ABSTRACT
Background The emergence of Coronavirus disease 2019 (COVID-19) has evolved into a global pandemic. Systems of care have been reorganized worldwide in an effort to preserve hospital bed capacity. In France, from March 17 to May 11 2020, government imposed a complete lockdown on the whole population. Only urgent cardiac procedures have been ensured such as ST-elevation myocardial infarction (STEMI) revascularization. Some previously published studies suggest a reduction of admission for STEMI in many countries. Nevertheless, strong evidences and data across different French regions that have been affected variously by the outbreak are still lacking. Purpose We aimed to describe the incidence rates and characteristics of patients presenting with STEMI in order to evaluate the impact of the COVID-19 outbreak on STEMI care in France covering the lockdown period compared to same period one year ago. Methods We performed a retrospective multicenter registry across 60 French interventional cardiology centers including all consecutive STEMI patients referred for urgent revascularization in the heart catheterization laboratory between two periods: March 1st to May 31th 2020 compared with March 1st to May 31th 2019. Comprehensive data, including clinical, biological, COVID status and angiographic variables including time taken for care were recorded at admission. The primary outcome was a composite of invasive mechanical ventilation support or in-hospital death. The secondary outcome was the occurrence of myocardial infarction related complications during hospitalization. Enrollement is not complete at the time of the submission. Conclusion This data collection between two periods with and without COVID19 will gave insights for a complete descriptive cartography of STEMI patients among different French regions which have been variously impacted by the outbreak.
ABSTRACT
Introduction - The smoking rate has decreased in France in recent years, with the implementation of national anti-smoking plans. France, like the rest of the world, was however affected by an exceptional crisis in 2020 linked to the COVID-19 pandemic. The objective of this study is to estimate the smoking rate in 2020 and its evolution since 2019. Methods - Data come from the 2020 Health Barometer of the national public health agency, Sante publique France, a telephone survey with random sampling conducted between January and March, then between June and July 2020, among 14,873 adults aged 18-85 living in metropolitan France. Results - In 2020, more than three out of ten French people between 18 and 75 years of age reported smoking (31.8%), and a quarter were daily smokers (25.5%). Overall, the smoking and daily smoking rates did not vary significantly between 2019 and 2020. However, the daily smoking rate increased among the lowest-income third of the population, from 29.8% to 33.3%. This increase is mainly due to an increase between 2019 and early 2020, before the first lockdown. Social inequalities thus remain very pronounced, with a 15-point gap between the lowest and highest incomes. Conclusion - After an unprecedented drop in smoking in France in recent years, the prevalence has stabilized in 2020. In a context of exceptional health, psychological, economic and social crisis, one of the challenges is to reinstate a downward trend, and to further strengthen the fight against social inequalities with regard to smoking, which are very marked.
ABSTRACT
Introduction: Although cardiac involvement has prognostic significance in COVID-19 and is associated with severe presentations, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19. Method: Consecutive patients with COVID-19 admitted in 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed-up for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Results: Among 2878 patients, 445 (15%) underwent TTE. Most had cardiovascular risk factors, a history of cardiovascular disease, and were under cardiovascular medications. Dilatation and dysfunction were observed in12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV), respectively. Primary composite outcome occurred in 44% (n = 196) of patients (9% [n = 42] for death without ICU transfer and 35% [n = 154] for admission to ICU). RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex (hazard ratio [HR] 1.56, 95% CI 1.09 − 2.25;P = 0.02), higher body mass index (HR 1.10, 95% CI 1.02 − 1.18;P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 − 0.86;P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 − 2.64;P = 0.03) remained independently associated with the primary outcome (Fig. 1). Conclusion: Echocardiographic evaluation of RV dilatation could be useful for assessing the risk of inhospital death or transfer to ICU in severe hospitalized COVID-19 patients.