ABSTRACT
Introduction: COVID-19 infection has been associated with acute myocardial dysfunction. However, long-term effects of myocardial injury during COVID-19 infection are not well characterized. Novel speckle tracking echocardiography (STE) may lend further insights into COVID-19 myocardial dysfunction. Method(s): Patients hospitalized with acute COVID-19 infection from March 2020 to September 2021 who underwent STE and had evidence of myocardial dysfunction (defined as left ventricular ejection fraction (LVEF) less than 55% and/or global longitudinal strain (GLS) less negative than -18%) were enrolled in follow-up 3-12 months after hospitalization. Clinical and laboratory data were collected, and follow-up STE was performed, including LVEF, GLS, myocardial work index (MWI) and myocardial work efficiency (MWE) measurements. Statistical analysis was performed to determine risk factors for worsening myocardial dysfunction at follow-up. Result(s): Twenty-four patients were enrolled at an average 239+/-102 days after the initial hospitalization echocardiogram: 13 (54%) male, 14 (58%) Black, and average age 56+/-14 years. Average duration of initial admission was 24+/-25 days;14 patients (58%) were admitted to the intensive care unit. Ten (42%) patients had acute respiratory distress syndrome, 1 (4%) had ST-elevation myocardial infarction and 1 (4%) had cardiac arrest. Eleven (46%) patients required mechanical ventilation and 2 (8%) required extracorporeal membrane oxygenation. Five (21%) patients had elevated troponin on admission and average peak troponin was 1.35+/-3.83 ng/ml. Follow-up STE showed significant improvement in average GLS (-13.7+/-3.2% vs -16.0+/-3.7%, P=0.03). There were no significant changes in average LVEF (55.9+/-12.6% vs 55.5+/-8.8%, P=0.90), MWI (1519+/-425 vs 1681+/-412, P=0.24) and MWE (93+/-4 vs 92+/-4, P=0.65) at follow-up compared to during COVID-19 infection. Patients with lower LVEF at follow-up as compared to acute infection (n=11, 46%) were more likely to have had longer duration of symptoms prior to initial presentation (11+/-5 days vs 6+/-5 days, P=0.02) and higher peak erythrocyte sedimentation rate (94+/-30 mm/h vs 44+/-36 mm/h, P=0.007) compared to those with stable or improved LVEF. Conclusion(s): Approximately 8 months after COVID-19 infection, average GLS was significantly improved in patients with myocardial dysfunction during acute COVID-19 infection. Close follow-up is recommended for patients with evidence of myocardial injury during COVID-19 infection, especially those who present with prolonged symptoms and those with high inflammatory markers.Copyright © 2022
ABSTRACT
Introduction: Innovative recruitment strategies such as patient portal messaging (PPM) hold promise for high yield, low-cost recruitment of heart failure (HF) patients for research studies but may impact the diversity of the sample. We aimed to examine strategies used to recruit older adults with advanced HF during COVID-19 in an ongoing prospective palliative care research study. Method(s): We used three recruitment strategies including the traditional in-person HF clinic screening or provider referral, and a more innovative direct-to-patient recruitment approach using EHR patient portal messaging (PPM) or email. We compared characteristics of participants recruited via PPM/email and traditional in-person recruitment strategies using chi-squared and t-tests. We used multiple logistic regression to examine associations between participant characteristics and recruitment type. Result(s): Most participants were recruited through PPM or email (86%, n=247) over 10 months and the remaining participants were recruited through provider referral or in-person recruitment at the heart failure clinic over 6 months (14%, n=40). Among our sample of 287 participants, 67% (n=201) were White, 28% (n=84) were Black, and the remaining 5% (n=13) were Asian, American Indian, or Alaska Native or identify with a non-listed race. The mean age was 68 years old. There was no significant difference in recruitment type by age, gender, or financial strain. There was a significant difference in recruitment type by race and education level. In a multiple logistic regression adjusting for age, gender, and financial strain, Black participants had a lower odds of PPM recruitment than white participants (OR 0.15, p<0.001). Additionally, those with higher education showed higher odds of PPM/email recruitment (OR 4.2 p = 0.001). Conclusion(s): In this study, PPM was an efficient recruitment strategy with higher odds of recruiting participants of White race and higher education compared to traditional recruitment strategies. Use of both traditional and more innovative direct-to-patient recruitment strategies may promote a more diverse study sample.
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Objective: To examine risk factors for cardiac-related postacute sequelae of SARS-CoV-2 infection (PASC) in community-dwelling adults after acute COVID-19 infection. Methods: We performed a cross-sectional analysis among adults who tested positive for COVID-19. Outcomes were self-reported cardiac-related PASC. We conducted stepwise multivariable logistic regression to assess association between the risk factors (existing cardiovascular disease (CVD), pre-existing conditions, days since positive test, COVID-19 hospitalisation, age, sex, education, income) and cardiac-related PASC. Results: In a sample of 442 persons, mean (SD) age was 45.4 (16.2) years, 71% were women, 13% were black, 46% had pre-existing conditions, 23% had cardiovascular (CV) risk factors and 4% had CVD. Prevalence of cardiac PASC was 43% and newly diagnosed cardiac conditions were 27%. The odds for cardiac-related PASC were higher among persons with underlying pre-existing conditions (adjusted OR (aOR): 2.00, 95% CI: 1.28 to 3.10) and among those who were hospitalised (aOR: 3.03, 95% CI: 1.58 to 5.83). Conclusions: More than a third of persons with COVID-19 reported cardiac-related PASC symptoms. Underlying CVD, pre-existing diseases, age and COVID-19 hospitalisation are possible risk factors for cardiac-related PASC symptoms. COVID-19 may exacerbate CV risk factors and increase risk of complications.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has been associated with a wide spectrum of cardiovascular manifestations. Since the beginning of the pandemic, echocardiography has served as a valuable tool for triaging, diagnosing and managing patients with COVID-19. More recently, speckle-tracking echocardiography has been shown to be effective in demonstrating subclinical myocardial dysfunction that is often not detected in standard echocardiography. Echocardiographic findings in COVID-19 patients include left or right ventricular dysfunction, including abnormal longitudinal strain and focal wall motion abnormalities, valvular dysfunction and pericardial effusion. Additionally, some of these echocardiographic abnormalities have been shown to correlate with biomarkers and adverse clinical outcomes, suggesting an additional prognostic value of echocardiography. With increasing evidence of cardiac sequelae of COVID-19, the use of echocardiography has expanded to patients with cardiopulmonary symptoms after recovery from initial infection. This article aims to highlight the available echocardiographic tools and to summarize the echocardiographic findings across the full spectrum of COVID-19 disease and their correlations with biomarkers and mortality.
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Background: Caregivers of persons with heart failure must manage high levels of patient health care utilization, treatment complexity and often unpredictable stressors associated with intermittent symptom exacerbations and mortality. Interventions have often focused on the needs of the person with HF, not the caregiver. Therefore, we developed an intervention using human-centered design to provide caregiver-targeted support for this population. Objective: Pilot test the feasibility and gauge initial effect size of the Caregiver Support intervention to improve quality of life (mental and physical), caregiver burden, and self-efficacy among family caregivers from baseline to 16 weeks. Methods: The intervention includes five individualized, nurse-led sessions over 10 weeks conducted remotely (due to COVID-19). Intervention components focus on 1) nature of caregiving, 2) life purpose, 3) co-development of an action plan to address caregiver goals to reduce caregiver burden and improve caregiver well-being, 4) exploration of social and community resources to support unmet needs, and 5) building a sustainability plan for addressing future caregiver needs. We tested our approach in a randomized waitlist control pilot trial (N=35) from August 2020 through March 2022. We calculated enrollment and retention rates, described acceptability, and computed intervention effect sizes from baseline to 16 weeks. Results: 35 out of 101 (35%) eligible caregivers enrolled and were majority female (93.3%), White (60%) and spousal caregivers (63.3%). Average age was 59.4 ± 16.6 years. Overall retention was 69%. All intervention participants completed the five core components, reporting high levels of satisfaction and acceptability of activities. Between-group effect sizes (n=21) at 16 weeks suggest improvement in the mental health component of quality of life, caregiver burden, and self-efficacy (effect sizes 0.88, 0.31, and 0.63, respectively). Conclusion: Caregivers found Caregiver Support acceptable and study methods were feasible, despite challenges to engaging during the COVID-19 pandemic. Findings provide foundational evidence that this person-centered behavioral intervention can contribute to enhanced caregiver outcomes.
ABSTRACT
Purpose There is increasing evidence of adverse cardiovascular morbidity associated with SARS-CoV-2 (COVID-19). Pro-B-type natriuretic peptide (proBNP) is a biomarker of myocardial stress associated with outcomes in various respiratory and cardiac diseases. We hypothesized that proBNP level would be associated with mortality and clinical outcomes in hospitalized COVID-19 patients. Methods We performed a retrospective analysis of hospitalized COVID-19 patients (n=1232) using adjusted logistic and linear regression to assess the association of admission proBNP (analyzed by both categorical cutoff >125 pg/mL and continuous log transformed proBNP) with clinical outcomes. Covariates included age, sex, race, body mass index (BMI), hypertension, coronary artery disease (CAD), diabetes, smoking history, and chronic kidney disease stage (Model 1), with Troponin I added in Model 2. We performed survival analysis by a multivariate Cox proportional hazard model, incorporating log transformed proBNP. We additionally treated BMI, a strong potential confounder of both proBNP levels and COVID-19 outcomes, as an ordinal variable ordered across tertiles. Results Patients were mean age 62.9±17.6, 53.8% male, and 35.9% Black. Preadmission comorbidities were hypertension (57.1%), diabetes (31.6%), CAD (9.0%) and heart failure (HF, 10.6%). In Model 1 and 2, higher proBNP level was significantly associated with death, new HF, length of stay, ICU duration and need for ventilation among hospitalized COVID-19 patients. This significance persisted after ordinal compression of BMI across tertiles. The adjusted hazard ratio of death for log[proBNP] was 1.56 (95% CI: 1.23-1.97;P<0.0001). Conclusion Using a relatively large and racially diverse hospitalized COVID-19 patient cohort, we find that proBNP is associated with adverse clinical outcomes, including mortality and new HF in COVID-19. Further prospective investigation is warranted on the utility of proBNP for clinical prognostication in COVID-19.