ABSTRACT
OBJECTIVE: To determine the effect of COVID-19 exposure or diagnosis on fertility-related stress and early pregnancy outcomes We hypothesize that COVID-19 exposure or diagnosis would negatively impact fertility-related stress and subsequently fertility and early pregnancy outcomes. MATERIALS AND METHODS: In a single academic center, patients undergoing fertility treatments via IVF or FET between the ages of 18 to 45 were eligible to participate in this study. Patients were recruited at the beginning of their treatment cycle and completed the validated FertiQOL questionnaire as well as an online survey assessing COVID-19 exposure. Primary outcomes include pandemic-related stress levels such as grief, mood, anger, and pain. Cohorts studied included: non-COVID (no concern for COVID-19 infection, including no formal diagnosis or perceived illness) and COVID (perceived/symptomatic or confirmed diagnosis) patients. FertiQOL questionnaire results were analyzed between the two cohort groups. RESULTS: A total of 115 subjects were recruited. The non-COVID cohort consisted of 64 participants and the COVID cohort consisted of 51 participants. There was a significant decrease in satisfaction with the level of support from friends/family (p=0.04), in COVID patients compared to non- COVID patients. COVID patients were more likely for their infertility to negatively impact their mood (p= 0.0005). Though not statistically significant, COVID cohort patients trended towards poorer self-perceived health and decreased satisfaction with available fertility services. There were no significant differences in overall quality of life, anger, depression, pain, or perceived complications with use of medications and treatments. There was also not a significant difference in number of eggs retrieved, percent of mature eggs, or clinical/ongoing pregnancy rates. CONCLUSIONS: The COVID-19 pandemic has had a negative impact on infertility patient populations. Specifically, COVID patients with infertility experienced significantly decreased mood and less support from family and friends compared to non-COVID patients. While there is no difference in overall quality of life, or fertility and early pregnancy outcomes, understanding the nuances of patients' experiences in the pandemic will allow for more insight into the way in which care is provided. Additionally, COVID-19 diagnosis and exposure does not appear to affect fertility treatment or early pregnancy outcomes. Therefore patients may be counseled that previous COVID-19 infection or concerns regarding possible exposure do not affect their fertility and early pregnancy outcomes. IMPACT STATEMENT: This study shows the negative impact of perceived and confirmed COVID-19 exposure on stress levels related to infertility. These findings can guide how IVF patients are counseled and reassured during the pandemic.
ABSTRACT
Introduction: Hospital admissions of patients with cardiovascular disease were markedly reduced in the UK in 2020 during the Covid-19 pandemic. In many institutions, including ours, patient care was redistributed from a specialty-based approach to a ward-based system, meaning some patients being admitted and managed under the care of non-specialist teams. Purpose: We wished to examine the impact of these changes on heart failure (HF) patients presenting during the pandemic and on appropriate delivery of complex device therapies. Methods: The study was undertaken in a large UK teaching hospital. The institution audit programme includes cardiac device therapy provision, aiming to ensure that implantable cardioverter defibrillators and cardiac resynchronisation therapy are offered to the target population in accordance with NICE guidance [Technology Appraisal 314]. In accordance with the guidance, patients admitted to hospital with serious ventricular arrhythmia, familial cardiac condition with high risk of sudden cardiac death (SCD), surgical repair of congenital heart disease (CHD) and patients with HF and LVEF<36% were identified from hospital coding. Findings during the pandemic (March to August 2020) were compared with the same period in 2019. Fisher's exact test was used to compare proportions. Results: Among non-HF patients, device therapy prescription was consistent in the two periods observed. Table 1 shows how many patients were eligible for device therapy and how many were offered it. Table 2 contains details of HF admissions, showing an 8% reduction in admissions during the pandemic. The proportion of patients eligible for device therapy did not change significantly. However, there was a significant reduction in the proportion of eligible patients who were offered device therapy (79% vs 94% p=0.03). In addition, during the pandemic there was a trend towards a greater chance of patients being considered too frail for device therapy (p=0.08). Among 12 patients overlooked for device therapy, 10 were not under the care of Cardiology. Among 31 patients considered too frail for device therapy, 26 were not under the care of Cardiology. Conclusion: During the Covid-19 pandemic, a modest reduction in HF hospital admission was observed with a marked fall in identification of patients eligible for device therapy. Possible explanations include intense pressure to discharge patients quickly, an increased perception of patient frailty during a crisis and the lack of recognition of indications for device therapy when patients are under the care of non-specialists. These findings suggest that cardiac services should actively look for HF patients who may have missed out on life-saving device therapies during the pandemic.
ABSTRACT
Introduction The 2020 Covid-19 pandemic saw a marked nationwide reduction in hospital admissions due to cardiovascular disease. In many institutions, including ours, it also saw redistribution of patient care from a specialty-based approach to a ward-based system, meaning patients being admitted and remaining under the care of non-specialist teams. We wished to examine the impact of these changes on heart failure patients presenting during the pandemic and on appropriate delivery of complex device therapies. Methods The study was undertaken in a large UK teaching hospital, where the annual audit programme includes NICE guidance (Technology Appraisal 314: Implantable Cardioverter Defibrillators and Cardiac Resynchronisation Therapy for Arrhythmias and Heart Failure). As per the NICE guideline, patients admitted to hospital were identified, using discharge codes, with: serious ventricular arrhythmia;familial cardiac condition with high risk of sudden cardiac death (SCD);surgical repair of congenital heart disease;and patients with heart failure and LVEF <36%. Findings during the pandemic (March to August 2020) were compared with non-pandemic (the same period in 2019). Fisher's exact test was used to compare proportions. Results Table 1 shows how many patients were eligible for device therapy and how many were offered it. Among nonheart failure patients, device therapy prescription was consistent in the 2 periods observed. Table 2 shows details of heart failure admissions during the study periods. Among heart failure patients, an 8% reduction in hospital admissions due to heart failure was observed during the pandemic. Among these patients, the proportion eligible for device therapy did not alter significantly. However, there was a significant reduction in the proportion of eligible patients who were offered device therapy (79% vs 94%, p=0.03). In addition, there was a trend towards a greater chance of patients being considered too frail for device therapy during the pandemic (p=0.08). Among 12 patients overlooked for device therapy, 10 were not under the care of Cardiology. Among 31 patients considered too frail for device therapy, 26 were not under the care of Cardiology. Conclusion During the Covid-19 pandemic, a modest reduction in hospital admission for heart failure was observed with a marked fall in identification of those eligible for device therapy. There are a number of possible explanations, including the lack of recognition of indications for device therapy when patients are under the care of non-specialists, an increased perception of patient frailty during a crisis and intense pressure to discharge patients quickly. These findings suggest that cardiac services should actively look for heart failure patients who may have missed out on life-saving device therapies during the pandemic.
ABSTRACT
Introduction The Covid-19 pandemic has put a considerable strain on procedural waiting lists, with the majority of elective outpatient work cancelled during the pandemic. With the vaccination programme and reducing infection levels, attention is turning to addressing these waiting lists. One procedure that was affected was the removal of implantable loop recorders (ILRs). Manufacturers recommend that ILRs are removed at the point of battery depletion (usually 3-4 years), if they have not already been removed due to a positive finding or patient preference. There is little evidence in the literature regarding late complications with ILRs, and we therefore wished to examine what patients' thoughts would be about keeping the ILR in for a longer period of time. Methods Patients awaiting ILR explantation and those who had undergone explantation, were identified. A retrospective review of the notes was used to get demographic and clinical data. Both groups of patients were contacted, and a questionnaire used to gain an understanding of patients' experience and expectations. Results Prior to the Covid-19 pandemic, 60 patients who had undergone ILR explantation were identified. A total of 22 responded to our questionnaire (table 1). The majority (86%) were happy to have their ILR removed, although a smaller majority (59%) would also have been happy to have had the device kept in, were it felt to be safe. Very few patients felt a tangible difference as a result of having the ILR removed (14%) and no patients were worried about the waiting time prior to Covid-19. Of 77 patients currently awaiting explant, 30 responded to our questionnaire (table 1), with 70% not being concerned by the wait for removal. This is likely aided by the fact that 80% of patients had no day to day symptoms as a result of the ILR. Half of the patients however, would be concerned about not having the ILR removed, predominantly due to mild discomfort or concerns regarding the presence of a battery. Across both groups (n=52) only 8 patients were concerned about the risk of coming into the hospital for the procedure, with patients commenting that the stringent regulations that hospitals had employed combined with the vaccination programme, gave them significant confidence in attending for outpatient procedures. Conclusions This study found that if patients are reassured about the safety of keeping an implantable loop recorder in, and do not suffer any discomfort or symptoms as a result of the device, they are happy both to wait longer for device removal, or even not have it removed at all. In the context of the current pandemic, more thought should perhaps be given to patient guided removal times, especially in cases of removals performed for battery depletion.