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Background Intermittent fasting modulates inflammation and reduces cardiometabolic risks, even without weight loss. Many Utahns (30%) engage in routine periodic fasting, primarily for religious purposes (1 day/month for?>40 years). Periodic fasting is associated with greater longevity, lower incidence of heart failure (HF) and diabetes, and lower COVID-19 severity. This study evaluated the association of periodic fasting with inpatient hospitalization (hosp.) for the primary diagnosis of HF after COVID-19 diagnosis. Methods Patients undergoing cardiac catheterization at Intermountain Healthcare from 2/2013-3/2020 were enrolled in the INSPIRE registry (NCT02450006) and provided survey data for periodic fasting (n=5,795). Between March 6, 2020 and April 8, 2022, COVID-19 was diagnosed in N=464 (1852 COVID-negative, 3466 no test, 13 fasted routinely <5 years). Subjects were followed to April 17, 2022 for HF hosp., mortality, MI, revascularization, and stroke. Results Periodic fasting was reported by 135 (29.1%) of the 464 subjects and they had fasted routinely for 42.7+/-19.0 years (min: 7 years, max: 82 years). HF hosp. (n=65, 14.0%) was found in 8.1% of fasters and 16.4% of non-fasters (HR=0.45, 95% CI=0.24, 0.87;p=0.017). Fasting was retained in multivariable analyses (adjusted HR=0.44, CI=0.23, 0.84;p=0.013). Age, diabetes, prior MI, TIA, and prior HF diagnosis also predicted HF hosp. Qualitative but non-significantly lower risk for fasting vs non-fasters was found for mortality (3.7% vs 5.8%), MI (0% vs 1.2%), and revasc. (1.5% vs 2.7%), but not stroke (1.5% vs 1.5%). Composites were significant: HF hosp./mortality, n=74 (10.4% vs 18.2%, adj. HR=0.55, CI=0.30, 0.99;p=0.047) and major adverse cardiovascular events (MACE: HF hosp., mortality, MI, revasc., stroke), n=86 (12.6% vs 21.0%, adj. HR=0.58, CI=0.34, 1.00;p=0.0504). Conclusion Routine periodic fasting was associated with a lower risk of HF hosp., HF hosp./mortality, and MACE in patients at high risk due to COVID-19 diagnosis. This supports and expands on previous studies that reported fasting may reduce the risk of incident HF and reduce the risk of severe COVID-19. Further study of fasting and heart failure is indicated. Prevention and Health PromotionCopyright © 2023 American College of Cardiology Foundation
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Background: The COVID-19 pandemic has affected nearly every aspect of daily life. The interpersonal loss due to quarantining and social distancing, compounded with societal disruption has negatively affected mental health. Once established, mental health conditions can become chronic with having subsequent effects on additional risk factors and disease incidence, such as cardiovascular disease (CVD). Methods: Patients who completed a PHQ-9 in a primary care setting in the year prior to the COVID pandemic (Mar 1, 2019 to Feb 29, 2020) and during the COVID pandemic (Mar 1, 2020 to Apr 20, 2021) were studied. Patients were stratified into 2 groups: no depression/no longer depressed and remained depressed/became depressed. Patients were assessed for follow-up emergency department (ED) visits for anxiety and chest pain (CP) after PHQ-9 completion during the pandemic. Results: A total of 4,633 patients were studied, with 2,848 (61.5%) being never/no longer depressed and 1,785 (38.5%) remaining/became depressed. PHQ-9 scores during the pandemic were higher than prior to the pandemic among those depressed. A total of 2,171 (46.6%) received a COVID test, with more depressed patients tested compared to non-depressed (Table), but with positivity for SARS-CoV-2 (n=362 [16.7%]) being similar (p=0.18). The table shows baseline characteristics and outcomes. Depression was associated with increased ED visits for anxiety (Table). Those with depression, visited the ED at 3.5 times and 2.7 times greater rate for anxiety and anxiety with CP compared to non-depressed, respectively. Conclusions: Depression was highly prevalent among patients who receive routine primary care, with depressive symptoms increasing during the pandemic. Since depression and anxiety are associated with an increased risk of CVD and associated risk factors, identifying and treating patients early who exhibit such symptoms will be important in reducing the risk of future CVD and risk factor incidence.
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Background: The SARS-CoV-2 B.1.1.7 variant, also known as the UK or alpha variant, carries the spike 69/70 deletion mutation and has been reported to be more contagious and possibly more virulent than other variants. This study examines follow-up cardiovascular outcomes for patients infected with deletion-carrying SARS-CoV-2 alpha variant. Methods: From October 2020 to May 2021, all positive SARS-CoV-2 samples at Intermountain Healthcare were tested for the 69/70 deletion (n=92822). Patient characteristics, COVID-19 treatments, and follow-up outcomes were extracted from Intermountain records. Cox hazard regression analysis with multivariable adjustment was used to determine risk of subsequent major cardiovascular adverse event outcomes (MACE), which included all-cause death, heart failure (HF), and hospitalization for coronary artery disease (CAD) or atrial fibrillation (AF). Results: Overall, 4.2% of patients testing positive for the SARS-CoV-2 virus carried the deletion mutation with prevalence increasing with time, ranging from 1.3% in October to 61.0% in May. Baseline characteristics, treatments, and outcomes stratified by non-mutant and deletion mutation status are shown in the Table. While the mutation did result in higher rates of COVID hospitalization (adjusted OR=1.68, p<0.001), there was no difference in overall MACE after adjustment by baselinecharacteristics and risk factors. There was a non-significant trend toward an increased rate of allcause death in patients carrying the mutant variant (adjusted HR=1.90, p=0.12). Conclusions: The SARS-CoV-2 deletion mutant, while resulting in an increased risk of COVID hospitalization and a trend toward increased death, did not increase the risk of subsequent CVD. Because of the recent emergence of the variant the long-term effects are not known. Thus, it remains important to minimize risk of exposure. Moreover, long-term surveillance of subsequent CVD risk is warranted.
ABSTRACT
Background: In the presence of comorbid conditions, COVID-19 infections are known to require more advanced treatment, poorer outcomes and have longer-term sequelae. New-onset atrial fibrillation (AF) during COVID-19 infection has been associated with worse cardiovascular outcomes but not mortality. However, it remains unclear whether a prior history (hx) of atrial fibrillation is a cardiovascular risk factor predicting a worse outcome in COVID-19 patients. As such, we examined, using propensity matching accounting for possible confounders, the need for advanced treatment and subsequent major cardiovascular events (MACE) in patients with a prior hx of AF with COVID19 infection. Methods: From March 2020 to May 2021, patients testing positive for SARS-CoV-2 with a prior AF diagnosis (n=3119) were propensity matched for age, gender, race/ethnicity, prior coronary artery disease (CAD), prior heart failure (HF), prior stroke and hypertension to non-AF SARS-CoV-2 positive patients. Cox hazard regression analysis with multivariable adjustment was used to determine risk of subsequent MACE (all-cause death, myocardial infarction, HF and stroke). Results: Baseline characteristics, treatments, and outcomes stratified by AF status are shown in the Table. While the groups had similar baseline characteristics, AF COVID-19 patients were more likely to require hospitalization, ICU care, and ventilator support. Consistent with our hypothesis, composite MACE event rates were higher in the AF patients (HR=1.60, p<0.0001) secondary to increases in heart failure and all-cause mortality rates. Conclusions: These data support AF as a cardiovascular risk factor predicting worse outcomes in COVID-19 patients. Specifically, AF increases the need for advanced treatments such as hospitalization, ICU care and ventilator support resulting in an increase in subsequent heart failure and all-cause mortality.