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1.
Ther Adv Cardiovasc Dis ; 16: 17539447221137170, 2022.
Article in English | MEDLINE | ID: covidwho-2139019

ABSTRACT

BACKGROUND: Management of high blood pressure (BP) typically requires adherence to medication regimes. However, it is known that the COVID-19 pandemic both interrupted access to some routine prescriptions and changed some patient health behaviours. AIM: This study, therefore, retrospectively investigated prescription reimbursement of cardiovascular (CVD) medicines as a proxy measure for patient adherence and access to medicines during the pandemic. METHODS: A cohort study of all primary care patients in England prescribed CVD medicines. The exposure was to the global pandemic. Prescriptions were compared before and after the pandemic's onset. Statistical variation was the outcome of interest. RESULTS: Descriptive statistics show changes to monthly prescriptions, with wide confidence intervals indicating varying underlying practice. Analysis of variance reveals statistically significant differences for bendroflumethiazide, potassium-sparing diuretics, nicorandil, ezetimibe, ivabradine, ranolazine, colesevelam and midodrine. After the pandemic began (March-October 2020), negative parameters are observed for ACE inhibitors, beta-blockers, calcium channel blockers, statins, antiplatelet, antithrombotics, ARBs, loop diuretics, doxazosin, bendroflumethiazide, nitrates and indapamide, indicating decelerating monthly prescription items (statistically significant declines of calcium channel blockers, antithrombotic, adrenoreceptor blockers and diuretics) of CVD medicines within the general population. Many data points are not statistically significant, but fluctuations remain clinically important for the large population of patients taking these medications. CONCLUSION: A concerning decline in uptake of CVD therapies for chronic heart disease was observed. Accessible screening and treatment alongside financial relief on prescription levies are needed. A video abstract is (4 min 51 s) available: https://bit.ly/39gvEHi.


Subject(s)
COVID-19 , Cardiovascular Agents , Cardiovascular Diseases , Heart Diseases , Humans , Pandemics , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Bendroflumethiazide , Retrospective Studies , Cohort Studies , Angiotensin Receptor Antagonists , Cardiovascular Agents/adverse effects , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Heart Diseases/drug therapy , Diuretics/therapeutic use , Drug Prescriptions
2.
BMJ Open ; 12(11): e066868, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2137796

ABSTRACT

OBJECTIVES: The North East of England, ranked as having the highest poverty levels and the lowest health outcomes, has the highest cardiovascular disease (CVD) premature mortality. This study aimed to compare CVD-related conditions and risk factors for deprived practice populations with other general practice (GP) populations in Northern England to England overall, before and during COVID-19 to identify changes in recorded CVD-related risk factors and conditions and evidence-based lipid prescribing behaviour. DESIGN: A population-based observational study of aggregated practice-level data obtained from publicly accessible data sets. SETTING: 34 practices that fall into the 15% most deprived practice populations in England were identified as the most deprived communities in the North East and North Cumbria (Deep End). PARTICIPANTS: Patients aged ≥16 registered with GP and diagnosed with any form of CVD. PRIMARY AND SECONDARY OUTCOME MEASURES: CVD-related conditions and risk factors, statin prescribing. RESULTS: Deep End (n=263 830) had a smaller, younger and more deprived population with lower levels of employment and full-time education and higher smoking prevalence. They had some higher recorded CVD-related conditions than England but lower than the non-Deep End. Atrial fibrillation (-0.9, -0.5), hypertension (-3.7, -1.3) and stroke and transient ischaemic attack rates (-0.5, -0.1) appeared to be lower in the Deep End than in the non-Deep End but the optimal statin prescribing rate was higher (3.1, 8.2) than in England. CONCLUSION: Recorded CVD-related risk factors and conditions remained comparable before and during COVID-19. These are higher in the Deep End than in England and similar or lower than the non-Deep End, with a higher optimal statin prescribing rate. However, it was not possible to control for age and sex. More work is needed to estimate the consequences of the pandemic on disadvantaged communities and to compare whether the findings are replicated in other areas of deprivation.


Subject(s)
COVID-19 , Cardiovascular Diseases , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Humans , Cardiovascular Diseases/epidemiology , COVID-19/epidemiology , Risk Factors , England/epidemiology , Primary Health Care
5.
Sci Rep ; 12(1): 18934, 2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2113253

ABSTRACT

Body mass index (BMI) distribution and its impact on cardiovascular disease (CVD) vary between Asian and western populations. The study aimed to reveal time-related trends in the prevalence of obesity and underweight and safe ranges of BMI in Japanese patients with CVD. We analyzed 5,020,464 records from the national Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination dataset over time (2012-2019) and evaluated BMI trends and the impact on in-hospital mortality for six acute CVDs: acute heart failure (AHF), acute myocardial infarction (AMI), acute aortic dissection (AAD), ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Patients were categorized into five groups using the WHO Asian-BMI criteria: underweight (< 18.5 kg/m2), normal (18.5-22.9 kg/m2), overweight at risk (23.0-24.9 kg/m2), obese I (25.0-29.9 kg/m2), and obese II (≥ 30.0 kg/m2). Age was significantly and inversely related to high BMI for all diseases (P < 0.001). The proportion of BMI categories significantly altered over time; annual BMI trends showed a significant and gradual increase, except AAD. In adjusted mixed models, underweight was significantly associated with a high risk of in-hospital mortality in all CVD patients (AHF, OR 1.41, 95% CI 1.35-1.48, P < 0.001; AMI, OR 1.27, 95% CI 1.20-1.35, P < 0.001; AAD, OR 1.23, 95% CI 1.16-1.32, P < 0.001; IS, OR 1.45, 95% CI 1.41-1.50, P < 0.001; ICH, OR 1.18, 95% CI 1.13-1.22, P < 0.001; SAH, OR 1.17, 95% CI 1.10-1.26, P < 0.001). Moreover, obese I and II groups were significantly associated with a higher incidence of in-hospital mortality, except AHF and IS. Age was associated with in-hospital mortality for all BMI categories in six CVD patients. BMI increased annually in patients with six types of CVDs. Although underweight BMI was associated with high mortality rates, the impact of obesity on in-hospital mortality differs among CVD types.


Subject(s)
Cardiovascular Diseases , Heart Failure , Myocardial Infarction , Humans , Body Mass Index , Thinness/complications , Thinness/epidemiology , Thinness/diagnosis , Hospital Mortality , Cardiovascular Diseases/epidemiology , Japan/epidemiology , Risk Factors , Obesity/complications , Obesity/epidemiology , Obesity/diagnosis , Acute Disease , Heart Failure/epidemiology
6.
Circ Cardiovasc Qual Outcomes ; 15(10): e008942, 2022 10.
Article in English | MEDLINE | ID: covidwho-2108428

ABSTRACT

BACKGROUND: Preexisting cardiovascular disease (CVD) is perceived as a risk factor for poor outcomes in patients with COVID-19. We sought to determine whether CVD is associated with in-hospital death and cardiovascular events in critically ill patients with COVID-19. METHODS: This study used data from a multicenter cohort of adults with laboratory-confirmed COVID-19 admitted to intensive care units at 68 centers across the United States from March 1 to July 1, 2020. The primary exposure was CVD, defined as preexisting coronary artery disease, congestive heart failure, or atrial fibrillation/flutter. Myocardial injury on intensive care unit admission defined as a troponin I or T level above the 99th percentile upper reference limit of normal was a secondary exposure. The primary outcome was 28-day in-hospital mortality. Secondary outcomes included cardiovascular events (cardiac arrest, new-onset arrhythmias, new-onset heart failure, myocarditis, pericarditis, or stroke) within 14 days. RESULTS: Among 5133 patients (3231 male [62.9%]; mean age 61 years [SD, 15]), 1174 (22.9%) had preexisting CVD. A total of 1178 (34.6%) died, and 920 (17.9%) had a cardiovascular event. After adjusting for age, sex, race, body mass index, history of smoking, and comorbidities, preexisting CVD was associated with a 1.15 (95% CI, 0.98-1.34) higher odds of death. No independent association was observed between preexisting CVD and cardiovascular events. Myocardial injury on intensive care unit admission was associated with higher odds of death (adjusted odds ratio, 1.93 [95% CI, 1.61-2.31]) and cardiovascular events (adjusted odds ratio, 1.82 [95% CI, 1.47-2.24]), regardless of the presence of CVD. CONCLUSIONS: CVD risk factors, rather than CVD itself, were the major contributors to outcomes in critically ill patients with COVID-19. The occurrence of myocardial injury, regardless of CVD, and its association with outcomes suggests it is likely due to multiorgan injury related to acute inflammation rather than exacerbation of preexisting CVD. REGISTRATION: NCT04343898; https://clinicaltrials.gov/ct2/show/NCT04343898.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Humans , Male , United States/epidemiology , Middle Aged , COVID-19/complications , COVID-19/diagnosis , SARS-CoV-2 , Critical Illness , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Troponin I , Hospital Mortality , Risk Factors
7.
Top Antivir Med ; 30(3): 522-527, 2022.
Article in English | MEDLINE | ID: covidwho-2102586

ABSTRACT

Comorbid conditions have a major impact on the health, quality of life, and survival of people with HIV, particularly as this population ages. The 2022 Conference on Retroviruses and Opportunistic Infections (CROI) featured excellent science related to specific comorbidities, such as cardiovascular disease, type 2 diabetes, cancer, and frailty. The role of systemic inflammation in the pathogenesis of cardiovascular disease was an important theme, with strong evidence regarding the impact of microbial translocation. Other studies examined functional impairment, frailty, and potential important contributors, such as concomitant medications and sleep disturbances. The ANCHOR (Anal Cancer/High-grade Squamous Intraepithelial Lesions Outcomes Research) study provided crucial evidence that treatment of high-risk anal lesions reduces the incidence of anal cancer, which has important implications in the prevention of this devastating comorbidity. In addition, numerous presentations demonstrated the importance of comorbid conditions in COVID-19 outcomes in people with HIV and described persistent symptoms after acute SARS-CoV-2 infection has resolved. This review focuses on the abstracts presented at CROI 2022 in these areas, highlighting those with the most clinical impact.


Subject(s)
Anus Neoplasms , COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Frailty , HIV Infections , Humans , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , COVID-19/complications , Cardiovascular Diseases/epidemiology , Frailty/complications , Quality of Life , Diabetes Mellitus, Type 2/complications , SARS-CoV-2
8.
Front Public Health ; 10: 1023717, 2022.
Article in English | MEDLINE | ID: covidwho-2099280

ABSTRACT

Objective: Little is known about pre-pandemic cardiovascular health (CVH) status and its temporal variation in Chinese children. Thus, we aimed to evaluate the secular trends and associated factors of CVH in Chinese urban children from 2004 to 2019. Methods: We identified 32,586 individuals in Beijing, aged 6 to 18 years, from three independent cross-sectional studies conducted in 2004, 2014, and 2019, respectively. CVH was assessed by 7 metrics according to modified American Heart Association criteria, including smoking, physical activity, diet, body mass index, total cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression was used to assess the associations between sociodemographic characteristics and the ideal CVH status. Results: The proportion of ideal CVH decreased from 27.7% (boys 26.6%, girls 28.9%) in 2004 to 4.2% (boys 3.8%, girls 4.8%) in 2014, and then increased to 16.2% (boys 13.5%, girls 18.9%) in 2019. Overall, ideal smoking was the most prevalent CVH component during 2004-2019 (2004, 97.5%; 2014, 92.9%; 2019, 98.0%), while ideal physical activity (2004, 27.6%; 2014, 14.4%; 2019, 28.0%) and dietary intake (2004, 26.0%; 2014, 10.7%; 2019, 23.5%) were the least prevalent components. Notably, the proportion of ideal body mass index (2004, 77.5%; 2019, 59.7%) and blood pressure (2004, 73.6%; 2019, 67.3%) continuously decreased from 2004 to 2019. Girls, parental normal weight status, free of family CVD history, and lower levels in fat mass were associated with higher odds of ideal CVH. Conclusion: The cardiovascular health in Chinese urban children deteriorated during 2004-2019. Distinct strategies are required to mitigate socioeconomic inequity in the intervention of CVH promotion.


Subject(s)
COVID-19 , Cardiovascular Diseases , Male , Child , Female , United States , Humans , Adolescent , Cross-Sectional Studies , COVID-19/epidemiology , Pandemics , Urban Population , Cardiovascular Diseases/epidemiology , Cholesterol , China/epidemiology
9.
Sci Rep ; 12(1): 18472, 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2096811

ABSTRACT

The northern region of Brazil is already vulnerable to other infectious diseases and it was no different in COVID-19. However, cardiovascular diseases still lead the causes of death. Thus, the objective of this study is to identify the clinical predictors and outcome of severe COVID-19 in hospitalized patients with and without CVD in this region of the Amazon. A retrospective cohort, referring to the notifications from January 1 to December 31, 2020, including cases confirmed by molecular testing. The study consisted of 9223 confirmed cases for COVID-19. Of these, 6011 (65.17%) did not have cardiovascular disease and 3212 (34.83%) had some cardiovascular disease. The significance of deaths was in the age group of < 1 to 59 CVD carriers (< 0.001). Predictor of mortality were invasive ventilation for patients with CVD, (OR 23,688 CI 18,180-30,866), followed by chronic kidney disease (OR 2442 CI 1568-3740), dyspnea (OR 2312 CI 1817-3941), respiratory distress (OR 1523 CI 1210-2919), cough (OR 1268 CI 1005-1599), Lower oxygen saturation 95% (OR 1281 CI 1039-1579), diabetes mellitus (OR 1267 CI 1050-1528) and age (OR 1051 CI 1044-1058). Carriers of CVD had a lower survival rate (< 0.0001). The order of the predictors of death differed among the non-carriers, as well as the high odds ratio in the predictors of CVD, only cough was an independent predictor. The age group under 59 years was associated with deaths. We also show the shorter survival in CVD carriers, as well as the higher cardiovascular morbidity rate than other studies in the literature.


Subject(s)
COVID-19 , Cardiovascular Diseases , Humans , Middle Aged , COVID-19/epidemiology , COVID-19/therapy , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Cardiovascular Diseases/etiology , Retrospective Studies , Cough/complications , Brazil/epidemiology , Dyspnea/complications
11.
BMC Public Health ; 22(1): 1935, 2022 10 18.
Article in English | MEDLINE | ID: covidwho-2079406

ABSTRACT

BACKGROUND: Community Heart Health Actions for Latinos at Risk (CHARLAR) is a promotora-led cardiovascular disease (CVD) risk-reduction program for socio-demographically disadvantaged Latinos and consists of 11 skill-building sessions. The COVID-19 pandemic has led to worsening health status in U.S. adults and necessitated transition to virtual implementation of the CHARLAR program. METHODS: A mixed-methods approach was used to evaluate virtual delivery of CHARLAR. Changes in health behaviors were assessed through a pre/post program survey. Results from virtual and historical (in-person delivery) were compared. Key informant interviews were conducted with promotoras and randomly selected participants and then coded and analyzed using a thematic approach. RESULTS: An increase in days of exercise per week (+ 1.52), daily servings of fruit (+ 0.60) and vegetables (+ 0.56), and self-reported general health (+ 0.38), were observed in the virtual cohort [all p < 0.05]. A numeric decrease in PHQ-8 (-1.07 p = 0.067) was also noted. The historical cohort showed similar improvements from baseline in days of exercise per week (+ 0.91), daily servings of fruit (+ 0.244) and vegetables (+ 0.282), and PHQ-8 (-1.89) [all p < 0.05]. Qualitative interviews revealed that the online format provided valuable tools supporting positive behavior change. Despite initial discomfort and technical challenges, promotoras and participants adapted and deepened valued relationships through additional virtual support. CONCLUSION: Improved health behaviors and CVD risk factors were successfully maintained through virtual delivery of the CHARLAR program. Optimization of virtual health programs like CHARLAR has the potential to increase reach and improve CVD risk among Latinos.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Humans , Pandemics , Health Promotion/methods , Hispanic or Latino , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control
13.
JAMA Netw Open ; 5(10): e2231633, 2022 10 03.
Article in English | MEDLINE | ID: covidwho-2059196

ABSTRACT

Importance: Older Syrian refugees have a high burden of noncommunicable diseases (NCDs) and economic vulnerability. Objectives: To develop and internally validate a predictive model to estimate inability to manage NCDs in older Syrian refugees, and to describe barriers to NCD medication adherence. Design, Setting, and Participants: This nested prognostic cross-sectional study was conducted through telephone surveys between September 2020 and January 2021. All households in Lebanon with Syrian refugees aged 50 years or older and who received humanitarian assistance from a nongovernmental organization were invited to participate. Refugees who self-reported having chronic respiratory disease (CRD), diabetes, history of cardiovascular disease (CVD), or hypertension were included in the analysis. Data were analyzed from November 2021 to March 2022. Main Outcomes and Measures: The main outcome was self-reported inability to manage any NCD (including CRD, CVD, diabetes, or hypertension). Predictors of inability to manage any NCD were assessed using logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination is presented using the C statistic, and calibration of the model is presented using calibration slope (C slope). Results: Of 3322 older Syrian refugees, 1893 individuals (median [IQR] age, 59 [54-65] years; 1089 [57.5%] women) reported having at least 1 NCD, among whom 351 (10.6% overall; 18.6% of those with ≥1 NCD) had CRD, 781 (23.7% overall; 41.4% of those with ≥1 NCD) had diabetes, 794 (24.1% overall; 42.2% of those with ≥1 NCD) had history of CVD, and 1388 (42.3% overall; 73.6% of those with ≥1 NCD) had hypertension. Among individuals with NCDs, 387 participants (20.4%) were unable to manage at least 1 of their NCDs. Predictors for inability to manage NCDs were age, nonreceipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases, with an adjusted C statistic of 0.650 (95% CI, 0.620-0.676) and C slope of 0.871 (95% CI, 0.729-1.023). The prevalence of nonadherence to medication was 9.2%, and the main reasons for nonadherence were unaffordability of medication (40.8%; 95% CI, 33.4%-48.5%) and the belief that they no longer required the medication after feeling better (22.4%; 95% CI, 16.4%-29.3%). Conclusions and Relevance: In this cross-sectional study, the predictors of inability to manage NCDs among older Syrian refugees in Lebanon were mainly related to financial barriers. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and health care.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus , Hypertension , Noncommunicable Diseases , Refugees , Aged , Cardiovascular Diseases/epidemiology , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Lebanon/epidemiology , Male , Middle Aged , Noncommunicable Diseases/epidemiology , Pandemics , Syria/epidemiology
16.
Am J Physiol Heart Circ Physiol ; 323(3): H535-H537, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-2053386
17.
Biochim Biophys Acta Mol Basis Dis ; 1868(12): 166559, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2041586

ABSTRACT

Obesity, type 2 diabetes (T2DM), hypertension (HTN), and Cardiovascular Disease (CVD) often cluster together as "Cardiometabolic Disease" (CMD). Just under 50% of patients with CMD increased the risk of morbidity and mortality right from the beginning of the COVID-19 pandemic as it has been reported in most countries affected by the SARS-CoV2 virus. One of the pathophysiological hallmarks of COVID-19 is the overactivation of the immune system with a prominent IL-6 response, resulting in severe and systemic damage involving also cytokines such as IL2, IL4, IL8, IL10, and interferon-gamma were considered strong predictors of COVID-19 severity. Thus, in this mini-review, we try to describe the inflammatory state, the alteration of the adipokine profile, and cytokine production in the obese state of infected and not infected patients by SARS-CoV2 with the final aim to find possible influences of COVID-19 on CMD and CVD. The immunological-based discussion of the molecular processes could inspire the study of promising targets for managing CMD patients and its complications during COVID-19.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Adipokines , Cardiovascular Diseases/epidemiology , Cytokines , Diabetes Mellitus, Type 2/complications , Humans , Interferon-gamma , Interleukin-10 , Interleukin-2 , Interleukin-4 , Interleukin-6 , Interleukin-8 , Obesity/complications , Obesity/epidemiology , Pandemics , RNA, Viral , SARS-CoV-2
18.
Cardiol J ; 29(5): 730-738, 2022.
Article in English | MEDLINE | ID: covidwho-2040289

ABSTRACT

Hypertension and lipid disorders are two of the main cardiovascular risk factors. Both risk factors - if detected early enough - can be controlled and treated with modern, effective drugs, devoid of significant side effects, available in four countries as different as Italy, Spain, Poland, and Uzbekistan. The aim herein, was to develop this TIMES TO ACT consensus to raise the awareness of the available options of the modern and intensified dyslipidemia and arterial hypertension treatments. The subsequent paragraphs involves consensus and discussion of the deleterious effects of COVID-19 in the cardiovascular field, the high prevalence of hypertension and lipid disorders in our countries and the most important reasons for poor control of these two factors. Subsequently proposed, are currently the most efficient and safe therapeutic options in treating dyslipidemia and arterial hypertension, focusing on the benefits of single-pill combination (SPCs) in both conditions. An accelerated algorithm is proposed to start the treatment with a PCSK9 inhibitor, if the target low-density-lipoprotein values have not been reached. As most patients with hypertension and lipid disorders present with multiple comorbidities, discussed are the possibilities of using new SPCs, combining modern drugs from different therapeutic groups, which mode of action does not confirm the "class effect". We believe our consensus strongly advocates the need to search for patients with cardiovascular risk factors and intensify their lipid-lowering and antihypertensive treatment based on SPCs will improve the control of these two basic cardiovascular risk factors in Italy, Spain, Poland and Uzbekistan.


Subject(s)
COVID-19 , Cardiovascular Diseases , Dyslipidemias , Hypertension , Antihypertensive Agents/therapeutic use , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Dyslipidemias/diagnosis , Dyslipidemias/drug therapy , Dyslipidemias/epidemiology , Humans , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Lipids , Lipoproteins , Poland , Proprotein Convertase 9 , Risk Factors
19.
J Am Heart Assoc ; 11(18): e7743, 2022 09 20.
Article in English | MEDLINE | ID: covidwho-2029586

ABSTRACT

Background The AHA Registry (American Heart Association COVID-19 Cardiovascular Disease Registry) captures detailed information on hospitalized patients with COVID-19. The registry, however, does not capture information on social determinants of health or long-term outcomes. Here we describe the linkage of the AHA Registry with external data sources, including fee-for-service (FFS) Medicare claims, to fill these gaps and assess the representativeness of linked registry patients to the broader Medicare FFS population hospitalized with COVID-19. Methods and Results We linked AHA Registry records of adults ≥65 years from March 2020 to September 2021 with Medicare FFS claims using a deterministic linkage algorithm and with the American Hospital Association Annual Survey, Rural Urban Commuting Area codes, and the Social Vulnerability Index using hospital and geographic identifiers. We compared linked individuals with unlinked FFS beneficiaries hospitalized with COVID-19 to assess the representativeness of the AHA Registry. A total of 10 010 (47.0%) records in the AHA Registry were successfully linked to FFS Medicare claims. Linked and unlinked FFS beneficiaries were similar with respect to mean age (78.1 versus 77.9, absolute standardized difference [ASD] 0.03); female sex (48.3% versus 50.2%, ASD 0.04); Black race (15.1% versus 12.0%, ASD 0.09); dual-eligibility status (26.1% versus 23.2%, ASD 0.07); and comorbidity burden. Linked patients were more likely to live in the northeastern United States (35.7% versus 18.2%, ASD 0.40) and urban/metropolitan areas (83.9% versus 76.8%, ASD 0.18). There were also differences in hospital-level characteristics between cohorts. However, in-hospital outcomes were similar (mortality, 23.3% versus 20.1%, ASD 0.08; home discharge, 45.5% versus 50.7%, ASD 0.10; skilled nursing facility discharge, 24.4% versus 22.2%, ASD 0.05). Conclusions Linkage of the AHA Registry with external data sources such as Medicare FFS claims creates a unique and generalizable resource to evaluate long-term health outcomes after COVID-19 hospitalization.


Subject(s)
COVID-19 , Cardiovascular Diseases , Aged , American Heart Association , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Female , Humans , Medicare , Registries , United States/epidemiology
20.
Int J Environ Res Public Health ; 19(17)2022 Sep 02.
Article in English | MEDLINE | ID: covidwho-2023719

ABSTRACT

BACKGROUND: The COVID-19 epidemic overloaded the São Paulo metropolitan area (SPMA) health system in 2020. The leading hospitals directed their attention to patients with COVID-19. At the same time, the SPMA Health Secretary decreed social isolation (SI), which compromised the care for cardiovascular diseases (CVD), even though higher cardiovascular events were expected. METHODS: This study analyzed mortality from CVD, ischemic heart disease (IHD), and stroke, along with hospital admissions for CVD, IHD, stroke, and SI in the SPMA in 2020. Data regarding hospitalization and mortality from CVD were obtained from the SPMA Health Department, and data regarding SI was obtained from the São Paulo Intelligent Monitoring System. Time-series trends were analyzed by linear regression, as well as comparisons between these trends. RESULTS: there was an inverse correlation between SI and hospitalizations for CVD (R2 = 0.70; p < 0.001), IHD (R2 = 0.70; p < 0.001), and stroke (R2 = 0.39; p < 0.001). The most significant hospitalization reduction was from March to May, when the SI increased from 43.07% to 50.71%. The increase in SI was also associated with a reduction in CVD deaths (R2 = 0.49; p < 0.001), IHD (R2 = 0.50; p < 0.001), and stroke (R2 = 0.26; p < 0.001). CONCLUSIONS: Increased social isolation was associated with reduced hospitalizations and deaths from CVD, IHD, and stroke.


Subject(s)
COVID-19 , Cardiovascular Diseases , Myocardial Ischemia , Stroke , Brazil/epidemiology , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Hospitalization , Humans , Myocardial Ischemia/epidemiology , Social Isolation
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