ABSTRACT
Background: COVID-19 pandemic negatively affected patients' will to seek urgent medical treatment as well as and health service performance. Purpose(s): The aim was to evaluate the impact of COVID-19 pandemic outbreak at the beginning of 2020 on heart failure epidemiology and outcomes in Poland. Method(s): The study is based on the Nationwide Polish Ministry of Health Registry, an administrative nation-wide database covering all heart failure patients in Poland who were beneficiaries of the public health sector between 2013 and 2021. Result(s): After COVID-19 outbreak in 2020, significantly fewer patients presented to health service due to HF than in previous years (Fig. 1). Compared to 2019, the number of HF hospitalisations declined by 21% and outpatient visits by 10% in 2020. Simultaneously, for the first time in the last decade, the trend in heart failure prevalence went down dropping by 3.7% (Fig. 1). The trend was driven by the greater reduction in ischaemic vs non-ischaemic HF prevalence (4.7% vs 1.3%) The longstanding downtrend in heart failure incidence accelerated markedly in 2020, decreasing by 20% between 2019 and 2020, compared to average fall of 8% in the previous decade (ranging between 4.1-12.9%). Likely, the drop was mainly attributable to the decline in the ischaemic HF incidence (23% vs 15.3% drop in nonischemic HF). The average in-hospital mortality due to HF in 2020 was higher compared to 2019 (12.9% vs 11.02%). As many as 1.18% of patients died on the day of admission in 2020, contrary to 0.94% in 2019 which accounts to 25% increase. Monthly distribution of in-hospital mortality aligned with peaks of COVID-19 waves (Fig. 2). Conclusion(s): The study shows unfavorable changes in HF epidemiology and outcomes due to the pandemic. The drop in prevalence and incidence seems to be associated with lower patient influx to the health service. It is unknown whether patient non-occurrence resulted from patients' actions or preoccupation of the health service with the pandemic. At the same time, a marked rise in in-hospital mortality was noted, with an over 25% increase in the number of deaths on the day of admission that could potentially reflect a more advanced disease state.
ABSTRACT
Background: According to the international recommendations, patients with inflammatory bowel disease (IBD) should be vaccinated against SARS-CoV-2 at the earliest opportunity to do so. The aim of this study was to assess the morbidity and mortality from COVID-19 in the adult IBD population in Poland with respect to their vaccin-ation status. Method(s): We conducted a retrospective analysis of administrative health claims collected by the National Health Fund, the sole public payer in Poland. We identified adult IBD patients as of December 31th, 2021 who had at least two or more records with K50 or K51 code and two or more prescriptions for IBD drugs reimbursed or else in-testinal surgery preceding the record. The vaccination status in 2021 was assessed using the database maintained by the Ministry of Health. We examined the vaccination process against SARS-CoV-2 among IBD patients along with morbidity and mortality from COVID-19. We conducted a Cox proportional hazard model analysis to determine the hazard ratio of SARS-CoV-2 infection, hospitalization and death in re-spect to the vaccination status during the autumn wave of the COVID-19 pandemic (October-December 2021). Result(s): As of December 31th, 2021 there were 93 068 adult patients diagnosed with IBD. The vaccination rate in IBD patients was significantly higher than in the general population of Poland (72.1% vs those aged 70-79 years (88.2%) [Figure 1]. 87 353 IBD patients were included into the Cox proportional hazard analysis of autumn pan-demic wave, during which there were 4 042 registered COVID-19 cases in IBD population. The peak value of a weekly average of incidence than for unvaccinated ones (13.0/10000). The risk of being infected 0.5-0.57;p<0.001). The cumulative risk of being positively tested for COVID-19 shows Figure 2. The most notable protective effect of vac-cination against SARS-CoV-2 was found in patients aged 60-69 years (HR 0.47;95%CI 0.39-0.55) and in those aged 80 years and above (HR 0.44;95%CI 0.32-0.63). The risk of hospitalization due to COVID-19 was also significantly lower among the vaccinated IBD patients (HR 19 was more than 3 times decreased in vaccinated IBD patients in com-parison to the remaining IBD population (HR 0.29, 95%CI 0.17-0.43, p<0.001) [Table 1]. Conclusion(s): Adult patients with IBD were more likely to get vaccinated against SARS-COV-2 than adults in the general population of Poland. The vaccination significantly decreased the risk of the infection, hospitalization and death due to COVID-19.