Myocarditis after RNA-based vaccines for coronavirus.

BACKGROUND: The incidence of myocarditis after RNA-based vaccines for coronavirus has gained social and medical interest. METHODS: We performed an intention-to-treat meta-analysis, following the PRISMA statement. After a systematic search, without language restriction, 9 publications were selected. Two were excluded (one was only in subjects with age 12-17 and other might had included subjects from a larger publication). We followed the PRISMA guidelines for abstracting data and assessing data quality and validity. Data was verified by 2 investigators. RESULTS: We analyzed 17,704,413 subjects, from 7 studies, that included 627 cases of confirmed myocarditis). The incidence of myocarditis was 0.0035% (95% CI 0.0034-0.0035). Mean incidence rate was 10.69 per 100.000 persons-year. Cases reported from Israel represented 45.14% from total (283 out of the 627). Only 1 case of fatal myocarditis or death was reported. There was significant heterogeneity between results. The meta-regression analysis excluded mean age, region, number of cases or number of people included as sources of heterogeneity. No small-study effect was observed (p = 0.19). CONCLUSIONS AND RELEVANCE: Myocarditis incidence after RNA vaccines is very rare (0.0035%) and has a very favorable clinical course.

Spanish Pacemaker Registry. 18th Official Report of the Cardiac Pacing Section of the Spanish Society of Cardiology (2020).

INTRODUCTION AND OBJECTIVES: This report describes the cardiac pacing activity performed in Spain in 2020, including the number and type of implanted devices, demographic and clinical factors, and data on remote monitoring. METHODS: Information consisted of the European Pacemaker Patient Card, data submitted to the cardiodispositivos.es online platform, the databases of participating centers, and supplier-reported data. RESULTS: A total of 14 662 procedures were registered from 102 hospitals, representing 39.2% of the estimated activity. The implantation rates of conventional and low-energy resynchronization pacemakers were 759 and 31 units per million population, respectively. In all, 520 leadless pacemakers were implanted, 70 with atrioventricular synchrony. The mean age at implantation was high (78.8 years), and the most frequent electrocardiographic change was atrioventricular block. There was a predominance of dual-chamber pacing mode but VVI/R single-chamber pacing was used in 19% of patients in sinus rhythm, depending on age and sex. Remote monitoring capability was present in 18.5% of implanted conventional pacemakers and 45.6% of low-energy resynchronization pacemakers, although registration in this system increased by 53% in 2020. CONCLUSIONS: In 2020, in the context of the SARS-CoV-2 pandemic, the number of implanted conventional pacemakers decreased by 8% and cardiac resynchronization therapy by 4.6%. The number of leadless pacemakers increased by 16.5%. Sequential pacing was predominant, influenced by age and sex. Home monitoring played a fundamental role as a mode of follow-up in this SARS-CoV-2 pandemic year.

Registro Español de Marcapasos. XVIII Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2020)

Resumen Introducción y objetivos Se describe la actividad de estimulación cardiaca realizada en España en 2020: cuantía y tipo de dispositivos, factores demográficos y clínicos y datos sobre monitorización a distancia. Métodos Se utilizan como fuentes de información la Tarjeta Europea de paciente portador de Marcapasos, la plataforma online cardiodispositivos.es, las bases de datos propias de centros y los datos facilitados por las empresas proveedoras. Resultados Se registran 14.662 procedimientos de 102 hospitales, lo que supone el 39,2% de la actividad estimada. La tasa de marcapasos convencionales y resincronizadores de baja energía es de 759 y 31 unidades/millón respectivamente. Se implantan 520 marcapasos sin cables, 70 con sincronía auriculoventricular. La media de edad al implante es elevada (78,8 años) y el bloqueo auriculoventricular, la alteración electrocardiográfica más frecuente. Predomina el modo de estimulación bicameral, aunque en el 19% de los pacientes en ritmo sinusal se realiza una estimulación monocameral VVI/R, condicionada por edad y sexo. Se incluyen en programa de monitorización a distancia el 18,5% de los marcapasos implantados y el 45,6% de los resincronizadores de baja energía, aunque aumentan en un 53% las altas en este sistema durante 2020. Conclusiones En 2020, en contexto de la pandemia por SARS-CoV-2, disminuye el número de marcapasos convencionales implantados un 8% y el de terapias se resincronización cardiaca, un 4,6%. Aumenta el número de marcapasos sin cables un 16,5%. Predomina la estimulación secuencial, influida por edad y sexo. La monitorización domiciliaria cobra un papel fundamental como modo de seguimiento en el año de la pandemia por SARS-CoV-2. Introduction and objectives This report describes the cardiac pacing activity performed in Spain in 2020, including the number and type of implanted devices, demographic and clinical factors, and data on remote monitoring. Methods Information consisted of the European Pacemaker Patient Card, data submitted to the cardiodispositivos.es online platform, the databases of participating centers, and supplier-reported data. Results A total of 14662 procedures were registered from 102 hospitals, representing 39.2% of the estimated activity. The implantation rates of conventional and low-energy resynchronization pacemakers were 759 and 31 units per million population, respectively. In all, 520 leadless pacemakers were implanted, 70 with atrioventricular synchrony. The mean age at implantation was high (78.8 years), and the most frequent electrocardiographic change was atrioventricular block. There was a predominance of dual-chamber pacing mode but VVI/R single-chamber pacing was used in 19% of patients in sinus rhythm, depending on age and sex. Remote monitoring capability was present in 18.5% of implanted conventional pacemakers and 45.6% of low-energy resynchronization pacemakers, although registration in this system increased by 53% in 2020. Conclusions In 2020, in the context of the SARS-CoV-2 pandemic, the number of implanted conventional pacemakers decreased by 8% and cardiac resynchronization therapy by 4.6%. The number of leadless pacemakers increased by 16.5%. Sequential pacing was predominant, influenced by age and sex. Home monitoring played a fundamental role as a mode of follow-up in this SARS-CoV-2 pandemic year. Full English text available from:www.revespcardiol.org/en

Mortality associated with cardiovascular disease in patients with COVID-19

Introduction and objectives: Cardiovascular disease (CVD) has been outlined as a possible risk factor for poorer outcomes in patients with COVID-19 infection. Methods: A meta-analysis was performed with currently available studies that report the prevalence of CVD in survivors vs non-survivors in patients with COVID-19 infection using reports available at 16 July 2020. Analyses were performed by a random effects model and sensitivity analyses were performed for the identification of potential sources of heterogeneity or assess the small-study effects. Results: A total of 307 596 patients from 16 reports were included and 46 321 (15.1%) had CVD. Globally, mortality rate was 8.2% (20 534 patients) and mortality rates were higher in hospital registries (48.7%) compared to national reports (23.1%). A total of 11 213 (24.2%) patients with CVD died and mortality rates were also higher in hospital registries (48.7%) compared to national reports (23.1%). CVD was associated to 4-fold higher risk of mortality (OR, 4.33;95%CI, 3.16-5.94). Data from 28 048 patients with diabetes was available. Diabetes was associated to higher mortality risk (OR, 2.41;95%CI, 1.79-3.26;P < .001). From 40 173 subjects with hypertension it could also be proven a risk factor for higher mortality (OR, 2.60;95%CI, 2.10-3.21;P < .001). Conclusions: patients with CVD and COVID-19 infection have 4-fold higher risk of death. Diabetes or hypertension are also associated with higher mortality risk. Resumen Introducción y objetivos: Las enfermedades cardiovasculares (ECV) se han identificado como un factor de riesgo de mal pronóstico en pacientes con infección por COVID-19. Métodos: Se realizó un metanálisis de estudios actualmente disponibles con la prevalencia de ECV en supervivientes frente a no supervivientes en pacientes con infección por COVID-19 hasta el 16 de julio de 2020. Los análisis se realizaron mediante un modelo de efectos aleatorios y sensibilidad. Se realizaron análisis para identificar posibles fuentes de heterogeneidad o evaluar los efectos de los estudios pequeños. Resultados: Se incluyó a 307.596 pacientes de 16 estudios, de los que 46.321 (15,1%) tenían ECV. La tasa de mortalidad fue del 8,2% (20.534 pacientes) y fue superior en los registros hospitalarios (48,7%) en comparación con los informes nacionales (23,1%). Un total de 11.213 (24,2%) pacientes con ECV fallecieron y las tasas de mortalidad también fueron más altas en los registros hospitalarios (48,7%) en comparación con los informes nacionales (23,1%). La ECV se asoció con un riesgo de mortalidad 4 veces mayor (OR, 4,33;IC95%, 3,16-5,94). Se disponía de datos de 28.048 pacientes con diabetes que también se asoció a un mayor riesgo de mortalidad (OR, 2,41;IC95%, 1,79-3,26;p < 0,001). De 40.173 pacientes con hipertensión, también se concluyó que era un factor de riesgo de mayor mortalidad (OR, 2,60, IC95%, 2,10-3,21;p < 0,001). Conclusiones: Los pacientes con ECV e infección por COVID-19 tienen un riesgo 4 veces mayor de muerte. La diabetes y la hipertensión arterial también son factores de mayor riesgo en los pacientes con COVID-19.

The Effect of Age on Mortality in Patients With COVID-19: A Meta-Analysis With 611,583 Subjects.

OBJECTIVES: Initial data on COVID-19 infection has pointed out a special vulnerability of older adults. DESIGN: We performed a meta-analysis with available national reports on May 7, 2020 from China, Italy, Spain, United Kingdom, and New York State. Analyses were performed by a random effects model, and sensitivity analyses were performed for the identification of potential sources of heterogeneity. SETTING AND PARTICIPANTS: COVID-19-positive patients reported in literature and national reports. MEASURES: All-cause mortality by age. RESULTS: A total of 611,1583 subjects were analyzed and 141,745 (23.2%) were aged ≥80 years. The percentage of octogenarians was different in the 5 registries, the lowest being in China (3.2%) and the highest in the United Kingdom and New York State. The overall mortality rate was 12.10% and it varied widely between countries, the lowest being in China (3.1%) and the highest in the United Kingdom (20.8%) and New York State (20.99%). Mortality was <1.1% in patients aged <50 years and it increased exponentially after that age in the 5 national registries. As expected, the highest mortality rate was observed in patients aged ≥80 years. All age groups had significantly higher mortality compared with the immediately younger age group. The largest increase in mortality risk was observed in patients aged 60 to 69 years compared with those aged 50 to 59 years (odds ratio 3.13, 95% confidence interval 2.61-3.76). CONCLUSIONS AND IMPLICATIONS: This meta-analysis with more than half million of COVID-19 patients from different countries highlights the determinant effect of age on mortality with the relevant thresholds on age >50 years and, especially, >60 years. Older adult patients should be prioritized in the implementation of preventive measures.