Impact of lockdown on cardiovascular disease hospitalizations in a Zero-COVID-19 country.

OBJECTIVES: There are concerns about the potential effect of social distancing used to control COVID-19 on the incidence of cardiovascular diseases (CVD). STUDY DESIGN: Retrospective cohort study. METHODS: We examined the association between lockdown and CVD incidence in a Zero-COVID country, New Caledonia. Inclusion criteria were defined by a positive troponin sample during hospitalization. The study period lasted for 2 months, starting March 20, 2020 (strict lockdown: first month; loose lockdown: second month) compared with the same period of the three previous years to calculate incidence ratio (IR). Demographic characteristics and main CVD diagnoses were collected. The primary endpoint was the change in incidence of hospital admission with CVD during lockdown compared with the historical counterpart. The secondary endpoint included influence of strict lockdown, change in incidence of the primary endpoint by disease, and outcome incidences (intubation or death) analyzed with inverse probability weighting method. RESULTS: A total of 1215 patients were included: 264 in 2020 vs 317 (average of the historical period). CVD hospitalizations were reduced during strict lockdown (IR 0.71 [0.58-0.88]), but not during loose lockdown (IR 0.94 [0.78-1.12]). The incidence of acute coronary syndromes was similar in both periods. The incidence of acute decompensated heart failure was reduced during strict lockdown (IR 0.42 [0.24-0.73]), followed by a rebound (IR 1.42 [1-1.98]). There was no association between lockdown and short-term outcomes. CONCLUSIONS: Our study showed that lockdown was associated with a striking reduction in CVD hospitalizations, independently from viral spread, and a rebound of acute decompensated heart failure hospitalizations during looser lockdown.

Exercise Limitation in Survivors of Severe Acute Respiratory Syndrome associated with novel coronavirus

Aim There are increasing reports of persisting exertional dyspnea several months after acute SARS-CoV-2 infection. The aim of this study was to evaluate pulmonary, cardiac, and functional capacity of SARS-CoV-2 survivors at 3 months after initial diagnosis by performing cardio-pulmonary exercise testing (CPET). Methods CPET was proposed to all patients who were treated both in and out of hospital settings at a tertiary university hospital at 3 months (±1 month) after the diagnosis of SARS-CoV-2 infection. Results A total of 114 patients were included in the study. The median age was 57 [48–66] and 30% were women. 91% required in-hospital treatment during the initial SARS-CoV-2 infection and 22% needed intensive care unit (ICU) admission. At 3-month follow-up, 51% of patients were still symptomatic and 40% reported dyspnea at exertion. During CPET, 71% of patients had impairment of exercise capacity, mostly due to muscle deconditioning (43%) and/or hyperventilation (16%). In multivariable-adjusted analysis, age (β=0.4, P=0.002), ICU stay (β=−10.27, P=0.017), endotracheal intubation and mechanical ventilation (β=−12.63, P=0.004) and total hospital length of stay (β=−0.24, P=0.009) were independently associated with % predicted oxygen uptake (peak VO2) (Fig. 1). Conclusion The majority of SARS-CoV-2 survivors had impairment of exercise capacity at 3 months after initial illness, mostly due to muscle deconditioning and exercise hyperventilation. Age and factors related to initial disease severity such as ICU stay and mechanical ventilation were predictive of worse performance during CPET.