Evaluation of the Existence of Post-COVID-19 Tachycardia in a Community Healthcare System

Background

Post-coronavirus disease 2019 (COVID-19) syndrome derives from lingering symptoms after an acute COVID-19 infection. Palpitation was one of the most common symptoms of post-COVID-19 syndrome that correlated with objective data such as persisting sinus tachycardia; but to our best knowledge, there is a scarcity of research regarding the association of COVID-19 and sinus tachycardia in the post-acute setting. Therefore, the purpose was to identify if there is an association between COVID-19 infection and sinus tachycardia in the post-acute phase, namely post-COVID-19 tachycardia (PCT) other than inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS).

Methods

This retrospective observational study entails 1,425 patients admitted for COVID-19 infection with the interest in finding an association with PCT. The prevalence of PCT was evaluated using descriptive statistics, predictions of patient characteristics and comorbidities were identified using multinomial logistic regression, and associations between patient comorbidities and characteristics were evaluated with corresponding Pearson Chi-square test and post hoc tests Phi and Cramer's V.

Results

The percentage of patients with PCT in our sample of interest was an average of 28.18%. There was a strong association of PCT with patients of age group less than 65 years. Other clinical characteristics, such as shorter length of stay, unknown smoking status, and patients with commercial type insurance, had significant association with PCT. COVID-19 severity categorized as "less severe", readmission rates within 30 days, and patients with less comorbidities were more likely to be associated with PCT.

Conclusions

PCT is likely a separate entity from IST and POTS, and an important entity under the umbrella of post-COVID-19 syndrome. It warrants further studies to elucidate the underlying pathophysiology and to confirm its presence as a distinct entity.

Retrospective single system analysis of side effects experienced with mRNA (Pfizer-BioNTech and Moderna) vaccinations in immunocompromised cancer patients compared with CDC VAERS database between December 15th, 2020, through July 31st, 2021

e18782

Background: Immunotherapy is becoming a common therapy in cancer patients. Cancer patients on systemic therapy are a vulnerable population, making them highly susceptible to illness from any infection. The purpose of this study was to collect and analyze data reported by patients regarding the side effects of COVID-19 vaccines (Pfizer-BioNTech and Moderna) in cancer patients with solid tumors receiving immunotherapy. Due to the lack of studies and inclusion of cancer patients in the clinical trials for the vaccine, it is pivotal to investigate of the effects of the SARS-2-CoV vaccine on patients receiving immunotherapy to begin to bridge the current gap in knowledge. Methods: We performed a two-phased retrospective analysis of adult patients (age ≥18 years) who received either Moderna or Pfizer-BioNTech COVID-19 vaccinations and were currently on immunotherapy (December 15th, 2020, through July 31st, 2021). Phase 1 included a tertiary health system (n = 15,910) in Northeast Georgia. Phase 2 involved cross-tabulation with the VAERS CDC database to compare results at a national level (n = 374,667). The primary endpoints were severity of side effects, timing of side effects and the relationship between the vaccines. The method to evaluate outcome was the Pearson-Chi-Squared test. Results: Results showed that patients on immunotherapy were more likely to have at least one side effect in the tertiary health system (OR 6.727 [95% CI, 2.748 - 16.465] compared to least two side effects in the national dataset (X² = 7.032, p < 0.05). This difference was driven by the Moderna vaccine recipients, demonstrating a higher likelihood of experiencing two or more side effects (X² = 6.159, p < 0.05). Those receiving the Pfizer-BioNTech vaccine did not demonstrate statistically significant side effects. The most common reaction noted was weakness in both datasets, which was more likely to occur after the Moderna vaccine. Gender analysis showed no difference in side effects in those receiving immunotherapy. In terms of timing of side effects, patients on immunotherapy (M = 10.66, SD = 25.1) had a delayed side effect onset of 10 days vs. four days. (M = 4.72, SD = 15.5, p < 0.05). Conclusions: Both local and national datasets demonstrate cancer patients receiving immunotherapy compared to those that were on immunotherapy, were more likely to experience mild vaccine side effects, specifically weakness being the most common. There was no statistically significant increase in more serious adverse reactions. Additionally, side effect onset was delayed in patients on immunotherapy. These findings provide a foundation for understanding mRNA vaccines in patients on immunotherapy, with future research needs involving larger sample sizes.