[Impact of the COVID-19 on health of critical patient]. / Impacto de la COVID-19 en la salud del paciente poscrítico.

INTRODUCTION: Many patients perceive persistent symptoms and impairment in their quality of life after COVID-19. The critical patient is vulnerable to presenting physical and emotional alterations. The objective of this study is to assess the functional evolution and quality of life of the critical patient due to COVID-19. METHODS: A prospective longitudinal multicenter study was carried out in critically ill hospitalized patients due to COVID-19 with a 6 month follow-up. Sociodemographic variables, comorbidity, the persistence of symptoms, SPPB scale, pulmonary and respiratory impact, CT scan, Barthel index, neuropsychological variables, physical activity (IPAQ scale), quality of life (Euroqol), and satisfaction were collected. RESULTS: 115 patients were included. 75% are male and 86% are obese or overweight. The average time of hospitalization was 38.1±18.4 days, with 80.9% requiring mechanical ventilation. 25% need help from another person for self-care at discharge. 29.2% had a normal CT lung screening at 134.1+70.9 days. At 6 months, functional recovery is favorable, although 36.5% perceive muscle weakness and 22% present fragility. 36.5% of patients report a lack of concentration. The most affected dimension in quality of life is that referred to pain (53%), followed by anxiety or depression. Most perform low physical activity. Satisfaction with clinical follow-up is high. CONCLUSIONS: In post-critical patients due to COVID-19, physical, functional, and quality of life alterations prevail at 6 months after hospital discharge.

Covid-19 pandemic's impact on management of cardiovascular risk factors in a Phase IIIs period of a cardiac rehabilitation program, fact or fiction?

Introduction: The global pandemic due to Covid-19 has constituded a challenge in the follow up and monitoring of cardiac rehabilitation's programs. The State of alarm declared last year in Spain, led to strict home confinement that could have had an impact in the progress of patients Aim: To analyze the effect of home confinement on the managment of cardiovascular risk factors (CVRF) in patients included in phase III of a cardiac rehabilitation program (CRP) and also to evaluate the self-care education received during CRP. Methods and materials: Descriptive, comparative and retrospective analysis of patients in phase III of a CRP. The sample was divided into two groups: Post-Covid group (consecutive CRP patients with follow up one year after the cardiac event from 6/21/2020 [date of end of home confinement in Spain] to 12/31/2020) and Group Pre-Covid (consecutive CRP patients with follow up one year after the cardiac event from 6/21/2019 to 12/31/2019). Demographic and CVRF data from end of phase II consultation were compared with those from the phase III consultation (one year after the event) for both groups. The SPSS statistics v23 program was used for statistical analysis. Results: 283 patients, 137 patients from the pre-Covid group and 146 patients from the post-Covid group. No statistically significant differences were found between the two populations (Table 1). No statistically significant differences were found in the achievement of the CVRF target values: systolic blood pressure <140mmHg (94 vs 107;p=0.216), diastolic blood pressure <90mmHg (121 vs 130, p=0.276), LDL-c <70 mg/dl (86 (71.7%) vs 89 (73.6%);p=0.743), LDL-c <55 mg/dl (41 (34.2%) Vs 47 (38.8%);p=0.451), HbA1c figure <7% (106 vs 111;p=0.478), baseline fasting blood glucose <110 mg/dl (103 vs 107;p=0.970). Regarding the variation of the CVRF figures between the final consultation of phase III and that of phase II, no statistically significant differences were found between the two groups: difference in LDL-c figure for phase III consultation with respect to phase II (-0.5±20.3 mg/dl in pre- Covid group vs -5.3±24.4 mg/dl in post-Covid group;p=0.102), difference in HDL-c (4.6±26.1 mg/dl pre-Covid group vs -0.6±24.9 mg/dl post-Covid group;p=0.113), difference in total cholesterol level (4.6±26.1 mg/dl vs -0.6±24.9 mg/dl;p=0.113), difference in HbA1c (0.1±0.3% in pre-Covid group vs 0.1±0.6% in group post-Covid), Table 2. Conclusions: Home confinement has not contribute to a worsening in CVRF control in patients in a phase III of a CRP, in our study. The education given in a CRP concerning to the management of CVRF is the essential factor that grant an adequate patient control in extraordinary circumstances. (Figure Presented).

Impact of SARS-CoV-2 pandemic in a phase II cardiac rehabilitation programme: Looking back

Introduction: SARS-CoV-2 has affected the whole world as a global health pandemic in 2020. A nationwide home confinement was declared in our country by beginning of March. Cardiac rehabilitation programs (CRP) had to adapt to new health requirements and the impact of these changes is unknown. Purpose: To analyse the impact of COVID-19 pandemic in improvement of cardiopulmonary exercise test (CPET) with maximal oxygen consumption uptake (VO2max) and control of cardiovascular risk factors in patients with cardiovascular established disease (coronary heart disease, heart failure or cardiac surgery) included in the phase II of our centre CRP. Methods: 510 consecutive patients were evaluated. A maximal CPET was performed for each patient from the beginning and at the end of phase II of CRP. Enrolled patients were divided in two groups: from March 2019 to March 2020 (before Covid pandemic) and second one, from the beginning of the pandemic in March 2020 until February 2021. Results: 296 patients were studied in preCovid group and 214 patients were studied in Covid group. There were no statistically significant differences between these two groups in reference to cardiovascular risk factors and medical treatment (Figure 1). 82.7% of patients completed a hospital-based program in preCovid group vs 36% in Covid (p=0.001). Comparing the percentage of patients that accomplished the risk factors control targets between pre- and Covid group, statistically significant differences have been seen referring to systolic BP <140mmHg (85.1 vs 95.4%, p=0.001) and cLDL <70 mg/dl (67.2 vs 77.7%, p=0.003). However, in terms of glucose control (fasting blood glucose <110 mg/dl: 78.4 vs 82.2%, p=0.612;HbA1c <7%: 90.7 vs 92.7%, p=0.464) and weight control (BMI: 27.8±4.69 kg/m2 vs 27.3±4.07 kg/m2, p=0.299) this could not be established. There were no differences in psychological attention demand (27 vs 23.3%, p=0.695). Statistical differences between two groups were found in terms of VO2max at the beginning phase II CPET (22.7±7 vs 20±5 ml/min/kg, p=0.006) and ending phase II CPET (24±7 vs 21±6, p=0.001). Nevertheless, no differences were found in the final phase II CPET improvement between both groups (1.4±4.1 ml/kg/min vs 0.81±2.9 ml/kg/min;p=0.221) (Figure 2). Conclusions: SARS-CoV-2 changed our practice from an in-hospital based phase II CRP to a home-based phase II CRP. COVID-19 pandemic had no negative impact in the control of risk factors in our phase II patients. In our experience, despite preCovid phase II patients have a better functional capacity in terms of VO2max, the improvement in VO2max after phase II CRP persists in the SARS-CoV-2 era. This might show that an accurate structure of home-based program could also have great results. (Figure Presented).