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1.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1638041

ABSTRACT

Introduction: Although home health aides (HHAs) often care for adults with heart failure (HF), studies have found that the majority have not received HF training and lack confidence with HF caregiving. To address this, we tested the feasibility, acceptability, and effectiveness of a virtual HF training course for HHAs. Methods: We partnered with the Education Fund of the 1199SEIU United Health Care Workers East, the largest healthcare union in the US, which provides training to 55,000 HHAs in NYC. HHAs typically receive in-person training, but due to COVID-19, we conducted this course virtually. The 2- hour course, taught in English and Spanish, utilized case-based learning and motivational interviewing to engage HHAs in interactive discussions on HF signs, symptoms, and HF self-care. HHAs with access to Zoom (via smartphone, computer, or tablet) were eligible. We conducted pre/post surveys and semi-structured interviews. Measures included: a) feasibility (attendance, retention), b) acceptability (modality, technological ease, satisfaction);and c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale, range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale, range 0-100]). Results: 48 HHAs employed by 15 distinct home care agencies enrolled and completed the course;course size ranged from 4-9 participants. The majority were middle-age women (60% Hispanic, 10% non-Hispanic Black). To participate, 59% used a smartphone, 32% a computer, and 10% a tablet. Compared to prior in-person courses, 83% participants reported that the course ran more smoothly and was more convenient;only 7% reported technical problems. Participants and course instructors reported high levels of satisfaction and engagement. Post-course data showed significant and clinically meaningful improvements in HF knowledge (11.21 [1.90] v. 12.21 [1.85];p = 0.0000) and HF caregiving self-efficacy (75.21 [16.57] v. 82.29 [16.49];p = 0.0017). Conclusions: A virtual HF training course was feasible and acceptable among HHAs and improved their HF knowledge and caregiving confidence. Efforts to scale and disseminate the course may be warranted. Future studies are needed to test the effect of the course among HHAs and their patients.

2.
Gastroenterology ; 160(6):S-425, 2021.
Article in English | EMBASE | ID: covidwho-1593860

ABSTRACT

We reported the results of our multicenter cohort study in all patients who presented for endoscopy between March 1 and May 17 and were evaluated before their endoscopy for SARS-CoV2 and were followed after their endoscopy for COVID-19 status. This cohort enabled us to calculate the conversion rate from COVID-19 negative to positive during the study period and evaluate the change in conversion rate with the implementation of social distancing and masking at the population level in New York City. Data were retrieved from electronic medical records systems of six tertiary care centers in New York City. We identified all adult patients who had endoscopy between March 1, and May 17, 2020. Conversion was defined as having a negative COVID-19 status before endoscopy and a positive status afterwards. Participants COVID-19 status was defined based on SARS-CoV2 PCR test or a combination of symptoms (Fever plus at least one of: dyspnea, cough, dysgeusia, or anosmia). Patients were evaluated before endoscopy and then by phone or telehealth visit afterwards. Spline regression was used to evaluate the conversion rate before and after adoption of social distancing (March 20, 2020) and mandatory masks (April 15, 2020) in New York City. Of the 1467 patients presenting for endoscopy during the study period, we had follow-up data on 1222 patients (51% outpatient and 49% inpatient endoscopies). Overall, 78 participants (6.38 %) converted after endoscopy (74 with a positive PCR, and 4 with symptoms as defined above), at a median of 23 days after endoscopy (IQR 11 to 42 days). Patients had a mean age of 62±15 years, and were 62% male (n=48). Multivariable analysis demonstrated that date of endoscopy, institution, and presence of cardiovascular disease were the independent predictors of conversion after endoscopy, with cardiovascular disease associated with a more than 2 fold increase in the risk of conversion (OR=2.1, 95%CI 1.2-3.6, p=0.009). The range of conversion from the six institutions varied widely (1 to 11%, p=0.035). Overall, participants whose endoscopies were performed later during the study period had a lower risk of conversion (OR for one week=0.87, 95%CI 0.80-0.94, p=0.001). Before social distancing, conversion rate was 8.4% on average and was increasing by 2.3% per week (p<0.001). After social distancing, the conversion rate was 6.7% on average, and started to decrease by 4.2% per week (p<0.001). After mandatory masks, the conversion rate was 2.2% on average but has started to increase slowly by 0.9% per week (p<0.001;see figure 1). These findings do support decrease in conversion rate amongst New Yorkers who presented for endoscopy with the implementation of social distancing and mandatory masking. We believe the slow but significant increase in conversion rates by the end of May reflects the relative loosening in social distancing in New York City.(Figure Presented)

3.
Public Health ; 198: 273-279, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1336868

ABSTRACT

OBJECTIVES: The role of overcrowded and multigenerational households as a risk factor for COVID-19 remains unmeasured. The objective of this study is to examine and quantify the association between overcrowded and multigenerational households and COVID-19 in New York City (NYC). STUDY DESIGN: Cohort study. METHODS: We conducted a Bayesian ecological time series analysis at the ZIP Code Tabulation Area (ZCTA) level in NYC to assess whether ZCTAs with higher proportions of overcrowded (defined as the proportion of the estimated number of housing units with more than one occupant per room) and multigenerational households (defined as the estimated percentage of residences occupied by a grandparent and a grandchild less than 18 years of age) were independently associated with higher suspected COVID-19 case rates (from NYC Department of Health Syndromic Surveillance data for March 1 to 30, 2020). Our main measure was an adjusted incidence rate ratio (IRR) of suspected COVID-19 cases per 10,000 population. Our final model controlled for ZCTA-level sociodemographic factors (median income, poverty status, White race, essential workers), the prevalence of clinical conditions related to COVID-19 severity (obesity, hypertension, coronary heart disease, diabetes, asthma, smoking status, and chronic obstructive pulmonary disease), and spatial clustering. RESULTS: 39,923 suspected COVID-19 cases were presented to emergency departments across 173 ZCTAs in NYC. Adjusted COVID-19 case rates increased by 67% (IRR 1.67, 95% CI = 1.12, 2.52) in ZCTAs in quartile four (versus one) for percent overcrowdedness and increased by 77% (IRR 1.77, 95% CI = 1.11, 2.79) in quartile four (versus one) for percent living in multigenerational housing. Interaction between both exposures was not significant (ßinteraction = 0.99, 95% CI: 0.99-1.00). CONCLUSIONS: Overcrowdedness and multigenerational housing are independent risk factors for suspected COVID-19. In the early phase of the surge in COVID cases, social distancing measures that increase house-bound populations may inadvertently but temporarily increase SARS-CoV-2 transmission risk and COVID-19 disease in these populations.


Subject(s)
COVID-19 , Bayes Theorem , Cohort Studies , Humans , SARS-CoV-2 , Socioeconomic Factors
4.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277388

ABSTRACT

Rationale: The optimal timing of invasive mechanical ventilation (IMV) among patients with COVID-19 related acute respiratory failure (ARF) is unknown. Use of high flow nasal cannula (HFNC) support could potentially avoid the need for IMV and related risks. However, patients failing HFNC may be at increased risk for peri-intubation complications such as cardiac arrest. At NewYork-Presbyterian Weill Cornell Medical Center (NYP-WCMC) and Lower Manhattan Hospital (LMH), an early IMV strategy prior to March 26th 2020. We subsequently switched to a prolonged observation strategy, supporting patients with non-invasive devices including HFNC. In this study, we compared in-hospital mortality in patients with ARF managed with early IMV strategy versus a prolonged observation strategy. Methods: This is a retrospective cohort study using the Weill Cornell COVID-19 Registry, which included 1869 patients admitted with a COVID-19 positive PCR test up until May 15, 2020. Patients at risk for intubation due to ARF, defined by requiring > 6 liters/min nasal cannula, were included. Patients who met ARF criteria prior to March 26, 2020 were in the early IMV strategy group, and those who met criteria on or after March 26, 2020 were in the prolonged observation strategy group. In-hospital mortality with intubation strategy as the main exposure was modelled with cox proportional hazards regression. Confounders included age, sex, BMI, comorbidities, severity of illness (SOFA) and hospital strain (difference between daily admissions and discharges). Both SOFA and hospital strain were calculated for each patient on the day that they developed ARF for modelling purposes. Results: We identified 774 patients at risk for intubation due to ARF (table), 141 were in the early IMV group and 633 were in the prolonged observation strategy group. Death occurred in 33.3% of patients in the early IMV group compared to 34.8% in the prolonged observation group. Patients in the early IMV group had a longer length of stay among survivors (27.2 ± 26.1 days vs 21.6 ± 22.8 days, p = .0213). Age-adjusted hazard ratio for death comparing early IMV versus prolonged observation was 1.35 (95% CI 0.86-2.12, which decreases to 0.87 (95% CI 0.52-1.45) after adjusting for confounders. Conclusion: In this retrospective observational study with a modest sized sample, early IMV strategy was not associated with excess mortality compared to prolonged observation. In resource constrained settings, prolonged observation with HFNC support is a reasonable hospital-level strategy in patients with ARF.

5.
Journal of the American College of Cardiology ; 77(18):3096, 2021.
Article in English | EMBASE | ID: covidwho-1223047

ABSTRACT

Background Biomarker-evidenced myocardial injury is common among patients with COVID-19 infection and confers an increased risk of mortality. Prevalence and incremental prognostic impact of myocardial dysfunction is unknown. Methods Consecutive COVID-19 patients undergoing clinical echocardiography during their index hospitalization at three New York City hospitals were studied. Images were analyzed by a central core lab blinded to all clinical data. LV dysfunction was defined as LVEF < 55% and RV dysfunction as TAPSE <1.6 cm or S’<10 mm/s. Results 733 patients (64 ± 15 years, 61% men) were studied. Myocardial injury (elevated troponin) occurred in 21% of patients, among whom either LV or RV myocardial dysfunction occurred in 72% (LV: 54%, RV:24%). Myocardial dysfunction was more common among patients with myocardial injury vs. without (LV: 54 vs. 32% p<0.001;RV: 24 vs. 10% p=0.001). During inpatient follow-up (median 15 [IQR 6-35] days), in-hospital mortality occurred in 34% with myocardial injury and 44% with LV or RV dysfunction vs. 23% without myocardial injury (p<0.001). Risk for death was greatest among patients with combined myocardial dysfunction and myocardial injury, and less with myocardial injury alone [Figure]. Conclusion Echo-evidenced myocardial dysfunction occurs in nearly three quarters of patients with myocardial injury and is a powerful predictor of in-hospital mortality. [Formula presented]

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