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2.
J Am Geriatr Soc ; 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1450565

ABSTRACT

BACKGROUND: We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID-19. METHODS: This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID-19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do-not-resuscitate [DNR] orders) and in-hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further explored the effect of ACP conversations on the relationship between dementia and outcomes, both at the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a hospital with low: <10%, medium 10%-20%, or high >20% ACP rates). RESULTS: Ten percent (n = 522) of the patients had documented dementia. Dementia patients were older (>80 years: 60% vs. 27%, p < 0.0001), had a lower burden of comorbidity (3+ comorbidities: 31% vs. 38%, p = 0.003), were more likely to have ACP (28% vs. 17%, p < 0.0001) and a DNR order (52% vs. 22%, p < 0.0001), had similar rates of ICU admission (26% vs. 28%, p = 0.258), were less likely to receive MV (11% vs. 16%, p = 0.001), and more likely to die (22% vs. 14%, p < 0.0001). Differential treatment intensity among patients with dementia was concentrated in hospitals with low, dementia-biased ACP billing practices (risk-adjusted ICU use: 21% vs. 30%, odds ratio [OR] = 0.6, p = 0.016; risk-adjusted MV use: 6% vs. 16%, OR = 0.3, p < 0.001). CONCLUSIONS: Dementia was associated with lower treatment intensity and higher mortality in patients hospitalized with COVID-19. Differential treatment intensity was concentrated in low ACP billing hospitals suggesting an interplay between provider bias and "preference-sensitive" care for COVID-19.

3.
Asian Economic Policy Review ; n/a(n/a), 2021.
Article in English | Wiley | ID: covidwho-1367285
5.
Stroke ; 51(12): 3570-3576, 2020 12.
Article in English | MEDLINE | ID: covidwho-892327

ABSTRACT

BACKGROUND AND PURPOSE: The impact of coronavirus disease 2019 (COVID-19) on the occurrence of ischemic stroke has been the subject of increased speculation but has not been confirmed in large observational studies. We investigated the association between COVID-19 and stroke. METHODS: We performed a cross-sectional study involving patients discharged from a healthcare system in New York State, from January to April 2020. A mixed-effects logistic regression analysis and a propensity score-weighted analysis were used to control for confounders and investigate the association of COVID-19 with ischemic stroke. Similar techniques were used to detect the impact of concurrent COVID-19 infection on unfavorable outcomes for patients with stroke. RESULTS: Among 24 808 discharges, 2513 (10.1%) were diagnosed with COVID-19, and 566 (0.2%) presented with acute ischemic stroke. Patients diagnosed with COVID-19 were at one-quarter the odds of stroke compared with other patients (odds ratio, 0.25 [95% CI, 0.16-0.40]). This association was consistent in all age groups. Our results were robust in sensitivity analyses, including propensity score-weighted regression models. In patients presenting with stroke, concurrent infection with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was associated with higher case-fatality (odds ratio, 10.50 [95% CI, 3.54-31.18]) and a trend towards increased occurrence of discharge to rehabilitation (odds ratio, 2.45 [95% CI, 0.81-1.25]). CONCLUSIONS: Using a comprehensive cross-section of patients from a large NY-based healthcare system, we did not identify a positive association between ischemic stroke and COVID-19. However, patients with stroke with COVID-19 had worse outcomes compared with those without, with over a 9-fold increase in mortality. Although no definitive conclusions can be reached from our observational study, our data do not support the concerns for an epidemic of stroke in young adults with COVID-19.


Subject(s)
COVID-19/epidemiology , Ischemic Stroke/epidemiology , Aged , Aged, 80 and over , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Middle Aged , Mortality , New York/epidemiology , Odds Ratio , Propensity Score
6.
Health Aff (Millwood) ; 39(11): 2010-2017, 2020 11.
Article in English | MEDLINE | ID: covidwho-791558

ABSTRACT

Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16 percent below prepandemic baseline volume (8 percent including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32 percent below baseline) and remained well below baseline for patients with pneumonia (-44 percent), chronic obstructive pulmonary disease/asthma (-40 percent), sepsis (-25 percent), urinary tract infection (-24 percent), and acute ST-elevation myocardial infarction (-22 percent). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.


Subject(s)
Chronic Disease/trends , Hospitalization , Pandemics/statistics & numerical data , Patient Admission , Aged , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections , Female , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Male , Middle Aged , Patient Admission/statistics & numerical data , Patient Admission/trends , Pneumonia , Pneumonia, Viral , Pulmonary Disease, Chronic Obstructive , SARS-CoV-2 , ST Elevation Myocardial Infarction , United States
7.
Heart Lung Circ ; 29(6): e57-e68, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-383246

ABSTRACT

The COVID-19 pandemic poses a significant stress on health resources in Australia. The Heart Rhythm Council of the Cardiac Society of Australia and New Zealand aims to provide a framework for efficient resource utilisation balanced with competing risks when appropriately treating patients with cardiac arrhythmias. This document provides practical recommendations for the electrophysiology (EP) and cardiac implantable electronic devices (CIED) services in Australia. The document will be updated regularly as new evidence and knowledge is gained with time.


Subject(s)
Betacoronavirus , Coronavirus Infections , Defibrillators, Implantable , Electrophysiologic Techniques, Cardiac , Pandemics , Pneumonia, Viral , Australia/epidemiology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2
8.
Heart Lung Circ ; 29(7): e85-e87, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-155331

ABSTRACT

In the context of the current global COVID-19 pandemic, this Consensus Statement provides current recommendations for patients with, or at risk of developing, genetic heart disease, and for their health care management and service provision in Australia and New Zealand. Apart from general recommendations, there are specific recommendations for the following conditions: cardiomyopathy, Brugada syndrome (including in children), long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). Other recommendations are relevant to patient self-care and primary health care.


Subject(s)
Cardiac Conduction System Disease , Cardiology , Communicable Disease Control , Coronavirus Infections , Pandemics , Patient Care Management/methods , Pneumonia, Viral , Adult , Australia/epidemiology , Betacoronavirus , COVID-19 , Cardiac Conduction System Disease/congenital , Cardiac Conduction System Disease/epidemiology , Cardiac Conduction System Disease/therapy , Cardiology/methods , Cardiology/organization & administration , Cardiology/trends , Child , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , New Zealand/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Societies, Medical
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