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Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, Neumar RW, Previdi JK, Uzendu A, Sasson C. The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and Call to Action to Improve Cardiac Arrest Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e914-e933. [PMID: 38250800 DOI: 10.1161/cir.0000000000001196] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.
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Balavenkataraman A, Saunders H, Helgeson SA. Trends in outcomes of hospitalizations from acute exacerbations of chronic obstructive pulmonary disease during the COVID-19 pandemic. Lung India 2024; 41:77-79. [PMID: 38160468 PMCID: PMC10883440 DOI: 10.4103/lungindia.lungindia_472_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
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Johnson AM, Rosamond WD. What does the COVID-19 pandemic reveal about out-of-hospital cardiac arrest? Insights from the Canadian EMS response. Resuscitation 2024; 194:110096. [PMID: 38135015 DOI: 10.1016/j.resuscitation.2023.110096] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
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Morales C, Bruckner TA, Du S, Young A, Ro A. Changes in Acute ED Visits by Race/Ethnicity During the Early COVID-19 Pandemic. J Immigr Minor Health 2023; 25:1286-1294. [PMID: 37269403 PMCID: PMC10239213 DOI: 10.1007/s10903-023-01499-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
Emergency department (ED) visits for conditions unrelated to the Coronavirus Disease 2019 (COVID-19) pandemic decreased during the early pandemic, raising concerns about critically ill patients forgoing care and increasing their risk of adverse outcomes. It is unclear if Hispanic and Black adults, who have a high prevalence of chronic conditions, sought medical assistance for acute emergencies during this time. This study used 2018-2020 ED visit data from the largest safety net hospital in Los Angeles County to estimate ED visit differences for cardiac emergencies, diabetic complications, and strokes, during the first societal lockdown among Black and Hispanic patients using time series analyses. Emergency department visits were lower than the expected levels during the first societal lockdown. However, after the lockdown ended, Black patients experienced a rebound in ED visits while visits for Hispanics remained depressed. Future research could identify barriers Hispanics experienced that contributed to prolonged ED avoidance.
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Affiliation(s)
- Celina Morales
- Department of Population Health and Disease Prevention, University of California Irvine, 653 E. Peltason Dr, Irvine, CA, 92697-3957, USA.
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
| | - Senxi Du
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Young
- Harbor UCLA Medical Center, Los Angeles, CA, USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
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Thyagaturu H, Roma N, Angirekula A, Thangjui S, Bolton A, Gonuguntla K, Sattar Y, Chobufo MD, Challa A, Patel N, Bondi G, Raina S. Trends and Outcomes of Type 2 Myocardial Infarction During the COVID-19 Pandemic in the United States. Korean Circ J 2023; 53:829-839. [PMID: 37880873 PMCID: PMC10751182 DOI: 10.4070/kcj.2023.0063] [Citation(s) in RCA: 1] [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] [Received: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is limited data on the impact of type 2 myocardial infarction (T2MI) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS The National Inpatient Sample (NIS) database from January 2019 to December 2020 was queried to identify T2MI hospitalizations based on the appropriate International Classification of Disease, Tenth Revision-Clinical Modification codes. Monthly trends of COVID-19 and T2MI hospitalizations were evaluated using Joinpoint regression analysis. In addition, the multivariate logistic and linear regression analysis was used to compare in-hospital mortality, coronary angiography use, and resource utilization between 2019 and 2020. RESULTS A total of 743,535 patients hospitalized with a diagnosis of T2MI were identified in the years 2019 (n=331,180) and 2020 (n=412,355). There was an increasing trend in T2MI hospitalizations throughout the study period corresponding to the increase in COVID-19 hospitalizations in 2020. The adjusted odds of in-hospital mortality associated with T2MI hospitalizations were significantly higher in 2020 compared with 2019 (11.1% vs. 8.1%: adjusted odds ratio, 1.19 [1.13-1.26]; p<0.01). In addition, T2MI hospitalizations were associated with lower odds of coronary angiography and higher total hospitalization charges, with no difference in the length of stay in 2020 compared with 2019. CONCLUSIONS We found a significant increase in T2MI hospitalizations with higher in-hospital mortality, total hospitalization costs, and lower coronary angiography use during the early COVID-19 pandemic corresponding to the trends in the rise of COVID-19 hospitalizations. Further research into the factors associated with increased mortality can increase our preparedness for future pandemics.
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Affiliation(s)
- Harshith Thyagaturu
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nicholas Roma
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA.
| | | | - Sittinun Thangjui
- Department of Internal Medicine, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Alex Bolton
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Karthik Gonuguntla
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Yasar Sattar
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Muchi Ditah Chobufo
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Abhiram Challa
- Department of Medicine, University of Kansas School of Medicine, Wichita, KS, USA
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | - Gayatri Bondi
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Sameer Raina
- Department of Cardiology, Stanford University School of Medicine, CA, USA
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Liu JZ, Counts CR, Drucker CJ, Emert JM, Murphy DL, Schwarcz L, Kudenchuk PJ, Sayre MR, Rea TD. Acute SARS-CoV-2 Infection and Incidence and Outcomes of Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2023; 6:e2336992. [PMID: 37801312 PMCID: PMC10559182 DOI: 10.1001/jamanetworkopen.2023.36992] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Little is known about how COVID-19 affects the incidence or outcomes of out-of-hospital cardiac arrest (OHCA), and it is possible that more generalized factors beyond SARS-CoV-2 infection are primarily responsible for changes in OHCA incidence and outcome. Objective To assess whether COVID-19 is associated with OHCA incidence and outcomes. Design, Setting, and Participants This retrospective cohort study was conducted in Seattle and King County, Washington. Participants included persons aged 18 years or older with nontraumatic OHCA attended by emergency medical services (EMS) between January 1, 2018, and December 31, 2021. Data analysis was performed from November 2022 to March 2023. Exposures Prepandemic (2018-2019) and pandemic (2020-2021) periods and SARS-CoV-2 infection. Main Outcomes and Measures The primary outcomes were OHCA incidence and patient outcomes (ie, survival to hospital discharge). Mediation analysis was used to determine the percentage change in OHCA incidence and outcomes between prepandemic and pandemic periods that was attributable to acute SARS-CoV-2 infection vs conventional Utstein elements related to OHCA circumstances (ie, witness status and OHCA location) and resuscitation care (ie, bystander cardiopulmonary resuscitation, early defibrillation, and EMS response intervals). Results There were a total of 13 081 patients with OHCA (7102 dead upon EMS arrival and 5979 EMS treated). Among EMS-treated patients, the median (IQR) age was 64.0 (51.0-75.0) years, 3864 (64.6%) were male, and 1027 (17.2%) survived to hospital discharge. The total number of patients with OHCA increased by 19.0% (from 5963 in the prepandemic period to 7118 in the pandemic period), corresponding to an incidence increase from 168.8 to 195.3 events per 100 000 person-years. Of EMS-treated patients with OHCA during the pandemic period, 194 (6.2%) were acutely infected with SARS-CoV-2 compared with 7 of 191 EMS-attended but untreated patients with OHCA (3.7%). In time-series correlation analysis, there was a positive correlation between community SARS-CoV-2 incidence and overall OHCA incidence (r = 0.27; P = .01), as well as OHCA incidence with acute SARS-CoV-2 infection (r = 0.43; P < .001). The survival rate during the pandemic period was lower than that in the prepandemic period (483 patients [15.4%] vs 544 patients [19.2%]). During the pandemic, those with OHCA and acute SARS-CoV-2 infection had lower likelihood of survival compared with those without acute infection (12 patients [6.2%] vs 471 patients [16.0%]). SARS-CoV-2 infection itself accounted for 18.5% of the pandemic survival decline, whereas Utstein elements mediated 68.2% of the survival decline. Conclusions and Relevance In this cohort study of COVID-19 and OHCA, a substantial proportion of the higher OHCA incidence and lower survival during the pandemic was not directly due to SARS-CoV-2 infection but indirect factors that challenged OHCA prevention and treatment.
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Affiliation(s)
- Jennifer Z Liu
- Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, Washington
| | - Catherine R Counts
- Seattle Fire Department, Seattle, Washington
- Department of Emergency Medicine, University of Washington, Seattle
| | - Christopher J Drucker
- Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, Washington
| | - Jamie M Emert
- Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, Washington
| | - David L Murphy
- Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, Washington
- Department of Emergency Medicine, University of Washington, Seattle
| | - Leilani Schwarcz
- Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, Washington
| | - Peter J Kudenchuk
- Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, Washington
- Division of Cardiology, University of Washington, Seattle
| | - Michael R Sayre
- Seattle Fire Department, Seattle, Washington
- Department of Emergency Medicine, University of Washington, Seattle
| | - Thomas D Rea
- Emergency Medical Services Division, Public Health-Seattle & King County, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
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Hussain A, Okobi OE, Obi CB, Chukwuedozie VC, Sike CG, Etomi EH, Akinyemi FB. Association Between Self-Rated Health and Medical Care Disruption Due to COVID-19 Among Individuals With Atherosclerotic Cardiovascular Disease. Cureus 2023; 15:e40697. [PMID: 37485099 PMCID: PMC10359049 DOI: 10.7759/cureus.40697] [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] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted medical care across diverse populations with varying outcomes. In this study, we evaluated the relationship between health rating and disruption in medical care due to COVID-19 among individuals with atherosclerotic cardiovascular disease (ASCVD). METHODS Data from the 2020 National Health Interview Survey was used for this study. ASCVD sample included those with self-reported coronary heart disease, stroke, and heart attack. Health rating was represented as fair to poor, good, and very good to excellent. The outcome variable was a disruption of medical care due to COVID-19 (delay in medical care or did not get care). The chi-square test was used for the descriptive analysis and multiple logistic regression was used to evaluate the relationship between health rating and disruption in medical care with demographic factors, comorbidities, and cumulative social risk adjusted for. RESULTS Among the 31,568 adults, 1,707/31,568 representing 9,385,855 adults 18 years and above with ASCVD reported experiencing or not experiencing a disruption in medical care. After adjusting for cumulative risk, the odds of not getting medical care due to COVID-19 were high for those who rated their health as fair/poor as compared to excellent (adjusted odds ratio (AOR) = 1.95, 95% CI = 1.24-3.08, p = 0.004). These odds remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.84, 95% CI = 1.11-3.06, p = 0.018). After adjusting for cumulative risk, medical care utilization (received, delayed, did not receive) was rated. Those who rated their health as fair to poor as compared to excellent were more likely to report a delay in health care due to COVID-19 (AOR = 1.85, 95% CI = 1.28-2.68, p = 0.001) and remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.86, 95% CI = 1.22-2.82, p = 0.004). Female respondents with ASCVD who rated their health as fair/poor were more likely to experience a delay in medical care due to COVID-19 (AOR = 2.06, 95% CI = 1.06-4.01, p = 0.033) or not get medical care due to COVID-19 (AOR = 2.86, 95% CI = 1.42-5.76, p = 0.003) as compared to those who rated their health as excellent. With regards to men with ASCVD, health rating was not related to their reported disruption of medical care due to COVID-19. CONCLUSIONS A poor to fair health rating is associated with a delay in getting or not getting medical care among individuals with ASCVD. Further studies are needed to evaluate this relationship further.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Health, Harlan, USA
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | | | - Cherechi G Sike
- General Practice, Windsor University School of Medicine, Cayon, KNA
| | - Eghogho H Etomi
- Cardiology, Kharkiv National Medical University, Kharkiv, UKR
- Research, Texas Southern University, Houston, USA
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Missel AL, Dowker SR, Dzierwa D, Krein SL, Coulter‐Thompson EI, Williams M, Trumpower B, Swor R, Hunt N, Friedman CP. Factors Impacting Treatment of Out-of-Hospital Cardiac Arrest: A Qualitative Study of Emergency Responders. J Am Heart Assoc 2023; 12:e027756. [PMID: 37158071 PMCID: PMC10227317 DOI: 10.1161/jaha.122.027756] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/03/2023] [Indexed: 05/10/2023]
Abstract
Background Of the more than 250 000 emergency medical services-treated out-of-hospital cardiac arrests that occur each year in the United States, only about 8% survive to hospital discharge with good neurologic function. Treatment for out-of-hospital cardiac arrest involves a system of care that includes complex interactions among multiple stakeholders. Understanding the factors inhibiting optimal care is fundamental to improving outcomes. Methods and Results We conducted group interviews with emergency responders including 911 telecommunicators, law enforcement officers, firefighters, and transporting emergency medical services personnel (ie, emergency medical technicians and paramedics) who responded to the same out-of-hospital cardiac arrest incident. We used the American Heart Association System of Care as the framework for our analysis to identify themes and their contributory factors from these interviews. We identified 5 themes under the structure domain, which included workload, equipment, prehospital communication structure, education and competency, and patient attitudes. In the process domain, 5 themes were identified focusing on preparedness, field response and access to patient, on-scene logistics, background information acquisition, and clinical interventions. We identified 3 system themes including emergency responder culture; community support, education, and engagement; and stakeholder relationships. Three continuous quality improvement themes were identified, which included feedback provision, change management, and documentation. Conclusions We identified structure, process, system, and continuous quality improvement themes that may be leveraged to improve outcomes for out-of-hospital cardiac arrest. Interventions or programs amenable to rapid implementation include improving prearrival communication between agencies, appointing patient care and logistical leadership on-scene, interstakeholder team training, and providing more standardized feedback to all responder groups.
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Affiliation(s)
- Amanda L. Missel
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Stephen R. Dowker
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Drake Dzierwa
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Sarah L. Krein
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
- Center For Clinical Management ResearchVeterans Affairs Ann Arbor Health SystemAnn ArborMichiganUSA
- Department of Internal Medicine, Division of General MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Emilee I. Coulter‐Thompson
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Michelle Williams
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Brad Trumpower
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Robert Swor
- Department of Emergency MedicineCorewell East William Beaumont University HospitalRoyal OakMichiganUSA
| | - Nathaniel Hunt
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Charles P. Friedman
- Department of Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Kim JH, Ahn C, Park Y, Won M. Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis. Front Public Health 2023; 11:1180511. [PMID: 37234770 PMCID: PMC10208072 DOI: 10.3389/fpubh.2023.1180511] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 05/28/2023] Open
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac arrest (OHCA) outcomes and epidemiological features compared with those before the pandemic. This review compares the regional and temporal features of OHCA prognosis and epidemiological characteristics. Various databases were searched to compare the OHCA outcomes and epidemiological characteristics during the COVID-19 pandemic with before the pandemic. During the COVID-19 pandemic, survival and favorable neurological outcome rates were significantly lower than before. Survival to hospitalization, return of spontaneous circulation, endotracheal intubation, and use of an automated external defibrillator (AED) decreased significantly, whereas the use of a supraglottic airway device, the incidence of cardiac arrest at home, and response time of emergency medical service (EMS) increased significantly. Bystander CPR, unwitnessed cardiac arrest, EMS transfer time, use of mechanical CPR, and in-hospital target temperature management did not differ significantly. A subgroup analysis of the studies that included only the first wave with those that included the subsequent waves revealed the overall outcomes in which the epidemiological features of OHCA exhibited similar patterns. No significant regional differences between the OHCA survival rates in Asia before and during the pandemic were observed, although other variables varied by region. The COVID-19 pandemic altered the epidemiologic characteristics, survival rates, and neurological prognosis of OHCA patients. Review registration: PROSPERO (CRD42022339435).
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Affiliation(s)
- Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Lee PC, Liang LL, Huang MH, Huang CY. A comparative study of positive and negative electronic word-of-mouth on the SERVQUAL scale during the COVID-19 epidemic - taking a regional teaching hospital in Taiwan as an example. BMC Health Serv Res 2022; 22:1568. [PMID: 36550550 PMCID: PMC9773606 DOI: 10.1186/s12913-022-08930-2] [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] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent years, studies have shown that electronic WOM (eWOM) directly reflects consumers' post-purchase psychological perception and directly affects repurchase behavior. This information is valued by institutions in various fields. Within the scope of the evaluation of service characteristics, medical service is the least visible and most difficult service attribute to evaluate. Service organizations must have high trust attributes. Therefore, an eWOM review significantly influences people's decision-making process when choosing a healthcare provider. The purpose of this research is to combine eWOM reviews with the SERVQUAL scale in a comparative study of positive and negative eWOM reviews of a regional teaching hospital in Taiwan. METHODS This research obtained data from publicly available eWOM reviews on Google Maps of a regional teaching hospital in Taiwan over the past 10 years (from June 24, 2011, to December 31, 2021) using website scraping technology. The semantic content analysis method was used in this study to classify eWOM reviews according to the revised PZB SERVQUAL scale. RESULTS Statistical analysis was conducted. During the COVID-19 pandemic, positive reviews showed a downward trend. Among the five determinants of the SERVQUAL of PZB, positive eWOM reviews performed best in "assurance" with a positive review rate of 60.00%, followed by 42.11% for "reliability". For negative eWOM reviews, "assurance" performed the worst with a positive rate of 72.34%, followed by "responsiveness" at 28.37% and "reliability" at 26.95%. CONCLUSION Since the onset of COVID-19 in 2020, negative eWOM has increased significantly and exceeded the amount of positive eWOM. Regardless of positive and negative reviews, what patients care most about is "assurance" of the professional attitude and skills of medical staff, which urgently needs to be strengthened. In addition, good "reliability" will help to develop positive eWOM. However, "responsiveness" as indicated by poor service waiting time can easily lead to the spread of negative eWOM. Hospital management should focus on these service-oriented qualities.
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Affiliation(s)
- Po-Chun Lee
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan ,grid.412036.20000 0004 0531 9758Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Li-Lin Liang
- grid.412036.20000 0004 0531 9758Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Min-Hsin Huang
- grid.412036.20000 0004 0531 9758Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ching-Yuan Huang
- grid.445041.00000 0004 0639 0695Department of Marketing Management, SHU-TE University, Kaohsiung, Taiwan
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Einav S, Tankel J. The unseen pandemic: treatment delays and loss to follow-up due to fear of COVID. J Anesth Analg Crit Care 2022. [PMCID: PMC8795953 DOI: 10.1186/s44158-021-00032-5] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Fear of contracting SARS-CoV-2 has transformed public interaction with healthcare professionals and hospitals alike. In turn, this has resulted in a collateral impact on patients’ health across medical and surgical paradigms. Understanding the causative factors of this fear, and tackling it head on, is vital to return to pre-pandemic levels of healthcare. Main body In this editorial, we explore the evidence base behind the fear of healthcare professionals and facilities that has developed during the course of the SARS-CoV-2pandemic. We also reflect on the ways in which these fears have affected the general public. In so doing, we review a recent article from Montalto et al. that has explored fear of SARS-CoV-2 among patients undergoing surgery in Italy. Conclusion While fear of SARS-CoV-2 is uncommon among surgical patients, there are still those who delay or avoiding seeking medical care due to fear of transmission. Physicians must lead the fight against this fear in a hope to regain the trust of the public.
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Schroeder AR, Dahlen A, Purington N, Alvarez F, Brooks R, Destino L, Madduri G, Wang M, Coon ER. Healthcare utilization in children across the care continuum during the COVID-19 pandemic. PLoS One 2022; 17:e0276461. [PMID: 36301947 PMCID: PMC9612476 DOI: 10.1371/journal.pone.0276461] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 05/19/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Healthcare utilization decreased during the COVID-19 pandemic, likely due to reduced transmission of infections and healthcare avoidance. Though various investigations have described these changing patterns in children, most have analyzed specific care settings. We compared healthcare utilization, prescriptions, and diagnosis patterns in children across the care continuum during the first year of the pandemic with preceding years. Study design Using national claims data, we compared enrollees under 18 years during the pre-pandemic (January 2016 –mid-March 2020) and pandemic (mid-March 2020 through March 2021) periods. The pandemic was further divided into early (mid-March through mid-June 2020) and middle (mid-June 2020 through March 2021) periods. Utilization was compared using interrupted time series. Results The mean number of pediatric enrollees/month was 2,519,755 in the pre-pandemic and 2,428,912 in the pandemic period. Utilization decreased across all settings in the early pandemic, with the greatest decrease (76.9%, 95% confidence interval [CI] 72.6–80.5%) seen for urgent care visits. Only well visits returned to pre-pandemic rates during the mid-pandemic. Hospitalizations decreased by 43% (95% CI 37.4–48.1) during the early pandemic and were still 26.6% (17.7–34.6) lower mid-pandemic. However, hospitalizations in non-psychiatric facilities for various mental health disorders increased substantially mid-pandemic. Conclusion Healthcare utilization in children dropped substantially during the first year of the pandemic, with a shift away from infectious diseases and a spike in mental health hospitalizations. These findings are important to characterize as we monitor the health of children, can be used to inform healthcare strategies during subsequent COVID-19 surges and/or future pandemics, and may help identify training gaps for pediatric trainees. Subsequent investigations should examine how changes in healthcare utilization impacted the incidence and outcomes of specific diseases.
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Affiliation(s)
- Alan R. Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
- * E-mail:
| | - Alex Dahlen
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Natasha Purington
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Francisco Alvarez
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Rona Brooks
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Lauren Destino
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Gayatri Madduri
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Marie Wang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Eric R. Coon
- Department of Pediatrics, Primary Children’s Hospital and University of Utah School of Medicine, Salt Lake City, UT, United States of America
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13
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Morgan RW, Atkins DL, Hsu A, Kamath-Rayne BD, Aziz K, Berg RA, Bhanji F, Chan M, Cheng A, Chiotos K, de Caen A, Duff JP, Fuchs S, Joyner BL, Kleinman M, Lasa JJ, Lee HC, Lehotzky RE, Levy A, McBride ME, Meckler G, Nadkarni V, Raymond T, Roberts K, Schexnayder SM, Sutton RM, Terry M, Walsh B, Zelop CM, Sasson C, Topjian A. Guidance for Cardiopulmonary Resuscitation of Children With Suspected or Confirmed COVID-19. Pediatrics 2022; 150:188494. [PMID: 35818123 DOI: 10.1542/peds.2021-056043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
This article aims to provide guidance to health care workers for the provision of basic and advanced life support to children and neonates with suspected or confirmed coronavirus disease 2019 (COVID-19). It aligns with the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular care while providing strategies for reducing risk of transmission of severe acute respiratory syndrome coronavirus 2 to health care providers. Patients with suspected or confirmed COVID-19 and cardiac arrest should receive chest compressions and defibrillation, when indicated, as soon as possible. Because of the importance of ventilation during pediatric and neonatal resuscitation, oxygenation and ventilation should be prioritized. All CPR events should therefore be considered aerosol-generating procedures. Thus, personal protective equipment (PPE) appropriate for aerosol-generating procedures (including N95 respirators or an equivalent) should be donned before resuscitation, and high-efficiency particulate air filters should be used. Any personnel without appropriate PPE should be immediately excused by providers wearing appropriate PPE. Neonatal resuscitation guidance is unchanged from standard algorithms, except for specific attention to infection prevention and control. In summary, health care personnel should continue to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission through vaccination and use of appropriate PPE during pediatric resuscitations. Health care organizations should ensure the availability and appropriate use of PPE. Because delays or withheld CPR increases the risk to patients for poor clinical outcomes, children and neonates with suspected or confirmed COVID-19 should receive prompt, high-quality CPR in accordance with evidence-based guidelines.
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Affiliation(s)
- Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Antony Hsu
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Superior Township, Michigan
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, Itasca, Illinois
| | - Khalid Aziz
- Department of Pediatrics, Division of Newborn Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Farhan Bhanji
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Melissa Chan
- Departments of Pediatrics and Pediatric Emergency Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Cheng
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Chiotos
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Allan de Caen
- Department of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan P Duff
- Department of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Benny L Joyner
- Departments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Monica Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Javier J Lasa
- Cardiovascular ICU, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Henry C Lee
- Division of Neonatology, Stanford University, Stanford, California
| | | | - Arielle Levy
- Departments of Pediatrics and Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, Montreal, Quebec, Canada
| | - Mary E McBride
- Cardiology, and Critical Care Medicine, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Garth Meckler
- Departments of Pediatrics and Pediatric Emergency Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Tia Raymond
- Department of Pediatric Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas
| | - Kathryn Roberts
- Center for Nursing Excellence, Education & Innovation, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Stephen M Schexnayder
- Departments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Springdale, Arkansas
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, Ohio
| | - Brian Walsh
- Respiratory Care, Children's Hospital Colorado, Aurora, Colorado
| | - Carolyn M Zelop
- Department of Obstetrics and Gynecology, NYU School of Medicine and The Valley Hospital, New York City, New York
| | - Comilla Sasson
- ECC Science & Innovation, American Heart Association, Dallas, Texas
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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14
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Zhong S, Huisingh-Scheetz M, Huang ES. Delayed medical care and its perceived health impact among US older adults during the COVID-19 pandemic. J Am Geriatr Soc 2022; 70:1620-1628. [PMID: 35393637 PMCID: PMC9177755 DOI: 10.1111/jgs.17805] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/07/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medical care delivery has been substantially disrupted during the coronavirus disease 2019 (COVID-19) pandemic, leading to delays in medical care, particularly among older adults. Less is known about how these delays have affected different segments of this population. Understanding the negative health consequences older adults face from delayed care will provide critical insights into the longer-term population health needs following the pandemic. METHODS We used data from a COVID-19 substudy embedded in a nationally representative longitudinal study of older adults, the National Social Life, Health, and Aging Project. Data were collected between September 14, 2020, and January 27, 2021. Two thousand six hundred seventy-two individuals responded to the survey. Using logistic and multinomial logistic regressions, we determined respondent-level characteristics associated with delayed medical care, experiencing a negative impact on physical health from delayed care, and with reporting worsening physical health during the pandemic. RESULTS Nearly, one-third (32.8%) of older adults reported delayed medical care during the pandemic. Female sex, higher levels of education, greater concerns about the pandemic, and poorer self-rated physical health were associated with delayed medical care. Blacks and those who are 70 and older were less likely to report delayed care. Among those whose care was delayed, 76.5% reported having already recovered delayed care. Nearly one in five (17.6%) reported that delayed care negatively affected their health. Older adults with worse self-rated physical and mental health or who had not fully recovered delayed care were more likely to report perceived negative health impacts from the delay. Regardless of delayed medical care, 10.2% reported worse physical health during the pandemic. CONCLUSIONS One-third of older adults experienced care delays during the pandemic. Despite high rates of care recovery, nearly one in five older adults who experienced delayed care reported being negatively affected. Strategies must be developed to reach these vulnerable patients to increase their healthcare utilization.
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Affiliation(s)
- Selena Zhong
- Department of Sociology, University of Chicago, IL, USA
| | - Megan Huisingh-Scheetz
- Section of Geriatrics and Palliative Care Medicine, Department of Medicine, University of Chicago, IL, USA
| | - Elbert S. Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, IL, USA
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15
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Baldi E, Cortegiani A, Savastano S. Cardiac arrest and coronavirus disease 2019. Curr Opin Crit Care 2022; 28:237-243. [PMID: 35275877 PMCID: PMC9208745 DOI: 10.1097/mcc.0000000000000931] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA). RECENT FINDINGS An increase in OHCA incidence occurred in different countries, especially in those regions most burdened by the COVID-19, as this seems to be bounded to the pandemic trend. A change of OHCA patients' characteristics, with an increase of the OHCA occurred at home, a decrease in bystander cardiopulmonary resuscitation and automated external defibrillator use before Emergency Medical Service (EMS) arrival and an increase in non-shockable rhythms, have been highlighted. A dramatic drop in the OHCA patients' survival was pointed out in almost all the countries, regardless of the high or low-incidence of COVID-19 cases. Concerning IHCA, a reduction in survival was highlighted in patients with COVID-19 who sustained a cardiac arrest. SUMMARY Cardiac arrest occurrence and survival were deeply affected by the pandemic. Informative campaigns to the population to call EMS in case of need and the re-allocation of the prehospital resources basing on the pandemic trend are needed to improve survival.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
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16
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Sun CLF, Jaffe E, Levi R. Increased emergency cardiovascular events among under-40 population in Israel during vaccine rollout and third COVID-19 wave. Sci Rep 2022; 12:6978. [PMID: 35484304 PMCID: PMC9048615 DOI: 10.1038/s41598-022-10928-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/14/2022] [Indexed: 01/10/2023] Open
Abstract
Cardiovascular adverse conditions are caused by coronavirus disease 2019 (COVID-19) infections and reported as side-effects of the COVID-19 vaccines. Enriching current vaccine safety surveillance systems with additional data sources may improve the understanding of COVID-19 vaccine safety. Using a unique dataset from Israel National Emergency Medical Services (EMS) from 2019 to 2021, the study aims to evaluate the association between the volume of cardiac arrest and acute coronary syndrome EMS calls in the 16-39-year-old population with potential factors including COVID-19 infection and vaccination rates. An increase of over 25% was detected in both call types during January-May 2021, compared with the years 2019-2020. Using Negative Binomial regression models, the weekly emergency call counts were significantly associated with the rates of 1st and 2nd vaccine doses administered to this age group but were not with COVID-19 infection rates. While not establishing causal relationships, the findings raise concerns regarding vaccine-induced undetected severe cardiovascular side-effects and underscore the already established causal relationship between vaccines and myocarditis, a frequent cause of unexpected cardiac arrest in young individuals. Surveillance of potential vaccine side-effects and COVID-19 outcomes should incorporate EMS and other health data to identify public health trends (e.g., increased in EMS calls), and promptly investigate potential underlying causes.
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Affiliation(s)
- Christopher L F Sun
- Sloan School of Management, Massachusetts Institute of Technology, 100 Main Street, Cambridge, MA, 02142-1347, USA
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, MA, USA
| | - Eli Jaffe
- Israel National Emergency Medical Services (Magen David Adom), Tel Aviv-Jaffo, Israel
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Retsef Levi
- Sloan School of Management, Massachusetts Institute of Technology, 100 Main Street, Cambridge, MA, 02142-1347, USA.
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17
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Lee KS, Park HJ, Kim JE, Kim HJ, Chon S, Kim S, Jang J, Kim JK, Jang S, Gil Y, Son HS. Compressed Deep Learning to Classify Arrhythmia in an Embedded Wearable Device. Sensors (Basel) 2022; 22:1776. [PMID: 35270923 DOI: 10.3390/s22051776] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 12/19/2022]
Abstract
The importance of an embedded wearable device with automatic detection and alarming cannot be overstated, given that 15-30% of patients with atrial fibrillation are reported to be asymptomatic. These asymptomatic patients do not seek medical care, hence traditional diagnostic tools including Holter are not effective for the further prevention of associated stroke or heart failure. This is likely to be more so in the era of COVID-19, in which patients become more reluctant on hospitalization and checkups. However, little literature is available on this important topic. For this reason, this study developed efficient deep learning with model compression, which is designed to use ECG data and classify arrhythmia in an embedded wearable device. ECG-signal data came from Korea University Anam Hospital in Seoul, Korea, with 28,308 unique patients (15,412 normal and 12,896 arrhythmia). Resnets and Mobilenets with model compression (TensorFlow Lite) were applied and compared for the diagnosis of arrhythmia in an embedded wearable device. The weight size of the compressed model registered a remarkable decrease from 743 MB to 76 KB (1/10000), whereas its performance was almost the same as its original counterpart. Resnet and Mobilenet were similar in terms of accuracy, i.e., Resnet-50 Hz (97.3) vs. Mo-bilenet-50 Hz (97.2), Resnet-100 Hz (98.2) vs. Mobilenet-100 Hz (97.9). Here, 50 Hz/100 Hz denotes the down-sampling rate. However, Resnets took more flash memory and longer inference time than did Mobilenets. In conclusion, Mobilenet would be a more efficient model than Resnet to classify arrhythmia in an embedded wearable device.
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18
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Atkins DL, Sasson C, Hsu A, Aziz K, Becker LB, Berg RA, Bhanji F, Bradley SM, Brooks SC, Chan M, Chan PS, Cheng A, Clemency BM, de Caen A, Duff JP, Edelson DP, Flores GE, Fuchs S, Girotra S, Hinkson C, Joyner BL, Kamath-Rayne BD, Kleinman M, Kudenchuk PJ, Lasa JJ, Lavonas EJ, Lee HC, Lehotzky RE, Levy A, McBride ME, Meckler G, Merchant RM, Moitra VK, Nadkarni V, Panchal AR, Ann Peberdy M, Raymond T, Roberts K, Sayre MR, Schexnayder SM, Sutton RM, Terry M, Topjian A, Walsh B, Wang DS, Zelop CM, Morgan RW. 2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists. Circ Cardiovasc Qual Outcomes 2022; 15:e008900. [PMID: 35072519 DOI: 10.1161/circoutcomes.122.008900] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 12/23/2022]
Affiliation(s)
- Dianne L Atkins
- Carver College of Medicine, University of Iowa (D.L.A., S.G.)
| | | | - Antony Hsu
- St Joseph Mercy Hospital, Ann Arbor, MI (A.H.)
| | - Khalid Aziz
- University of Alberta, Edmonton, Canada (K.A.)
| | - Lance B Becker
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.)
| | - Robert A Berg
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
| | | | - Steven M Bradley
- Minneapolis Heart Institute, Healthcare Delivery Innovation Center, MN (S.M.B.)
| | | | - Melissa Chan
- University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada (M.C., G.M.)
| | - Paul S Chan
- Mid America Heart Institute and the University of Missouri-Kansas City, MO (P.S.C.)
| | - Adam Cheng
- Alberta Children's Hospital, University of Calgary, AB, Canada (A.C.)
| | | | - Allan de Caen
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | - Jonathan P Duff
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | | | - Gustavo E Flores
- Emergency & Critical Care Trainings, San Juan, Puerto Rico (G.E.F.)
| | - Susan Fuchs
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL (S.F., M.E.M.)
| | - Saket Girotra
- Carver College of Medicine, University of Iowa (D.L.A., S.G.)
| | - Carl Hinkson
- Providence Regional Medical Center, Everett, WA (C.H.)
| | - Benny L Joyner
- University of North Carolina at Chapel Hill, NC (B.L.J.)
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, Itasca, IL (B.D.K.-R.)
| | | | | | | | | | | | | | - Arielle Levy
- Sainte-Justine Hospital University Center, University of Montreal, QC, Canada (A.L.)
| | - Mary E McBride
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL (S.F., M.E.M.)
| | - Garth Meckler
- University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada (M.C., G.M.)
| | - Raina M Merchant
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.).,University of Pennsylvania, Philadelphia, PA (R.M.M.)
| | - Vivek K Moitra
- College of Physicians & Surgeons of Columbia University, NY (V.K.M.)
| | - Vinay Nadkarni
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
| | - Ashish R Panchal
- The Ohio State University Wexner Medical Center, Columbus, OH (A.R.P.)
| | | | - Tia Raymond
- Medical City Children's Hospital, Dallas, TX (T.R.)
| | | | | | | | - Robert M Sutton
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, OH (M.T.)
| | - Alexis Topjian
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.)
| | - Brian Walsh
- Children's Hospital Colorado, Aurora, CO (B.W.)
| | - David S Wang
- Columbia University Irving Medical Center, NY (D.S.W.)
| | | | - Ryan W Morgan
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
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19
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Teoh SE, Masuda Y, Tan DJH, Liu N, Morrison LJ, Ong MEH, Blewer AL, Ho AFW. Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Ann Intensive Care 2021; 11:169. [PMID: 34874498 PMCID: PMC8649312 DOI: 10.1186/s13613-021-00957-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 09/12/2021] [Accepted: 11/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has significantly influenced epidemiology, yet its impact on out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to evaluate the impact of the pandemic on the incidence and case fatality rate (CFR) of OHCA. We also evaluated the impact on intermediate outcomes and clinical characteristics. METHODS PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases were searched from inception to May 3, 2021. Studies were included if they compared OHCA processes and outcomes between the pandemic and historical control time periods. Meta-analyses were performed for primary outcomes [annual incidence, mortality, and case fatality rate (CFR)], secondary outcomes [field termination of resuscitation (TOR), return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge], and clinical characteristics (shockable rhythm and etiologies). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). RESULTS The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p < 0.001). Pooled CFR was increased by 2.65% (p < 0.001), with a pooled odds ratio (OR) of 1.95 for mortality [95% confidence interval (95%CI) 1.51-2.51]. There was increased field TOR (OR = 2.46, 95%CI 1.62-3.74). There were decreased ROSC (OR = 0.65, 95%CI 0.55-0.77), survival to hospital admission (OR = 0.65, 95%CI 0.48-0.89), and survival to discharge (OR = 0.52, 95%CI 0.40-0.69). There was decreased shockable rhythm (OR = 0.73, 95%CI 0.60-0.88) and increased asphyxial etiology of OHCA (OR = 1.17, 95%CI 1.02-1.33). CONCLUSION Compared to the pre-pandemic period, the COVID-19 pandemic period was significantly associated with increased OHCA incidence and worse outcomes.
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Affiliation(s)
- Seth En Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Laurie J Morrison
- Division of Emergency Medicine, Department of Medicine, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Marcus Eng Hock Ong
- Office C, Department of Emergency Medicine, Singapore General Hospital, 1 Outram Rd, Singapore, 169608, Singapore.,Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Fu Wah Ho
- Office C, Department of Emergency Medicine, Singapore General Hospital, 1 Outram Rd, Singapore, 169608, Singapore. .,Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore.
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20
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Porter A, Brown CC, Tilford JM, Cima M, Zohoori N, McCormick D, Wilson MP, Amick BC, Romero JR. Association of the COVID-19 pandemic and dying at home due to ischemic heart disease. Prev Med 2021; 153:106818. [PMID: 34599924 PMCID: PMC8480010 DOI: 10.1016/j.ypmed.2021.106818] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been associated with a declining volume of patients seen in the emergency department. Despite the need for seeking urgent care for conditions such as myocardial infarction, many people may not seek treatment. This study seeks to measure associations between the COVID-19 pandemic and location of death among individuals who died from ischemic heart disease (IHD). Data obtained from death certificates from the Arkansas Department of Health was used to conduct a difference-in-difference analysis to assess whether decedents of IHD were more likely to die at home during the pandemic (March 2020 through September 2020). The analysis compared location of death for decedents of IHD pre and during the pandemic to location of death for decedents from non-natural causes. Before the pandemic, 50.0% of decedents of IHD died at home compared to 57.9% dying at home during (through September 2020) the pandemic study period (p < .001). There was no difference in the proportion of decedents who died at home from non-natural causes before and during the pandemic study period (55.8% vs. 53.5%; p = .21). After controlling for confounders, there was a 48% increase in the odds of dying at home from IHD during the pandemic study period (p < .001) relative to the change in dying at home due to non-natural causes. During the study period, there was an increase in the proportion of decedents who died at home due to IHD. Despite the ongoing pandemic, practitioners should emphasize the need to seek urgent care during an emergency.
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Affiliation(s)
- Austin Porter
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Arkansas Department of Health, Little Rock, AR 72205, United States of America.
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Michael Cima
- Arkansas Department of Health, Little Rock, AR 72205, United States of America
| | - Namvar Zohoori
- Arkansas Department of Health, Little Rock, AR 72205, United States of America; Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Donald McCormick
- Arkansas Department of Health, Little Rock, AR 72205, United States of America
| | - Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Benjamin C Amick
- Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - José R Romero
- Arkansas Department of Health, Little Rock, AR 72205, United States of America; Pediatric Infectious Diseases Section, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72205, United States of America
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21
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Cho SK, Mattke S, Sheridan M, Ennis W. Outpatient Wound Clinics During COVID-19 Maintained Quality but Served Fewer Patients. J Am Med Dir Assoc 2021; 23:660-665.e5. [PMID: 34861225 PMCID: PMC8572697 DOI: 10.1016/j.jamda.2021.11.001] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/30/2022]
Abstract
Objective To evaluate the impact of COVID-19–related disruptions on care continuity and outcomes of chronic wounds. Design Retrospective cohort study. Setting and Participants Electronic medical records for 152,225 chronic wounds from a network of 488 wound care clinics in 45 US states and the District of Columbia. Methods Wound and patient characteristics, the number of chronic wounds newly seen at the clinics, and 12-week healing rates were compared between the first 2 quarters of 2019 and 2020. Multivariable regression models were constructed to evaluate whether the pandemic was associated with a statistically significant change in the probability of 12-week wound healing after risk adjustment. Results During the pandemic, wound and patient characteristics did not change compared to the previous year. Case volume dropped as much as 40% in April 2020 but returned to the previous year's level by June. No systematic changes in measures of care continuity were observed. Unadjusted 12-week healing rates remained stable at 0.502 in 2019 and 0.503 in 2020. Likewise, risk-adjusted 12-week healing rates were 0.504 and 0.505 in 2019 and 2020, respectively, but the difference was not statistically significant. States with stricter lockdowns saw a greater decline in case volume. However, the pandemic was not associated with a statistically significant change in the probability of 12-week wound healing in most states. The percentage of wounds with 1 or more telehealth visits increased from 0.14% in 2019 to 1.04% in 2020. Conclusions and Implications Despite COVID-19–related disruptions, our results suggest that wound care clinics maintained standards of care and outcomes for patients who sought care. This positive result should not detract from the problem that the number of new wounds seen at the clinics dropped sharply. Further research should evaluate outcomes in patients with unattended chronic wounds.
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Affiliation(s)
- Sang Kyu Cho
- College of Pharmacy, University of Houston, TX, USA
| | - Soeren Mattke
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.
| | | | - William Ennis
- Healogics Inc, Jacksonville, FL, USA; Wound Healing and Tissue Repair Program, University of Illinois at Chicago, Chicago, IL, USA
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22
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Hsu A, Sasson C, Kudenchuk PJ, Atkins DL, Aziz K, Becker LB, Berg RA, Bhanji F, Bradley SM, Brooks SC, Chan M, Chan PS, Cheng A, Clemency BM, de Caen A, Duff JP, Edelson DP, Flores GE, Fuchs S, Girotra S, Hinkson C, Joyner BL, Kamath-Rayne BD, Kleinman M, Lasa JJ, Lavonas EJ, Lee HC, Lehotzky RE, Levy A, Mancini ME, McBride ME, Meckler G, Merchant RM, Moitra VK, Morgan RW, Nadkarni V, Panchal AR, Peberdy MA, Raymond T, Roberts K, Sayre MR, Schexnayder SM, Sutton RM, Terry M, Walsh B, Wang DS, Zelop CM, Topjian A. 2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19. Circ Cardiovasc Qual Outcomes 2021; 14:e008396. [PMID: 34641719 PMCID: PMC8522336 DOI: 10.1161/circoutcomes.121.008396] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Antony Hsu
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI (A.H.)
| | - Comilla Sasson
- ECC Science & Innovation, American Heart Association, Dallas, TX (C.S., R.E.L.)
| | - Peter J Kudenchuk
- Department of Medicine/Division of Cardiology (P.J.K.), University of Washington, Seattle
| | - Dianne L Atkins
- Stead Family Department of Pediatrics (D.L.A), Carver College of Medicine, University of Iowa
| | - Khalid Aziz
- Division of Newborn Medicine, Department of Pediatrics, University of Alberta, Edmonton, Canada (K.A.)
| | - Lance B Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.)
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Farhan Bhanji
- Department of Pediatrics, McGill University, Montreal, QC, Canada (F.B.)
| | - Steven M Bradley
- Minneapolis Heart Institute, Healthcare Delivery Innovation Center, MN (S.M.B.)
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada (S.C.B.)
| | - Melissa Chan
- Department of Pediatrics and Department of Pediatric Emergency Medicine, BC Children's Hospital, University of British Columbia, Vancouver, Canada (M.C., G.M.)
| | - Paul S Chan
- Department of Internal Medicine, Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City (P.S.C.)
| | - Adam Cheng
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Canada (A.C.)
| | - Brian M Clemency
- Department of Emergency Medicine, University at Buffalo, NY (B.M.C.)
| | - Allan de Caen
- Division of Critical Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | - Jonathan P Duff
- Division of Critical Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | - Dana P Edelson
- Section of Hospital Medicine, University of Chicago, IL (D.P.E.)
| | - Gustavo E Flores
- Emergency and Critical Care Trainings, San Juan, Puerto Rico (G.E.F.)
| | - Susan Fuchs
- Division of Emergency Medicine (S.F.), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - Saket Girotra
- Department of Internal Medicine and Division of Cardiovascular Diseases (S.G.), Carver College of Medicine, University of Iowa
| | - Carl Hinkson
- Respiratory Care, Providence Regional Medical Center, Everett, WA (C.H.)
| | - Benny L Joyner
- Departments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill (B.L.J.)
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, Itasca, IL (B.D.K.-R.)
| | - Monica Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, MA (M.K.)
| | - Javier J Lasa
- Cardiovascular Intensive Care Unit, Texas Children's Hospital, Baylor College Of Medicine, Houston (J.J.L.)
| | - Eric J Lavonas
- Department of Emergency Medicine, Denver Health and Hospital Authority, CO (E.J.L.)
| | - Henry C Lee
- Division of Neonatology, Stanford University, CA (H.C.L.)
| | - Rebecca E Lehotzky
- ECC Science & Innovation, American Heart Association, Dallas, TX (C.S., R.E.L.)
| | - Arielle Levy
- Department of Pediatrics and Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, QC, Canada (A.L.)
| | - Mary E Mancini
- College of Nursing, University of Texas at Arlington (M.E. Mancini)
| | - Mary E McBride
- Divisions of Cardiology and Critical Care Medicine (M.E. McBride), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - Garth Meckler
- Department of Pediatrics and Department of Pediatric Emergency Medicine, BC Children's Hospital, University of British Columbia, Vancouver, Canada (M.C., G.M.)
| | - Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia (R.M.M.)
| | - Vivek K Moitra
- Department of Anesthesiology, Division of Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (V.K.M., D.S.W.)
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (A.R.P.)
| | - Mary Ann Peberdy
- Division of Cardiology, Virginia Commonwealth University, Richmond (M.A.P.)
| | - Tia Raymond
- Department of Pediatrics and Pediatric Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX (T.R.)
| | - Kathryn Roberts
- Center for Nursing Excellence, Education & Innovation, Joe DiMaggio Children's Hospital, Hollywood, FL (K.R.)
| | - Michael R Sayre
- Department of Emergency Medicine (M.R.S.), University of Washington, Seattle
| | - Stephen M Schexnayder
- Departments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Little Rock (S.M.S.)
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, OH (M.T.)
| | - Brian Walsh
- Respiratory Care, Children's Hospital Colorado, Aurora (B.W.)
| | - David S Wang
- Department of Anesthesiology, Division of Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (V.K.M., D.S.W.).,Department of Obstetrics and Gynecology, New York, NY (D.S.W.)
| | - Carolyn M Zelop
- NYU School of Medicine, New York, NY and The Valley Hospital, Ridgewood, NJ (C.M.Z.)
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
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23
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Smulowitz PB, O'Malley AJ, Khidir H, Zaborski L, McWilliams JM, Landon BE. National Trends In ED Visits, Hospital Admissions, And Mortality For Medicare Patients During The COVID-19 Pandemic. Health Aff (Millwood) 2021; 40:1457-1464. [PMID: 34495730 DOI: 10.1377/hlthaff.2021.00561] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. Using data on all traditional Medicare beneficiaries in the US from October 1, 2018, to September 30, 2020, we examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not. We found reductions in ED visits that were largest by the first week of April 2020 (52 percent relative decrease), with volume recovering somewhat by mid-June (25 percent relative decrease). These reductions were of similar magnitude in counties that were and were not designated as COVID-19 hot spots. There was an early increase in hospitalizations and in the relative risk for thirty-day mortality, starting with the first surge of the pandemic, peaking at just over a 2-percentage-point increase. These results suggest that patients were presenting with more serious illness, perhaps related to delays in seeking care.
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Affiliation(s)
- Peter B Smulowitz
- Peter B. Smulowitz is an associate professor of emergency medicine in the Department of Emergency Medicine at the University of Massachusetts Medical School, in Worcester, Massachusetts, and chief medical officer at Milford Regional Medical Center, in Milford, Massachusetts
| | - A James O'Malley
- A. James O'Malley is a professor of biomedical data science at the Dartmouth Institute for Health Policy and Clinical Practice and in the Department of Biomedical Data Science at the Geisel School of Medicine at Dartmouth, in Hanover, New Hampshire
| | - Hazar Khidir
- Hazar Khidir is a fellow in the National Clinician Scholars Program, Department of Internal Medicine and Emergency Medicine, Yale University School of Medicine, in New Haven, Connecticut. He was an emergency medicine resident physician in the Harvard Affiliated Emergency Medicine Residency Program, Massachusetts General Hospital and Brigham and Women's Hospital, in Boston, Massachusetts, when this work was performed
| | - Lawrence Zaborski
- Lawrence Zaborski is a senior statistical programmer in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts
| | - J Michael McWilliams
- J. Michael McWilliams is the Warren Alpert Foundation Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School and a professor of medicine and general internist at Brigham and Women's Hospital
| | - Bruce E Landon
- Bruce E. Landon is a professor of health care policy in the Department of Health Care Policy at Harvard Medical School and a professor of medicine and practicing internist at Beth Israel Deaconess Medical Center
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