Admissions to the Emergency Department Due to Atrial Fibrillation/Atrial Flutter Incidents during the Third Wave of COVID-19 Pandemic.

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the risk of atrial fibrillation/flutter (AF/AFL) incident. The study aimed to present the characteristics of admissions to the emergency department (ED) due to AF/AFL incidents during the third COVID-19 pandemic wave. (2) Methods: A retrospective analysis of the medical records of the ED patients: 8399 during 3 months of the second and 11,144 during the 3 months of the third pandemic wave. (3) Results: SARS-CoV-2 positive patients there were 295 (3.5%) during the second wave and 692 (6.2%) during the third wave (p < 0.001). Among patients with SARS-CoV-2 infection, there were 44 (14.9%) patients with known AF/AFL during the second wave and 75 (10.8%) during the third wave, respectively (0.07). There were 116 visits with a diagnosis of AF/AFL incident during the third wave (study group) and 76 visits during the second wave (control group). The SARS-CoV-2 test was positive in 11 (9.5%) visits in the study group and in 1 (1.3%) visit in the control group p = 0.047. During the third wave, the patients with AF/AFL incidents with positive tests were older and more often had new-onset AF/AFL than those with negative tests: 76.3 (13.2) years vs. 71.8 (12.6) years; and 4 (36.4%) patients vs. 7 (7.6%) patients, respectively. (5) Conclusions: During the third pandemic wave, the number of patients with SARS-CoV-2 infection increased in comparison to the second wave. Additionally, among patients with AF/AFL incidents, the percentage of SARS-CoV-2-positive patients increased. During the third wave, the patients with positive tests and AF/AFL incident were older and more often had new-onset AF/AFL than those with AF/AFL incident and negative test which indicate the arrhythmogenic effect at the onset of the disease, especially in the older population.

Simple demographic characteristics and laboratory findings on admission may predict in-hospital mortality in patients with SARS-CoV-2 infection: development and validation of the covid-19 score.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality. METHODS: Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome. RESULTS: The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84-0.95), 0.850 (0.75-0.88), and 0.773 (0.731-0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0-2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%. CONCLUSION: The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.

The Impact of COVID-19 on Admissions and Management of Patients with Atrial Fibrillation Episodes in the Emergency Department.

BACKGROUND: During the COVID-19 pandemic, the number of admissions to the emergency department (ED) due to a primary diagnosis of atrial fibrillation (AF) has decreased when compared to pre-pandemic times. The principal aim of the study was to assess the frequency of SARS-CoV-2 infections and sinus rhythm restoration among patients who arrived at the ED with AF. Secondary aims included determining whether patients arriving at the ED principally due to AF delayed their presentations and whether the frequency of successful cardioversion for AF was decreased during the pandemic period. MATERIALS AND METHODS: A retrospective analysis of medical records of patients admitted to two hospital EDs due to AF during July-December 2019 (pre-pandemic period) versus July-December 2020 (pandemic period) was performed. RESULTS: During the study periods, 601 ED visits by 497 patients were made due to the primary diagnosis of AF. The patients were aged 71.2+/-13.5 years and 51.3% were male. The duration of an AF episode before the ED admission was 10 h (4.5-30 h) during the pandemic period vs. 5 h (3-24 h) during the non-pandemic period (p = 0.001). A shorter duration of the AF episode before ED admission was associated with the successful restoration of the sinus rhythm. During the pandemic period, among patients with short-lasting AF who were not treated with Phenazolinum, the restoration of the sinus rhythm was more frequent in the Copernicus Memorial Hospital than in the University Hospital (p = 0.026). A positive SARS-CoV-2 test was found in 5 (1%) patients, while 2 other patients (0.5%) had a prior diagnosis of COVID-19 disease noted in their medical history. CONCLUSIONS: 1. The number of AF episodes treated in these two EDs was lower during the pandemic than non-pandemic period. 2. The patients with AF appeared at the ED later after AF onset in the pandemic period. 3. Successful cardioversion of atrial fibrillation was more frequent during the pre-pandemic period in one of the two hospitals. 4. A difference of approaches to the treatment of short-lasting AF episodes between EDs during the pandemic period may exist between these two EDs. 5. The patients with SARS-CoV-2 infection during the second wave of the COVID-19 pandemic constituted a small percentage of the patients admitted to EDs due to an AF episode.

RETROSPECTIVE ANALYSIS OF INTERVENTIONS PERFORMED BY EMERGENCY MEDICAL TEAMS IN POLAND BEFORE AND DURING THE SARS COV-2 PANDEMIC.

OBJECTIVE: Introduction: The SARS-CoV-2 virus was recognized in December 2019 in China. From that moment it has quickly spread around the whole world. It causes COVID-19 disease manifested by breathlessness, coughing and high temperature. The COVID-19 pandemic has become a great challenge for humanity. The aim: To analyze interventions of emergency medical teams during the SAR-CoV-2 pandemic, and to compare obtained data with the same periods in 2018-2019. PATIENTS AND METHODS: Material and methods: The study retrospectively analyzed interventions of emergency medical teams in the period from 15.03 to 15.05 in 2018 - 2020. 1,479,530 interventions of emergency medical teams were included in the study. The number of interventions, reasons for calls, and diagnoses made by heads of the emergency medical teams during the SARS-CoV-2 pandemic were compared to the same period in 2018-2019. RESULTS: Results: Authors observed the decline in the number of interventions performed by emergency medical teams during the pandemic in relation to earlier years by approximately 25%. The big decline concerned interventions that were the reason for calls to public places, such as "traffic accident" and "collapse". In the case of diagnoses made by the head of the emergency medical team, the diagnoses regarding stroke or sudden cardiac arrest remained at the similar level. Others showed a marked decline. CONCLUSION: Conclusions: Reduced social activity contributed to a reduced number of interventions by emergency medical teams in public places. The societal fear of the unknown also contributed to the decrease in the number of interventions performed by emergency medical teams. People began to avoid contact with other people.