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2.
Can J Cardiol ; 36(8): 1313-1316, 2020 08.
Article in English | MEDLINE | ID: covidwho-733905

ABSTRACT

The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.


Subject(s)
Cardiology Service, Hospital , Cardiovascular Diseases , Coronavirus Infections , Ethics, Institutional , Infection Control/methods , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , Canada/epidemiology , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control
3.
Open Heart ; 7(2)2020 08.
Article in English | MEDLINE | ID: covidwho-733137

ABSTRACT

OBJECTIVE: The COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity. METHODS: We analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision. RESULTS: There has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation. CONCLUSIONS: As ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.


Subject(s)
Cardiac Rehabilitation , Cardiology , Cardiovascular Diseases , Coronavirus Infections , Delivery of Health Care , Pandemics , Pneumonia, Viral , State Medicine , Betacoronavirus/isolation & purification , Cardiac Rehabilitation/methods , Cardiac Rehabilitation/statistics & numerical data , Cardiology/methods , Cardiology/organization & administration , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/rehabilitation , Critical Pathways/trends , Delivery of Health Care/organization & administration , Delivery of Health Care/statistics & numerical data , Humans , Infection Control/methods , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/rehabilitation , State Medicine/organization & administration , State Medicine/trends , United Kingdom
4.
Crit Care Nurs Q ; 43(4): 381-389, 2020.
Article in English | MEDLINE | ID: covidwho-729218

ABSTRACT

COVID-19, a symptom complex of respiratory failure induced by a highly infectious pathogen, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been classified as a pandemic. As of April 15, 2020, there have been 2 million people diagnosed with the viral infection and 130 000 deaths globally. It is highly likely that the number of infections is underrepresented secondary to variations in testing and reporting strategies globally. In this short review, we aim to summarize the current understanding of SARS-CoV-2 as it pertains to cardiovascular disease. We discuss the basis of cardiac pathophysiology and address some of the clinical scenarios that cardiovascular physicians may face. We introduce the concept of conservative management of acute coronary syndromes and address some complications such as myocarditis, heart failure, and cardiac arrhythmias that may be relevant for the management of patients presenting with COVID-19.


Subject(s)
Cardiovascular Diseases/therapy , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Coronavirus Infections/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Cardiovascular Diseases/epidemiology , Clinical Trials as Topic , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology
5.
PLoS One ; 15(8): e0237131, 2020.
Article in English | MEDLINE | ID: covidwho-717596

ABSTRACT

BACKGROUND: The ongoing pandemic of Novel Coronavirus Disease 2019 (COVID-19) infection has created a global emergency. Despite the infection causes a mild illness to most people, some patients are severely affected, demanding an urgent need to better understand how to risk-stratify infected subjects. DESIGN: This is a meta-analysis of observational studies evaluating cardiovascular (CV) complications in hospitalized COVID-19 patients and the impact of cardiovascular risk factors (RF) or comorbidities on mortality. METHODS: Data sources: PubMed, Scopus, and ISI from 1 December 2019 through 11 June 2020; references of eligible studies; scientific session abstracts; cardiology web sites. We selected studies reporting clinical outcomes of hospitalized patients with COVID-19. The main outcome was death. Secondary outcomes were cardiovascular symptoms and cardiovascular events developed during the COVID-19-related hospitalization. Extracted data were recorded in excel worksheets and analysed using statistical software (MedCalc, OpenMetanalyst, R). We used the proportion with 95% CI as the summary measure. A Freeman-Tukey transformation was used to calculate the weighted summary proportion under the random-effects model. Heterogeneity was assessed by using the Cochran Q test and I2 values. RESULTS: Among 77317 hospitalized patients from 21 studies, 12.86% had cardiovascular comorbidities or RF. Cardiovascular complications were registered in 14.09% of cases during hospitalization. At meta-regression analysis, pre-existing cardiovascular comorbidities or RF were significantly associated to cardiovascular complications in COVID-19 patients (p = 0.019). Pre-existing cardiovascular comorbidities or RF (p<0.001), older age (p<0.001), and the development of cardiovascular complications during the hospitalization (p = 0.038) had a significant interaction with death. CONCLUSIONS: Cardiovascular complications are frequent among COVID-19 patients, and might contribute to adverse clinical events and mortality, together with pre-existing cardiovascular comorbidities and RF. Clinicians worldwide should be aware of this association, to identifying patients at higher risk.


Subject(s)
Betacoronavirus , Cardiovascular Diseases/epidemiology , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Aged , Cardiovascular Diseases/mortality , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/virology , Female , Hospitalization , Humans , Male , Middle Aged , Observational Studies as Topic , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Risk Factors
6.
Dtsch Med Wochenschr ; 145(16): 1157-1160, 2020 08.
Article in German | MEDLINE | ID: covidwho-714209

ABSTRACT

Since its outbreak, coronavirus disease 2019 (COVID-19) has rapidly resulted in a global pandemic. Underlying cardiovascular disease (CVD) is associated with severe COVID-19 infection and adverse clinical outcomes. While COVID-19 predominantly causes respiratory symptoms, a substantial number of patients eventually develop an acute cardiovascular syndrome associated with an excessive risk of mortality. While the exact mechanisms remain uncertain, angiotensin-converting enzyme 2 plays a pivotal role as a link between COVID-19 and the cardiovascular system. As there is no evidence that inhibition of the renin-angiotensin-aldosterone-system is harmful in COVID-19, therapy should be continued as indicated in hypertension or heart failure patients. As multiple drugs are being investigated in ongoing clinical trials, potential cardiotoxicity remains an important issue. In times of rigorous public health measures such as social distancing, efforts should be undertaken to ensure timely treatment of acute CVD and continuation of guideline-directed treatment in order to avoid an increase in morbidity and mortality. In addition to its acute complications, COVID-19 is likely to be associated with long-term cardiovascular damage. Consequently, for a subgroup of patients a long-term management strategy is needed.


Subject(s)
Cardiovascular Diseases/epidemiology , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/therapy , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/therapy , Humans , Pandemics , Personal Space , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Prognosis , Renin-Angiotensin System/physiology
9.
Curr Probl Cardiol ; 45(8): 100618, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-694853

ABSTRACT

Since the outbreak and rapid spread of COVID-19 starting late December 2019, it has been apparent that disease prognosis has largely been influenced by multiorgan involvement. Comorbidities such as cardiovascular diseases have been the most common risk factors for severity and mortality. The hyperinflammatory response of the body, coupled with the plausible direct effects of severe acute respiratory syndrome on body-wide organs via angiotensin-converting enzyme 2, has been associated with complications of the disease. Acute respiratory distress syndrome, heart failure, renal failure, liver damage, shock, and multiorgan failure have precipitated death. Acknowledging the comorbidities and potential organ injuries throughout the course of COVID-19 is therefore crucial in the clinical management of patients. This paper aims to add onto the ever-emerging landscape of medical knowledge on COVID-19, encapsulating its multiorgan impact.


Subject(s)
Cardiovascular Diseases/epidemiology , Coronavirus Infections , Multiple Organ Failure , Pandemics , Pneumonia, Viral , Betacoronavirus/physiology , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Humans , Multiple Organ Failure/etiology , Multiple Organ Failure/immunology , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Risk Factors
10.
Ethn Dis ; 30(3): 421-424, 2020.
Article in English | MEDLINE | ID: covidwho-693530

ABSTRACT

The COVID-19 pandemic is revealing the deeply entrenched structural inequities in health that exist in the United States. We draw parallels between the COVID-19 pandemic and our cardiovascular health equity research focused on physical activity and diabetes to highlight three common needs: 1) access to timely and disaggregated data; 2) how to integrate community-engaged approaches in telehealth; and 3) policy initiatives that explicitly integrate health equity and social justice principles and action. We suggest that a similar sense of urgency regarding COVID-19 should be applied to slow the burgeoning costs and suffering associated with cardiovascular disease overall and in marginalized communities specifically. We remain hopeful that the current crisis can serve as a guide for aligning our principles as a just and democratic society with a health agenda that explicitly recognizes that social inequities in health for some impacts all members of society.


Subject(s)
Cardiovascular Diseases , Coronavirus Infections , Health Equity/organization & administration , Pandemics , Pneumonia, Viral , Betacoronavirus , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Needs Assessment , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Social Justice , Social Marginalization , United States
12.
West J Emerg Med ; 21(4): 779-784, 2020 Jul 08.
Article in English | MEDLINE | ID: covidwho-690365

ABSTRACT

INTRODUCTION: Rapid spread of coronavirus disease 2019 (COVID-19) in the United States, especially in New York City (NYC), led to a tremendous increase in hospitalizations and mortality. There is very limited data available that associates outcomes during hospitalization in patients with COVID-19. METHODS: In this retrospective cohort study, we reviewed the health records of patients with COVID-19 who were admitted from March 9-April 9, 2020, to a community hospital in NYC. Subjects with confirmed reverse transcriptase-polymerase chain reaction (RT-PCR) of the nasopharyngeal swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were included. We collected data related to demographics, laboratory results, and outcome of hospitalization. Outcome was measured based on whether the patient was discharged home or died during hospitalization. RESULTS: There were 888 consecutive admissions with COVID-19 during the study period, of which 513 were excluded with pending outcome or incomplete information. We included a total of 375 patients in the study, of whom 215 (57%) survived and 160 (43%) died during hospitalization. The majority of patients were male (63%) and of Hispanic origin (66%) followed by Blacks (25%), and others (9%). Hypertension (60%) stands out to be the most common comorbidity followed by diabetes mellitus (47%), cardiovascular disease (17%), chronic kidney disease (17%), and human immunodeficiency virus/acquired immunodeficiency syndrome (9%). On multiple regression analysis, increasing odds of mortality during hospitalization was associated with older age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01-1.06 per year increase; p < 0.0001), admission D-dimer more than 1000 nanograms per milliliter (ng/mL) (OR 3.16; 95% CI, 1.75-5.73; p<0.0001), admission C-reactive protein (CRP) levels of more than 200 milligrams per liter (mg/L) (OR 2.43; 95% CI, 1.36-4.34; p = 0.0028), and admission lymphopenia (OR 2.63; CI, 1.47-4.69; p 0.0010). CONCLUSION: In this retrospective cohort study originating in NYC, older age, admission levels of D-dimer of more than 1000 ng/mL, CRP of more than 200 mg/L and lymphopenia were associated with mortality in individuals hospitalized for COVID-19. We recommend using these risk factors on admission to triage patients to critical care units or surge units to maximize the use of surge capacity beds.


Subject(s)
Betacoronavirus , Coronavirus Infections/mortality , Hospitalization , Pneumonia, Viral/mortality , Adult , Age Factors , Aged , Aged, 80 and over , C-Reactive Protein/analysis , Cardiovascular Diseases/epidemiology , Cohort Studies , Comorbidity , Continental Population Groups/statistics & numerical data , Diabetes Mellitus/epidemiology , Female , Fibrin Fibrinogen Degradation Products/analysis , HIV Infections/epidemiology , Hospitals, Community , Humans , Hypertension/epidemiology , Lymphopenia/epidemiology , Male , Middle Aged , New York City/epidemiology , Pandemics , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , Risk Factors , Young Adult
13.
Front Immunol ; 11: 1548, 2020.
Article in English | MEDLINE | ID: covidwho-687591

ABSTRACT

Background: The COVID-19 pandemic has been causing varying severities of illness. Some are asymptomatic and some develop severe disease leading to mortality across ages. This contrast triggered us explore the causes, with the background that a vaccine for effective immunization or a drug to tackle COVID-19 is not too close to reality. We have discussed strategies to combat COVID-19 through immune enhancement, using simple measures including nutritional supplements. Discussion: A literature search on mortality-related comorbid conditions was performed. For those conditions, we analyzed the pro-inflammatory cytokines, which could cause the draining of the immune reservoir. We also analyzed the immune markers necessary for the defense mechanism/immune surveillance against COVID-19, especially through simple means including immune enhancing nutritional supplement consumption, and we suggest strategies to combat COVID-19. Major comorbid conditions associated with increased mortality include cardiovascular disease (CVD), diabetes, being immunocompromised by cancer, and severe kidney disease with a senile immune system. Consumption of Aureobasidium pullulans strain (AFO-202) beta 1,3-1,6 glucan supported enhanced IL-8, sFAS macrophage activity, and NK cells' cytotoxicity, which are major defense mechanisms against viral infection. Conclusion: People with co-morbid conditions who are more prone to COVID-19-related deaths due to immune dysregulation are likely to benefit from consuming nutritional supplements that enhance the immune system. We recommend clinical studies to validate AFO-202 beta glucan in COVID-19 patients to prove its efficacy in overcoming a hyper-inflammation status, thus reducing the mortality, until a definite vaccine is made available.


Subject(s)
Betacoronavirus , Cardiovascular Diseases/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Diabetes Mellitus/epidemiology , Dietary Supplements , Neoplasms/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Renal Insufficiency, Chronic/epidemiology , Actinobacteria/chemistry , Biomarkers/blood , Cardiovascular Diseases/immunology , Comorbidity , Coronavirus Infections/diet therapy , Coronavirus Infections/mortality , Cytokines/blood , Diabetes Mellitus/immunology , Humans , Immunocompromised Host , Neoplasms/immunology , Pandemics , Pneumonia, Viral/diet therapy , Pneumonia, Viral/mortality , Renal Insufficiency, Chronic/immunology , beta-Glucans/pharmacology , beta-Glucans/therapeutic use
14.
J Am Heart Assoc ; 9(13): e016997, 2020 07 07.
Article in English | MEDLINE | ID: covidwho-683343

ABSTRACT

Medicine and public health have traditionally separated the prevention and treatment of communicable and noncommunicable diseases. The coronavirus disease 2019 (COVID-19) pandemic has challenged this paradigm, particularly in the setting of cardiovascular disease (CVD). Overall, individuals with underlying CVD who acquire severe acute respiratory syndrome coronavirus 2 experience up to a 10-fold higher case-fatality rate compared with the general population. Although the impact of the pandemic on cardiovascular health continues to evolve, few have defined this association from a frontline, public health perspective of populations disproportionately affected by CVD and COVID-19. Louisiana is ranked within the bottom 5 states for cardiovascular health, and it is home to several parishes that have experienced among the highest COVID-19 case-fatality rates nationally. Herein, we review CVD prevention and implications of COVID-19 in New Orleans, LA, a city holding a sobering yet resilient history with previous public health disasters. In particular, we discuss potential pandemic-driven changes in access to health care, preventive pharmacotherapy, and lifestyle behaviors, all of which may adversely affect CVD prevention and management, while amplifying racial disparities. Through this process, we highlight proposed recommendations for how CVD prevention efforts can be improved in the midst of the current COVID-19 pandemic and future public health crises.


Subject(s)
Betacoronavirus , Cardiovascular Diseases/prevention & control , Coronavirus Infections/complications , Delivery of Health Care/methods , Life Style , Pandemics , Pneumonia, Viral/complications , Public Health , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Coronavirus Infections/epidemiology , Humans , Incidence , New Orleans/epidemiology , Pneumonia, Viral/epidemiology
16.
G Ital Cardiol (Rome) ; 21(8): 565-569, 2020 Aug.
Article in Italian | MEDLINE | ID: covidwho-680055

ABSTRACT

In Italy, the epidemic explosion stage of COVID-19 seems to have been overcome; however, the virus has not been eradicated and the re-emergence of some outbreaks of infection substantiates the danger that the disease may persist. It is therefore necessary to keep the level of surveillance high, to maintain social distancing measures and to act in the control of disease risk factors of a serious or complicated course. Among the risk factors of severe COVID-19 in addition to age, male gender, hypertension and cardiovascular diseases, a major role seems to be played by other cardiovascular risk factors conditioned by an unhealthy lifestyle such as obesity, metabolic syndrome, diabetes and smoking. The new phase requires the maintenance of measures that avoid crowding and close interpersonal contact especially during exercise, in addition to controlled access to hospitals. This will require the reorganization of the traditional methods of cardiovascular prevention and rehabilitation activities, such as gyms and collective educational sessions, and the dilution of outpatient checks. The risk that this scenario may worsen the already suboptimal control of cardiovascular risk factors is therefore real. We do not currently know how long this new phase will last, therefore it is necessary to give impetus to new tele-health initiatives to stimulate the adoption of a healthy lifestyle in primary prevention and tele-monitoring and tele-rehabilitation programs in secondary prevention.


Subject(s)
Cardiovascular Diseases/epidemiology , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Telemedicine/organization & administration , Cardiologists , Cardiovascular Diseases/diagnosis , Coronavirus Infections/prevention & control , Female , Follow-Up Studies , Hospitals, University , Humans , Italy/epidemiology , Male , Pandemics/prevention & control , Physician's Role , Pneumonia, Viral/prevention & control , Risk Assessment , Time Factors
17.
Clin Rheumatol ; 39(9): 2789-2796, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-679750

ABSTRACT

BACKGROUND: Over the month of April, Spain has become the European country with more confirmed cases of COVID-19 infection, after surpassing Italy on April 2nd. The community of Castile and León in Spain is one of the most affected by COVID-19 infection and the province of León has a total of 3711 cases and 425 deaths so far. Rheumatic patients should be given special attention regarding COVID-19 infection due to their immunocompromised state resulting from their underlying immune conditions and use of targeted immune-modulating therapies. Studying epidemiological and clinical characteristics of patients with rheumatic diseases infected with SARS-CoV2 is pivotal to clarify determinants of COVID-19 disease severity in patients with underlying rheumatic disease. OBJECTIVES: To describe epidemiological characteristics of patients with rheumatic diseases hospitalized with COVID-19 and determine risk factors associated with mortality in a third level Hospital setting in León, Spain. METHODS: We performed a prospective observational study, from 1st March 2020 until the 1st of June including adults with rheumatic diseases hospitalized with COVID-19 and performed a univariate and multivariate logistic regression model to estimate ORs and 95% CIs of mortality. Age, sex, comorbidities, rheumatic disease diagnosis and treatment, disease activity prior to infection, radiographic and laboratorial results at arrival were analysed. RESULTS: During the study period, 3711 patients with COVID-19 were admitted to our hospital, of whom 38 (10%) had a rheumatic or musculoskeletal disease. Fifty-three percent were women, with a mean age at hospital admission of 75.3 (IQR 68-83) years. The median length of stay was 11 days. A total of 10 patients died (26%) during their hospital admission. Patients who died from COVID-19 were older (median age 78.4 IQR 74.5-83.5) than those who survived COVID-19 (median age 75.1 IQR 69.3-75.8) and more likely to have arterial hypertension (9 [90%] vs 14 [50%] patients; OR 9 (95% CI 1.0-80.8), p 0.049), dyslipidaemia (9 (90%) vs 12 (43%); OR 12 (95% CI 1.33-108), p 0.03), diabetes ((9 (90%) vs 6 (28%) patients; OR 33, p 0.002), interstitial lung disease (6 (60%) vs 6 (21%); OR 5.5 (95% CI 1.16-26), p 0.03), cardiovascular disease (8 (80%) vs 11 (39%); OR 6.18 (95% IC 1.10-34.7, p 0.04) and a moderate/high index of rheumatic disease activity (7 (25%) vs 6(60%); OR 41.4 (4.23-405.23), p 0.04). In univariate analyses, we also found that patients who died from COVID-19 had higher hyperinflammation markers than patients who survived: C-reactive protein (181 (IQR 120-220) vs 107.4 (IQR 30-150; p 0.05); lactate dehydrogenase (641.8 (IQR 465.75-853.5) vs 361 (IQR 250-450), p 0.03); serum ferritin (1026 (IQR 228.3-1536.3) vs 861.3 (IQR 389-1490.5), p 0.04); D-dimer (12,019.8 (IQR 843.5-25,790.5) vs 1544.3 (IQR 619-1622), p 0.04). No differences in sex, radiological abnormalities, rheumatological disease, background therapy or symptoms before admission between deceased patients and survivors were found. In the multivariate analysis, the following risk factors were associated with mortality: rheumatic disease activity (p = 0.003), dyslipidaemia (p = 0.01), cardiovascular disease (p = 0.02) and interstitial lung disease (p = 0.02). Age, hypertension and diabetes were significant predictors in univariate but not in multivariate analysis. Rheumatic disease activity was significantly associated with fever (p = 0.05), interstitial lung disease (p = 0.03), cardiovascular disease (p = 0.03) and dyslipidaemia (p = 0.01). CONCLUSIONS: Our results suggest that comorbidities, rheumatic disease activity and laboratorial abnormalities such as C-reactive protein (CRP), D-Dimer, lactate dehydrogenase (LDH), serum ferritin elevation significantly associated with mortality whereas previous use of rheumatic medication did not. Inflammation is closely related to severity of COVID-19. Key Points • Most patients recover from COVID-19. • The use of DMARDs, corticosteroids and biologic agents did not increase the odds of mortality in our study. • Rheumatic disease activity might be associated with mortality.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Rheumatic Diseases/epidemiology , Age Factors , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus , C-Reactive Protein/metabolism , Cardiovascular Diseases/epidemiology , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Diabetes Mellitus/epidemiology , Drug Combinations , Dyslipidemias/epidemiology , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/metabolism , Hospitalization , Humans , Hydroxychloroquine/therapeutic use , Hypertension/epidemiology , Interleukin 1 Receptor Antagonist Protein/therapeutic use , L-Lactate Dehydrogenase/blood , Length of Stay , Lopinavir/therapeutic use , Lung Diseases, Interstitial/epidemiology , Male , Mortality , Odds Ratio , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prospective Studies , Rheumatic Diseases/physiopathology , Risk Factors , Ritonavir/therapeutic use , Severity of Illness Index , Spain/epidemiology
18.
Can J Cardiol ; 36(7): 1068-1080, 2020 07.
Article in English | MEDLINE | ID: covidwho-679669

ABSTRACT

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), represents the pandemic of the century, with approximately 3.5 million cases and 250,000 deaths worldwide as of May 2020. Although respiratory symptoms usually dominate the clinical presentation, COVID-19 is now known to also have potentially serious cardiovascular consequences, including myocardial injury, myocarditis, acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock. The cardiac manifestations of COVID-19 might be related to the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure, electrolytic imbalances, fluid overload, and side effects of certain COVID-19 medications. COVID-19 has profoundly reshaped usual care of both ambulatory and acute cardiac patients, by leading to the cancellation of elective procedures and by reducing the efficiency of existing pathways of urgent care, respectively. Decreased use of health care services for acute conditions by non-COVID-19 patients has also been reported and attributed to concerns about acquiring in-hospital infection. Innovative approaches that leverage modern technologies to tackle the COVID-19 pandemic have been introduced, which include telemedicine, dissemination of educational material over social media, smartphone apps for case tracking, and artificial intelligence for pandemic modelling, among others. This article provides a comprehensive overview of the pathophysiology and cardiovascular implications of COVID-19, its impact on existing pathways of care, the role of modern technologies to tackle the pandemic, and a proposal of novel management algorithms for the most common acute cardiac conditions.


Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cause of Death , Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Cardiovascular Diseases/therapy , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Global Health , Hospital Mortality/trends , Humans , Male , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prevalence , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Survival Analysis
19.
Nutr Hosp ; 34(3): 622-630, 2020 Jul 13.
Article in Spanish | MEDLINE | ID: covidwho-663764

ABSTRACT

Introduction: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections/diet therapy , Critical Care/methods , Critical Illness , Malnutrition/diet therapy , Pandemics , Pneumonia, Viral/diet therapy , Cardiovascular Diseases/epidemiology , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Dietary Proteins/administration & dosage , Enteral Nutrition/adverse effects , Enteral Nutrition/methods , Gastrointestinal Diseases/complications , Humans , Inflammation/epidemiology , Inflammation/physiopathology , Malnutrition/diagnosis , Malnutrition/etiology , Malnutrition/prevention & control , Meta-Analysis as Topic , Micronutrients/administration & dosage , Nutrition Assessment , Nutritional Requirements , Nutritional Support , Obesity/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Refeeding Syndrome/prevention & control , Respiration, Artificial , Sarcopenia/epidemiology
20.
Arterioscler Thromb Vasc Biol ; 40(9): 2045-2053, 2020 09.
Article in English | MEDLINE | ID: covidwho-659528

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge and opportunity for translational investigators to rapidly develop safe and effective therapeutic interventions. Greater risk of severe disease in COVID-19 patients with comorbid diabetes mellitus, obesity, and heart disease may be attributable to synergistic activation of vascular inflammation pathways associated with both COVID-19 and cardiometabolic disease. This mechanistic link provides a scientific framework for translational studies of drugs developed for treatment of cardiometabolic disease as novel therapeutic interventions to mitigate inflammation and improve outcomes in patients with COVID-19.


Subject(s)
Betacoronavirus , Cardiovascular Diseases/epidemiology , Coronavirus Infections/epidemiology , Inflammation/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Cardiovascular System , Comorbidity , Humans , Risk Factors
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