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INTRODUCTION: Recent reports suggest very low to no hospital survival among COVID-19 patients with in-hospital cardiac arrest (IHCA). However, studies to date included generally very small number of IHCA events and were often single-centered. The population-level outcomes of IHCA among COVID-19 patients is unknown. METHOD(S): We used a statewide data set to identify hospitalizations aged >=18 years in acute care hospitals in Texas with a diagnosis of COVID-19 between April 1st and December 31st, 2020. COVID-19 infection was identified using ICD-10 code U071. Cardiopulmonary resuscitation was identified using ICD-10 code 5A12012. Hospitalizations with cardiac arrest as a primary diagnosis and those without a primary diagnosis of COVID-19 were excluded. Mixed-effects multivariable logistic regression modelling was used to identify predictors of hospital survival among those with IHCA. RESULT(S): Among 65,482 hospitalizations with COVID-19, 893 (1.4%) had IHCA. Among those with IHCA, 57.1% were aged >= 65 years, 64.2% male, 70.9% racial/ethnic minority, and 7.1% had shockable rhythm. IHCA occurred in 12.7% [95% CI 11.8-13.6] of terminal hospitalizations. Hospital survival was 7.3% [95%CI 5.6-9.3], ranging from 6.7% [95% CI 4.6-9.3] among those aged >=65 years to 10.7% [95% CI 4.6-21.0] among those aged < 45 years. On adjusted analyses, among examined patient and hospital characteristics, only shockable rhythm (adjusted odds ratio [aOR] 2.63 [95% CI 1.05-6.56]) and management in hospitals with 200-399 beds (aOR 0.14 [95% CI 0.03- 0.58]), but not demographics, comorbidities, or illness severity, were associated with hospital survival. Among hospital survivors, 23.1% were transferred to hospice and 35.4% were discharged home. CONCLUSION(S): Resuscitation of IHCA among COVID-19 patients occurred more selectively compared to the general population. Hospital survival was very low, and less than 3% of those with IHCA were discharged home. Once developing among patients with COVID-19, the short-term survival of IHCA was no longer affected by demographic characteristics, comorbidity burden, or illness severity. Further large studies, using granular data, are needed to better guide clinicians', patients', and surrogates' decision-making and to improve patients' outcomes.
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Background: There is limited empirical evidence exploring the patient experience and treatment needs in AL-amyloidosis. Many patients experience delays in receiving a diagnosis and research suggests they suffer from a lack of support and information about the condition, worsening the impact of the disease on their quality-of-life. In June 2021 the EMA granted marketing authorisation for daratumumab in combination with bortezomib, cyclophosphamide and dexamethasone (DBCd) to treat adults with newly diagnosed AL-amyloidosis. Previously, patients have been treated with off-label therapies for multiple myeloma. Objective(s): To develop greater understanding of the diagnosis, management of the disease, and impact on patients and carers, in the UK. Method(s): A literature review and focus groups with adults living with AL-amyloidosis and a carer. Group 1 consisted of 3 adults, group 2 of 3 adults plus 1 carer. Groups were semi-structured;discussion topics included the patient journey, impact of disease, and COVID-19. Result(s): Despite delays to diagnosis, ongoing relationships with consultants fostered good communication with patients. In the treatment pathway, patients prioritised extension of life and quality-of-life, even if side-effects from treatment impaired quality-of-life. Participants spoke highly of their healthcare teams and experiences with the National Amyloidosis Centre. Impacts on daily life and emotional well-being tended to be more prominent among patients with a more complex disease pathway. For patients, time to diagnosis, ongoing communication with a trustworthy consultant, treatment outcomes and support was important. Although generally satisfied, suggestions for change across the diagnostic and treatment pathway were recommended. Striving for consistency of care and communication was paramount, and treatment impacts on day-to-day life (e.g., through minimising side-effects and convenient administration) should be prioritised. Conclusion(s): Results have the power to better inform healthcare decisions and the development of specific treatments, prioritising interventions that align with the unmet needs and preferences of people living with AL-amyloidosis. Copyright © 2022
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COVID-19 also has long-term health implications. The number of reports of people having persisting symptoms is increasing, but the characteristics of a COVID-19 syndrome are unknown. The aim is to assess the presentation of physical and psychological symptoms post-COVID in patients who experienced mild to moderate COVID-19, and to investigate to which extent these constitute a syndrome. A cross-sectional survey, distributed via social media groups of long-COVID sufferers, was conducted. The eligibility criteria were: aged 18 years or older, a history of COVID-19 and the first symptoms of COVID-19 had to be older than 6 weeks. Primary outcome measures are the prevalence of persisting symptoms 3 and 6 months after a COVID-19 infection to identify a post-COVID syndrome. A secondary outcome measure are the patient characteristics associated with persisting symptoms 3 months post-COVID. 787 respondents consented and 539 completed the survey. 471 (87%) participants are female and 259 (49%) are between the age of 36 and 50 years. The most frequently reported symptoms after 6 months are fatigue (52%), decreased concentration and cognitive function (42%), muscle complaints (42%), dyspnoea (39%), sleeping problems (35%), mood swings (20%), depressed mood (19%) and anxiety (18%). A post-COVID syndrome cannot be described. Only the female gender is associated with an increase in the number of symptoms post-COVID. We see a high prevalence of persistent symptoms 3 and 6 months post-COVID. However, despite the high prevalence of symptoms, our analyses do not identify a post-COVID-19 syndrome. Copyright © 2022 Tijdschrift voor Geneeskunde en Gezondheidszorg. All rights reserved.
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Objective: The objective of the study was to evaluate the incidence of COVID-19 infections after vaccination in NMOSD patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected and vaccinated for COVID-19. Method(s): Retrospective cohort study developed between May 2021 to December 2021. The primary outcome was the appearance of infection during the follow up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (vaccine received, dose, date, symptoms, COVID-19 infection, need for hospitalization, ventilatory assistance, treatment, and evolution). The primary objective of the analysis was to compare the incidence of breakthrough SARS-CoV-2 19 infections among the vaccinated pwMS in each DMT group. These conditions entail a PCR-confirmed test, and a time lag of at least 14 days from a full vaccination cycle (after the second vaccination dose). Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. Result(s): A total of 49 NMOSD patients from eight countries in LATAM were included. Mean age was 43.8 +/-13 years. The most frequent treatment use was rituximab in 29 (59.2%). The mean follow up after the second dose was 149 +/- 32 days. Most frequent first and second dose received was Pfizer (28.6%), followed by Sinopharm (24.5%). During follow up a total of 2 COVID-19 cases were observed for a total exposure time of 8627 days. Cumulative incidence was 4.1% (SE 0.87%) with an overall incidence density of 2.31 x 10.000 patients/day (95%CI 1.13-3.71). Both cases occurred in patients under rituximab (2/29, exposure time 4208, IR 4.7 x 10,000 patients/day 95%CI 3.5-5.1). No hospitalizations were reported for both cases. Conclusion(s): We observed an ID of COVID-19 infection after vaccination of 2.31 x 10.000 patients/day in NMOSD patients.
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Background: Antiviral medications such as remdesivir, molnupiravir, and nirmatrelvir/ritonavir are most effective when used early in the course of COVID-19. These medications are authorized for patients with COVID-19 with mild symptoms who are at high risk for severe disease. ESKD is among the strongest risk factors for mortality from COVID-19. As the ESKD population is highly linked to care, we hypothesized that they are more likely to be admitted to the hospital within five days of symptom onset when antiviral medications are maximally effective. Method(s): We identified patients with ESKD on dialysis who were admitted to Massachusetts General Hospital with COVID-19 by using dialysis records and manually extracted the date of symptom onset as shown in the admission note. Primary outcome was the proportion of patients with ESKD admitted within 5 days of symptom onset;secondary outcome was the risk of respiratory failure within 90 days among the early presenters. Result(s): After implementing the exclusion criteria shown in Figure 1, we included 99 patients with community-acquired COVID-19 admitted between March 2020 and Jan 2022. Thirty patients (30%) remained asymptomatic during their hospitalization. Among patients with symptomatic COVID-19, 56 (81%) were admitted within 5 days of symptom onset;among them, 17 developed respiratory failure within 90 days (30%) and 11 died from respiratory failure (20%). (Figure1) Conclusion(s): We found that most patients with ESKD on dialysis admitted for symptomatic COVID-19 presented within 5 days of symptom onset. We conjectured that because of this, inpatient antiviral therapy may be more effective in the ESKD population than in a typical inpatient population with COVID-19 that presents later in the disease course. Given the high risk of respiratory failure in ESKD population who developed COVID-19, improved treatment strategies are urgently needed.
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Study Objectives: Patients infected with SARS-CoV-2 who are evaluated in the emergency department but well enough to go home are still at risk for clinical deterioration. They may benefit from a program to monitor oxygen levels at home using portable pulse oximeter devices. Our study aims to evaluate patient engagement in and compliance with a home pulse oximetry monitoring program. The results of this study will be important to inform development and operationalization of remote patient monitoring programs. Methods: This was a single center, prospective pilot study of patients who presented to the ED or urgent care for symptoms consistent with SARS-CoV-2 infection and were considered to have some risk of clinical deterioration and thus could benefit from home SpO2 monitoring. Subjects were given a portable pulse oximeter and diary. They were instructed to perform readings at rest and with exertion twice daily for 14 days. Patients also recorded the presence or absence of symptoms associated with COVID-19 and whether they required additional medical care due to worsening symptoms. Subjects were contacted daily to obtain the recorded data. If contact could not be made with 3 attempts on each of 3 successive days, the subject was considered lost to follow up. The primary outcome of interest was patient engagement in the program defined as completion of the entire 14-day assessment. Secondary outcomes included patient compliance with performing the SpO2 readings and the proportion of subjects who had worsening clinical status requiring medical evaluation. Patient compliance was calculated as a percentage of completed readings out of the total number of possible readings. The difference in engagement and compliance rates between COVID-positive and COVID-negative patients was calculated using the Pearson Chi-squared test and Mann-Whitney U test, respectively. Results: Fifty patients were enrolled in the study with 3 screen failures. The remaining 47 were included in the final analysis. All patients received a qualitative test for detection of SARS-CoV-2;27 (57.4%) patients tested positive. Overall, engagement in the program was 46.8% with no significant difference between COVID- positive and COVID-negative groups (48.15% vs 45 %, p = 0.831). Median compliance was 42.9% (IQR 22.22 78.57) with compliance of 50.0% (IQR 20 - 85.71) and 42.86% (IQR 22.92 - 76.44) for COVID-positive and COVID-negative groups, respectively (p= 0.838). A total of 4 patients required additional medical care during the study period. Of those, two sought medical attention after advisement by the study team members due to decreasing SpO2 levels. Conclusion: Our study demonstrated that there was limited engagement and compliance in a 14-days home pulse oximetry monitoring program. A positive SARS-CoV-2 test did not predict a higher likelihood of engagement or compliance. Our program was helpful in detecting worsening SpO2 levels in two patients who sought medical care and were admitted for further management. These results support the use of home pulse oximetry monitoring;however, design of programs should focus on increasing patient engagement and compliance.