ABSTRACT
Introduction: COVID19-associated cardio complications occur through different mechanisms including the inflammatory response causing severe issues such as ARDS, sepsis, and coagulopathy. Many points remain unclear regarding the impact of coagulation disorder in patients who are admitted with COVID19 infection. We present an analysis of the cardiovascular outcomes of coagulation disorders in COVID19-related hospitalizations. Method(s): The Nationwide Inpatient Sample database from 2020 was queried to identify COVID-19 patients. Subsequently, we classified COVID hospitalization based on the presence or absence of coagulation disorder. The primary outcome measure was in-hospital mortality. Secondary outcomes were in-hospital cardiovascular outcomes, ICU admissions, bleeding, Stroke, and resource utilization. Result(s): Out of 1,060,885 patients with a diagnosis of COVID, 43905 had coagulation disorder. On adjusted analysis, patients with COVID and coagulation disorder had significantly higher odds of MACCE (aOR 1.57, 95% CI 1.47-1.67, p<0.001), in-hospital mortality (aOR 1.56, 95% CI 1.46-1.67, p<0.001), cardiac arrest (aOR 1.38, 95% CI 1.28-1.57, P<0.001), acute MI (aOR 1.32, 95% CI 1.19-1.47, P<0.001), stroke (aOR 2.11, 95% CI 1.76-2.52, P<0.001), cardiogenic shock (aOR 2.19, 95% CI 1.78-2.70, P<0.001), MCS (aOR 3.98 CI 2.31-6.85 p<0.001), and bleeding (aOR 1.64 CI1.40-1.92 p<0.001) compared to patients without coagulation disorder. The length of stay (11.43 vs 7.27) and mean in-hospital cost was increased ($150,759.70 vs $75321.1) in patients with and without coagulation disorders. Conclusion(s): COVID patients with coagulation disorder have a significantly higher risk of MACCE, in-hospital mortality, cardiac arrest, AMI, stroke, shock, MCS, and bleeding. Large prospective trials are needed to further study these findings. [Formula presented]Copyright © 2023
ABSTRACT
Introduction: It is known that patients with COVID-19 infection have a significant incidence of arrhythmias. According to a study from Wuhan, China in 2020, approximately 17% of hospitalized COVID-19 patients suffered from arrhythmia, including Atrial Fibrillation (AF). Here we present a study of the outcomes of AF in COVID admissions at the national cohort registry. Method(s): Utilizing the NIS of the year 2020, we identified patients with diagnosis of COVID-19 and subsequently classified COVID-admission into with and without AF. Multilogistic regression analysis (OR) was done to compare in hospital outcomes. Result(s): Of 1,060,976 patients with diagnosis of COVID, 57,011 (5.37%) had AF. On adjusted analysis, COVID-AF patients had significantly higher odds of heart failure (aOR 1.25, 95% CI 1.19-1.31, P=0.001). On the contrary, there was no statistically significant difference in the odds of MACCE (aOR 0.97, 95% CI 0.91-1.01, P=0.19), in hospital mortality (aOR 0.93, 95% CI 0.88-0.09, P=0.07), AMI (aOR 1.12, 95% CI 1.03-1.22, P=0.08), MCS (aOR 0.86, 95% CI 2.08 - 2.60, P= 0.789), cardiogenic shock (aOR 1.15, 95% CI 0.90-1.45, P=0.257), major bleeding (aOR 1.12, 95% CI 0.96-1.30, P=0.136), PCA (aOR 0.30, 95% CI 0.87-1.93, P=0.205), PCI (aOR 0.10, 95% CI 0.49-2.40, P= 0.82), stroke (aOR 1.02, 95% CI 0.84-1.23, P=0.871) between the two cohorts. The presence of AF in COVID-19 hospitalizations was associated with higher length of stay (9.25 +/-9.05 vs 7.35 +/- 8) and higher adjusted total charge(97,321 155,117+/- vs 77,372+/- 149,354) compared to COVID without AF association. Conclusion(s): COVID-19 patients with AF can have higher odds of heart failure compared to COVID-19 patients without AF. The odds of in hospital mortality, MACCE, MCS, AMI, major bleeding, PCI, PCA and stroke were similar. Large prospective trials are needed to validate these findings. [Formula presented]Copyright © 2023
ABSTRACT
Introduction: Congestive heart failure (CHF) is the most common cardiac admission diagnosis worldwide with high risk of morbidity and mortality. The data on the clinical impact of CHF on COVID-19 hospitalizations is limited. Here we present a study of the cardiovascular outcomes of baseline CHF on COVID-19 admissions at a national level. Method(s): The National Inpatient Sample database from 2020 was queried to identify patients with a primary diagnosis of COVID-19 and stratified based on the presence of congestive heart failure. Multivariate regressions analysis was done to compare inpatient outcomes among COVID patients with and without CHF. The primary outcome measure was in-hospital mortality. Secondary outcomes were in hospital cardiovascular outcomes. The adjusted odds ratios (aOR) of in-hospital outcomes were calculated using chi-square statistics in software STATA v.17. Result(s): 1,060,885 weighted COVID-19 hospitalizations were identified, of which 115,685(10.9%) were associated with CHF. On adjusted analysis, patients with COVID-CHF had significantly higher odds of MACCE (aOR 1.23, 95% CI 1.182-1.28, P<0.001), MCS ( aOR 3.22, 95% CI 2.26-3.26, P<0.001), cardiogenic shock ( aOR 2.72, 95% CI 2.26-3.26, P<0.001), AMI (aOR 2.72, 95% C. On the contrary, patients with COVID and baseline CHF had a lower incidence of inpatient AKI (aOR 0.64, 95% CI 0.49-0.84, P<0.001). The odds of in-hospital mortality, major bleeding and cardiac arrest between the two cohorts were similar. Additionally, presence of CHF in COVID hospitalization was associated with higher length of stay (8.81+/- 8.91 vs 7.28 +/-7.9) and adjusted total charge ($96,640 +/- 177,439 vs $76,214 +/-145,830) compared to COVID without CHF Conclusion(s): COVID 19 patients with CHF have increased odds of MACCE, MCS, cardiogenic shock, AMI, PCA and PCI. Out of hospital outcomes need further studies. [Formula presented]Copyright © 2023
ABSTRACT
Introduction: It is now evident that anticoagulation plays a key role in the management of COVID-19 infection, however the significance of previous long-term oral anticoagulation in patients who later presented with COVID-19 is still unknown. Here we present an analysis of the impact of long-term oral AC on COVID-19 hospitalizations at the national cohort registry. Method(s): The NIS database from 2020 was queried to identify COVID-19 patients on long term AC use. Multivariate regression was done to compare inpatient outcomes among COVID-19 patients with and without AC. Result(s): Of 1,060,925 patients with primary diagnosis of COVID, 102, 560 (9.6%) were on AC. On adjusted analysis, patients with COVID-19 and AC use had significantly lower odds of MACCE (aOR 0.63, 95% CI 0.6-0.66, p<0.001), in-hospital mortality (aOR 0.61, 95% CI 0.58-0.64, p<0.001), cardiac arrest (aOR 0.67, 95% CI 0.6-0.75, P<0.001), acute MI (aOR 0.72, 95% CI 0.63-0.83, P<0.001), stroke (aOR 0.79, 95% CI 0.66-0.95, P=0.002), cardiogenic shock (aOR 0.58, 95% CI 0.44-0.75, P<0.001), ICU admission, (aOR 0.53, 95% CI 0.49-.57, p<0.001) mechanical ventilation,(aOR 0.54, 95% CI 0.51-.58, p<0.001) tracheostomy, (aOR 0.4, 95% CI 0.32-.5, p<0.001) and septic shock, (aOR 0.53, 95% CI 0.48-.58, p<0.001) compared to patients without AC. Additionally, lower adjusted total charge ($70,987+/-109,234 vs 79,239+/-153,418, p<0.001) in patients taking AC was observed. However, the adjusted OR of major bleeding, MCS, PCI, new HD and length of stay were similar between the two groups. Conclusion(s): Patients with COVID-19 infection who are on long term AC use have lower risk of MACCE, in-hospital mortality, cardiac arrest, acute MI, stroke cardiogenic shock and ICU admissions with no significant increased risk of major bleeding. Large prospective trials are needed to validate these findings. [Formula presented]Copyright © 2023
ABSTRACT
Background: COVID rapidly became a multisystemic infection with varied cardiovascular complications including Acute Coronary Syndrome. Current literature is limited on the impact of COVID on ACS patients. Methods: We queried the national inpatient sample (NIS) from 2020 to identify patients who were admitted for ACS and stratified them based on the presence or absence of COVID. The adjusted odds ratios (aOR) of in-hospital outcomes and resource utilization were calculated using chi-square statistics in the software STATA v.17. Results: Out of 883940 patients analyzed, who were admitted for ACS, 3900 patients had COVID. On adjusted analysis, patients with COVID had significantly elevated In-Hospital mortality (aOR, 2.91 CI 2.25-3.79), MACCE (aOR 2.53, CI 1.90-3.10), cardiac arrest (aOR 3.34, CI 1.1-10.1) with longer length of stay (6.34 ± 0.39 vs 4.48 ± 0.02). Interestingly, the outcome PCA (aOR, 0.39 CI 0.33-0.46) showed significant improvement. Interestingly, mean costs were elevated in patients without COVID at $105,550.8 vs $98597.7 in patients without COVID. In terms of trends, as exposure increased through the year with the highest levels in December, the mortality also increased (April 18.52% vs 25.64%). Interestingly, the cardiac arrest percentage decreased from April 2020 (7.4%) to Dec 2020 (1.98%) as well as MCS in April 202 (11.11%)vs December 2020 (3.47%) in patients exposed to COVID. Conclusions: In patients admitted for ACS, the presence of COVID significantly increases the risk of MACCE, in-hospital mortality, and cardiac arrest. Prospective trials are necessary for the identification of risk factors to improve clinical outcomes in these patients. Key words: COVID, Sars-2 coronavirus. Coronavirus. ACS. Acute Coronary Syndrome. [Formula presented]
ABSTRACT
Objective: To determine the frequency and pattern of myths and misconceptions regarding COVID-19 vaccine in the general population at Isra University Hospital Hyderabad Material and Methods: This cross-sectional survey base study was conducted at the Isra University Hospital Hyderabad, during a period of six months from August 2021 to January 2022. All the patients who visited the OPD and their attendants of any age or gender, were included. All the subjects were properly counseled that their privacy was fully secured and their name and contact numbers were taken. After obtaining sociodemographic information, the participants were interviewed regarding COVID-19 infection in the past, previous vaccination history for diseases other than COVID-19, conceptions, and myths regarding COVID-19 vaccination, acceptance of COVID-19 vaccination, reasons to vaccinate for COVID-19, and reasons not to vaccinate for COVID-19. All the information was gathered via study proforma including questioner and SPSS version 26 was used for the purpose of data analysis. Results: A total of 145 individuals of either gender were studied regarding myths and misconceptions of COVID-19 vaccine, their average age was 27.71+9.86 years and females were in majority 62.1%. Among the study population, doctors, private employee and housewives were the most common as 44.1%, 11%, 11.7% and 9% respectively. Most of the cases 62.1% were unmarried. According to the myths and misconceptions, 8.3% said it can affect fertility, 23.4% had no trust on its effectiveness and safety, 14.5% said it is an artificial infection procedure, 11% were afraid from its dangerous side effects, 3.4% said the vaccine will change their DNA, 13.8% said it is a controversial substance and 6.9% afraid that they will die within 2 years. 24.1% cases heard myths from family, 24.8% heard from friends and 51% heard by social media. 17.2% had idea that it is an international conspiracy and 4.8% said this may cause sexual dysfunction and 4.8% said it is a procedure of implanting microchip to control them. Conclusion: There were several misconceptions in the general population, most myths like effects of male fertility, distrust on vaccine efficacy, they will be infected artificially, fear of dangerous side effects, controversial substances were observed to be the commonest myths and misconceptions regarding the COVID-19 vaccine in the general population. Above ideas were adopted mostly by the friends and social media.