COVID-19 outcomes in people living with HIV: Peering through the waves

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Delivering patient-centered care: outcomes of comprehensive geriatric assessment across healthcare settings / Avaliação geriátrica ampla: uma revisão narrativa sobre os benefícios do cuidado centrado no paciente nos vários ambientes de saúde

Comprehensive geriatric assessment (CGA) is a systematic multidimensional and interdisciplinary evaluation that enables clinicians to recognize age-related impairments and develop a coordinated treatment plan and follow-up suited to the patient's needs. Considering the growing number of older persons requiring care in health systems everywhere and the importance of shifting from a disease-specific care model to a more comprehensive care model, we aimed to present the benefits of CGA for older people in different healthcare settings using a narrative review. This patient-centered model of care has been associated with lower hospital (re)admission, maintenance of function, improved quality of life, less caregiver burden, and higher patient satisfaction with the care provided across different healthcare settings. In some contexts ­ for example, hospitalized older people ­, CGA has already been established as the standard model of care as it was consistently related to reduced mortality. Consistent findings from specific contexts (eg, oncology, orthopaedics) also show the importance of CGA in aiding clinicians make better decisions for older patients. It is noteworthy that further evidence from costeffectiveness studies is still warranted, particularly in community settings. Another encouraging topic for future research is the role of technology in disseminating CGA-based models of care.

A avaliação geriátrica ampla (AGA) é um modelo de atenção sistemático, multidimensional e interdisciplinar, que permite aos médicos reconhecer incapacidades relacionadas à idade e desenvolver um plano de tratamento e acompanhamento voltado para as necessidades específicas do paciente. Considerando o crescente número de pessoas idosas que procuram cuidados de saúde em todos os países e a importância de mudar de um modelo de atenção centrado na doença para um modelo mais abrangente e centrado no paciente, nosso objetivo foi apresentar os benefícios da AGA para idosos em diferentes ambientes de saúde usando uma revisão narrativa. Essa forma de abordagem tem sido associada à menor taxa de (re)internação hospitalar, à manutenção da funcionalidade, à melhoria da qualidade de vida, à menor sobrecarga do cuidador e à maior satisfação do paciente com os cuidados recebidos nos diferentes ambientes de saúde. Em alguns contextos, por exemplo, de idosos hospitalizados, a AGA já se estabeleceu como padrão de atendimento, pois tem sido consistentemente associada à redução da mortalidade. Há também evidências substanciais de contextos específicos, como de oncologia e ortopedia, mostrando a importância da avaliação ampla para os médicos, pois colabora com a tomada de decisão quanto ao melhor tratamento dos pacientes idosos. Vale ressaltar que mais evidências baseadas em estudos de custo-efetividade ainda são necessárias, principalmente em ambientes da comunidade. Outro tópico interessante para pesquisas futuras é examinar o papel das tecnologias na disseminação de modelos de atendimento baseados na AGA.

Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

ABSTRACT Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.