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2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317153

ABSTRACT

Background: Coronavirus disease (COVID-19) has overwhelmed healthcare systems worldwide often at the cost of patients with serious non-COVID-19 conditions. Outcomes and risks of contracting COVID-19 in patients hospitalized during the pandemic are unknown. Objective: To report our experience in safely performing electrophysiology procedures during the COVID-19 pandemic. Methods: We examined non-COVID-19 patients who underwent electrophysiology procedures during the peak of the pandemic between March 16, 2020 and May 11, 2020 at seven Northwell Health hospitals. We developed a priority algorithm to stratify inpatients and outpatients requiring electrophysiology procedures and instituted a protocol to minimize hospital length of stay (LOS). All patients underwent post discharge 30-day tele-health follow-up and chart review up to 150 days. Results: A total of 217 patients underwent electrophysiology procedures, of which 86 (39%) patients were outpatients. A total of 108 (49.8%) patients had a LOS less than 24 hours, including 74 device implantations and generator changes, 24 cardioversions, five ablations, and one electrophysiology study. There were eleven (5.1%) procedure or arrhythmia related re-admissions and two (0.9%) minor procedural complications. Overall average hospital LOS was 83.4±165.1 hours and a median of 24.0 hours. For outpatient procedures, average hospital LOS was 9.4±13.4 hours and a median of 4.3 hours. Overall follow-up time was 83.9 ±42 days and a median of 84 days. During follow-up, two (0.9%) patients tested positive for COVID-19 and recovered uneventfully. No deaths occurred. Conclusion: During the peak of the COVID-19 pandemic, patients safely underwent essential electrophysiological procedures without increased incidence of acquiring COVID-19.

3.
J Am Heart Assoc ; 10(16): e020255, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1356988

ABSTRACT

Background The acuity and magnitude of the first wave of the COVID-19 epidemic in New York mandated a drastic change in healthcare access and delivery of care. Methods and Results We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID-19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID-19 positive) were admitted for an acute cardiovascular syndrome during the first COVID-19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P<0.001). During this time, patients with cardiovascular disease presented later to the hospital (360 versus 120 minutes for acute myocardial infarction), underwent fewer procedures (34.6% versus 45.6%, P<0.001), were less likely to be treated in an intensive care unit setting (8.7% versus 10.8%, P<0.001), and had a longer hospital stay (2.91 [1.71-6.05] versus 2.87 [1.82-4.95] days, P=0.033). Inpatient cardiovascular mortality during the first epidemic outbreak increased by 111.1% (3.8 versus 1.8, P<0.001) and was not related to COVID-19-related admissions, all cause in-hospital mortality, or incidence of out-of-hospital cardiac deaths in New York. Admission during the first COVID-19 surge along with age and positive COVID-19 test independently predicted mortality for cardiovascular admissions (odds ratios, 1.30, 1.05, and 5.09, respectively, P<0.0001). Conclusions A lower rate and later presentation of patients with cardiovascular pathology, coupled with deviation from common clinical practice mandated by the first wave of the COVID-19 pandemic, might have accounted for higher in-hospital cardiovascular mortality during that period.


Subject(s)
COVID-19 , Cardiovascular Diseases/mortality , Hospital Mortality/trends , Hospitalization , Inpatients , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Female , Humans , Male , Middle Aged , New York City/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Young Adult
8.
Heart Rhythm ; 18(2): 215-218, 2021 02.
Article in English | MEDLINE | ID: covidwho-1118446

ABSTRACT

BACKGROUND: Increased incidence of out-of-hospital sudden death (OHSD) has been reported during the coronavirus 2019 (COVID-19) pandemic. New York City (NYC) represents a unique opportunity to examine the epidemiologic association between the two given the variable regional distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its highly diverse neighborhoods. OBJECTIVE: The purpose of this study was to examine the association between OHSD and SARS-CoV-2 epidemiologic burden during the first COVID-19 pandemic across the highly diverse neighborhoods of NYC. METHODS: The incidences of OHSD between March 20 and April 22, 2019, and between March 20 and April 22, 2020, as reported by the Fire Department of New York were obtained. As a surrogate for viral epidemiologic burden, we used percentage of positive SARS-CoV-2 antibody tests performed between March 3 and August 20, 2020. Data were reported separately for the 176 zip codes of NYC. Correlation analysis and regression analysis were performed between the 2 measures to examine association. RESULTS: Incidence of OHSD per 10,000 inhabitants and percentage of SARS-CoV-2 seroconversion were highly variable across NYC neighborhoods, varying from 0.0 to 22.9 and 12.4% to 50.9%, respectively. Correlation analysis showed a moderate positive correlation between neighborhood data on OHSD and percentage of positive antibody tests to SARS-CoV-2 (Spearman ρ 0.506; P <.001). Regression analysis showed that seroconversion to SARS-CoV-2 and OHSD in 2019 were independent predictors for OHSD during the first epidemic surge in NYC (R2 = 0.645). CONCLUSION: The association in geographic distribution between OHSD and SARS-CoV-2 epidemiologic burden suggests either a causality between the 2 syndromes or the presence of local determinants affecting both measures in a similar fashion.


Subject(s)
COVID-19/immunology , Death, Sudden/epidemiology , Seroconversion , COVID-19/epidemiology , Female , Humans , Incidence , Male , New York City/epidemiology , Pandemics , SARS-CoV-2
9.
Heart Rhythm ; 18(4): 501-507, 2021 04.
Article in English | MEDLINE | ID: covidwho-1046413

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. OBJECTIVE: This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality. METHODS: Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF. RESULTS: AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P < .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42-1.71; P < .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1). CONCLUSION: In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality.


Subject(s)
Atrial Fibrillation/epidemiology , COVID-19/complications , COVID-19/mortality , Aged , Aged, 80 and over , Atrial Fibrillation/diagnosis , Atrial Fibrillation/virology , COVID-19/diagnosis , Female , Hospital Mortality , Hospitalization , Humans , Incidence , Male , Middle Aged , Propensity Score , Retrospective Studies
10.
Circ Arrhythm Electrophysiol ; 13(11): e008937, 2020 11.
Article in English | MEDLINE | ID: covidwho-945067

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) has resulted in a global pandemic. Hydroxychloroquine±azithromycin have been widely used to treat coronavirus disease 2019 (COVID-19) despite a paucity of evidence regarding efficacy. The incidence of torsade de pointes remains unknown. Widespread use of these medications forced overwhelmed health care systems to search for ways to effectively monitor these patients while simultaneously trying to minimize health care provider exposure and use of personal protective equipment. METHODS: Patients with COVID-19 positive who received hydroxychloroquine±azithromycin across 13 hospitals between March 1 and April 15 were included in this study. A comprehensive search of the electronic medical records was performed using a proprietary python script to identify any mention of QT prolongation, ventricular tachy-arrhythmias and cardiac arrest. RESULTS: The primary outcome of torsade de pointes was observed in 1 (0.015%) out of 6476 hospitalized patients with COVID-19 receiving hydroxychloroquine±azithromycin. Sixty-seven (1.03%) had hydroxychloroquine±azithromycin held or discontinued due to an average QT prolongation of 60.5±40.5 ms from a baseline QTc of 473.7±35.9 ms to a peak QTc of 532.6±31.6 ms. Of these patients, hydroxychloroquine±azithromycin were discontinued in 58 patients (86.6%), while one or more doses of therapy were held in the remaining nine (13.4%). A simplified approach to monitoring for QT prolongation and arrythmia was implemented on April 5. There were no deaths related to the medications with the simplified monitoring approach and health care provider exposure was reduced. CONCLUSIONS: The risk of torsade de pointes is low in hospitalized patients with COVID-19 receiving hydroxychloroquine±azithromycin therapy.


Subject(s)
Antiviral Agents/adverse effects , Azithromycin/adverse effects , COVID-19/drug therapy , Delivery of Health Care , Heart Conduction System/drug effects , Hydroxychloroquine/adverse effects , Torsades de Pointes/chemically induced , Action Potentials/drug effects , Adolescent , Adult , Aged , Antiviral Agents/administration & dosage , Azithromycin/administration & dosage , COVID-19/diagnosis , Cardiotoxicity , Female , Heart Conduction System/physiopathology , Heart Rate/drug effects , Hospitalization , Humans , Hydroxychloroquine/administration & dosage , Male , Middle Aged , New York , Patient Safety , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Torsades de Pointes/diagnosis , Torsades de Pointes/physiopathology , Treatment Outcome , Young Adult
12.
Circ Arrhythm Electrophysiol ; 13(6): e008662, 2020 06.
Article in English | MEDLINE | ID: covidwho-141719

ABSTRACT

BACKGROUND: The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death. METHODS: Hospitalized patients treated with chloroquine/hydroxychloroquine±azithromycin from March 1 to the 23 at 3 hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in Torsade de pointes. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation, and arrhythmogenic death. RESULTS: Two hundred one patients were treated for coronavirus disease 2019 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine, and 119 (59.2%) also received azithromycin. The primary outcome of torsade de pointes was not observed in the entire population. Baseline corrected QT interval intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) versus those treated with combination group (chloroquine/hydroxychloroquine and azithromycin; 440.6±24.9 versus 439.9±24.7 ms, P=0.834). The maximum corrected QT interval during treatment was significantly longer in the combination group versus the monotherapy group (470.4±45.0 ms versus 453.3±37.0 ms, P=0.004). Seven patients (3.5%) required discontinuation of these medications due to corrected QT interval prolongation. No arrhythmogenic deaths were reported. CONCLUSIONS: In the largest reported cohort of coronavirus disease 2019 patients to date treated with chloroquine/hydroxychloroquine±azithromycin, no instances of Torsade de pointes, or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made.


Subject(s)
Arrhythmias, Cardiac/chemically induced , Azithromycin/adverse effects , Betacoronavirus , Chloroquine/adverse effects , Coronavirus Infections/drug therapy , Electrocardiography/drug effects , Hydroxychloroquine/adverse effects , Pneumonia, Viral/drug therapy , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Antimalarials/adverse effects , Antimalarials/therapeutic use , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/epidemiology , Azithromycin/therapeutic use , COVID-19 , Chloroquine/therapeutic use , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Drug Therapy, Combination , Follow-Up Studies , Humans , Hydroxychloroquine/therapeutic use , Incidence , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Prospective Studies , Risk Factors , SARS-CoV-2 , United States/epidemiology
15.
HeartRhythm Case Rep ; 6(5): 237-240, 2020 May.
Article in English | MEDLINE | ID: covidwho-15096
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