Franz A, Alfatlawi H, Wazzan M, Alsughayer A, Eltahawy E, Assaly R. Impact of COVID-19 Pandemic on the Outcomes of Acute Coronary Syndrome. Curr Probl Cardiol 2023; 48:101575. [PMID: 36584730 PMCID: PMC9793956 DOI: 10.1016/j.cpcardiol.2022.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
During the pandemic, health care resources were primarily focused on treating COVID-19 infections and its related complications, with various Clinical units were converted to COVID-19 units, This study aims to investigate the impact of the COVID-19 pandemic on the clinical course of patients who had developed acute coronary syndrome (ACS) including ST-elevation myocardial infarction (STEMI). In this large nationwide observational study utilizing National Inpatient Sample 2019 and 2020.The primary outcomes of our study were in-hospital mortality, length of stay (LOS), total hospital charges and time from admission to percutaneous coronary intervention (PCI). Using the National Inpatient Sample 2020 database we found 32,355,827 hospitalizations in 2020 and 521,484 of which had a primary diagnosis of STEMI that met our criteria. Patients with COVID-19 infection were similar in mean age, more likely to be men, were treated in the same hospital settings as those without COVID-19 and had higher rates of diabetes with chronic complications. These patients had a similar prevalence of traditional coronary artery disease risk factors including hypertension, peripheral vascular disease and obesity. There was higher inpatient mortality (adjusted odds ratios 3.10; 95% CI, 2.40-4.02; P < 0.01) and LOS (95% CI 1.07-2.25; P < 0.01) in STEMI patient with concurrent COVID-19 infection. The average time from admission to PCI was significantly higher among unstable angina (UA) and None ST-segment elevated myocardial infarction (NSTEMI) in patients with a secondary diagnosis of COVID-19 infection compared to patients without: 0.45 days (95% CI: .155-758; P < 0.01). The COVID-19 pandemic had a significant impact on the treatment of patients with ACS, resulting in increased inpatient mortality, higher costs, and longer lengths of stay. During the pandemic, for patients with UA and NSTEMI the time from admission to PCI was significantly longer in patients with a secondary diagnosis of COVID-19 compared to patients without. When comparing ACS outcomes between pre-pandemic to pandemic periods (2019 versus 2020), the 2020 data showed higher mortality, higher hospital costs, and a decrease in LOS. Finally, the time from admission to PCI was longer for UA and NSTEMI in 2020 but not for patients with STEMI.
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Affiliation(s)
| | - Allison Franz
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Halah Alfatlawi
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Mohaamed Wazzan
- Division of Cardiology, University Hospitals Cleveland Medical Center, OH
| | - Anas Alsughayer
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Ehab Eltahawy
- Department of Cardiology, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, OH,Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH
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Ghasemzadeh N, Kim N, Amlani S, Madan M, Shavadia JS, Chong AY, Bagherli A, Bagai A, Saw J, Singh J, Dehghani P. A Review of ST-Elevation Myocardial Infarction in Patients with COVID-19. Heart Fail Clin 2023; 19:197-204. [PMID: 36863811 PMCID: PMC9973551 DOI: 10.1016/j.hfc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in worldwide morbidity and mortality. Patients with COVID-19 are at risk for developing a variety of cardiovascular conditions including acute coronary syndromes, stress-induced cardiomyopathy, and myocarditis. Patients with COVID-19 who develop ST-elevation myocardial infarction (STEMI) are at a higher risk of morbidity and mortality when compared with their age- and sex-matched STEMI patients without COVID-19. We review current knowledge on the pathophysiology of STEMI in patients with COVID-19, clinical presentation, outcomes, and the effect of the COVID-19 pandemic on overall STEMI care.
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Affiliation(s)
| | - Nathan Kim
- Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Shy Amlani
- William Osler Health System, Brampton, 2100 Bovaird Drive East, Ontario L6R 3J7, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Jay S Shavadia
- Royal University Hospital, Saskatchewan Health, University of Saskatchewan Saskatoon, 103 Hospital Drive, Saskatchewan S7N 0W8, Canada
| | - Aun-Yeong Chong
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Alireza Bagherli
- Windsor Regional Hospital, 1030 Ouellette Avenue, Windsor, Ontario N9A 1E1, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada.
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Correale M, Croella F, Leopizzi A, Mazzeo P, Tricarico L, Mallardi A, Fortunato M, Magnesa M, Ceci V, Puteo A, Iacoviello M, Di Biase M, Brunetti ND. The Evolving Phenotypes of Cardiovascular Disease during COVID-19 Pandemic. Cardiovasc Drugs Ther 2023; 37:341-351. [PMID: 34328581 PMCID: PMC8322635 DOI: 10.1007/s10557-021-07217-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
COVID-19 pandemic has negatively impacted the management of patients with acute and chronic cardiovascular disease: acute coronary syndrome patients were often not timely reperfused, heart failure patients not adequately followed up and titrated, atrial arrhythmias not efficaciously treated and became chronic. New phenotypes of cardiovascular patients were more and more frequent during COVID-19 pandemic and are expected to be even more frequent in the next future in the new world shaped by the pandemic. We therefore aimed to briefly summarize the main changes in the phenotype of cardiovascular patients in the COVID-19 era, focusing on new clinical challenges and possible therapeutic options.
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Affiliation(s)
| | - Francesca Croella
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandra Leopizzi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lucia Tricarico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Adriana Mallardi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Martino Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Michele Magnesa
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vincenzo Ceci
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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8
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Busljetik O, Cercek M, Jensen LO, Loh PH, Calmac L, Ferrer GRI, Quadros A, Milewski M, Scotto D’Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra Munoz V, Lee MKY, Juzar DA, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Arpad L, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Martínez-Luengas IL, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo-Silberman S, Ordoñez S, Arat Özkan A, Scheller B, Lehitola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Zoni CR, Bessonov I, Uccello G, Kochiadakis G, Alexopulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Saint-Joy V, Pessah G, Tuccillo A, Ielasi A, Cortese G, Parodi G, Burgadha MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry. J Clin Med 2023; 12:2116. [PMID: 36983119 PMCID: PMC10059932 DOI: 10.3390/jcm12062116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The constraints in the management of patients with ST-segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic have been suggested to have severely impacted mortality levels. The aim of the current analysis is to evaluate the age-related effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI within the registry ISACS-STEMI COVID-19. METHODS This retrospective multicenter registry was performed in high-volume PPCI centers on four continents and included STEMI patients undergoing PPCI in March-June 2019 and 2020. Patients were divided according to age (< or ≥75 years). The main outcomes were the incidence and timing of PPCI, (ischemia time longer than 12 h and door-to-balloon longer than 30 min), and in-hospital or 30-day mortality. RESULTS We included 16,683 patients undergoing PPCI in 109 centers. In 2020, during the pandemic, there was a significant reduction in PPCI as compared to 2019 (IRR 0.843 (95%-CI: 0.825-0.861, p < 0.0001). We found a significant age-related reduction (7%, p = 0.015), with a larger effect on elderly than on younger patients. Furthermore, we observed significantly higher 30-day mortality during the pandemic period, especially among the elderly (13.6% vs. 17.9%, adjusted HR (95% CI) = 1.55 [1.24-1.93], p < 0.001) as compared to younger patients (4.8% vs. 5.7%; adjusted HR (95% CI) = 1.25 [1.05-1.49], p = 0.013), as a potential consequence of the significantly longer ischemia time observed during the pandemic. CONCLUSIONS The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures, with a larger reduction and a longer delay to treatment among elderly patients, which may have contributed to increase in-hospital and 30-day mortality during the pandemic.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, AOU Policlinico G Martino, 98124 Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
- Division of Cardiology, Galeazzi-Sant’Ambrogio Hospital, 20157 Milan, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut 71515, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, 16110 Bursa, Türkiye
| | - Dinaldo C. Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife 1235, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, 653002 Kemerovo, Russia
| | - Oliver Busljetik
- University Clinic for Cardiology, Medical Faculty, Ss’ Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Miha Cercek
- Department of Cardiology, Medical Center Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore 119074, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, 010001 Bucharest, Romania
| | - Gerard Roura i Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, 08016 Barcelona, Spain
| | - Alexandre Quadros
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre 90000-00, Brazil
| | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, 40-002 Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, 7541 Enschede, The Netherlands
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti Latina, 04100 Latina, Italy
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, 3434 Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, 40100 Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, 60200 Bohunice, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics, 1811 Alkmaar, The Netherlands
| | | | - Michael Kang-yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center “Harapan Kita”, Jakarta 11402, Indonesia
| | | | - Roberto Paladino
- Division of Cardiology, Clinica Villa dei Fiori, 80011 Acerra, Italy
| | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, 10000 Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, 26221 Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, 38014 Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale ”S. Maurizio”, 39100 Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggid’Aragona, 84070 Salerno, Italy
| | - Lux Arpad
- Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61121 Pesaro, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, 42121 Reggio Emilia, Italy
| | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University, 34093 Istanbul, Türkiye
| | - Kadir Ugur Mert
- Division of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, 02640 Eskisehir, Türkiye
| | | | - Tomas Kovarnik
- University Hospital Prague, 12808 Prague, Czech Republic
| | - Michal Kidawa
- Central Hospital, Medical University of Lodz, 90-008 Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, 45001 Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero, Universitaria Ospedali Riuniti Trieste, 34142 Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, 80078 Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, 38001 Santa Cruz de Tenerife, Spain
| | | | - Gianluca Caiazzo
- Division of Cardiology, Ospedale “G Moscati”, 81031 Aversa, Italy
| | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, 8865, Taipei 600, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, 43121 Parma, Italy
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta, Pragal, 2805-267 Almada, Portugal
| | - Stephane Manzo-Silberman
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, 75010 Paris, France
| | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, 6302, Buenos Aires C1428 CABA, Argentina
| | - Alev Arat Özkan
- Cardiology Institute, Instanbul University, 34000 Istanbul, Türkiye
| | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, 66421 Saarland, Germany
| | - Heidi Lehitola
- Division of Cardiology, Oulu University Hospital, 90220 Oulu, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO-Nova Medical School, 1000 Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, 10431 Athens, Greece
| | - Ylitalo Antti
- Division of Cardiology, Heart Centre Turku, 20521 Turku, Finland
| | | | - Cesar Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes “Juana F. Cabral”, Corrientes W3400CDS, Argentina
| | - Ivan Bessonov
- Tyumen Cardiology Research Center, 625026 Tyumen, Russia
| | - Giuseppe Uccello
- Division of Cardiology, Ospedale “A. Manzoni”, 23900 Lecco, Italy
| | | | | | - Carlos E. Uribe
- Division of Cardiology, Universidad UPB-CES, Medellin 050001, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, 10431 Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, 38000 Grenoble, France
| | | | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo 11700, Uruguay
| | - Frankie C. C. Tam
- Department of Cardiology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Alfredo Rodriguez
- Division of Cardiology, Otamendi Hospital, Buenos Aires 1001, Argentina
| | - Antonia Anna Lukito
- Heart Center Siloam Lippo Village Hospital, Cardiovascular Department Pelita Harapan University, Tangerang 15810, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospital Cordoba, Cordoba 5000, Argentina
| | - Andrea Tuccillo
- Division of Cardiology, Ospedale del Mare, 80147 Napoli, Italy
| | - Alfonso Ielasi
- Division of Cardiology, Galeazzi-Sant’Ambrogio Hospital, 20157 Milan, Italy
| | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Guido Parodi
- Cardiology, Azienda Ospedaliera Lavagna, 16033 Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, 1050 Bruxelles, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, 6302, Buenos Aires C1428 CABA, Argentina
| | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, 6525 Nijmegen, The Netherlands
| | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, 25121 Brescia, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, 13900 Biella, Italy
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 919] [Impact Index Per Article: 919.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Sticchi A, Costa F, Muscoli S, Zilio F, Buono A, Ruggiero R, Scoccia A, Caracciolo A, Licordari R, Cammalleri V, Iacovelli F, Loffi M, Scordino D, Ferro J, Rognoni A, Nava S, Albani S, Pavani M, Colaiori I, Benenati S, Pescetelli F, DE Marzo V, Borghesi M, Regazzoni V, Mannarini A, Spione F, Doronzo B, de Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Micari A, Pasceri V, Patti G, Porto I, Campo G, Colombo A, Giannini F. Symptoms-to-emergency-call timing delay in acute coronary syndrome before and during COVID-19: independent predictors and their impact on mortality. Minerva Cardiol Angiol 2023; 71:12-19. [PMID: 36305773 DOI: 10.23736/s2724-5683.22.05985-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The COVID-19 pandemic severely impacted global health. The aim of this study was to compare predictors of symptoms-to-emergency-call timing delay in acute coronary syndrome (ACS) and their impact on mortality before and during the COVID-19 outbreak. METHODS We collected sociodemographic, clinical data, procedural features, preadmission and intra-hospital outcomes of consecutive patients admitted for ACS in seventeen Italian centers from March to April 2018, 2019, and 2020. RESULTS In 2020, a 32.92% reduction in ACS admissions was observed compared to 2018 and 2019. Unstable angina, typical and atypical symptoms, and intermittent angina were identified as significant predictors of symptoms-to-emergency-call timing delay before and during the COVID-19 pandemic (P<0.005 for all the items). Differently from 2018-2019, during the pandemic, hypertension and dyspnea (P=0.002 versus P=0.490 and P=0.001 vs. P=0.761 for 2018-2019 and 2020, respectively) did not result as predictors of delay in symptoms-to-emergency-call timing. Among these predictors, only the atypical symptoms (HR 3.36; 95% CI: 1.172-9.667, P=0.024) in 2020 and the dyspnea (HR 2.64; 95% CI: 1.345-5.190, P=0.005) in 2018-2019 resulted significantly associated with higher mortality. Finally, the family attendance at the onset of the symptoms resulted in a reduction in symptoms-to-emergency-call timing (in 2020 P<0.001; CI: -1710.73; -493.19) and in a trend of reduced mortality (HR 0.31; 95% CI: 0.089-1.079, P=0.066) in 2020. CONCLUSIONS During the COVID-19 outbreak, atypical symptoms and family attendance at ACS onset were identified, respectively, as adverse and favorable predictors of symptoms-to-emergency-call timing delay and mortality.
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Affiliation(s)
- Alessandro Sticchi
- Humanitas Research Hospital IRCCS, Milan, Italy - .,Centro per la Lotta Contro L'Infarto (CLI) Foundation, Rome, Italy - .,GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Filippo Zilio
- Unit of Cardiology, Santa Chiara Hospital, Trento, Italy
| | | | - Rossella Ruggiero
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Fortunato Iacovelli
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | - Marco Loffi
- Department of Cardiology, Hospital of Cremona, Cremona, Italy
| | | | - Jayme Ferro
- UOSD Cardiology, Department of Emergency, Intensive Care and Anesthesia, Hemodynamics Laboratory, ASST Lariana, S. Anna Hospital, Como, Italy
| | | | - Stefano Nava
- Division of Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Marco Pavani
- SS Annunziata Civil Hospital, Savigliano, Cuneo, Italy
| | | | - Stefano Benenati
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Fabio Pescetelli
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Vincenzo DE Marzo
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Marco Borghesi
- Unit of Cardiology, Santa Chiara Hospital, Trento, Italy
| | | | - Antonia Mannarini
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | - Francesco Spione
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | | | | | | | - Gian B Danzi
- Department of Cardiology, Hospital of Cremona, Cremona, Italy
| | - Mario Galli
- UOSD Cardiology, Department of Emergency, Intensive Care and Anesthesia, Hemodynamics Laboratory, ASST Lariana, S. Anna Hospital, Como, Italy
| | | | | | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | | | | | - Italo Porto
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Gianluca Campo
- Cardiovascular Institute, AOU Ferrara, Cona, Ferrara, Italy
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Angellotti D, Manzo R, Castiello DS, Piccolo R, Avvedimento M, Leone A, Ilardi F, Mariani A, Iapicca C, Di Serafino L, Cirillo P, Franzone A, Esposito G. Impact of COVID-19 pandemic on timing and early clinical outcomes of transcatheter aortic valve implantation. Acta Cardiol 2022; 77:937-942. [PMID: 36197014 DOI: 10.1080/00015385.2022.2119660] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND We sought to investigate the applicability and outcomes of a novel system to manage patients requiring transcatheter aortic valve implantation (TAVI) at a tertiary level hospital during the coronavirus disease-2019 (COVID-19) pandemic. METHODS To analyse the impact of hospitalisation pathways during the pandemic on clinical outcomes of TAVI patients, the study population was divided into two groups (pre-pandemic and pandemic groups) and all perioperative/follow-up data were compared. The primary endpoint was all-cause mortality at 30 days; secondary endpoints included procedural success and short-term complications. RESULTS A total of 315 patients received TAVI during the study period. Pandemic group (n = 77) showed a more complex baseline clinical profile (NYHA class III-IV, 70.1% vs. 56.3%; p = 0.03). The overall time to procedure was significantly longer during pandemic (56.9 ± 68.3 vs.37.7 ± 25.4; p = 0.004) while intensive care unit stay was shorter (2.2 ± 1.4 vs. 3.7 ± 3.9, p < 0.05). Hospitalisation length was similar in both groups as well as all-cause mortality rate and the incidence of major periprocedural complications. No case of infection by COVID-19 was reported among patients during the hospital stay. CONCLUSIONS Comparative analysis of early clinical outcomes showed that COVID-19 pandemic did not affect the safety and effectiveness of TAVI as similar rates of procedural complications and all-cause mortality were reported than before February 2020. Despite the increased time lag between diagnosis and procedure and a more complex clinical profile of patients at baseline, the revised pathway of hospitalisation allowed to resume inpatient procedures while not affecting patients' and healthcare workers' safety.
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Affiliation(s)
- Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina Iapicca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Rymer JA, Kirtane AJ, Farb A, Malone M, Jaff MR, Seward K, Stephens D, Barakat MK, Krucoff MW. One-Year Follow-Up of Vascular Intervention Trials Disrupted by the COVID-19 Pandemic: A Use-Case landscape. Cardiovasc Revasc Med 2022; 45:67-73. [PMID: 35953406 PMCID: PMC9323208 DOI: 10.1016/j.carrev.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The COVID-19 pandemic had an unprecedented impact on cardiovascular clinical research. The decision-making and state of study operations in cardiovascular trials 1-year after interruption has not been previously described. METHODS In the spring of 2020, we created a pandemic impact task force to develop a landscape of use case scenarios from 17 device trials of peripheral artery disease (PAD) and coronary artery disease (CAD) interventions. In conjunction with publicly available (clinictrials.gov) study inclusion criteria, primary endpoints and study design, information was shared for this use-case landscape by trial leadership and data owners. RESULTS A total of 17 actively enrolling trials (9 CAD and 8 PAD) volunteered to populate the use case landscape. All 17 were multicenter studies (12 in North America and 5 international). Fifteen studies were industry-sponsored, of which 13 were FDA approved IDEs, one was PCORI-sponsored and two were sponsored by the NIH. Enrollment targets ranged from 150 to 9000 pts. At the time of interruption, 5 trials were <20 % enrolled, 9 trials were 50-80 % enrolled and 3 trials were >80 % enrolled. At 1 year, the majority of studies were continuing to enroll in the context of more sporadic but ongoing pandemic activity. CONCLUSIONS At 1 year from the first surge interruptions, most trials had resumed enrollment. Trials most heavily interrupted were trials early in enrollment and those trials not able to pivot to virtual patient and site visits. Further work is needed to determine the overall impact on vascular intervention trials disrupted during the COVID-19 pandemic.
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Affiliation(s)
- Jennifer A. Rymer
- Duke University School of Medicine, Durham, NC, United States of America,Duke Clinical Research Institute, Durham, NC, United States of America,Corresponding author at: Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, United States of America
| | - Ajay J. Kirtane
- Columbia University Irving Medical Center, New York, United States of America
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Misti Malone
- US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Michael R. Jaff
- Boston Scientific Corporation, Marlborough, MA, United States of America
| | - Kirk Seward
- Mercator MedSystems, Inc., Emeryvlle, CA, United States of America
| | - Dan Stephens
- Boston Scientific Corporation, Marlborough, MA, United States of America
| | - Mark K. Barakat
- CeloNova BioSciences, San Antonio, TX, United States of America
| | - Mitchell W. Krucoff
- Duke University School of Medicine, Durham, NC, United States of America,Duke Clinical Research Institute, Durham, NC, United States of America
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Azzalini L, Seth M, Sukul D, Valle JA, Daher E, Wanamaker B, Tucciarone MT, Zaitoun A, Madder RD, Gurm HS. Trends and outcomes of percutaneous coronary intervention during the COVID-19 pandemic in Michigan. PLoS One 2022; 17:e0273638. [PMID: 36156591 PMCID: PMC9512204 DOI: 10.1371/journal.pone.0273638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 08/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic has severely impacted healthcare delivery and patient outcomes globally. Aims We aimed to evaluate the influence of the COVID-19 pandemic on the temporal trends and outcomes of patients undergoing percutaneous coronary intervention (PCI) in Michigan. Methods We compared all patients undergoing PCI in the BMC2 Registry between March and December 2020 (“pandemic cohort”) with those undergoing PCI between March and December 2019 (“pre-pandemic cohort”). A risk-adjusted analysis of in-hospital outcomes was performed between the pre-pandemic and pandemic cohort. A subgroup analysis was performed comparing COVID-19 positive vs. negative patients during the pandemic. Results There was a 15.2% reduction in overall PCI volume from the pre-pandemic (n = 25,737) to the pandemic cohort (n = 21,822), which was more pronounced for stable angina and non-ST-elevation acute coronary syndromes (ACS) presentations, and between February and May 2020. Patients in the two cohorts had similar clinical and procedural characteristics. Monthly mortality rates for primary PCI were generally higher in the pandemic period. There were no significant system delays in care between the cohorts. Risk-adjusted mortality was higher in the pandemic cohort (aOR 1.26, 95% CI 1.07–1.47, p = 0.005), a finding that was only partially explained by worse outcomes in COVID-19 patients and was more pronounced in subjects with ACS. During the pandemic, COVID-19 positive patients suffered higher risk-adjusted mortality (aOR 5.69, 95% CI 2.54–12.74, p<0.001) compared with COVID negative patients. Conclusions During the COVID-19 pandemic, we observed a reduction in PCI volumes and higher risk-adjusted mortality. COVID-19 positive patients experienced significantly worse outcomes.
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Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Milan Seth
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Devraj Sukul
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Javier A. Valle
- Michigan Heart and Vascular, Ann Arbor, MI, United States of America
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Edouard Daher
- Cardiac Catheterization Laboratory, Ascension St John Hospital, Detroit, MI, United States of America
| | - Brett Wanamaker
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | | | - Anwar Zaitoun
- Covenant Cardiology, Saginaw, MI, United States of America
| | - Ryan D. Madder
- Spectrum Health Hospitals Fred and Lena Meijer Heart Center, Grand Rapids, MI, United States of America
| | - Hitinder S. Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
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Koh HP, Md Redzuan A, Mohd Saffian S, R Nagarajah J, Ross NT, Hassan H. Impact of COVID-19 pandemic on STEMI thrombolysis and Emergency Department's performance in a non-PCI capable tertiary hospital. Am J Emerg Med 2022; 60:9-14. [PMID: 35872375 DOI: 10.1016/j.ajem.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Some guidelines had recommended “thrombolysis first” in ST-elevated myocardial infarction (STEMI) during the Coronavirus Disease 2019 (COVID-19) outbreak. The impact of COVID-19 solely on STEMI thrombolysis is lacking as most studies reported outcomes related to percutaneous coronary intervention (PCI) setting. Thus, this study aimed to assess the impact of the COVID-19 pandemic on STEMI thrombolysis outcomes and the Emergency Department's performance in a non-PCI capable centre. Methods This single-centre retrospective study analysed data on consecutive STEMI patients who received thrombolytic therapy from May 2019 to December 2020 (20 months) in a non-PCI capable tertiary hospital. Total population sampling was used in this study. We compared all patients' characteristics and outcomes ten months before and during the pandemic. Regression models were used to assess the impact of COVID-19 pandemic on door-to-needle time (DNT), mortality, bleeding events, and the number of overnight stays. Results and discussion We analysed 323 patients with a mean age of 52.9 ± 12.9 years and were predominantly male (n = 280, 88.9%). There was a 12.5% reduction in thrombolysis performed during the pandemic. No significant difference in timing from symptoms onset to thrombolysis and DNT was observed. In-hospital mortality was significantly higher during the pandemic (OR 2.02, 95% CI 1.02–4.00, p = 0.044). Bleeding events post thrombolysis remained stable and there was no significant difference in the number of overnight stays during the pandemic. Conclusion STEMI thrombolysis cases were reduced during the COVID-19 pandemic, with an inverse increase in mortality despite the preserved Emergency Department performance in timely thrombolysis.
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de Miguel-Diez J, Jimenez-Garcia R, de Miguel-Yanes JM, Hernández-Barrera V, Carabantes-Alarcon D, Zamorano-Leon JJ, Noriega C, Lopez-de-Andres A. Impact of the COVID-19 Pandemic on the Use and Outcomes of Cardiac Procedures in COPD Patients. J Clin Med 2022; 11:3924. [PMID: 35807209 PMCID: PMC9267656 DOI: 10.3390/jcm11133924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The aim of this study was to assess the effects of the COVID-19 pandemic on the use and outcomes of cardiac procedures among people with chronic obstructive pulmonary disease (COPD) in Spain. (2) Methods: We used national hospital discharge data to select patients admitted to hospital with a diagnosis of COPD from 1 January 2019 to 31 December 2020. (3) Results: The number of COPD patients hospitalized in 2019 who underwent a cardiac procedure was 4483, 16.2% higher than in 2020 (n = 3757). The length of hospital stay was significantly lower in 2020 than in 2019 (9.37 vs. 10.13 days; p = 0.004), and crude in-hospital mortality (IHM) was significantly higher (5.32% vs. 4.33%; p = 0.035). Multivariable logistic regression models to assess the differences in IHM from 2019 to 2020 showed Odds Ratio (OR) values over 1, suggesting a higher risk of dying in 2020 compared to in 2019. However, the ORs were only statistically significant for "any cardiac procedure" (1.18, 95% CI 1.03-1.47). The Charlson comorbidity index increased IHM for each of the procedures analyzed. The probability of IHM was higher for women and older patients who underwent coronary artery bypass graft or open valve replacement procedures. Suffering a COVID-19 infection was associated with significantly higher mortality after cardiac procedures. (4) Conclusions: The COVID-19 pandemic limited the access to healthcare for patients with COPD.
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Affiliation(s)
- Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007 Madrid, Spain;
| | - Rodrigo Jimenez-Garcia
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
| | - Jose M. de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007 Madrid, Spain;
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - David Carabantes-Alarcon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
| | - Jose J. Zamorano-Leon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
| | - Concepción Noriega
- Department of Nursery and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, 28871 Alcalá de Henares, Spain;
| | - Ana Lopez-de-Andres
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, IdISSC, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
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Piccolo R, Leone A, Avvedimento M, Galano G, Esposito G. Pre-hospital electrocardiogram in patients with acute myocardial infarction during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care 2022; 11:510-511. [PMID: 35543255 PMCID: PMC9384073 DOI: 10.1093/ehjacc/zuac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/17/2022] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Raffaele Piccolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Attilio Leone
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marisa Avvedimento
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Galano
- Centrale Operativa Territoriale 118 - Attività Territoriali ASL Napoli 1 Centro, Naples, Italy
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Ramzy J, Martin CA, Burgess S, Gooley R, Zaman S. COVID-19 Pandemic Impact on Percutaneous Coronary Intervention for Acute Coronary Syndromes: An Australian Tertiary Centre Experience. Heart Lung Circ 2022; 31:787-794. [PMID: 35165052 PMCID: PMC8836676 DOI: 10.1016/j.hlc.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022]
Abstract
Background Countries who suffered large COVID-19 outbreaks reported a decrease in acute coronary syndrome (ACS) presentations and percutaneous coronary intervention (PCI). The impact of the pandemic in countries like Australia, with relatively small outbreaks yet significant social restrictions, is relatively unknown. There is also limited and conflicting data regarding the impact on clinical outcomes, symptom-to-door time (STDT) and door-to-balloon time (DTBT). Methods Consecutive ACS patients treated with PCI were prospectively recruited from a tertiary hospital network in Melbourne, Australia. The pre-pandemic period (11 March 2019–10 March 2020) was compared to the pandemic period (11 March 2020–10 May 2020) using an interrupted time series analysis with a primary endpoint of number PCI-treated ACS per day. Secondary endpoints included STDT, DTBT, total mortality and major adverse cardiac events (MACE). Results A total 984 ACS patients (14.8% during the pandemic period) received PCI. Mean number of PCI-treated ACS per day did not differ between the two periods (2.3 vs 2.4, p=0.61) with no difference in STDT [+51.3 mins, 95% confidence interval (CI) -52.4 to 154.9, p=0.33], 30-day mortality (5% vs 5.3%, p=0.86) or MACE (5.2% vs 6.1%, p=0.68). DTBT was significantly longer during the pandemic versus the pre-pandemic period (+18.1 mins, 95% CI 1.6–34.5, p=0.03) and improved with time (slope estimate: -0.76, 95% CI -1.62 to 0.10). Conclusions Despite significant social restrictions imposed in Melbourne, numbers of ACS treated with PCI and 30-day outcomes were similar to pre-pandemic times. DTBT was significantly longer during the COVID-19 pandemic period, likely reflecting infection control measures, which reassuringly improved with time.
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Affiliation(s)
- John Ramzy
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia; MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Catherine A Martin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Data Science and Artificial Intelligence platform (DSAI), eResearch, Monash University, Melbourne, Vic, Australia
| | - Sonya Burgess
- Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia; The University of Sydney, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia
| | - Robert Gooley
- MonashHeart, Monash Health, Melbourne, Vic, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
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18
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Al-Abid M, Petrucci R, Preda TC, Lord SJ, Lord RV. Reduced number of admissions with acute appendicitis but not severe acute appendicitis at two Sydney hospitals during the first COVID-19 lockdown period. ANZ J Surg 2022; 92:1737-1741. [PMID: 35635054 PMCID: PMC9347848 DOI: 10.1111/ans.17793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/04/2022] [Accepted: 04/17/2022] [Indexed: 12/01/2022]
Abstract
Background This study investigated whether there was a change in acute appendicitis, appendicectomy admissions or disease severity during the 2020 lockdown period in NSW. Methods A retrospective before‐and‐after study was undertaken of patients admitted to two Sydney hospitals (St. Vincent's and Liverpool Hospitals) who had appendicectomy for presumed acute appendicitis and patients who had confirmed appendicitis but did not undergo surgery. Study periods were the 2020 lockdown period (15 March–15 May 2020), the corresponding period in the previous year, and the 1‐month after these periods. Patients were classified as having no, mild or severe appendicitis using operation and histopathological reports. Results (Thirty‐six percent) fewer patients were admitted with acute appendicitis during the lockdown period compared with the previous year with a substantial reduction in normal/mild appendicitis presentations (OR 0.56, 95% CI 0.34–0.93, P = 0.03). There were 46% fewer patients with mild appendicitis during lockdown (56) compared with the previous year (103); numbers of patients with severe appendicitis were very similar (46 vs. 51). There was no increase in number of admissions with severe appendicitis, or in the time from onset of symptoms to admission, in the month following lockdown. Conclusion Compared with the previous year, there were markedly fewer admissions with appendicitis during lockdown, with no evidence of a shift to more cases of severe appendicitis nor delayed presentation in the post‐lockdown period. It is plausible that some patients with mild appendicitis may have recovered without hospitalization, supporting the importance of implementing trials on non‐surgical management of appendicitis. During COVID‐19 lockdown in Sydney we noted a reduction in hospital presentations with acute appendicitis but not severe acute appendicitis. Mild appendicitis may be able to be successfully managed in the outpatient setting.
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Affiliation(s)
- Meryem Al-Abid
- Department of Surgery, University of Notre Dame School of Medicine, Sydney
| | - Ryan Petrucci
- Department of Surgery, Liverpool Hospital, Sydney, Australia
| | - Tamara C Preda
- Department of Surgery, University of Notre Dame School of Medicine, Sydney
| | - Sally J Lord
- Department of Epidemiology and Medical Statistics, University of Notre Dame School of Medicine, Sydney, Australia
| | - Reginald V Lord
- Department of Surgery, University of Notre Dame School of Medicine, Sydney
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Zuo M, Xiang S, Bhattacharyya S, Chen Q, Zeng J, Li C, Deng Y, Siu C, Yin L. Management strategies and outcomes of acute coronary syndrome (ACS) during Covid-19 pandemic. BMC Cardiovasc Disord 2022; 22:242. [PMID: 35614403 PMCID: PMC9130978 DOI: 10.1186/s12872-022-02680-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/13/2022] [Indexed: 02/08/2023] Open
Abstract
Background The COVID-19 outbreak represents a significant challenge to international health. Several studies have reported a substantial decrease in the number of patients attending emergency departments with acute coronary syndromes (ACS) and there has been a concomitant rise in early mortality or complications during the COVID-19 pandemic. A modified management system that emphasizes nearby treatment, safety, and protection, alongside a closer and more effective multiple discipline collaborative team was developed by our Chest Pain Center at an early stage of the pandemic. It was therefore necessary to evaluate whether the newly adopted management strategies improved the clinical outcomes of ACS patients in the early stages of the COVID-19 pandemic. Methods Patients admitted to our Chest Pain Center from January 25th to April 30th, 2020 based on electronic data in the hospitals ACS registry, were included in the COVID-19 group. Patients admitted during the same period (25 January to 30 April) in 2019 were included in the pre-COVID-19 group. The characteristics and clinical outcomes of the ACS patients in the COVID-19 period group were compared with those of the ACS patients in the pre-COVID-19 group. Multivariate logistic regression analyses were used to identify the risk factors associated with clinical outcomes.
Results The number of patients presenting to the Chest Pain Center was reduced by 45% (p = 0.01) in the COVID-19 group, a total of 223 ACS patients were included in the analysis. There was a longer average delay from the onset of symptom to first medical contact (FMC) (1176.9 min vs. 625.2 min, p = 0.001) in the COVID-19 period group compared to the pre-COVID-19 group. Moreover, immediate percutaneous coronary intervention (PCI) (80.1% vs. 92.3%, p = 0.008) was performed less frequently on ACS patients in the COVID-19 group compared to the pre-COVID-19 group. However, more ACS patients received thrombolytic therapy (5.8% vs. 0.6%, p = 0.0052) in the COVID-19 group than observed in the pre-COVID-19 group. Interestingly, clinical outcome did not worsen in the COVID-19 group when cardiogenic shock, sustained ventricular tachycardia, ventricular fibrillation or use of mechanical circulatory support (MCS) were compared against the pre-COVID-19 group (13.5% vs. 11.6%, p = 0.55). Only age was independently associated with composite clinical outcomes (HR = 1.3; 95% CI 1.12–1.50, p = 0.003). Conclusion This retrospective study showed that the adverse outcomes were not different during the COVID-19 pandemic compared to historical control data, suggesting that newly adopted management strategies might provide optimal care for ACS patients. Larger sample sizes and longer follow-up periods on this issue are needed in the future.
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Affiliation(s)
- Mingliang Zuo
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Shoubo Xiang
- West China Hospital, Sichuan University, Chengdu, China
| | - Sanjib Bhattacharyya
- College of Pharmaceutical Sciences, Southwest University, Beibei, Chongqing, China
| | - Qiuyi Chen
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Jie Zeng
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunmei Li
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Chungwah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Room 1929, Block K, 102 Pokfulam Road, Hong Kong SAR, China.
| | - Lixue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Altobelli E, Angeletti PM, Marzi F, D’Ascenzo F, Petrocelli R, Patti G. Impact of SARS-CoV-2 Outbreak on Emergency Department Presentation and Prognosis of Patients with Acute Myocardial Infarction: A Systematic Review and Updated Meta-Analysis. J Clin Med 2022; 11:jcm11092323. [PMID: 35566450 PMCID: PMC9102296 DOI: 10.3390/jcm11092323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/23/2022] Open
Abstract
We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies having the same observation period for the comparison between SARS-CoV-2 outbreak in 2020 versus control period in 2019 were included. Primary endpoints were the relative variation of hospital admissions, the difference of in-hospital mortality for STEMI and NSTEMI. Secondary were: mortality according to countries, income levels and data quality; cardiogenic shock, mechanical complications, door-to-balloon time, time from symptom onset to first medical contact, left ventricular ejection fraction (LVEF) and troponin. In total, 61 observational studies with 125,346 patients were included. Compared with 2019, during the pandemic for STEMI were observed: a 24% reduction of hospitalizations with an impact on early survival (OR = 1.33 in-hospital mortality); the time from symptom onset to first medical contact was 91.31 min longer, whereas door-to-balloon time was increased (+5.44 min); after STEMI, the rate of cardiogenic shock was 33% higher; LVEF at discharge was decreased (−3.46); elevated high-sensitivity troponin levels (1.52) on admission. For NSTEMI, in the COVID-19 period, we observed a 31% reduction of hospitalizations and higher in-hospital deaths (OR = 1.34). The highest mortality rates among countries were: Italy OR = 3.71 (high income), Serbia OR = 2.15 (upper middle) and Pakistan OR = 1.69 (lower middle). Later hospital presentation was associated with larger infarctions, as well as with increased cardiogenic shock and in-hospital mortality.
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Affiliation(s)
- Emma Altobelli
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (P.M.A.); (F.M.)
- Correspondence: ; Tel.: +39-0862-434-666
| | - Paolo Matteo Angeletti
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (P.M.A.); (F.M.)
- Cardiac Surgical Intensive Care Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy
| | - Francesca Marzi
- Department of Life, Public Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (P.M.A.); (F.M.)
| | - Fabrizio D’Ascenzo
- Cardiovascular and Thoracic Department, Division of Cardiology, University of Turin, 10126 Turin, Italy;
| | | | - Giuseppe Patti
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy;
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Ghasemzadeh N, Kim N, Amlani S, Madan M, Shavadia JS, Chong AY, Bagherli A, Bagai A, Saw J, Singh J, Dehghani P. A Review of ST-elevation Myocardial Infarction in Patients with COVID-19. Cardiol Clin 2022; 40:321-328. [PMID: 35851455 PMCID: PMC8960128 DOI: 10.1016/j.ccl.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nathan Kim
- Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Shy Amlani
- William Osler Health System, Brampton, 2100 Bovaird Drive East, Ontario L6R 3J7, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Jay S Shavadia
- Royal University Hospital, Saskatchewan Health, University of Saskatchewan Saskatoon, 103 Hospital Drive, Saskatchewan S7N 0W8, Canada
| | - Aun-Yeong Chong
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Alireza Bagherli
- Windsor Regional Hospital, 1030 Ouellette Avenue, Windsor, Ontario N9A 1E1, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada.
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22
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Jensen LO, Loh PH, Calmac L, Roura-Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong ASL, Kala P, Diez Gil JL, Carrillo X, Dirksen MT, Becerra-Muñoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld AO, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac A, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martìnez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Fores J, Vignali L, Pereira H, Manzo-Silberman S, Ordonez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Ylitalo A, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe C, Kanakakis J, Faurie B, Gabrielli G, Gutiérrez A, Bachini JP, Rocha A, Tam FC, Rodriguez A, Lukito A, Saint-Joy V, Pessah G, Tuccillo B, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction. Heart 2022; 108:458-466. [PMID: 34711661 PMCID: PMC8561823 DOI: 10.1136/heartjnl-2021-319750] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER NCT04412655.
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Affiliation(s)
- Giuseppe De Luca
- Department of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | | | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico, Centro PROCAPE Prof. Tavares, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, Kemerovo Cardiology Center, Кемерово, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Ss Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, Singapore Health Service, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital, University of Bucharest, Bucuresti, Romania
| | - Gerard Roura-Ferrer
- Interventional Cardiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Alexandre Quadros
- Instituto de Cardiologia, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Marek Milewski
- Division of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Academisch Medisch Centrum, Twente, The Netherlands
| | | | - Jurriën Ten Berg
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | | | - Petr Kala
- University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Jose Luis Diez Gil
- Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Xavier Carrillo
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen ElizabethHospital University of Hong Kong, Hong Kong, Hong Kong
| | - Dafsah A Juzar
- Department of cardiology and Vascular Medicine, National Cardiovascular Center 'Harapan Kita', Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University of Zagreb, Zagreb, Croatia
| | | | - Nikola Bakraceski
- Center for Cardiovascular Diseases, Ohrid University Hospital, Ohrid, Macedonia
| | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | | | | | - Gennaro Galasso
- Division of Cardiology, University of Salerno, Salerno, Italy
| | - Arpad Lux
- Cardiology, Maastricht University Hospital, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Ancona, Italy
| | | | - Maurizio Menichelli
- Cardiology Division, Ospedale Fabrizio Spaziani, Roma, Italy
- Cardiology Division, Ospedale "F. Spaziani", Frosinone, Italy
| | | | - Aylin Yamac
- Department of Cardiology, Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi Universitesi, Eskisehir, Turkey
| | | | - Tomas Kovarnik
- Department of Cardiovascular Medicine, University Hospital Prague, Prague, Czech Republic
| | - Michal Kidawa
- Central Hospital, Medical University of Lodz, Lodz, Poland
| | - Jose Moreu
- Division of Cardiology, Hospital Complex of Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Lille University Hospital Center, Lille, France
| | - Enrico Fabris
- Department of Cardiology, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Naples, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Consorcio Sanitario de Tenerife, Santa Cruz de Tenerife, Spain
| | | | - Gianluca Caiazzo
- Division of Cardiology, Ospedale "G Moscati", Aversa, Aversa, Italy
| | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juan Sanchis Fores
- Department of Cardiology, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Garcia de Orta Hospital, Almada, Portugal
| | | | - Santiago Ordonez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, Saarland University, Saarbrucken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Department of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School,CEDOC, Carnaxide, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Athens, Greece
| | - Antti Ylitalo
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Argentina
| | | | | | | | | | - Carlos Uribe
- Division of Cardiology, Medellin Clinic Universidad UPB, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, General Hospital of Athens Alexandra, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- SOD Cardiologia-Emodinamica-UTIC, Azienda Ospedali Riuniti - Presidio 'GM Lancisi', Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Franckie Cc Tam
- Department of Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Alfredo Rodriguez
- Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina
| | - Antonia Lukito
- Cardiovascular Department, Pelita Harapan University, Tangerang, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Cordoba Hospital, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Guido Parodi
- Division of cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Elvin Kedhi
- Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Matteo Nardin
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Ospedali Riuniti, Brescia, Italy
| | - Monica Verdoia
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Cardiology, Nuovo Ospedale degli Infermi ASL Biella, Biella, italy
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23
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Indolfi C, Esposito G. Universal Health Care System and Cardiovascular Disease Burden in Italy. Circulation 2022; 145:559-561. [PMID: 35188793 DOI: 10.1161/circulationaha.121.057496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ciro Indolfi
- Division of Cardiology, Research Center for Cardiovascular Diseases, University Magna Graecia, Viale Europa, Catanzaro, Italy (C.I.).,Mediterranea Cardiocentro, Naples, Italy (C.I.)
| | - Giovanni Esposito
- Division of Cardiology Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.E.)
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2192] [Impact Index Per Article: 1096.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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25
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Piane M, Bianco L, Mancini R, Fornelli P, Gabriele A, Medici F, Battista C, Greco S, Croce G, Franceschetti L, Napoli C, Ronchetti M, Anibaldi P, Banchieri G. Impact of the COVID-19 Pandemic on Clinical Pathways for Non-SARS-CoV-2 Related Diseases in the Lazio Region, Italy. Int J Environ Res Public Health 2022; 19:635. [PMID: 35055455 DOI: 10.3390/ijerph19020635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
Clinical pathways (CPs) are multidisciplinary clinical governance tools necessary for the care management of the patients, whose aim is to outline the best practicable path within a health organization related to an illness or to a complex clinical situation. The COVID-19 pandemic emergency has created the need for an organizational renewal of care pathways based on the principles of “primary health care” recommended by the WHO. In Italy, the Hospitals and Local Health Authorities (ASL) have tried to guarantee the continuity of non-deferrable treatments and the maximum safety of both patients and health professionals. This study analyzes the organizational and managerial responses adopted in pathology-specific care pathways to assess how CPs as diagnostic tools responded to the COVID-19 pandemic in the first two waves. Twenty-four referents of Operational Units (UU OO) from Hospitals (AO) and Local Health Authorities (ASL) of the Lazio Region (Central Italy) that apply four different CPs responded to a survey, which analyzes the managerial and organizational responses of CPs in regard to different contexts. Results show that the structural and organizational adjustments of the CPs have made it possible to maintain an adequate level of care for specific treatment processes, with some common critical aspects that require improvement actions. The adjustments found could be useful for dealing with new outbreaks and/or new epidemics in order to try to mitigate the potential negative impact, especially on the most vulnerable patient categories.
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [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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27
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Araiza-Garaygordobil D, Montalto C, Martinez-Amezcua P, Cabello-Lopez A, Gopar-Nieto R, Alabrese R, Almaghraby A, Catoya-Villa S, Chacon-Diaz M, Kaufmann CC, Corbi-Pascual M, Deharo P, El-Tahlawi M, Elgohari-Abdelwahab A, Guerra F, Jarakovic M, Martinez-Gomez E, Moderato L, Montero S, Morejon-Barragan P, Omar AM, Jorge-Pérez P, Przybyło P, Selim E, Sinan UY, Stratinaki M, Tica O, Trêpa M, Uribarri A, Uzokov J, Wilk K, Czerwińska-Jelonkiewicz K, Sionis A, Gierlotka M, Leonardi S, Krychtiuk KA, Tavazzi G. Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study. QJM 2021; 114:642-647. [PMID: 33486512 PMCID: PMC7928691 DOI: 10.1093/qjmed/hcab013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). AIM To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. DESIGN Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. RESULTS A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. CONCLUSIONS Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.
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Affiliation(s)
- D Araiza-Garaygordobil
- From the Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, México
| | - C Montalto
- Department of Cardiology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA
| | - A Cabello-Lopez
- Occupational Health Research Unit, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, México
| | - R Gopar-Nieto
- From the Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, México
| | - R Alabrese
- Department of Cardiology, Parma University Hospital, Italy
| | - A Almaghraby
- Department of Cardiology and Angiology, University of Alexandria, Egypt
| | - S Catoya-Villa
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Chacon-Diaz
- Cardiology Clinic and Intensive Cardiac Care, Instituto Nacional Cardiovascular INCOR-Essalud, Lima, Perú
| | - C C Kaufmann
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - M Corbi-Pascual
- Coronary Care Unit, Cardiology Service, Albacete General Hospital, Albacete
| | - P Deharo
- Aix Marseille University, Inserm, Inra, C2VN, Marseille, France
| | - M El-Tahlawi
- Department of Cardiology, Zagazig University Hospital, Zagazig, Egypt
| | | | - F Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ospedali Riuniti “Umberto I—Lancisi—Salesi”, Ancona, Italy
| | - M Jarakovic
- Cardiology Intensive Care Unit, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - E Martinez-Gomez
- Acute Cardiovascular Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - L Moderato
- Cardiology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - S Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - P Morejon-Barragan
- Coronary Care Unit, Cardiology Service, UAI University Hospital, Buenos Aires, Argentina
| | - A M Omar
- Tripoli University Hospital, Tripoli, Libya
| | - P Jorge-Pérez
- Acute Cardiovascular Care Unit, Cardiology Department, Canary Islands University Hospital, Tenerife, Spain
| | - P Przybyło
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - E Selim
- Coronary Care Unit, Emergency Department and Cardiology Clinic, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - U Y Sinan
- Department of Cardiology, PH and ACHD, Istanbul University-Cerrahpasa Institute of Cardiology, Istanbul, Turkey
| | - M Stratinaki
- Cardiology Department, General Hospital Venizeleio, Heraklion, Crete, Greece
| | - O Tica
- Faculty of Medicine and Pharmacy, University of Oradea; Emergency County Clinical Hospital of Oradea, Romania
| | - M Trêpa
- Cardiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Uribarri
- Cardiovascular Care Unit, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - J Uzokov
- Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - K Wilk
- Department of Cardiology, Medical University of Białystok, Bialystok, Poland
| | - K Czerwińska-Jelonkiewicz
- Intensive Therapy Unit, Harefield Hospital, Royal Brompton & Harefield NHS Fundation Trust, London, UK
| | - A Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - S Leonardi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology-Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - K A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - G Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
- Address correspondence to Dr Guido Tavazzi, MD, PhD, University of Pavia, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences; Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Anestesia e Rianimazione I, DEA Piano-1, Viale Golgi 19, 27100 Pavia, Italy.
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Yu AY, Lee DS, Vyas MV, Porter J, Rashid M, Fang J, Austin PC, Hill MD, Kapral MK. Emergency Department Visits, Care, and Outcome After Stroke and Myocardial Infarction During the COVID-19 Pandemic Phases. CJC Open 2021; 3:1230-1237. [PMID: 34723166 PMCID: PMC8548659 DOI: 10.1016/j.cjco.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background It is not known if initial reductions in hospitalization for stroke and myocardial infarction early during the coronavirus disease–2019 pandemic were followed by subsequent increases. We describe the rates of emergency department visits for stroke and myocardial infarction through the pandemic phases. Methods We used linked administrative data to compare the weekly age- and sex-standardized rates of visits for stroke and myocardial infarction in Ontario, Canada in the first 9 months of 2020 to the mean baseline rates (2015-2019) using rate ratios (RRs) and 95% confidence intervals (CIs). We compared care and outcomes by pandemic phases (pre-pandemic was January-March, lockdown was March-May, early reopening was May-July, and late reopening was July-September). Results We identified 15,682 visits in 2020 for ischemic stroke (59.2%; n = 9279), intracerebral hemorrhage (12.2%; n = 1912), or myocardial infarction (28.6%; n = 4491). The weekly rates for stroke visits in 2020 were lower during the lockdown and early reopening than at baseline (RR 0.76, 95% CI [0.66, 0.87] for the largest weekly decrease). The weekly rates for myocardial infarction visits were lower during the lockdown only (RR 0.61, 95% CI [0.46, 0.77] for the largest weekly decrease), and there was a compensatory increase in visits following reopening. Ischemic stroke 30-day mortality was increased during the lockdown phase (11.5% pre-coronavirus disease; 12.2% during lockdown; 9.2% during early reopening; and 10.6% during late reopening, P = 0.015). Conclusion After an initial reduction in visits for stroke and myocardial infarction, there was a compensatory increase in visits for myocardial infarction. The death rate after ischemic stroke was higher during the lockdown than in other phases.
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Affiliation(s)
- Amy Y.X. Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Corresponding author: Dr Amy Y.X. Yu, Neurologist, Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Office A-455, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada. Tel.: +1-416-480-4866; fax: +1-416-480-5753.
| | - Douglas S. Lee
- ICES, Toronto, Ontario, Canada
- Department of Medicine (Cardiology), University of Toronto–University Health Network, Toronto, Ontario, Canada
| | - Manav V. Vyas
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | | | | | - Michael D. Hill
- Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Moira K. Kapral
- ICES, Toronto, Ontario, Canada
- Department of Medicine (General Internal Medicine), University of Toronto–University Health Network, Toronto, Ontario, Canada
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Kassa ET. Determinants of the continuous operations of micro and small enterprises during COVID-19 pandemic in Ethiopia. J Innov Entrep 2021; 10:42. [PMID: 34745824 PMCID: PMC8559426 DOI: 10.1186/s13731-021-00187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
The main objective of this study is to assess determinant factors for the continuous operations of micro and small enterprises during COVID-19 pandemic. The study adopted a cross-sectional design, with both descriptive and explanatory research design. To achieve the objectives of the study, 276 respondents were selected from 890 micro and small enterprise owners. The sample of the study was selected through proportional stratified random sampling technique from the business types (manufacturing, construction, urban agriculture, service and trade). To collect the primary data, questionnaires were dispatched to owners/operators of micro and small enterprises. The collected data were analyzed through descriptive, correlation and regression analysis techniques. The finding of the study revealed that people and administrative factors, regulatory factors, economic factors, partnerships, leadership of owner have a positive relationship to micro-small enterprise continuous operations during COVID-19 pandemic with the value of r = 0.457, 0.558, 0.572, 0.519 and 0.654, respectively. The study regression analysis result assured that partnership, economic factors, and leadership of the owner has a positive statistical significant effect on the continuous operations of the micro and small enterprise during COVID-19 pandemic with the value of (p < 0.05). The researcher recommended that strenghtening partnership with stakeloders and excersing best leadership practices are essential to ensure the continuous operations of the micro and small enterpreses.
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Campanile A, Verdecchia P, Ravera A, Coiro S, Mattei C, Scavelli F, Bearzot L, Cutolo A, Centola M, Carugo S, De Rosa S, Guerra F, Marini M, Perna GP, Indolfi C, Cavallini C. Intensive cardiac care unit admission trends during the COVID-19 outbreak in Italy: a multi-center study. Intern Emerg Med 2021; 16:2077-2086. [PMID: 33768468 PMCID: PMC7993896 DOI: 10.1007/s11739-021-02718-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
A significant decline in the admission to intensive cardiac care unit (ICCU) has been noted in Italy during the COVID-19 outbreak. Previous studies have provided data on clinical features and outcome of these patients, but information is still incomplete. In this multicenter study conducted in six ICCUs, we enrolled consecutive adult patients admitted to ICCU in three specific time intervals: from February 8 to March 9, 2020 [before national lockdown (pre-LD)], from March 10 to April 9, 2020 [during the first period of national lockdown (in-LD)] and from May 18 to June 17, 2020 [soon after the end of all containment measures (after-LD)]. Compared to pre-LD, in-LD was associated with a significant drop in the admission to ICCU for all causes (- 35%) and acute coronary syndrome (ACS; - 49%), with a rebound soon after-LD. The in-LD reduction was greater for women (- 49%) and NSTEMI (- 61%) compared to men (- 28%) and STEMI (- 33%). Length-of-stay, and in-hospital mortality did not show any significant change from to pre-LD to in-LD in the whole population as well as in the ACS group. This study confirms a notable reduction in the admissions to ICCUs from pre-LD to in-LD followed by an increment in the admission rates after-LD. These data strongly suggest that people, particularly women and patients with NSTEMI, are reluctant to seek medical care during lockdown, possibly due to the fear of viral infection. Such a phenomenon, however, was not associated with a rise in mortality among patients who get hospitalization.
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Affiliation(s)
- Alfonso Campanile
- Cardiology Department, Intensive Cardiac Care Unit, S. Giovanni Di Dio E Ruggi D'Aragona Hospital, Via San Leonardo 1, 84131, Salerno, Italy.
| | - Paolo Verdecchia
- Fondazione Umbra Cuore E Ipertensione-ONLUS', Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Amelia Ravera
- Cardiology Department, Intensive Cardiac Care Unit, S. Giovanni Di Dio E Ruggi D'Aragona Hospital, Via San Leonardo 1, 84131, Salerno, Italy
| | - Stefano Coiro
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Cristian Mattei
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Francesca Scavelli
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Luca Bearzot
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Ada Cutolo
- Cardiology Department, Intensive Cardiac Care Unit, Dell'Angelo Hospital, Mestre, Italy
| | - Marco Centola
- Department of Cardio-Respiratory Disease, University of Milan, Division of Cardiology, ASST Santi Paolo E Carlo, Milano, Italy
| | - Stefano Carugo
- Department of Cardio-Respiratory Disease, University of Milan, Division of Cardiology, ASST Santi Paolo E Carlo, Milano, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Cardiovascular Research Center, "Magna Graecia" University, Catanzaro, Italy
| | - Federico Guerra
- Cardiology Department, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Marco Marini
- Cardiology Department, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
| | - Gian Piero Perna
- Cardiology Department, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Cardiovascular Research Center, "Magna Graecia" University, Catanzaro, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Claudio Cavallini
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
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Dondi M, Milan E, Pontone G, Hirschfeld CB, Williams M, Shaw LJ, Pynda Y, Raggi P, Cerci R, Vitola J, Better N, Villines TC, Dorbala S, Pascual TNB, Giubbini R, Einstein AJ, Paez D. Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID). Int J Cardiol 2021; 341:100-106. [PMID: 34478789 PMCID: PMC8406540 DOI: 10.1016/j.ijcard.2021.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
Background In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p < 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures.
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Affiliation(s)
- Maurizio Dondi
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
| | | | | | - Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, USA
| | | | - Leslee J Shaw
- Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, USA
| | - Yaroslav Pynda
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Paolo Raggi
- Division of Cardiology, University of Alberta, Canada
| | | | | | - Nathan Better
- Royal Melbourne Hospital and University of Melbourne, Australia
| | - Todd C Villines
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | | | | | - Raffaele Giubbini
- Department of Imaging, Spedali Civili and University of Brescia, Italy
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, USA; Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, USA
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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32
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Scalise M, Bossone E, Mannelli MP, Ranieri B, Franzese M, Castaldo R, Fidecicchi A, Esposito M, Cocchia R, Lodato S, Majolo M, Russo G, Longo G, Mauro C. STEMI-PCI incidence rates and outcomes during COVID-19 pandemic: insights from Cardarelli Hospital, Naples, Southern Italy. Eur J Prev Cardiol 2021; 29:e216-e219. [PMID: 34626179 DOI: 10.1093/eurjpc/zwab165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Martina Scalise
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Eduardo Bossone
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Maria Pia Mannelli
- Clinical Epidemiology and Statistics Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | | | | | | | - Andrea Fidecicchi
- Clinical Epidemiology and Statistics Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Mafalda Esposito
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Rosangela Cocchia
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Sergio Lodato
- Clinical Epidemiology and Statistics Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Massimo Majolo
- Health Management Office, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Giuseppe Russo
- Health Management Office, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
| | - Giuseppe Longo
- CEO, General Management Office, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9 - 80131 Naples, Italy
| | - Ciro Mauro
- Cardiology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy
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33
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Cioni G, Canini J. The side effects of the COVID-19 pandemic on key public health elements - How the global emergency has changed the acute management of myocardial infarction and stroke, the network of cancer care, and assistance to frail individuals. Ital J Med 2021. [DOI: 10.4081/itjm.2021.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a primary health problem globally. In particular, it has caused troubles even to the advanced health systems of Western countrieswho attempted to limit the spread of the infection and manage patients with severe respiratory distress. However, this sudden contingency has had a much higher cost if we also consider the cost of suspending ordinary clinical care or delays in the emergency pathways of non-COVID-19 patients. Furthermore, the policies applied to contain the contagion have exacerbated the socio-economic disparities of the population and isolated fragile patients, making them subject to clinical relapses or aggravation of chronic diseases. For this reason, the various specialist centers have equipped themselves to guarantee an effective therapeutic path. In this brief review, we have outlined some consequent repercussions on the management of acute and chronic cardiovascular and neurovascular diseases and on oncological treatment. In particular, we have described the effects of the current health reorganization on some acute and time-dependent diseases, such as stroke and acute coronary syndromes, in which therapeutic delay is potentially disabling or fatal. Furthermore, we have focused on cancer treatments, whose essential cornerstones are early screening and follow-up. Finally, the suffering of the local health network has led to a lack of continuity of care in fragile patients, such as psychiatric, marginalized, or multiple comorbid patients.
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Uimonen M, Ponkilainen V, Kuitunen I, Eskola M, Mattila VM. Emergency department visits due to coronary artery disease during COVID-19 in Finland: A register-based study. Scand J Public Health 2021; 50:117-123. [PMID: 34494487 DOI: 10.1177/14034948211038422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: This multi-centre study examined the effects of restricted availability of health-care services during the COVID-19 pandemic on treatment of coronary artery disease (CAD) in Finland. Methods: Data on referrals to cardiological units (n=81,008), emergency department (ED) visits (n=10,001) and hospitalisations (n=8654) for CAD were collected from three large Finnish hospitals, and incidences were calculated per 100,000 persons for the years 2017 through 2020. Year 2020 was compared to the reference years 2017-2019 by incidence rate ratios (IRR) with 95% confidence intervals (CI). Results: Referrals to cardiological units decreased after the onset of the pandemic in March to May (IRR=0.83, 95% CI 0.81-0.86). ED visits due to acute coronary syndrome decreased during the first months of the pandemic, with the overall annual incidence 2-14% lower than in the reference years. ED visits due to chronic CAD increased prominently during in April and May compared to the corresponding months in the reference years (IRR=1.49, 95% CI 1.23-1.81 in April; IRR=1.57, 95% CI 1.32-1.89 in May) and remained elevated until the end of 2020, with an increase in annual incidence of 17% (IRR=1.17, 95% CI 1.11-1.24). Conclusions: The first COVID-19 wave decreased ED visits due to acute coronary syndromes and increased those due to chronic CAD. The changes in referral and ED visit incidences during the second wave were rather modest.
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Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Finland
| | | | - Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Finland.,Mikkeli Central Hospital, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Finland.,Faculty of Medicine and Health Technologies, Tampere University, Finland
| | - Ville M Mattila
- Department of Orthopaedics, Tampere University Hospital, Finland.,Faculty of Medicine and Health Technologies, Tampere University, Finland
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Everitt R, Robinson N, Marco D, Weil J, Bryan T. Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit. Palliat Med 2021; 35:1508-1513. [PMID: 34159860 DOI: 10.1177/02692163211026518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND COVID-19 has led to implementation of wide-ranging social restriction measures with consequent impact on health care utilisation in many domains. There is little published data on the experience of palliative care services catering to a population with low case numbers of COVID-19. AIM This study aimed to consider the impact of COVID-19 on utilisation of inpatient palliative care in the context of low community transmission, and low numbers of cases in hospital. DESIGN A retrospective service evaluation examining differences in number of admissions, diagnoses, number of deaths and time from admission to death, across three discrete 8-week time periods spanning the early COVID-19 pandemic. SETTING/PARTICIPANTS All admissions (n = 194) to a metropolitan tertiary hospital inpatient palliative care unit in Melbourne during the study period. RESULTS An initial 16.9% fall in admissions was followed by a return to baseline admission numbers, with a 46.7% increase in number of deaths compared to baseline. The number of deaths within 24 h rose from 10.8% to 37.3% (p < 0.01). The number of patients with non-malignant diagnoses increased from 32.4% to 52%, and those with non-malignant diagnoses were more likely to die rapidly (p < 0.01). There were no patients with COVID-19 infection. CONCLUSION Increased numbers of deaths within 24 h of admission occurred on the palliative care unit despite low COVID-19 case numbers in the wider community, and in the setting of widespread social restriction measures. More research is needed examining the health-related consequences of such restrictions for individuals not infected with COVID-19.
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Affiliation(s)
- Rachel Everitt
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Neil Robinson
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - David Marco
- Centre for Palliative Care, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Weil
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Tamsin Bryan
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
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Castaldi B, Sirico D, Meliota G, Vairo U, Luciani GB, Pilati M, Russo MG, Limongelli G, Favilli S, Santoro G, Guccione P, Rinelli G, Agnoletti G, Carminati M, Flocco S, Donti A, Assenza GE, Ciuffreda M, Saitta M, Di Salvo G, Formigari R. Impact of hard lockdown on interventional cardiology procedures in congenital heart disease: a survey on behalf of the Italian Society of Congenital Heart Disease. J Cardiovasc Med (Hagerstown) 2021; 22:701-705. [PMID: 34714259 DOI: 10.2459/jcm.0000000000001184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has thoroughly and deeply affected the provision of healthcare services worldwide. In order to limit the in-hospital infections and to redistribute the healthcare professionals, cardiac percutaneous intervention in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergency ones. The aim of this article is to describe the impact of the COVID-19 pandemic on Pediatric and ACHD cath laboratory activity during the so-called 'hard lockdown' in Italy. Eleven out of 12 Italian institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated in the survey. The interventional cardiology activity was reduced by more than 50% in 6 out of 11 centers. Adolescent and ACHD patients suffered the highest rate of reduction. There was an evident discrepancy in the management of the hard lockdown, irrespective of the number of COVID-19 positive cases registered, with a higher reduction in Southern Italy compared with the most affected regions (Lombardy, Piedmont, Veneto and Emilia Romagna). Although the pandemic was brilliantly addressed in most cases, we recognize the necessity for planning new, and hopefully homogeneous, strategies in order to be prepared for an upcoming new outbreak.
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Affiliation(s)
| | | | | | - Ugo Vairo
- Ospedale Pediatrico Giovanni XXIII, Bari
| | | | - Mara Pilati
- Azienda Ospedaliera Universitaria di Verona, Verona
| | | | | | | | | | | | | | | | | | | | - Andrea Donti
- Azienda Ospedaliera Sant'Orsola-Malpighi, Bologna
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Hirschfeld CB, Shaw LJ, Williams MC, Lahey R, Villines TC, Dorbala S, Choi AD, Shah NR, Bluemke DA, Berman DS, Blankstein R, Ferencik M, Narula J, Winchester D, Malkovskiy E, Goebel B, Randazzo MJ, Lopez-Mattei J, Parwani P, Vitola JV, Cerci RJ, Better N, Raggi P, Lu B, Sergienko V, Sinitsyn V, Kudo T, Nørgaard BL, Maurovich-Horvat P, Cohen YA, Pascual TNB, Pynda Y, Dondi M, Paez D, Einstein AJ. Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World. JACC Cardiovasc Imaging 2021; 14:1787-1799. [PMID: 34147434 PMCID: PMC8374310 DOI: 10.1016/j.jcmg.2021.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. BACKGROUND The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. METHODS Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. RESULTS Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. CONCLUSIONS We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.
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Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Leslee J Shaw
- Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Ryan Lahey
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Todd C Villines
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Sharmila Dorbala
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew D Choi
- George Washington University School of Medicine, Washington, DC, USA
| | - Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, Rhode Island, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Madison, Wisconsin, USA
| | - Daniel S Berman
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maros Ferencik
- Division of Cardiovascular Medicine, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Jagat Narula
- Mount Sinai Medical Center, New York, New York, USA
| | - David Winchester
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Eli Malkovskiy
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Benjamin Goebel
- Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York, USA
| | - Michael J Randazzo
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, MD Anderson Cancer Center, Houston, Texas, USA
| | - Purvi Parwani
- Department of Cardiology, Loma Linda University Health, Loma Linda, California, USA
| | - Joao V Vitola
- Quanta Diagnostico por Imagem, Curitiba, Paraná, Brazil
| | | | - Nathan Better
- Royal Melbourne Hospital and University of Melbourne, Victoria, Australia
| | - Paolo Raggi
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Bin Lu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Vladimir Sergienko
- National Medical Research Center of Cardiology of Health care Ministry, Moscow, Russian Federation
| | - Valentin Sinitsyn
- University Hospital, Lomonosov Moscow State University, Moscow, Russian Federation
| | | | | | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Yosef A Cohen
- Technion Israel Institute of Technology, Haifa, Israel
| | | | | | | | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA.
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Russo V, Boggian G, Bolognesi MG, Carretta DM, Cencetti S, De Laura D, Hrovatin E, Pastori P, Tomaselli C, Parente E, Rafanelli M, Ungar A. The Impact of COVID-19 Outbreak on Syncope Units Activities in Italy: A Report from the Italian Multidisciplinary Working Group on Syncope (GIMSI). Int J Environ Res Public Health 2021; 18:9194. [PMID: 34501793 PMCID: PMC8431220 DOI: 10.3390/ijerph18179194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/23/2022]
Abstract
The aim of our study was to evaluate the impact of the COVID-19 outbreak on Syncope Units (SUs) Activities in Italy. Methods: Data about types of SU activities and admissions were obtained from 10 SUs throughout Italy, certified by the Italian Multidisciplinary Working Group on Syncope (GIMSI), from 10 March 2020 to 31 December 2020 and compared with the same time frame in 2019. Results: A remarkable reduction in overall non-invasive diagnostic tests (-67%; p < 0.001) and cardiac invasive procedure. Elective cardiac pacing procedures disclosed a significant decrease (-62.7%; p < 0.001); conversely, the decrease of urgent procedures was not significant (-50%; p = 0.08). There was a significantly increased rate of patients who underwent both telemedicine follow-up visits (+225%, p < 0.001) and cardiac implantable electronic devices (CIEDs) remote monitoring follow-up visits (+100%; p < 0.001). Conclusion: The COVID-19 outbreak was associated with a remarkable decrease in all clinical activities of Syncope Units in Italy, including both non-invasive tests and cardiac invasive procedures; conversely, a significant increase in telehealth activities was shown.
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Affiliation(s)
- Vincenzo Russo
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy;
| | - Giulio Boggian
- Internal Medicine and Syncope Unit, Bentivoglio Hospital, Health Authority Bologna, 40053 Bologna, Italy;
| | | | | | - Simone Cencetti
- Internal Medicine and Syncope Unit, Piero Palagi Hospital, Health Authority Toscana Centro, 50122 Firenze, Italy;
| | | | - Enzo Hrovatin
- Cardiology and Syncope Unit, Monfalcone Hospital, Health Authority Giuliano Isontina (GO), 34074 Monfalcone, Italy;
| | - Paolo Pastori
- Cardiology and Syncope Unit, Fidenza Hospital, Health Authority Parma, 43036 Fidenza, Italy;
| | | | - Erika Parente
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy;
| | - Martina Rafanelli
- Geriatrics and Intensive Care Unit, Hypertension Centre—Syncope Unit University of Florence and Careggi Hospital, 50134 Florence, Italy; (M.R.); (A.U.)
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Hypertension Centre—Syncope Unit University of Florence and Careggi Hospital, 50134 Florence, Italy; (M.R.); (A.U.)
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Carbone L, Raffone A, Travaglino A, Sarno L, Conforti A, Gabrielli O, De Vivo V, De Rosa M, Migliorini S, Saccone G, Locci M, Alviggi C, Mollo A, Guida M, Zullo F, Maruotti GM. Obstetric A&E unit admission and hospitalization for obstetrical management during COVID-19 pandemic in a third-level hospital of southern Italy. Arch Gynecol Obstet 2021; 305:859-867. [PMID: 34455467 PMCID: PMC8403252 DOI: 10.1007/s00404-021-06212-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
Background The COronaVIrus Disease 2019 (COVID-19) has spread in Italy since February 2020, inducing the government to call for lockdown of any activity, apart primary needs, during the months March–May 2020. During the lockdown, a reduction of admissions and hospitalizations for ischemic diseases was noticed. Purpose of this study was to observe if there has been the same reduction trend in Accident & Emergency (A&E) unit admissions also for obstetric-gynecological conditions. Methods Medical records and electronic clinical databases were searched for all patients who were admitted to the obstetric A&E department or hospitalized at the Gynecology and Obstetrics Unit of University hospital of Naples Federico II, during the quarter March–May in the years 2019 and 2020. The mean ± standard deviation (SD) of monthly admission to the obstetric A&E department and hospitalization of the year 2020 was compared with that of the year 2019, using the unpaired T test with α error set to 0.05 and 95% confidence intervals (95% CI). Results Admissions were 1483 in the year 2020 and 1786 in 2019. Of total, 1225 (37.5%) women were hospitalized: 583 in the year 2020, 642 in 2019. Mean ± SD of patients monthly admitted to our obstetric A&E department was 494 ± 33.7 in the year 2020, and 595.3 ± 30.9 in 2019, with a mean difference of − 101.3 (95% CI − 103.5 to − 99.1; p < 0.0001). Mean ± SD of patients monthly hospitalized to our department was 194 ± 19.1 in the year 2020, 213.7 ± 4.7 in 2019, with a mean difference of − 19.7 (95% CI − 23.8 to − 15.6; p < 0.0001). Conclusion A significant decrease in the mean of monthly admissions and hospitalizations during the COVID-19 pandemic when compared to the previous year was found also for obstetric–gynecological conditions. Further studies are necessary to assess COVID-19 impact and to take the most appropriate countermeasures.
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Affiliation(s)
- Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Laura Sarno
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Alessandro Conforti
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Olimpia Gabrielli
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Valentino De Vivo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Martina De Rosa
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sonia Migliorini
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Gabriele Saccone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Mariavittoria Locci
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Carlo Alviggi
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
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Affiliation(s)
- G P Fadini
- Department of Medicine, University of Padova, 35128, Padova, Italy.
| | - B M Bonora
- Department of Medicine, University of Padova, 35128, Padova, Italy
| | - M L Morieri
- Department of Medicine, University of Padova, 35128, Padova, Italy
| | - A Avogaro
- Department of Medicine, University of Padova, 35128, Padova, Italy
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Nguyen TC, Thourani VH, Nissen AP, Habib RH, Dearani JA, Ropski A, Crestanello JA, Shahian DM, Jacobs JP, Badhwar V. The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717 103 Patients. Ann Thorac Surg 2021; 113:738-746. [PMID: 34343473 PMCID: PMC8325556 DOI: 10.1016/j.athoracsur.2021.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022]
Abstract
Background COVID-19 has changed the world as we know it, and the United States continues to accumulate the largest number of COVID-related deaths worldwide. There exists a paucity of data regarding the effect of COVID-19 on adult cardiac surgery trends and outcomes on regional and national levels. Methods The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried from January 1, 2018, to June 30, 2020. The Johns Hopkins COVID-19 database was queried from February 1, 2020, to January 1, 2021. Surgical and COVID-19 volumes, trends, and outcomes were analyzed on a national and regional level. Observed-to-expected ratios were used to analyze risk-adjustable mortality. Results The study analyzed 717 103 adult cardiac surgery patients and more than 20 million COVID-19 patients. Nationally, there was a 52.7% reduction in adult cardiac surgery volume and a 65.5% reduction in elective cases. The Mid-Atlantic region was most affected by the first COVID-19 surge, with 69.7% reduction in overall case volume and 80.0% reduction in elective cases. In the Mid-Atlantic and New England regions, the observed-to-expected mortality for isolated coronary bypass increased as much as 1.48 times (148% increase) pre-COVID rates. After the first COVID-19 surge, nationwide cardiac surgical case volumes did not return to baseline, indicating a COVID-19–associated deficit of cardiac surgery patients. Conclusions This large analysis of COVID-19–related impact on adult cardiac surgery volume, trends, and outcomes found that during the pandemic, cardiac surgery volume suffered dramatically, particularly in the Mid-Atlantic and New England regions during the first COVID-19 surge, with a concurrent increase in observed-to-expected 30-day mortality.
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Affiliation(s)
- Tom C Nguyen
- Department of Surgery, Division of Cardiothoracic Surgery, University of California San Francisco, San Francisco, California.
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Alexander P Nissen
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Allan Ropski
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | | | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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De Luca G, Debel N, Cercek M, Jensen LO, Vavlukis M, Calmac L, Johnson T, Ferrer GR, Ganyukov V, Wojakowski W, Kinnaird T, von Birgelen C, Cottin Y, IJsselmuiden A, Tuccillo B, Versaci F, Royaards KJ, Berg JT, Laine M, Dirksen M, Siviglia M, Casella G, Kala P, Díez Gil JL, Banning A, Becerra V, De Simone C, Santucci A, Carrillo X, Scoccia A, Amoroso G, Van't Hof AW, Kovarnik T, Tsigkas G, Mehilli J, Gabrielli G, Rios XF, Bakraceski N, Levesque S, Cirrincione G, Guiducci V, Kidawa M, Spedicato L, Marinucci L, Ludman P, Zilio F, Galasso G, Fabris E, Menichelli M, Garcia-Touchard A, Manzo S, Caiazzo G, Moreu J, Forés JS, Donazzan L, Vignali L, Teles R, Benit E, Agostoni P, Ojeda FB, Lehtola H, Camacho-Freiere S, Kraaijeveld A, Antti Y, Boccalatte M, Deharo P, Martínez-Luengas IL, Scheller B, Varytimiadi E, Moreno R, Uccello G, Faurie B, Gutierrez Barrios A, Milewski M, Bruwiere E, Smits P, Wilbert B, Di Uccio FS, Parodi G, Kedhi E, Verdoia M. Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry. Atherosclerosis 2021; 332:48-54. [PMID: 34391035 PMCID: PMC8294603 DOI: 10.1016/j.atherosclerosis.2021.06.926] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 01/16/2023]
Abstract
Background and aims SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure. Results Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and a significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29% vs 5.5%, p < 0.001), definite in-stent thrombosis (8.1% vs 1.6%, p = 0.004) and heart failure (22.6% vs 10.6%, p = 0.001) that was confirmed after adjustment for confounding factors. Conclusions Our study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Italy.
| | - Niels Debel
- Catholic University of Leuven, Leuven, Belgium
| | - Miha Cercek
- Department of Cardiology, Medical Center Ljubljana, Slovenia
| | | | - Marija Vavlukis
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, Macedonia
| | | | - Tom Johnson
- Division of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, UK
| | - Gerard Rourai Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, Spain
| | - Vladimir Ganyukov
- Division of Cardiology,State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Wojtek Wojakowski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | - Tim Kinnaird
- Division of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | - Yves Cottin
- Division of Cardiology, University Hospital, Dijon, France
| | | | | | | | - Kees-Jan Royaards
- Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Finland
| | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics Alkmaar, the Netherlands
| | - Massimo Siviglia
- Division of Cardiology, Division of Cardiology, Ospedali Riuniti, Reggio Calabria, Italy
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Italy
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | | | - Victor Becerra
- Cardiology Unit, Virgen de la Victoria University Hospital; IBIMA, Málaga, Spain. CIBERCV
| | - Ciro De Simone
- Division of Cardiology, Clinica Villa dei Fiori, Acerra, Italy
| | | | | | | | | | | | | | - Grigorios Tsigkas
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | - Julinda Mehilli
- University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Sébastien Levesque
- Center Hospitalier Universitaire de Poitiers, Poitiers, University Hospital, Poitiers, France
| | | | | | - Michał Kidawa
- Central Hospital of Medical University of Lodz, Poland
| | - Leonardo Spedicato
- Division of Cardiology, Ospedale "Santa Maria della Misericordia", Udine, Italy
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggid'Aragona, Salerno, Italy
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Italy
| | - Maurizio Menichelli
- Division of Cardiology, Medical University of Silezia, Katowice, Poland; Division of Cardiology, Ospedale "F. Spaziani", Frosinone, Italy
| | | | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, France
| | | | - Jose Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio", Bolzano, Italy
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Edouard Benit
- Division of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | | | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Finland
| | | | | | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Pierre Deharo
- Division of Cardiology, CHU Timone, Marseille, France; Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | | | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Germany
| | | | - Raul Moreno
- Division of Cardiology, Hospital la Paz, Madrid, Spain
| | | | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France
| | | | - Marek Milewski
- Division of Cardiology, Ospedale "F. Spaziani", Frosinone, Italy
| | - Ewout Bruwiere
- Division of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Pieter Smits
- Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Bor Wilbert
- Division of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Guido Parodi
- Azienda Ospedaliero-Universitaria Sassari, Italy
| | - Elvin Kedhi
- Division of Cardiology, Hopital Erasme, Universitè Libre de Bruxelles, Belgium
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy
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Polito MV, Silverio A, Bellino M, Iuliano G, Di Maio M, Alfano C, Iannece P, Esposito N, Galasso G. Cardiovascular Involvement in COVID-19: What Sequelae Should We Expect? Cardiol Ther 2021; 10:377-396. [PMID: 34191268 PMCID: PMC8243311 DOI: 10.1007/s40119-021-00232-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Several forms of cardiovascular involvement have been described in patients with Coronavirus disease 19 (COVID-19): myocardial injury, acute coronary syndrome, acute heart failure, myocarditis, pericardial diseases, arrhythmias, takotsubo syndrome, and arterial and venous atherothrombotic and thromboembolic events. Data on long-term outcome of these patients are still sparse, and the type and real incidence of cardiovascular sequelae are poorly known. It is plausible that myocardial injury may be the initiator of an inflammatory cascade, edema, and subsequent fibrosis, but also a consequence of systemic inflammation. The extent and distribution of ongoing inflammation may be the basis for ventricular dysfunction and malignant arrhythmias. Indeed, preliminary observational findings seem to emphasize the importance of close monitoring of COVID-19 patients with myocardial injury after discharge. Residual subclinical disease may be effectively investigated by using second-level imaging modalities such as cardiac magnetic resonance, which allows better characterization of the type and extension of myocardial damage, as well as of the ongoing inflammation after the acute phase. In patients with venous thromboembolism, a very common complication of COVID-19, the type and the duration of anticoagulation therapy after the acute phase should be tailored to the patient and based on the estimation of the individual thromboembolic and hemorrhagic risk. Large randomized clinical trials are ongoing to address this clinical question. Whether the severity of cardiovascular involvement, the type of treatments adopted during the acute phase, and the hemodynamic response, may influence the long-term outcome of patients recovered from COVID-19 is unknown. An etiological diagnosis of myocardial injury during the hospitalization is the first step for an appropriate follow-up in these patients. After discharge, the screening for residual left and right ventricular dysfunction, arrhythmias, residual thrombosis, and myocardial scar should be considered on a case-by-case basis, whereas an active clinical surveillance is mandatory in any patient.
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Affiliation(s)
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy.
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Giuseppe Iuliano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Carmine Alfano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Patrizia Iannece
- Department of Chemistry and Biology, University of Salerno, Fisciano, Italy
| | - Nicolino Esposito
- Department of Cardiology, Ospedale Evangelico Betania, Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) spread rapidly around the world in the early months of 2020 before the COVID-19 outbreak was officially declared a pandemic in March 2020. Worldwide volumes of non-emergent testing, such as cardiac PET and SPECT, decreased dramatically at the beginning of the lockdown as health systems attempted to limit the spread of the COVID-19 virus. Published reports of increasing cardiovascular mortality compared to months prior to the pandemic raised concerns that lack of access to appropriate cardiovascular testing was adversely affecting patient outcomes. Medical societies published guidance for the best practices of cardiovascular nuclear medicine laboratories to address this emerging cardiovascular epidemic. These nuclear cardiology expert consensus recommendations were remarkably consistent with those from other health organizations and heavily emphasized patient triage, screening of symptoms, strict PPE usage, and limiting patient dwell time in the nuclear medicine lab by favoring shorter testing protocols. Survey responses indicated that nuclear medicine labs took heed of these recommendations and adjusted practices to meet the cardiovascular needs of their population while minimizing transmission risk.
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Affiliation(s)
- Richard A Mills
- Saint Luke's Mid America Heart Institute and The University of Missouri, Kansas City, MO
| | - Randall C Thompson
- Saint Luke's Mid America Heart Institute and The University of Missouri, Kansas City, MO.
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Helal A, Shahin L, Abdelsalam M, Ibrahim M. Global effect of COVID-19 pandemic on the rate of acute coronary syndrome admissions: a comprehensive review of published literature. Open Heart 2021; 8:openhrt-2021-001645. [PMID: 34083389 PMCID: PMC8182753 DOI: 10.1136/openhrt-2021-001645] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly. Objectives The purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country. Method Search engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions. Results A total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175). Conclusion There was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.
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Affiliation(s)
- Ayman Helal
- Cardiology Department, Portsmouth Hospital NHS Trust, Portsmouth, UK
- Cardiology Department, Fayoum University, Fayoum, Portsmouth, Egypt
| | - Lamis Shahin
- Fellowship Program, Cardiology Department, Ministry of Health and Population, Cairo, Egypt
| | - Mahmoud Abdelsalam
- Cardiology Department, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA
| | - Mokhtar Ibrahim
- Cardiology Department, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
- Cardiology Department, Ain Shams University, Cairo, Egypt
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46
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Clifford SP, Ramirez J, Akca O, Ghafghazi S, Huang J. Perioperative Cardiac Research Considerations During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Cardiothorac Vasc Anesth 2021; 35:1573-1577. [PMID: 33618962 PMCID: PMC7863767 DOI: 10.1053/j.jvca.2021.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Sean P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Julio Ramirez
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Ozan Akca
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Comprehensive Stroke Clinical Research Program (CSCRP), University of Louisville, Louisville, KY
| | - Shahab Ghafghazi
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY.
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47
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Kite TA, Ludman PF, Gale CP, Wu J, Caixeta A, Mansourati J, Sabate M, Jimenez-Quevedo P, Candilio L, Sadeghipour P, Iniesta AM, Hoole SP, Palmer N, Ariza-Solé A, Namitokov A, Escutia-Cuevas HH, Vincent F, Tica O, Ngunga M, Meray I, Morrow A, Arefin MM, Lindsay S, Kazamel G, Sharma V, Saad A, Sinagra G, Sanchez FA, Roik M, Savonitto S, Vavlukis M, Sangaraju S, Malik IS, Kean S, Curzen N, Berry C, Stone GW, Gersh BJ, Gershlick AH. International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19. J Am Coll Cardiol 2021; 77:2466-2476. [PMID: 34016259 PMCID: PMC8128002 DOI: 10.1016/j.jacc.2021.03.309] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Background Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear. Objectives The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre–COVID-19 cohorts. Methods From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re–myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre–COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019). Results In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non–ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001). Conclusions In this multicenter international registry, COVID-19–positive ACS patients presented later and had increased in-hospital mortality compared with a pre–COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.
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Affiliation(s)
- Thomas A Kite
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, and the Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Jianhua Wu
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, and the Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Adriano Caixeta
- Division of Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest and University of Western Brittany, Orphy, France
| | - Manel Sabate
- Cardiovascular Institute, Interventional Cardiology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Pilar Jimenez-Quevedo
- Interventional Cardiology Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Angel M Iniesta
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Stephen P Hoole
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Nick Palmer
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alim Namitokov
- Scientific Research Institute-Regional Clinical Hospital #1 NA Prof. S.V. Ochapovsky, Krasnodar, Russia
| | | | - Flavien Vincent
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Otilia Tica
- University of Oradea, Faculty of Medicine and Pharmacy, Department of Medical disciplines, Oradea, Romania
| | - Mzee Ngunga
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Imad Meray
- Peoples Friendship University of Russia, Hospital n∖a V.V.Vinogradov, Moscow, Russia
| | - Andrew Morrow
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Md Minhaj Arefin
- Department of Cardiology, National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh
| | - Steven Lindsay
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ghada Kazamel
- Cardiology Department, National Heart Institute, Cairo, Egypt
| | - Vinoda Sharma
- Birmingham City Hospital, SWBH NHS Trust, Birmingham, United Kingdom
| | - Aly Saad
- Department of Cardiovascular Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Marija Vavlukis
- University Clinic for Cardiology, Medical Faculty, Ss' Cyrial and Methodius University, Skopje, Macedonia
| | | | - Iqbal S Malik
- Cardiology Department, Imperial College Healthcare Trust, London, United Kingdom
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, and University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Colin Berry
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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48
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Bogh SB, Fløjstrup M, Nissen SK, Hanson S, Bech M, Johnsen SP, Kristensen MR, Laugesen LE, Søndergaard J, Folkestad L, Christensen EF, Henriksen DP, Hsia RY, Graham CA, Lindskou TA, Byg KE, Søvsø MB, Laugesen H, Hallas P, Mikkelsen S, Olsen KR, Thygesen LC, Gamst-Jensen H, Brabrand M. Nationwide study on trends in unplanned hospital attendance and deaths during the 7 weeks after the onset of the COVID-19 pandemic in Denmark. BMJ Qual Saf 2021; 30:986-995. [PMID: 33952687 DOI: 10.1136/bmjqs-2020-012144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The impact of a pandemic on unplanned hospital attendance has not been extensively examined. The aim of this study is to report the nationwide consequences of the COVID-19 pandemic on unplanned hospital attendances in Denmark for 7 weeks after a 'shelter at home' order was issued. METHODS We merged data from national registries (Civil Registration System and Patient Registry) to conduct a study of unplanned (excluding outpatient visits and elective surgery) hospital-based healthcare and mortality of all Danes. Using data for 7 weeks after the 'shelter at home' order, the incidence rate of unplanned hospital attendances per week in 2020 was compared with corresponding weeks in 2017-2019. The main outcome was hospital attendances per week as incidence rate ratios. Secondary outcomes were general population mortality and risk of death in-hospital, reported as weekly mortality rate ratios (MRRs). RESULTS From 2 438 286 attendances in the study period, overall unplanned attendances decreased by up to 21%; attendances excluding COVID-19 were reduced by 31%; non-psychiatric by 31% and psychiatric by 30%. Out of the five most common diagnoses expected to remain stable, only schizophrenia and myocardial infarction remained stable, while chronic obstructive pulmonary disease exacerbation, hip fracture and urinary tract infection fell significantly. The nationwide general population MRR rose in six of the recorded weeks, while MRR excluding patients who were COVID-19 positive only increased in two. CONCLUSION The COVID-19 pandemic and a governmental national 'shelter at home' order was associated with a marked reduction in unplanned hospital attendances with an increase in MRR for the general population in two of 7 weeks, despite exclusion of patients with COVID-19. The findings should be taken into consideration when planning for public information campaigns.
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Affiliation(s)
- Søren Bie Bogh
- Odense Patient Exploratory Network (OPEN), University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Marianne Fløjstrup
- Department of Emergency Medicine, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark.,Institute of Regional Health Research, Centre South West Jutland, University of Southern Denmark, Esbjerg, Denmark
| | - Søren Kabell Nissen
- Department of Emergency Medicine, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark.,Department of Regional Health Research, Syddansk Universitet, Odense, Syddanmark, Denmark
| | - Stine Hanson
- Department of Emergency Medicine, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark.,Department of Regional Health Research, Syddansk Universitet, Odense, Syddanmark, Denmark
| | - Mickael Bech
- Management & VIVE Health, VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, Syddansk Universitet, Odense, Syddanmark, Denmark
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Erika Frischknecht Christensen
- Clinic of Internal and Emergency Medicine, Department of Emergency and Trauma Care, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,CPER - Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | | | - Renee Y Hsia
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Tim Alex Lindskou
- CPER - Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Keld-Erik Byg
- The Rheumatology Research Unit and Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Morten Breinholt Søvsø
- CPER - Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.,Prehospital Emergency Services, North Denmark Region, Aalborg, Denmark
| | - Henrik Laugesen
- Department of Emergency Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Peter Hallas
- Department of Emergency Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense, Denmark
| | - Kim Rose Olsen
- Research Unit for General Practice, Department of Public Health, Syddansk Universitet, Odense, Syddanmark, Denmark.,Danish Center for Health Economics (DaCHE), Syddansk Universitet, Odense, Syddanmark, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, Syddansk Universitet, Copenhagen, Denmark
| | | | - Mikkel Brabrand
- Department of Emergency Medicine, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark .,Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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49
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Flori M, Marinucci L, Gabrielli G, Baiocco E, Accardi R, Scalone G, Grossi P, Guerra F. Reduction in acute coronary syndromes during coronavirus disease 2019 global pandemic: data from the Marche region of Italy. J Cardiovasc Med (Hagerstown) 2021; 22:350-356. [PMID: 33136811 DOI: 10.2459/jcm.0000000000001130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS During the novel severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic, a worldwide reduction in total acute coronary syndrome (ACS) has been reported. In early 2020, Italy became the most affected country and national lockdown was declared early on in March. We described trends in ACS from all the Marche coronary catheterization laboratories (CCL) during the global pandemic. METHODS Retrospective study of all consecutive patients admitted to the four regional CCL. The coronavirus disease 2019 period (20 February 2020 to 15 April 2020) was compared with the interyear control period (1 January 2020 to 19 February 2020) and to the intrayear control period (20 February 2019 to 15 April 2019). All patients with an initial diagnosis of ACS were included in the analysis, and further stratified into ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI)/unstable angina. RESULTS A total of 1239 patients were enrolled. Daily incidence of ACS was 6.1, 6.3 and 4.5 for the interyear control period, the intrayear control period and the case period, respectively. There was no difference in overall STEMI daily incidence while NSTEMI/unstable angina fell from 3.6 and 3.3-1.8 during the case period (P = 0.01). Incidence rate ratios were significantly lower when the case period was compared with the intrayear control period (incidence rate ratios: 0.49, 95% confidence interval 0.41-0.59, P = 0.001) and the interyear control period (incidence rate ratios: 0.67, 95% confidence interval 0.50-0.90, P = 0.008). CONCLUSION During the global pandemic there was a significant reduction in total ACS and NSTEMI in the Marche region. Unlike previous reports, there was no difference in overall access to CCL for STEMI during the same period.
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Affiliation(s)
- Marco Flori
- Intensive Cardiac Care and Cardiology Unit, Civil Hospital, Urbino
| | - Lucia Marinucci
- Interventional Cardiology Unit, 'Ospedali Riuniti Marche Nord', Pesaro
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, University Hospital 'Umberto I - Lancisi - Salesi', Ancona
| | | | - Roberto Accardi
- Interventional Cardiology Unit, Ospedale Generale Provinciale, Macerata
| | | | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy
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50
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Nissen AP, Nguyen TC. Commentary: Coronary artery bypass grafting during COVID: Safe for some, but where are the rest? ACTA ACUST UNITED AC 2021; 6:146-147. [PMID: 33937880 PMCID: PMC8080169 DOI: 10.1016/j.xjon.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Alexander P Nissen
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Tex
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif
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