ABSTRACT
Objectives The effects of in-utero SARS-CoV-2 exposure on the long-term health of exposed infant are unknown. Many in-utero events, including maternal illness, affect the developing fetus. Early impacts often manifest as body size differences, which can herald cardiometabolic risk later in life. Our objective is to determine the effects of in-utero SARS-CoV-2 exposure on fetal body growth and composition. Methods This study is nested in the COVID-19 Mother Baby Outcomes (COMBO) Initiative, a multidisciplinary collaborative intended to follow health outcomes in SARS-CoV-2 exposed mothers and their newborns. Anthropometric measures (weight, length, head circumference) and body composition measures by Quantitative Magnetic Resonance (QMR;fat mass, lean mass and total water) were obtained at two time points: 0-2 weeks of life and 16-32 weeks of life. Continuous variables were compared using Wilcoxon Rank Sum and categorical variables using chi2 test. Stepwise regression identified the most parsimonious model by AIC when estimating lean and fat mass, with exposure status, infant age, infant sex, mode of delivery, gestational age, maternal ethnicity and all anthropometric parameters in the full model, using the statistical program R (Version 4.0.3);p-value<0.05. Results The infant cohort to date (20 exposed [EXP], 19 unexposed [UNEXP]) includes 64% male, 62% born by vaginal delivery, and a median gestational age of 39.0 weeks (Table 1). Maternal Hispanic ethnicity differed between groups (78% EXP vs. 33% UNEXP, p=0.007). Distribution of crude anthropometric and body composition measures are shown in Table 2. Following stepwise model selection, the final lean mass model retained maternal exposure status as a predictor and gestational age and weight were significant predictors in the final linear regression model. In the final fat mass model, exposure status was not retained after stepwise model selection and length and weight were significant predictors (Table 3). Conclusions In a prospective observational cohort study of infants born during the COVID-19 pandemic, Hispanic maternal ethnicity was overrepresented in the exposed group, adding to our growing understanding of the COVID-19 pandemic exacerbating health disparities. In parsimonious linear regression models obtained using stepwise model selection, length and weight were predictors of fat mass, and gestational age and weight were predictors of lean mass. Recruitment and prospective measurements are ongoing.
ABSTRACT
Introduction: The HEART score is an effective method of risk stratifying emergency department (ED) patients with chest pain. The low rate of major adverse cardiovascular events (MACE) in patients with a moderate risk HEART score referred from an urgent care (UC) center for an expedited outpatient cardiology evaluation was first described by this group in 2020. This is a follow up study with a total of 446 patient over a 36 month period. Hypothesis: Patients with a moderate risk HEART score who present to the ED are usually hospitalized for further evaluation. The safety of outpatient evaluation of these patients is not well studied. We assessed the hypothesis that there is a low rate of MACE when patients with a moderate risk HEART score were referred from an UC for an expedited outpatient cardiology follow up. Method(s): A cross sectional study was performed from 2/14/2019 through 3/30/2022 in 5 UC centers of 446 patients who presented with chest pain or anginal equivalent and a HEART score of 4 to 6 in Las Vegas, Nevada. A streamlined disposition protocol was adopted by all UC providers for an expedited outpatient cardiology instead of ED referral. The population was followed for 6 weeks with a primary endpoint of MACE (death, myocardial infarction (MI), revascularization) determined by electronic medical records review and direct phone contact with patients. Outcomes were confirmed in 93% of patients. Result(s): The average age was 65 years with 52% female and 48% male. 395 patients (89%) were seen by a cardiology provider, 346 patients (88%) were seen within 3 days. 265 stress tests (67%), 42 coronary CT angiograms (11%) and 19 invasive coronary angiograms (5%) were ordered. 8 patients (2%) were found to have MACE: 2 had routine surgical revascularization, 4 had non-fatal MI followed by revascularization, 2 patients died: 1 was urgently referred for mitral valve replacement and died after surgery from renal failure and COVID, the other patient died from COVID pneumonia. There were no ischemic cardiac deaths. Conclusion(s): In conclusion, patients with a moderate risk HEART score referred from UC for an expedited outpatient cardiology evaluation had a low rate of MACE and no ischemic cardiac deaths due to delay of care.
ABSTRACT
Background: Patients with SARS-CoV-2 who initially present with gastrointestinal (GI) symp-toms, with or without respiratory symptoms, have a milder clinical course than those who do not have GI complaints. Risk factors for severe COVID-19 disease include increased adiposity and sarcopenia, but whether these risk factors are similarly associated with worse outcomes among patients with GI symptoms has not been established. Methods: This was a retrospective study of hospitalized patients with COVID-19 who underwent abdominal CT scan for clinical indications within 30 days of positive SARS-COV-2 test. Abdominal body composition measures including skeletal muscle index (SMI), intramuscular adipose tissue index (IMATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral-to-subcutaneous adipose tissue ratio (VAT/SAT Ratio) were measured on a single axial CT slice at the L3 vertebral level. Hepatic steatosis was measured by absolute liver attenuation and by liver/spleen attenuation ratio. Clinical characteristics and outcomes were collected from the electronic medical record. GI symptoms were classified at time of first positive SARS-CoV-2 test. The association between body composition measurements and the primary outcome of death or discharge to hospice within 30 days after positive SARS-CoV-2 test was tested. Results: Of 190 patients with COVID-19 who had abdominal CT scans, 117 (62%) had GI symptoms including nausea, vomiting, diarrhea, or abdominal pain. Among those without GI symptoms at presentation, the most common reasons for abdominal CT scan were as part of a multi-organ evaluation of fever/sepsis, evaluation of GI symptoms that developed later during the hospital course, and evaluation for retroperitoneal hemorrhage. There were no differences in baseline patient characteristics comparing those with or without GI symptoms (Table 1). Patients with GI symptoms were less likely to be admitted to the ICU than patients without GI symptoms (16% versus 37% respectively;p <0.01) but had similar 30-day mortality (15% versus 18% respectively;p=0.66). Among patients with GI symptoms, those who died or were discharged to hospice had significantly increased IMATI (unadjusted p=0.025) and no differences in other measures (Table 2). On the other hand, among patients without GI symptoms, those who died or were discharged to hospice within 30 days had increased IMATI (p=0.049), reduced SMI (p=0.010), and increased VAT/SAT Ratio that was not statistically significant (p=0.419). Conclusions: Among patients with COVID-19, the relationship between measures of adiposity/sarcopenia and death differs in patients with and without GI symptoms.(Table Presented)Table 1. Clinical Characteristics among 190 patients hospitalized for COVID-19 based on presence of GI symptoms.(Table Presented)Table 2. Body composition measurements among 117 patients with GI symptoms and 73 patients with no GI symptoms based on death/hospice at 30 days.
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Background: Hospitalised cancer patients have a three times higher risk of death (14%) from COVID-19 than the general public. Vaccination provides an unprecedented opportunity to decrease morbidity & mortality, however, there is a limited data regarding cancer patients’ attitudes towards COVID-19 vaccination. Methods: An anonymised questionnaire was completed by volunteering cancer patients attending the ambulatory care unit of a large tertiary cancer centre (Feb to April 2021), prior to vaccination rollout in this cohort. It assessed patients’ acceptance of, and attitudes toward, COVID-19 vaccination. Statistical significance was assessed with Chi-square test (χ2). Results: There was an 80% response rate (143/179). This included 79 females (55%) with a median age range of 51–60 yrs. (n = 35/24%). Most (78%) had a good performance status (PS = 0-1) & lung was the most frequent (28%) cancer type. Eight (6%) had previous COVID-19 infection. Among respondents, 128 (90%) intended on getting vaccinated, 12 (8%) were unsure & three (2%) would refuse. Those intent on vaccination were less concerned with side effects, viewed the pandemic as serious & perceived cancer as a cause for more severe infection compared to the rest (Table). All 101 (71%) patients who received the influenza vaccine were intent on COVID vaccination. Almost 20% (n=28) reported that they were more likely to receive the flu vaccine due to the pandemic. Twelve (8%) identified attending their GP as a barrier, with 97% (n=135) willing to attend hospital for vaccination. While this service is free, 69% (n=99) were willing to pay, with nearly 40% (n=57) up to €50. [Formula presented] Conclusions: Our study demonstrates a very high acceptance rate of COVID-19 vaccination among Irish cancer patients such that many would be willing to pay & attend hospital to receive it. The barriers to uptake provide an opportunity to improve education. An unexpected consequence, may be a beneficial increased uptake of the influenza vaccine. Legal entity responsible for the study: S. Cuffe. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
The HEART score is an effective method of risk stratifying emergency department (ED) patients with chest pain. The rate of major adverse cardiovascular events (MACE) Background in patients with moderate HEART score referred from an urgent care (UC) for an expedited outpatient cardiology evaluation for 11 months was described in 133 patients in a previous study. This is a follow-up study with 18 months of data and 206 patients. The primary outcome was to examine the rate of MACE when patients with moderate HEART score were referred for an expedited outpatient cardiology Aim follow-up after evaluation in urgent care. The secondary outcome was to determine if there is a decrease in rate of ED transfer after this protocol was introduced. A cross-sectional study was conducted by a multispecialty group in Las Vegas, Nevada, which included 206 patients with a HEART score of 4 to 6 (i.e.: moderate risk) who presented to one of five UC centers with chest pain or an anginal equivalent. A streamlined evaluation protocol to assess each HEART score component was adopted by all UC providers to facilitate an expedited outpatient cardiology follow-up, Methods as an alternative to referral to the emergency department. Data was collected from February 14, 2019 through August 13, 2020. The population was followed for 6 weeks with a primary endpoint of MACE determined by electronic medical record review and direct phone contact with patients. Outcomes were confirmed in 98% of patients. Chest pain transfer data was compared between 12 months prior to implementing HEART protocol and 18 months of data analysis while using the new protocol. Over the course of 18 months, 206 patients with a moderate risk HEART score were referred to outpatient cardiology in an expedited manner. The average age was 65 with 53% female and 47% male patients. 150 patients (73% of the 206) were seen within 3 days, 114 (55%) underwent stress testing, 6 (3%) had coronary computed tomography angiogram, and 6 (3%) received an invasive coronary angiogram. Five patients were found to have MACE: one patient who had a non-ST-elevation myocardial infarction Results and subsequent coronary stent, two patients were found to have obstructive disease after coronary angiography with subsequent coronary artery bypass graft, one patient had an abnormal stress test and subsequent coronary stent, and one patient had critical mitral stenosis, multi-vessel coronary artery disease and underwent coronary artery bypass graft with mitral valve replacement with complications of renal failure and COVID-19 and expired. The emergency department referral rate declined by 21%. Patients with a moderate risk HEART score referred from UC for an expedited Conclusion outpatient cardiology evaluation had a low rate of MACE and no deaths due to delay of care. There was also a significant decrease in the rate of ED referrals. © 2021 Complex Issues of Cardiovascular Diseases. All rights reserved.