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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323743

ABSTRACT

Abstract Background: With the emergence of coronavirus disease 2019 in many places around the world, the main medical resources currently focus on the treatment of confirmed patients and the screening of suspected cases. Asymptomatic patients are difficult to detect, but they may be contagious, which makes epidemic control more difficult. We found a case of asymptomatic patient with positive urine coronavirus nucleic acid test, and we hope to attract attention of all circles.Case presentation: An asymptomatic patient with novel coronavirus infection was found in an epidemiological investigation of patients with confirmed coronavirus disease 2019. The patient was admitted to the hospital on February 24, 2020. She had no clinical manifestations such as fever, dry cough, and fatigue, and no abnormal signs. The examination showed that her throat swab was negative for nucleic acid but the urine was positive for nucleic acid. She was given antiviral and symptomatic supportive treatment. On February 26, her throat swab was checked for nucleic acid positive. On March 3 and 5, her throat swab and urine nucleic acid were negative. On March 9 and 12, her throat swab nucleic acid were negative. The patient was discharged from the hospital on March 13 and continued to be isolated and observed outside the hospital. Follow-up was conducted on March 26, the patient did not have any discomfort, the throat swab nucleic acid test was negative, and the isolation was lifted.Conclusion: There are asymptomatic patients with coronavirus disease 2019, and their urine may be one of the sources of infection.

2.
Food Funct ; 12(20): 9607-9619, 2021 Oct 19.
Article in English | MEDLINE | ID: covidwho-1500759

ABSTRACT

At the end of 2019, the COVID-19 virus spread worldwide, infecting millions of people. Infectious diseases induced by pathogenic microorganisms such as the influenza virus, hepatitis virus, and Mycobacterium tuberculosis are also a major threat to public health. The high mortality caused by infectious pathogenic microorganisms is due to their strong virulence, which leads to the excessive counterattack by the host immune system and severe inflammatory damage of the immune system. This paper reviews the efficacy, mechanism and related immune regulation of epigallocatechin-3-gallate (EGCG) as an anti-pathogenic microorganism drug. EGCG mainly shows both direct and indirect anti-infection effects. EGCG directly inhibits early infection by interfering with the adsorption on host cells, inhibiting virus replication and reducing bacterial biofilm formation and toxin release; EGCG indirectly inhibits infection by regulating immune inflammation and antioxidation. At the same time, we reviewed the bioavailability and safety of EGCG in vivo. At present, the bioavailability of EGCG can be improved to some extent using nanostructured drug delivery systems and molecular modification technology in combination with other drugs. This study provides a theoretical basis for the development of EGCG as an adjuvant drug for anti-pathogenic microorganisms.


Subject(s)
Anti-Infective Agents/pharmacology , Catechin/analogs & derivatives , Catechin/pharmacology , Immunologic Factors/pharmacology , Animals , Antioxidants/pharmacology , COVID-19/drug therapy , Coronavirus/drug effects , Hepatitis Viruses/drug effects , Humans , Inflammation/drug therapy , Mycobacterium tuberculosis/drug effects , Orthomyxoviridae/drug effects , Oxidative Stress/drug effects , SARS-CoV-2/drug effects , Virus Replication/drug effects
3.
Food Funct ; 12(20): 9607-9619, 2021 Oct 19.
Article in English | MEDLINE | ID: covidwho-1434159

ABSTRACT

At the end of 2019, the COVID-19 virus spread worldwide, infecting millions of people. Infectious diseases induced by pathogenic microorganisms such as the influenza virus, hepatitis virus, and Mycobacterium tuberculosis are also a major threat to public health. The high mortality caused by infectious pathogenic microorganisms is due to their strong virulence, which leads to the excessive counterattack by the host immune system and severe inflammatory damage of the immune system. This paper reviews the efficacy, mechanism and related immune regulation of epigallocatechin-3-gallate (EGCG) as an anti-pathogenic microorganism drug. EGCG mainly shows both direct and indirect anti-infection effects. EGCG directly inhibits early infection by interfering with the adsorption on host cells, inhibiting virus replication and reducing bacterial biofilm formation and toxin release; EGCG indirectly inhibits infection by regulating immune inflammation and antioxidation. At the same time, we reviewed the bioavailability and safety of EGCG in vivo. At present, the bioavailability of EGCG can be improved to some extent using nanostructured drug delivery systems and molecular modification technology in combination with other drugs. This study provides a theoretical basis for the development of EGCG as an adjuvant drug for anti-pathogenic microorganisms.


Subject(s)
Anti-Infective Agents/pharmacology , Catechin/analogs & derivatives , Catechin/pharmacology , Immunologic Factors/pharmacology , Animals , Antioxidants/pharmacology , COVID-19/drug therapy , Coronavirus/drug effects , Hepatitis Viruses/drug effects , Humans , Inflammation/drug therapy , Mycobacterium tuberculosis/drug effects , Orthomyxoviridae/drug effects , Oxidative Stress/drug effects , SARS-CoV-2/drug effects , Virus Replication/drug effects
4.
BMC Infect Dis ; 21(1): 833, 2021 Aug 19.
Article in English | MEDLINE | ID: covidwho-1365329

ABSTRACT

BACKGROUND: Bordetella avium, an aerobic bacterium that rarely causes infection in humans, is a species of Bordetella that generally inhabits the respiratory tracts of turkeys and other birds. It causes a highly contagious bordetellosis. Few reports describe B. avium as a causative agent of eye-related infections. CASE PRESENTATION: We report a case of acute infectious endophthalmitis associated with infection by B. avium after open trauma. After emergency vitrectomy and subsequent broad-spectrum antibiotic treatment, the infection was controlled successfully, and the patient's vision improved. CONCLUSIONS: B. avium can cause infection in the human eye, which can manifest as acute purulent endophthalmitis. Nanopore targeted sequencing technology can quickly identify this organism. Emergency vitrectomy combined with lens removal and silicone oil tamponade and the early application of broad-spectrum antibiotics are key for successful treatment.


Subject(s)
Bordetella avium , Bordetella , Cataract Extraction , Endophthalmitis , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/surgery , Humans , Vitrectomy
5.
BMJ Qual Saf ; 31(2): 116-122, 2022 02.
Article in English | MEDLINE | ID: covidwho-1280435

ABSTRACT

BACKGROUND AND OBJECTIVE: The impact of the COVID-19 pandemic on the quality of care for patients with acute myocardial infarction (AMI) is uncertain. We aimed to compare quality of AMI care in England and Wales during and before the COVID-19 pandemic using the 2020 European Society of Cardiology Association for Acute Cardiovascular Care quality indicators (QIs) for AMI. METHODS: Cohort study of linked data from the AMI and the percutaneous coronary intervention registries in England and Wales between 1 January 2017 and 27 May 2020 (representing 236 743 patients from 186 hospitals). At the patient level, the likelihood of attainment for each QI compared with pre COVID-19 was calculated using logistic regression. The date of the first national lockdown in England and Wales (23 March 2020) was chosen for time series comparisons. RESULTS: There were 10 749 admissions with AMI after 23 March 2020. Compared with before the lockdown, patients admitted with AMI during the first wave had similar age (mean 68.0 vs 69.0 years), with no major differences in baseline characteristics (history of diabetes (25% vs 26%), renal failure (6.4% vs 6.9%), heart failure (5.8% vs 6.4%) and previous myocardial infarction (22.9% vs 23.7%)), and less frequently had high Global Registry of Acute Coronary Events risk scores (43.6% vs 48.6%). There was an improvement in attainment for 10 (62.5%) of the 16 measured QIs including a composite QI (43.8% to 45.2%, OR 1.06, 95% CI 1.02 to 1.10) during, compared with before, the lockdown. CONCLUSION: During the first wave of the COVID-19 pandemic in England and Wales, quality of care for AMI as measured against international standards did not worsen, but improved modestly.


Subject(s)
COVID-19 , Myocardial Infarction , Aged , Cohort Studies , Communicable Disease Control , England/epidemiology , Humans , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Pandemics , SARS-CoV-2 , Wales/epidemiology
6.
Eur Heart J Qual Care Clin Outcomes ; 7(4): 378-387, 2021 07 21.
Article in English | MEDLINE | ID: covidwho-1246705

ABSTRACT

AIMS: We hypothesized that a decline in admissions with heart failure during COVID-19 pandemic would lead to a reciprocal rise in mortality for patients with heart failure in the community. METHODS AND RESULTS: We used National Heart Failure Audit data to identify 36 974 adults who had a hospital admission with a primary diagnosis of heart failure between February and May in either 2018, 2019, or 2020. Hospital admissions for heart failure in 2018/19 averaged 160/day but were much lower in 2020, reaching a nadir of 64/day on 27 March 2020 [incidence rate ratio (IRR): 0.40, 95% confidence interval (CI): 0.38-0.42]. The proportion discharged on guideline-recommended pharmacotherapies was similar in 2018/19 compared to the same period in 2020. Between 1 February-2020 and 31 May 2020, there was a 29% decrease in hospital deaths related to heart failure (IRR: 0.71, 95% CI: 0.67-0.75; estimated decline of 448 deaths), a 31% increase in heart failure deaths at home (IRR: 1.31, 95% CI: 1.24-1.39; estimated excess 539), and a 28% increase in heart failure deaths in care homes and hospices (IRR: 1.28, 95% CI: 1.18-1.40; estimated excess 189). All-cause, inpatient death was similar in the COVID-19 and pre-COVID-19 periods [odds ratio (OR): 1.02, 95% CI: 0.94-1.10]. After hospital discharge, 30-day mortality was higher in 2020 compared to 2018/19 (OR: 1.57, 95% CI: 1.38-1.78). CONCLUSION: Compared with the rolling daily average in 2018/19, there was a substantial decline in admissions for heart failure but an increase in deaths from heart failure in the community. Despite similar rates of prescription of guideline-recommended therapy, mortality 30 days from discharge was higher during the COVID-19 pandemic period.


Subject(s)
COVID-19 , Communicable Disease Control , Heart Failure , Hospital Mortality/trends , Hospitalization/statistics & numerical data , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Cause of Death , Clinical Audit/statistics & numerical data , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Electronic Health Records/statistics & numerical data , Female , Heart Failure/mortality , Heart Failure/therapy , Humans , Male , Mortality , Quality of Health Care , SARS-CoV-2 , Severity of Illness Index , State Medicine/standards , State Medicine/statistics & numerical data , United Kingdom/epidemiology
8.
J Am Coll Cardiol ; 77(20): 2466-2476, 2021 05 25.
Article in English | MEDLINE | ID: covidwho-1226298

ABSTRACT

BACKGROUND: Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear. OBJECTIVES: The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre-COVID-19 cohorts. METHODS: From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re-myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre-COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019). RESULTS: In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001). CONCLUSIONS: In this multicenter international registry, COVID-19-positive ACS patients presented later and had increased in-hospital mortality compared with a pre-COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.


Subject(s)
Acute Coronary Syndrome/virology , COVID-19/complications , Registries , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/mortality , Aged , Coronary Angiography , Female , Hospital Mortality , Humans , Male , Middle Aged
9.
Heart ; 107(9): 734-740, 2021 05.
Article in English | MEDLINE | ID: covidwho-1123608

ABSTRACT

OBJECTIVE: There are concerns that healthcare and outcomes of black, Asian and minority ethnic (BAME) communities are disproportionately impacted by the COVID-19 pandemic. We investigated admission rates, treatment and mortality of BAME with acute myocardial infarction (AMI) during COVID-19. METHODS: Using multisource national healthcare records, patients hospitalised with AMI in England during 1 February-27 May 2020 were included in the COVID-19 group, whereas patients admitted during the same period in the previous three consecutive years were included in a pre-COVID-19 group. Multilevel hierarchical regression analyses were used to quantify the changes in-hospital and 7-day mortality in BAME compared with whites. RESULTS: Of 73 746 patients, higher proportions of BAME patients (16.7% vs 10.1%) were hospitalised with AMI during the COVID-19 period compared with pre-COVID-19. BAME patients admitted during the COVID-19 period were younger, male and likely to present with ST-elevation acute myocardial infarction. COVID-19 BAME group admitted with non-ST-elevation acute myocardial infarction less frequently received coronary angiography (86.1% vs 90.0%, p<0.001) and had a longer median delay to reperfusion (4.1 hours vs 3.7 hours, p<0.001) compared with whites. BAME had higher in-hospital (OR 1.68, 95% CI 1.27 to 2.28) and 7-day mortality (OR 1.81 95% CI 1.31 to 2.19) during COVID-19 compared with pre-COVID-19 period. CONCLUSION: In this multisource linked cohort study, compared with whites, BAME patients had proportionally higher hospitalisation rates with AMI, less frequently received guidelines indicated care and had higher early mortality during COVID-19 period compared with pre-COVID-19 period. There is a need to develop clinical pathways to achieve equity in the management of these vulnerable populations.


Subject(s)
COVID-19 , Critical Pathways , Healthcare Disparities , Non-ST Elevated Myocardial Infarction , ST Elevation Myocardial Infarction , COVID-19/mortality , COVID-19/therapy , Coronary Angiography/methods , Coronary Angiography/statistics & numerical data , Critical Pathways/organization & administration , Critical Pathways/standards , England/epidemiology , Female , Health Services Needs and Demand , Healthcare Disparities/standards , Healthcare Disparities/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Non-ST Elevated Myocardial Infarction/ethnology , Non-ST Elevated Myocardial Infarction/therapy , Outcome and Process Assessment, Health Care , Race Factors , SARS-CoV-2 , ST Elevation Myocardial Infarction/ethnology , ST Elevation Myocardial Infarction/therapy
10.
Thromb Res ; 202: 17-23, 2021 06.
Article in English | MEDLINE | ID: covidwho-1121292

ABSTRACT

BACKGROUND: Evidence supports an excess of deaths during the COVID-19 pandemic. We report the incidence and mortality of thrombo-embolic events (TE) during the COVID-19 pandemic. METHODS: Multi-sourced nationwide cohort study of adults (age ≥18 years) admitted to hospital with TE and deaths from TE in England (hospital and community) between 1st February 2018 and 31st July 2020. Relative risks, adjusted for age, sex, atrial fibrillation, co-morbidities and time trend comparing before and during the COVID-19 pandemic were estimated using Poisson regression. FINDINGS: Of 272,423 patients admitted with TE to 195 hospitals, 86,577 (31.8%) were admitted after 2nd March 2020 (first COVID-19 death in the UK). The incidence of TE hospitalised increased during the COVID-19 pandemic from 1090 to 1590 per 100,000 (absolute risk change 45.9% [95% CI 45.1-46.6%], adjusted relative risk [ARR] 1.43 [95% CI 1.41-1.44]) driven particularly by pulmonary embolism; 1.49, 95% CI 1.46-1.52. TE were more frequent among those with COVID-19; 1.9% vs. 1.6%, absolute risk change 21.7%, 95% CI 21.0-22.4%, ARR 1.20, 95% CI 1.18-1.22. There was an increase in the overall mortality from TE during the pandemic (617, 6.7% proportional increase compared with the historical baseline), with more TE deaths occurring in the community compared with the historical rate (44% vs. 33%). INTERPRETATION: The COVID-19 pandemic has resulted in an increase in the incidence of hospitalised TE. There were more deaths from TE in the community highlighting a number of mechanisms including the hypercoagulable state associated with COVID-19 infection and potential impact of delays in seeking help. RESEARCH IN CONTEXT: Evidence before this study We searched PubMed on 16 November 2020 for articles that documented the incidence and mortality of thrombo-embolic events (TE) during the COVID-19 pandemic using the search terms "COVID-19" OR "Coronavirus*" OR "2019-nCOV" OR "SARS-CoV" AND ("Thromboembolism" OR "Venous Thromboembolism" OR "thromboembol*") with no language or time restrictions. The majority of data on TE in COVID-19 pertains to hospitalised patients from retrospective cohort studies. One study found that TE in hospitalised patients was associated with an increased mortality rate (adjusted hazard ratio 1.82; 95% CI 1.54-2.15). A systematic review and meta-analysis of 35 studies in 9249 hospitalised patients calculated an overall pooled incidence of TE of 17.8% (95% CI: 9.9-27.4%), rising to 22.9% (95% CI: 14.5-32.4%) in patients admitted to intensive care (ICU). The most contemporary data are from a cohort of 1114 patients (715 outpatient, 399 hospitalised, 170 admitted to ICU). With robust COVID-19-specific therapies and widespread thromboprophylaxis the prevalence of venous TE in ICU patients was reported as 7% (n = 12) when catheter-/device-related events were excluded, and among the outpatients there was no TE reported. No published studies have used nationwide data to investigate TE during the pandemic or the effect of the pandemic on outcomes of patients with TE but without Covid-19. Added value of this study This retrospective multi-sourced nationwide unlinked cohort study compares the overall incidence and mortality of TE prior to and during the COVID-19 pandemic. We found an increased incidence of TE despite only a small proportion having a diagnosis of COVID-19. This may highlight the lack of testing, particularly in the community during the initial phase of the pandemic, and the possibility of other factors contributing to TE risk, such as decreased daily activity mandated by home quarantine and alterations in medication concordance. Mortality from TE was higher in the community during the pandemic and this highlights that adverse societal effects of the pandemic, such as aversion to seeking medical assessment, may precipitate worse outcomes related to TE. Implications of all the available evidence Evidence suggests that COVID-19 produces a hypercoagulable state and thromboprophylaxis is recommended in hospitalised patients to prevent excess mortality from TE. Whether to anticoagulate non-hospitalised ambulatory patients with COVID-19 will be answered by ongoing trials. Clinicians should consider the risks posed by decreased daily activity and fear of medical contact, and provide appropriate advice to patients.


Subject(s)
COVID-19 , Venous Thromboembolism , Adolescent , Adult , Anticoagulants , Cohort Studies , England/epidemiology , Humans , Incidence , Pandemics , Retrospective Studies , SARS-CoV-2
11.
Mayo Clin Proc ; 96(4): 952-963, 2021 04.
Article in English | MEDLINE | ID: covidwho-1085507

ABSTRACT

OBJECTIVE: To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. METHODS: This national death registry included all adult (aged ≥18 years) deaths in England and Wales between January 1, 2014, and June 30, 2020. Daily deaths during the COVID-19 pandemic were compared against the expected daily deaths, estimated with use of the Farrington surveillance algorithm for daily historical data between 2014 and 2020 by place and cause of death. RESULTS: Between March 2 and June 30, 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (87%) were COVID-19 related. At home, only 14% (2267) of the 16,190 excess deaths were related to COVID-19, with 5963 deaths due to cancer and 2485 deaths due to cardiac disease, few of which involved COVID-19. In care homes or hospices, 61% (15,623) of the 25,611 excess deaths were related to COVID-19, 5539 of which were due to respiratory disease, and most of these (4315 deaths) involved COVID-19. In the hospital, there were 16,174 fewer deaths than expected that did not involve COVID-19, with 4088 fewer deaths due to cancer and 1398 fewer deaths due to cardiac disease than expected. CONCLUSION: The COVID-19 pandemic has resulted in a large excess of deaths in care homes that were poorly characterized and likely to be the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, suggesting public avoidance of hospital care for non-COVID-19 conditions.


Subject(s)
COVID-19 , Cause of Death/trends , Heart Diseases/mortality , Home Care Services/statistics & numerical data , Neoplasms/mortality , Nursing Homes/statistics & numerical data , Adult , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Diagnostic Errors/mortality , Diagnostic Errors/statistics & numerical data , England/epidemiology , Female , Hospice Care/statistics & numerical data , Hospital Mortality/trends , Humans , Male , Middle Aged , Mortality , SARS-CoV-2 , Wales/epidemiology
13.
J Intern Med ; 290(1): 88-100, 2021 07.
Article in English | MEDLINE | ID: covidwho-1035336

ABSTRACT

BACKGROUND: Patients with underlying cardiovascular disease and coronavirus disease 2019 (COVID-19) infection are at increased risk of morbidity and mortality. OBJECTIVES: This study was designed to characterize the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID-19 infection. METHODS: This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID-19 infection between 1 March and 31 May 2020 were included. The primary outcome was in-hospital and 30-day mortality. RESULTS: A total of 12 958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID-19-positive and were more likely to present with non-ST-elevation acute myocardial infarction. The COVID-19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with the non-COVID-19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID-19 ACS had higher in-hospital (adjusted odds ratio (aOR): 3.27; 95% confidence interval (CI): 2.41-4.42) and 30-day mortality (aOR: 6.53; 95% CI: 5.1-8.36) compared to patients with the non-COVID-19 ACS. CONCLUSION: COVID-19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline-recommended treatment and significant mortality hazard.


Subject(s)
Acute Coronary Syndrome/complications , Acute Coronary Syndrome/mortality , COVID-19/complications , COVID-19/mortality , Aged , Electronic Health Records , England/epidemiology , Female , Guideline Adherence , Hospital Mortality , Hospitalization , Humans , Male , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Prevalence , Risk Factors , SARS-CoV-2
14.
J Invasive Cardiol ; 33(3): E206-E219, 2021 03.
Article in English | MEDLINE | ID: covidwho-984606

ABSTRACT

BACKGROUND: Public reporting of percutaneous coronary intervention (PCI) outcomes is a performance metric and a requirement in many healthcare systems. There are inconsistent data on the causes of death after PCI, and the proportion of these deaths that are attributable to cardiac causes. METHODS: All patients undergoing PCI in England between January 1, 2017 and May 10, 2020 (n = 273,141) were retrospectively analyzed according to their outcome from the date of PCI: no death, in-hospital death, postdischarge death, and total 30-day death. The present study examined short-term primary causes of death after PCI in a national cohort before and during COVID-19. RESULTS: The overall rates of in-hospital and 30-day death were 1.9% and 2.8%, respectively. The rate of 30-day death declined between 2017 (2.9%) and February 2020 (2.5%), mainly due to lower in-hospital death (2.1% vs 1.5%), before rising again from March 1, 2020 (3.2%) due to higher rates of postdischarge mortality. Only 59.6% of 30-day deaths were due to cardiac causes, with the most common causes being acute coronary syndrome, cardiogenic shock, and heart failure, and this persisted throughout the study period. In the 30-day death group, 10.4% after March 1, 2020 were due to confirmed COVID-19. CONCLUSIONS: In this nationwide study, we show that 40% of 30-day deaths are due to non-cardiac causes. Non-cardiac deaths have increased even more from the start of the COVID-19 pandemic, with 1 in 10 deaths from March 2020 being COVID-19 related. These findings raise a question of whether public reporting of PCI outcomes should be cause specific.


Subject(s)
Acute Coronary Syndrome/surgery , COVID-19/epidemiology , Pandemics , Percutaneous Coronary Intervention/mortality , Acute Coronary Syndrome/epidemiology , Aged , Cause of Death/trends , Comorbidity , England/epidemiology , Female , Follow-Up Studies , Hospital Mortality/trends , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Survival Rate/trends
15.
Front Med (Lausanne) ; 7: 604980, 2020.
Article in English | MEDLINE | ID: covidwho-983761

ABSTRACT

Introduction: COVID-19 has had a huge impact on society and healthcare and it has been suggested that people with periodontal disease are at risk of having worse outcomes from the disease. The aim of this study was to quantify the impact of periodontal disease on hospital admission and mortality during the COVID-19 pandemic. Materials and Methods: The study extracted UK Biobank participants who had taken a COVID-19 test between March and June 2020 (n = 13,253), of which 1,616 were COVID-19 positive (12%) and 11,637 were COVID-19 negative (88%). Self-reported oral health indicators of painful or bleeding gums and loose teeth were used as surrogates for periodontal disease, participants who did not report any of the aforementioned indicators were used as controls. Multivariable logistic regressions were used to obtain crude and adjusted odds ratios of COVID-19 infection, subsequent hospital admission and mortality adjusted for demographics, BMI, biomarkers, lifestyle and co-morbidities. Results: Painful gums, bleeding gums and loose teeth were reported in 2.7, 11.2 and 3.3% of participants with COVID-19 infection, respectively. Risk of COVID-19 infection in participants with painful or bleeding gums and loose teeth compared to controls was not increased (odds ratio [OR]: 1.10, 95% CI: 0.72-1.69; OR: 1.15, 95% CI: 0.84-1.59). COVID-19 positive participants with painful or bleeding gums had a higher risk of mortality (OR: 1.71, 95% CI: 1.05-2.72) but not hospital admission (OR: 0.90, 95% CI: 0.59-1.37). Participants with loose teeth did not show higher risk of hospital admission or mortality compared to the control group (OR = 1.55, 95% CI: 0.87-2.77; OR: 1.85; 95% CI: 0.92-2.72). Conclusion: There was insufficient evidence to link periodontal disease with an increased risk of COVID-19 infection. However, amongst the COVID-19 positive, there was significantly higher mortality for participants with periodontal disease. Utilization of linked dental and hospital patient records would improve the understanding of the impact of periodontal disease on COVID-19 related outcomes.

16.
J Am Heart Assoc ; 9(22): e018379, 2020 11 17.
Article in English | MEDLINE | ID: covidwho-941677

ABSTRACT

Background Studies have reported significant reduction in acute myocardial infarction-related hospitalizations during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends are associated with increased incidence of out-of-hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID-19 period (February 1-May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre-COVID-19 period (February 1-May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID-19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID-19 period compared with the pre-COVID-19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39-1.74). Patients experiencing OHCA during COVID-19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST-segment-elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P<0.001) were significantly lower among the OHCA group during COVID-19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P=0.05) in those with ST-segment-elevation myocardial infarction. The adjusted in-hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID-19 group (P<.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID-19 period paralleled with reduced access to guideline-recommended care and increased in-hospital mortality.


Subject(s)
COVID-19/epidemiology , Hospitalization/trends , Out-of-Hospital Cardiac Arrest/epidemiology , ST Elevation Myocardial Infarction/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Female , Humans , Incidence , Male , Medical Audit , Middle Aged , Myocardial Reperfusion/trends , Out-of-Hospital Cardiac Arrest/diagnosis , Out-of-Hospital Cardiac Arrest/mortality , Out-of-Hospital Cardiac Arrest/therapy , Prevalence , Prospective Studies , Registries , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Time Factors , Time-to-Treatment/trends , United Kingdom/epidemiology , Young Adult
17.
Heart ; 107(2): 113-119, 2021 01.
Article in English | MEDLINE | ID: covidwho-808650

ABSTRACT

OBJECTIVE: To describe the place and causes of acute cardiovascular death during the COVID-19 pandemic. METHODS: Retrospective cohort of adult (age ≥18 years) acute cardiovascular deaths (n=5 87 225) in England and Wales, from 1 January 2014 to 30 June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2 March 2020). The main outcome was acute cardiovascular events directly contributing to death. RESULTS: After 2 March 2020, there were 28 969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10 318, 35.6%), followed by acute coronary syndrome (ACS) (7 098, 24.5%), heart failure (6 770, 23.4%), pulmonary embolism (2 689, 9.3%) and cardiac arrest (1 328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital. CONCLUSIONS AND RELEVANCE: The COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19.


Subject(s)
Acute Coronary Syndrome , COVID-19 , Cause of Death , Mortality/trends , Stroke , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/mortality , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , Causality , England/epidemiology , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Residence Characteristics/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , Stroke/etiology , Stroke/mortality
18.
Heart ; 106(23): 1805-1811, 2020 12.
Article in English | MEDLINE | ID: covidwho-738353

ABSTRACT

BACKGROUND: The objective of the study was to identify any changes in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England by analysing procedural numbers, clinical characteristics and patient outcomes during the COVID-19 pandemic. METHODS: We conducted a retrospective cohort study of patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database. Analysis was restricted to 44 hospitals that reported contemporaneous activity on PCI. Only patients with primary PCI for STEMI were included in the analysis. RESULTS: A total of 34 127 patients with STEMI (primary PCI 33 938, facilitated PCI 108, rescue PCI 81) were included in the study. There was a decline in the number of procedures by 43% (n=497) in April 2020 compared with the average monthly procedures between 2017 and 2019 (n=865). For all patients, the median time from symptom to hospital showed increased after the lockdown (150 (99-270) vs 135 (89-250) min, p=0.004) and a longer door-to-balloon time after the lockdown (48 (21-112) vs 37 (16-94) min, p<0.001). The in-hospital mortality rate was 4.8% before the lockdown and 3.5% after the lockdown (p=0.12). Following adjustment for baseline characteristics, no differences were observed for in-hospital death (OR 0.87, 95% CI 0.45 to 1.68, p=0.67) and major adverse cardiovascular events (OR 0.71, 95% CI 0.39 to 1.32, p=0.28). CONCLUSIONS: Following the lockdown in England, we observed a decline in primary PCI procedures for STEMI and increases in overall symptom-to-hospital and door-to-balloon time for patients with STEMI. Restructuring health services during COVID-19 has not adversely influenced in-hospital outcomes.


Subject(s)
Betacoronavirus , Communicable Disease Control , Coronavirus Infections/epidemiology , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral/epidemiology , ST Elevation Myocardial Infarction/therapy , Aged , COVID-19 , England , Female , Hospital Mortality , Humans , Male , Middle Aged , Pandemics , Procedures and Techniques Utilization , Retrospective Studies , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , Time-to-Treatment , Treatment Outcome
19.
Eur Heart J Qual Care Clin Outcomes ; 7(3): 238-246, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-691280

ABSTRACT

AIMS: COVID-19 might have affected the care and outcomes of hospitalized acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment, and mortality from AMI. METHODS AND RESULTS: Admission was classified as non-ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1 January 2019 and 22 May 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23 March 2020 (UK lockdown), median daily hospitalizations decreased more for NSTEMI [69 to 35; incidence risk ratios (IRR) 0.51, 95% confidence interval (CI) 0.47-0.54] than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19 April 2020. During lockdown, patients were younger (mean age 68.7 vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%), or had cerebrovascular disease (7.0% vs. 8.6%). ST-elevation myocardial infarction more frequently received primary percutaneous coronary intervention (81.8% vs. 78.8%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 h), median duration of hospitalization decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each > 94.7%). Mortality at 30 days increased for NSTEMI [from 5.4% to 7.5%; odds ratio (OR) 1.41, 95% CI 1.08-1.80], but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97). CONCLUSION: During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less comorbid and, for NSTEMI, had higher 30-day mortality.


Subject(s)
COVID-19 , Non-ST Elevated Myocardial Infarction , ST Elevation Myocardial Infarction , Aged , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Cardiovascular Agents/therapeutic use , Communicable Disease Control/organization & administration , Communicable Disease Control/statistics & numerical data , Coronary Angiography/methods , Coronary Angiography/statistics & numerical data , Coronary Artery Bypass/methods , Coronary Artery Bypass/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Mortality/trends , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/mortality , Non-ST Elevated Myocardial Infarction/therapy , Non-ST Elevated Myocardial Infarction/virology , Outcome and Process Assessment, Health Care , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/statistics & numerical data , Registries/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/virology , Seasons , United Kingdom/epidemiology
20.
Mayo Clin Proc ; 95(10): 2110-2124, 2020 10.
Article in English | MEDLINE | ID: covidwho-664771

ABSTRACT

OBJECTIVE: To address the issue of limited national data on the prevalence and distribution of underlying conditions among COVID-19 deaths between sexes and across age groups. PATIENTS AND METHODS: All adult (≥18 years) deaths recorded in England and Wales (March 1, 2020, to May 12, 2020) were analyzed retrospectively. We compared the prevalence of underlying health conditions between COVID and non-COVID-related deaths during the COVID-19 pandemic and the age-standardized mortality rate (ASMR) of COVID-19 compared with other primary causes of death, stratified by sex and age group. RESULTS: Of 144,279 adult deaths recorded during the study period, 36,438 (25.3%) were confirmed COVID deaths. Women represented 43.2% (n=15,731) of COVID deaths compared with 51.9% (n=55,980) in non-COVID deaths. Overall, COVID deaths were younger than non-COVID deaths (82 vs 83 years). ASMR of COVID-19 was higher than all other common primary causes of death, across age groups and sexes, except for cancers in women between the ages of 30 and 79 years. A linear relationship was observed between ASMR and age among COVID-19 deaths, with persistently higher rates in men than women across all age groups. The most prevalent reported conditions were hypertension, dementia, chronic lung disease, and diabetes, and these were higher among COVID deaths. Pre-existing ischemic heart disease was similar in COVID (11.4%) and non-COVID (12%) deaths. CONCLUSION: In a nationwide analysis, COVID-19 infection was associated with higher age-standardized mortality than other primary causes of death, except cancer in women of select age groups. COVID-19 mortality was persistently higher in men and increased with advanced age.


Subject(s)
Betacoronavirus , Coronavirus Infections/mortality , Healthcare Disparities/statistics & numerical data , Hospital Mortality/trends , Pneumonia, Viral/mortality , Adult , Age Distribution , Age Factors , Aged , COVID-19 , Cause of Death , England/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sex Distribution , Socioeconomic Factors , Wales/epidemiology
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