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Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry. Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 - in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards - from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0 +/- 1.5 months.Results. The age of post-COVID patients with CVMM was 73.7 +/- 9.6 years, without CVD - 49.4 +/- 12.4 years (p<0.001), the proportion of men was 53.9% and 58.4% (p=0.34). In the group with CVMM the majority of patients had AH (92.3-93.3%), CHD (90.4-91.4%), and minority - CHF (42.7-46.0%) and AF (42.9-43.4%). The combination of 3-4 CVDs prevailed (58.9-60.3%). The proportion of cases of chronic non-cardiac pathologies was higher in the CVMM group (80.9%) compared to the group without CVD (36.7%;p<0.001). The frequency of proper cardiovascular pharmacotherapy during the follow-up period decreased from 56.8% to 51.3% (p for trend = 0.18). The frequency of anticoagulant therapy in AF decreased significantly: from 89.1% at the discharge from the hospital to 56.4% after 30-60 days (p=0.001), 57.1% and 53.6% after 6 and 12 months of monitoring (p for a trend <0.001). There were no other significant changes in the frequency of other kinds of the proper cardiovascular pharmacotherapy (p>0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p<0.001) as well as rates of hospitalization (34.7% and 9.9%, p<0.001) and non-fatal myocardial infarction (MI) - 2.5% vs 0.5% (p=0.048). The proportion of new cases of CVD in the groups with CVMM and without CVD was 5.5% and 3.7% (p=0.33). The incidence of acute respiratory viral infection (ARVI)/influenza was higher in the group without CVD - 28.3% vs 19.0% (p=0.02). The proportion of cases of recurrent COVID-19 in groups with CVMM and without CVD was 3.7 % and 1.8% (p=0.19).Conclusion. Post COVID-19 patients with CVMM were older and had the bigger number of chronic non-cardiac diseases than patients without CVD. The quality of cardiovascular pharmacotherapy in patients with CVMM was insufficient at the discharge from the hospital with following non-significant decrease during 12 months of follow-up. The frequency of anticoagulant therapy in AF decreased by 1.6 times after 30-60 days and by 1.7 times during the year of follow-up. The proportion of new cases of CVD was 5.5% and 3.7% with no significant differences between compared groups. The rate of all-cause mortality, hospitalizations and non-fatal MI was significantly higher in patients with CVMM, but the frequency of ARVI/influenza was significantly higher in patients without CVD. Recurrent COVID-19 was registered in 3.7% and 1.8% of cases, there were no significant differences be-tween compared groups.
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Objective. To assess the adherence of COVID-19 convalescents to vaccination against SARS-CoV-2 and immune status based on long-term follow-up (12 months or more after hospital discharge). Material and methods. Using the TARGET-VIP registry, 775 patients (age 57.5+/-1.4 years;50.6% males) with the in-hospital diagnosis of COVID-19 were followed for 13.7+/-3.0 months after discharge. Comparison groups included 190 (24.5%) subjects vaccinated against SARS-CoV-2 and 585 (75.5%) unvaccinated during the follow-up period. Immune status was assessed in a representative sample of 283 (36.5%) patients (age 56.9+/-12.7 years, 44.9% males) who came for outpatient visits 14.6+/-4.1 months after hospital discharge, including 97 (34.3%) vaccinated and 186 (65.7%) unvaccinated against SARS-CoV-2. Results. No significant differences were found between the SARS-CoV-2 vaccinated and unvaccinated groups in age, gender char-acteristics, cardiovascular disease rate, chronic non-cardiac disease rate, and proportion of smokers. In the unvaccinated group, a higher proportion of patients with a history of ICU treatment for COVID-19 and/or grade 3-4 lung injury measured by CT scans was observed: 55.0% versus 46.8% (p=0.048). The vaccinated group included less active smokers: 3.7% versus 6.0% (p=0.22). Among the patients who came to the visit, antibody titer of IgG type N was increased in 50.4% of cases, and antibody titer of IgG type S (quantitatively) - in 98.6% of cases. After 14.6+/-4.1 months of follow-up, the SARS-CoV-2 vaccinated group (12.3+/-2.7 months after COVID-19) had higher IgG type S levels (505+/-103 versus 376+/-171 BAU/mL;p<0.001) compared with unvaccinated patients and no statistically significant difference in IgG (type N) and IgM titers. The SARS-CoV-2 vaccinated group had significantly higher rates of influenza vaccination both before COVID-19 (34.8% versus 21.9%;p=0.0004) and after hospitalization for COVID-19 (37.0% versus 15.0%;p<0.0001) compared with the unvaccinated group. After COVID-19, compared to the period before hospitalization, the proportion of vaccinated against influenza in the group vaccinated against SARS-CoV-2 increased (from 34.8% to 37.0%;p=0.65) and decreased in the group unvaccinated against SARS-CoV-2 (from 21.9% to 15.0%;p=0.003). Conclusion. The study showed that only 24.5% of COVID-19 survivors were subsequently vaccinated against SARS-CoV-2 over a fol-low-up period of 13.7+/-3.0 months. One year after hospital discharge, 50.4% of patients had elevated IgG type N titer, and 98.6% of patients had high IgG type S titer, significantly higher in vaccinated patients. Adherence to influenza vaccination after hospitalization for COVID-19 increased in patients subsequently vaccinated against SARS-CoV-2 and decreased in unvaccinated patients. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.
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Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry. Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 - in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards - from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0+/-1.5 months. Results. The age of post-COVID patients with CVMM was 73.7+/-9.6 years, without CVD - 49.4+/-12.4 years (p<0.001), the proportion of men was 53.9% and 58.4% (p=0.34). In the group with CVMM the majority of patients had AH (92.3-93.3%), CHD (90.4-91.4%), and minority - CHF (42.7-46.0%) and AF (42.9-43.4%). The combination of 3-4 CVDs prevailed (58.9-60.3%). The proportion of cases of chronic non-cardiac pathologies was higher in the CVMM group (80.9%) compared to the group without CVD (36.7%;p<0.001). The frequency of proper cardiovascular pharmacotherapy during the follow-up period decreased from 56.8% to 51.3% (p for trend = 0.18). The frequency of anticoagulant therapy in AF decreased significantly: from 89.1% at the discharge from the hospital to 56.4% after 30-60 days (p=0.001), 57.1% and 53.6% after 6 and 12 months of monitoring (p for a trend <0.001). There were no other significant changes in the frequency of other kinds of the proper cardiovascular pharmacotherapy (p>0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p<0.001) as well as rates of hospitalization (34.7% and 9.9%, p<0.001) and non-fatal myocardial infarction (MI) - 2.5% vs 0.5% (p=0.048). The proportion of new cases of CVD in the groups with CVMM and without CVD was 5.5% and 3.7% (p=0.33). The incidence of acute respiratory viral infection (ARVI)/influenza was higher in the group without CVD - 28.3% vs 19.0% (p=0.02). The proportion of cases of recurrent COVID-19 in groups with CVMM and without CVD was 3.7 % and 1.8% (p=0.19). Conclusion. Post COVID-19 patients with CVMM were older and had the bigger number of chronic non-cardiac diseases than patients without CVD. The quality of cardiovascular pharmacotherapy in patients with CVMM was insufficient at the discharge from the hospital with following non-significant decrease during 12 months of follow-up. The frequency of anticoagulant therapy in AF decreased by 1.6 times after 30-60 days and by 1.7 times during the year of follow-up. The proportion of new cases of CVD was 5.5% and 3.7% with no significant differences between compared groups. The rate of all-cause mortality, hospitalizations and non-fatal MI was significantly higher in patients with CVMM, but the frequency of ARVI/influenza was significantly higher in patients without CVD. Recurrent COVID-19 was registered in 3.7% and 1.8% of cases, there were no significant differences between compared groups. Copyright © 2022 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.
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Aim. To assess long-term outcomes within 12 months after hospital treatment of patients with coronavirus disease 2019 (COVID-19) as part of a prospective registry. Material and methods. Outcomes in the posthospital period were assessed in 827 patients diagnosed with COVID-19 (age, 58,0±14,8 years;men, 51,3%). For periods of 30-60 days, 6 and 12 months after discharge from the hospital,cases of death, nonfatal myocardial infarction (MI) and stroke, hospitalization, acute respiratory viral infections/influenza were assessed. The follow-up period was 13,0±1,5 months. Results. During the follow-up period, 35 (4,2%) patients died, 6 (0,73%) and 4 (0,48%) cases of MI and stroke were registered. In addition, 142 (17%) patients were hospitalized, while 217 (26,2%) patients had acute respiratory viral infections/influenza. Factors of age and length of intensive care unit stay were significantly associated (p<0,001) with the risk of all-cause death (hazard ratio (HR)=1,085 per 1 year of life and HR=6,98, respectively), with the risk of composite endpoint (death, non-fatal MI and stroke): HR=1,081 per 1 year of life and HP=4,47. Of the 35 deaths, 11 (31%) were within the first 30 days of follow-up, and 19 (54%) — 90 days after discharge from the hospital. A higher probability of hospitalization was associated with older age (odds ratio (OR)=1,038;p<0,001), while a higher probability of acute respiratory viral infections/influenza was associated with younger age (OR=0,976 per 1 year of life;p<0,001) and female sex (OR=1,414;p=0,03). Conclusion. A prospective follow-up of 827 patients in the TARGET-VIP registry revealed that 12-month mortality was 4,2%, while more than half of the deaths (54%) were registered in the first 90 days, including 31% — for the first month after discharge from the hospital. The most common events were hospitalizations (17,0%) and acute respiratory viral infections/influenza (26,2%), while the rarest were myocardial infarction (0,73%) and stroke (0,48%). The key factors associated with 12-month mortality in the post-COVID-19 period were older age and intensive care unit stay during the reference hospitalization. A higher readmission rate during the follow-up period was associated with older age, and the prevalence of acute respiratory viral infections /influenza during the follow-up period was associated with younger patients and female sex.
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Aim. According to hospitalbased registry, to evaluate the age characteristics and prevalence of concomitant cardiovascular and nonсardiovascular diseases in patients hospitalized with COVID19 during epidemic wave. Material and methods. The TARGETVIP register included 1130 patients aged 57,5±12,8 years (men, 51,2%) hospitalized at the Pirogov National Medical and Surgical Center from April 6, 2020 to June 22, 2020 with COVID19. Cardiovascular diseases (CVDs) were diagnosed in 51,6% of patients, nonсardiovascular chronic diseases — in 48,6%, while CVDs and/or nonсardiovascular chronic diseases — in 65,8% of patients. Results. The average age of patients significantly increased by an average of 0,77 years per week (p<0,001), while the difference between the 1st week (52,8 years) and 11th week (62,2 years) was 9,4 years;the proportion of men did not change significantly. The proportion of patients with CVDs increased significantly — from 34,2% to 66,7%, on average by 3,7% per week (p<0,001;Incidence Risk Ratio (IRR)=1,037;95% confidence interval (CI), 1,0171,058), with chronic noncardiovascular diseases — from 32,5% to 43,2%, on average by 2,5% per week (p<0,001;IRR=1,025;95% CI, 1,0021,049), as well as those with CVDs and/or chronic noncardiovascular diseases — from 47,5% to 75,3%, on average by 3,2% per week (p<0,001;IRR=1,032;95% CI, 1,0171,048). Over the entire period, the proportion of people with hypertension (HTN) was 47,0%, with coronary artery disease (CAD) — 15,4%, with heart failure (HF) — 4,0%, and with atrial fibrillation (AF) — 10,1%. The proportion of patients with НTN increased by 9,5% (p<0,001;OR=1,095;95% CI, 1,0471,144), with СAD — by 9,4% (p=0,01;OR=1,094;95% CI, 1,0221,172) and with AF — by 9,4% (p<0,001;OR=1,094;95% CI, 1,0231,170) per week. The proportion of patients with diabetes was 16,5%, with respiratory diseases — 11,4%, with chronic kidney disease (CKD) — 12,6%, with digestive diseases — 22,5%, with obesity — 6,1%. During the epidemic wave, the most pronounced increase in the proportion of patients with CKD was by 6,2% (p=0,036;OR=1,062;95% CI, 1,0041,124) and with digestive diseases — by 6,0% (p=0,01;OR=1,060;95% CI, 1,0141,109) per week. Conclusion. According to the 11week TARGETVIP registry, the age of patients increased by 9,4 years, CVD cases — by 1,9 times (mainly HTN, CAD, AF), and chronic nonсardiovascular pathology — by 1,3 times (mainly CKD and digestive diseases). These trends in hospital practice corresponded to a weekly increase in the proportion of patients with a higher risk of fatal and nonfatal complications, which is the basis for further research in order to develop a system for a comprehensive prognostic assessment of the degree and rate of increase in the load on hospitals during COVID19 epidemic wave.
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Aim. Based on the data from the register of patients with COVID-19 and community-acquired pneumonia (CAP), analyze the duration of the prehospital period, cardiovascular comorbidity and the quality of prehospital pharmacotherapy of concomitant cardiovascular diseases (CVD). Material and methods. Patients were included to the study which admitted to the FSBI "NMHC named after N.I. Pirogov" of the Ministry of Health of the Russian Federation with a suspected or confirmed diagnosis of COVID-19 and/or CAP. The data for prehospital therapy, information from medical histories and a patients’survey in the hospital or by telephone contact 1-2 weeks after discharge were study. The duration of the prehospital stage was determined from the date of the appearance of clinical symptoms of coronavirus infection to the date of hospitalization. Results. The average age of the patients (n=1130;579 [51.2%] men and 551 [48.8%] women) was 57.5±12.8 years. The prehospital stage was 7 (5,0;10,0) days and did not differ significantly in patients with the presence and absence of CVD, but was significantly less in the deceased than in the surviving patients, as well as in those who required artificial lung ventilation (ALV). 583 (51.6%) patients had at least one CVD. Cardiovascular comorbidity was registered in 222 (42.7%) patients with hypertension, 210 (95.5%) patients with coronary heart disease (CHD), 104 (91.2%) patients with atrial fibrillation (AF). The inclusion of non-cardiac chronic diseases in the analysis led to an increase in the total proportion of patients with concomitant diseases to 65.8%. Approximately a quarter of hypertensive patients did not receive antihypertensive therapy, a low proportion of patients receiving antiplatelet agents and statins for CHD was revealed – 53% and 31.8%, respectively, anticoagulants for AF – 50.9%. Conclusion. The period from the onset of symptoms to hospitalization was significantly shorter in the deceased than in the surviving patients, as well as in those who required ALV. The proportion of people with a history of at least one CVD was about half of the entire cohort of patients. In patients with CVD before COVID-19 disease, a low frequencies of prescribing antihypertensive drugs, statins, antiplatelet agents and anticoagulants (in patients with AF) were recorded at the prehospital stage. © 2021 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.
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Aim: To estimate age characteristics, proportion of concomitant cardiovascular diseases (CVD), cardiovascular pharmacotherapy during prehospital period in patients with COVID-19 and community acquired pneumonia (CAP) according the data of hospital registry. Methods: The registry included all patients admitted to the special COVID-19 center from April 6 to June 2, 2020 with suspected or confirmed COVID-19 and CAP. This enrollment period was corresponding to the main part of the first epidemic wave of COVID-19 in megapolis (the number of new cases on April 6 and July 2, 2020 was 591 and 662, respectively, the maximal number, 6703 cases, was registered on May 7). COVID-19 was diagnosed in cases of positive polymerase chain reaction test (60.7%) or according to computed tomography data. Results: The registry included 1.130 patients (age 57.5±12.8 years, 51.2% men). CAP was diagnosed in 94% of cases, CVD -in 52.9%. Mean age values (from the 1-st up to the 11-th weeks of enrollment period) were, respectively, week by week: 52.8;54.3;57.3;59.6;56.9;60.0;57.2;62.7;59.3;57.4 and 62.2 years (p<0.001;B-coefficient 0.78;95% Confidential Interval, CI 0.50-1.07). The proportion of patients with CVD was for each of these weeks, respectively: 34.2%;43.0%;52.9%;53.5%;50.5%;61.4%;53.9%;68.9;63.1%;54.8% and 66.7% (p<0.001;Odds Ratio 1.04;95% CI 1.02-1.06). So, during enrollment period the mean age of patients increased significantly (on average by 0.78 years per week) as well as the proportion of CVD cases increased from 34.2% up to 66.7% (average 51.5%). The mean duration of period from the first day of clinical symptoms until the date of hospitalization was 8.3±5.9 days (median 7;with Q1-Q3 from 5 to 10). There were no significant difference for the length of this period between groups of patients with and without CVD: 8.4±6.2 and 8.3±5.7 days (median 7;with Q1-Q3 from 5 to 10 for both groups), p=0.82;between age groups of ≥65 years and <65 years: 8.8±7.2 and 8.1±5.3 days (median 7 with Q1-Q3 from 5 to 10, and 7 with Q1-Q3 from 4 to 10, respectively), p=0.07. Antihypertensive therapy during prehospital period was administered in 78.4% cases of hypertension, ACE inhibitors/sartans in patients with chronic heart failure (CHF) and history of myocardial infarction (MI) -in 64.6% and 52.3%, beta-blockers in CHF and history of MI-54.4% and 42.2%, statins in coronary artery disease (CAD)-28.9%, antiplatelets in CAD without atrial fibrillation (AF)-50.4%, anticoagulants in AF-57.5%. Conclusions: Prehospital period in patients with COVID-19, communityacquired pneumonia enrolled into the hospital registry was characterized by rising of age and proportion of CVD cases during enrollment period. The correspondence of cardiovascular pharmacotherapy to clinical guidelines was insufficient that must be improved in clinical practice during time interval between first symptoms and hospitalization date.
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Aim. To characterize patients admitted to hospital with suspected or documented COVID-19 infection and community-acquired pneumonia (CAP) and to assess the prevalence of concomitant cardiovascular, non-cardiac diseases, prehospital cardiovascular therapy and outcomes of in-hospital treatment. Material and methods. The TARGET-VIP registry includes patients admitted to the N. I. Pirogov National Medical and Surgical Center with suspected or documented COVID-19 infection and/or CAP for the period from April 6, 2020 to July 2, 2020. COVID-19 infection was diagnosed using polymerase chain reaction (PCR) tests and chest computed tomography (CT). Comorbid conditions and pre-hospital therapy were assessed. Results. A total of 1,130 patients were included in the registry (mean age, 57,5±12,8 years;men, 579 (51,2%)). Using PCR test, COVID-19 infection was established in 686 (60,7%) patients;using chest CT - 334 (29,6%) patients. The most numerous were the group with a combination of COVID-19 and CAP (n=662;58,6%) and the group with CAP without positive PCR (n=402;35,6%). The group of patients with COVID-19 without CAP was the smallest (n=24;2,1%);in 3,7% of patients (n=42), CAP was not confirmed and PCR were negative. The proportion of people with cardiovascular diseases (CVD) according to the survey, in comparison with data of medical records, was higher by 2% (52,2 vs 50,2%);the proportion of persons with chronic non-cardiac diseases - higher by 6,7% (50,8 vs 44,1%). Among patients with CVD (n=598), compared with patients without CVD (n=532), following diseases was diagnosed significantly more often: diabetes (odds ratio (OR), 5,66;95% confidence interval (CI), 3,52-9,12), respiratory disease (OR, 2.,7;95% CI, 1,43-4,27), chronic kidney disease (OR, 3,32;95% CI, 1,97-5,59), obesity (OR, 15,35;95% CI, 6,62-35,59). Hospital mortality was 4,2% and significantly differs (4,7 times) in patients with and without COVID-19 according to PCR (6,6 vs 1,4%, p=0,0001), including among patients with CAP and positive or negative PCR (6,0 vs 1,2%, p=0,0002). Conclusion. COVID-19 infection was diagnosed in 60,7% of patients according to PCR and in 90,3% of patients according to the combination of PCR and chest CT. Among patients with CVD, the proportion of people with chronic noncardiac diseases was significantly higher (regardless of age and sex), in particular, with diabetes, chronic kidney disease and obesity. Questionnaires provided important data on the history of noncommunicable diseases and prehospital cardiovascular therapy. The mortality rate of patients with documented COVID-19 infection was 4,7 times higher than with undocumented. Цель. Дать характеристику больных, госпитализированных с предполагаемыми или подтвержденными COVID-19 (corona virus disease 2019) и внебольничной пневмонией (ВБП), оценить на основании данных истории болезни (ИБ) и дополнительного опроса частоту сочетанных сердечно-сосудистых, некардиальных заболеваний, догоспитальную кардиоваскулярную фармакотерапию и исходы госпиального этапа лечения. Материал и методы. В регистр ТАРГЕТ-ВИП (проспекТивный госпитАльный РеГистр пациЕнТов с предполагаемыми либо подтвержденными коронаВИрусной инфекцией (COVID-19) и внебольничной Пневмонией) включены пациенты, госпитализированные в ФГБУ “НМХЦ им. Н. И. Пирогова” Минздрава России с предполагаемыми либо подтвержденными диагнозами COVID-19 и/или ВБП за период 06.04.2020-02.07.2020. Диагностика COVID-19 выполнялась по данным тестов полимеразной цепной реакции (ПЦР) и компьютерной томографии (КТ) грудной клетки. Сопоставлены данные электронной ИБ и дополнительного опроса пациентов с целью уточнения информации об имеющихся соматических заболеваниях и догоспитальной фармакотерапии. Дана характеристика групп пациентов с различными вариантами сочетания диагнозов COVID-19 и ВБП по результатам ПЦР-тестов и КТ. Результаты. Включено в регистр 1130 пациентов, средний возраст 57,5±12,8 лет, 579 (51,2%) мужчин. Диагноз COVID-19 по данным ПЦР-тестов установлен у 686 (60,7%) пациентов, а дополнительно - у 334 (29,6%) по данным КТ, несмотря на отрицательные ПЦР-тесты. Наиболее многочисленными были группа с сочетанием COVID-19 и ВБП (n=662;58,6%) и группа с ВБП без ПЦР-подтверждения COVID-19 (n=402;35,6%). Группа пациентов с COVID-19 без ВБП была самой малочисленной (n=24;2,1%), у 3,7% пациентов (n=42) не была подтверждена ВБП и ПЦР-тесты были отрицательными. Доля лиц с сердечно-сосудистыми заболеваниями (ССЗ) по результатам опроса, по сравнению с данными ИБ, была > на 2% - 52,2 vs 50,2%;доля лиц с хроническими некардиальными заболеваниями > на 6,7% - 50,8 vs 44,1%. Среди пациентов с наличием ССЗ (n=598), по сравнению с пациентами без ССЗ (n=532), с учетом применения поправки на возраст и пол, значимо чаще диагностировались сахарный диабет - отношение шансов (ОШ) =5,66;95% доверительный интервал (ДИ): 3,52-9,12, болезни органов дыхания - ОШ =2,47;95%ДИ: 1,43-4,27, хроническая болезнь почек - ОШ =3,32;95%ДИ: 1,97-5,59, ожирение - ОШ =15,35;95%ДИ: 6,62-35,59. Частота должных догоспитальных назначений по поводу ССЗ составила 56,6%, что было > на 10,9%, чем по данным только ИБ и > на 15,9%, чем по данным только дополнительного опроса пациентов. Госпитальная летальность была 4,2%, значимо различалась (в 4,7 раза) у пациентов с наличием и отсутствием COVID-19 по данным ПЦР-тестирования (6,6 vs 1,4%, p=0,0001), в т. ч. среди пациентов с ВБП и положительными либо отрицательными результатами ПЦР-тестов (6,0 vs 1,2%, p=0,0002). Заключение. Диагноз COVID-19 установлен у 60,7% больных по данным ПЦР-тестов и у 90,3% больных по совокупности данных ПЦР-диагностики и КТ. Среди больных ССЗ доля лиц с хроническими некардиальными заболеваниями была значимо выше (независимо от факторов возраста и пола), в частности, с сахарным диабетом, хронической болезнью почек и ожирением. Анкетирование пациентов дало важную информацию об анамнезе неинфекционных заболеваний и плановой кардиоваскулярной фармакотерапии на догоспитальном этапе. Смертность больных с подтвержденным COVID-19 была в 4,7 раза выше, чем с неподтвержденным.
ABSTRACT
Objective. To describe the methodology for creating and the first results of the prospective hospital registry of patients with suspected or confirmed coronavirus infection (COVID-19) and community-acquired pneumonia (TARGET-VIP) Material and methods. The registry included all patients admitted to the National Medical and Surgical Center named after N.I. Pirogov from April 6 to June 2, 2020 with suspected or confirmed coronavirus infection and community-acquired pneumonia. All patients’ data were taken from medical records. An additional survey of patients was performed (in the hospital or during the first 30 days of post-hospital period) in order to clarify data on risk factors, history of somatic and infectious diseases, pre-hospital drug therapy. At the outpatient stage, it is planned to collect data about the dynamics of clinical status and long-term outcomes in patients enrolled into the registry. For this purpose, a special survey of patients or their relatives during telephone contact 1-2, 6, 12 and 24 months after discharge from the hospital will be performed. Results. The registry included 1.130 patients (age 57.5±12.8 years, 51.2% men). COVID-19 was diagnosed in 60.7% of cases when PCR-tests were positive, and community-acquired pneumonia was confirmed in 94.2% of patents, cardiovascular diseases (CVD) were diagnosed in 52.9% of cases. Among chronic non-cardiac diseases the incidence of digestive diseases (22.1%) and diabetes (16.3%) was maximal, but those with bronchial asthma and anemia - were minimal (3.1 and 3.5%, respectively). CVDs or non- CVDs were revealed in 75.8% of cases. Data on the values of height and body weight were available in the medical records in 97% of cases, but the calculation of body mass index (BMI) was practically not used. The incidence of obesity according to clinical diagnosis was 6.1% while BMI≥30 kg/m2 was revealed in 35.2% of cases. Hydroxychloroquine was administrated in 84.3% of patients, anticoagulants - in 84.2%, antibiotics - in 70.0%, glucocorticoids - in 15.2%, antiviral drugs - in 5.9%, immune-suppressants - in 8.6% of patients. The rate of prescriptions of ACE-inhibitors/angiotensin receptor blockers (53.7%) and beta-blockers (45.6%) was bigger than those of other components of cardiovascular pharmacotherapy in 598 patients with CVD. The hospital mortality rate was 4.2%. Among the age group 65 years and older mortality (9.7%) was 6 times higher than among younger patients (1.6%). Patients who died were 16 years older than survivals. The proportion of patients with coronary artery disease, atrial fibrillation and chronic kidney disease was significantly bigger in non-survivals than in survivals (Odds Ratio after adjustment to age and sex was 2.2, 5.0 and 4.1, respectively;p<0.05). Conclusion. The majority of patients in the TARGET-VIP registry had COVID-19 (60.7% of PCR-tests were positive), communityacquired pneumonia (94.2%), CVDs of non-CVDs (75.8%). The incidence of obesity in clinical diagnosis was 6 times less than those according to the BMI value. The rate of prescription of hydroxychloroquine and anticoagulants was maximal (84.3 and 84.2%, respectively). Hospital mortality was 4.2%. Among the age group 65 years and older, hospital mortality was 6 times higher than among younger patients. © 2020, Media Sphera Publishing Group. All rights reserved.