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1.
Front Endocrinol (Lausanne) ; 13: 855650, 2022.
Article in English | MEDLINE | ID: covidwho-1809371

ABSTRACT

Introduction: Obesity has long been considered an independent risk factor for cardiovascular diseases (CVD), even in the COVID-19 pandemic. However, recent studies have found that a certain degree of obesity may be beneficial for patients who have already suffered from CVD, which is called the "obesity paradox". Our objective was to investigate whether the obesity paradox existed in coronary care unit (CCU) patients and the relationship between body mass index (BMI) and short- and long-term mortality. Methods: We performed a cohort analysis of 3,502 adult CCU patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients were divided into four groups according to the WHO BMI categories. Both multivariable logistic regression and Cox regression were used to reveal the relation between BMI and mortality. Subgroup analyses were performed based on Simplified Acute Physiology Score (SAPS) and age. Results: After adjusting for confounders, obese patients had 33% and 30% lower mortality risk at 30-day and 1-year (OR 0.67, 95% CI 0.51 to 0.89; HR 0.70, 95% CI 0.59 to 0.83; respectively) compared with normal-weight patients, while the underweight group were opposite, with 141% and 81% higher in short- and long-term (OR 2.41, 95% CI 1.37 to 4.12; HR 1.81, 95% CI 1.34 to 2.46; respectively). Overweight patients did not have a significant survival advantage at 30-day (OR 0.91, 95% CI 0.70 to 1.17), but did have a 22% lower mortality risk at 1-year (HR 0.78; 95% CI 0.67 to 0.91). The results were consistent after being stratified by SAPS and age. Conclusion: Our study supports that obesity improved survival at both 30-day and 1-year after CCU admission, and the obesity paradox existed in CCU patients.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Cohort Studies , Coronary Care Units , Critical Care , Humans , Obesity/complications , Obesity/epidemiology , Pandemics
2.
Med Klin Intensivmed Notfmed ; 117(3): 175-176, 2022 04.
Article in German | MEDLINE | ID: covidwho-1800372
3.
Int Heart J ; 62(3): 540-545, 2021 May 29.
Article in English | MEDLINE | ID: covidwho-1216967

ABSTRACT

This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on patient admissions to Hunan's cardiac intensive care units (CCUs).We conducted a retrospective, single-center study. Data were collected from patients who were confirmed to have critical cardiovascular disease and admitted to the CCU of the Second Xiangya Hospital of Central South University, Hunan, from January 23 to April 23, 2020. Compared with the same period in 2019, the results show that the number of hospitalization decreased by 19.6%; the inhospital mortality rate of CCU was decreased (28.57% versus 16.67%; odds ratio (OR), 0.50; 95% confidence interval (CI), 0.251-0.996; P = 0.047); hospital stay was decreased (7.97 versus 12.36, P < 0.001); hospital emergency percutaneous coronary intervention (PCI) rate in patients with acute coronary syndromes (ACS) significantly decreased (76.00% versus 39.00%, P < 0.001); among this, the PCI rate of patients with ST-segment elevation myocardial infarction (STEMI) decreased (76.32% versus 55.17%, P = 0.028) as well. In addition, the number of patients transferred from other hospitals significantly decreased (76.79% versus 56.67%, P = 0.002), and the number of patients transferred from other cities also decreased by 10.75%.During the outbreak of the COVID-19 epidemic in Hunan Province, the number of patients admitted to CCU decreased, as well as the mortality rate; fewer patients with severe cardiovascular disease can be transported to better hospitals from remote rural areas. In addition to epidemic prevention and control, experts in China should focus on improved emergency transport medical services to reduce this impact.


Subject(s)
COVID-19 , Cardiovascular Diseases/mortality , Coronary Care Units/trends , Hospital Mortality/trends , Patient Admission/trends , Patient Transfer/trends , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , China/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies
4.
Intern Emerg Med ; 16(8): 2077-2086, 2021 11.
Article in English | MEDLINE | ID: covidwho-1152109

ABSTRACT

A significant decline in the admission to intensive cardiac care unit (ICCU) has been noted in Italy during the COVID-19 outbreak. Previous studies have provided data on clinical features and outcome of these patients, but information is still incomplete. In this multicenter study conducted in six ICCUs, we enrolled consecutive adult patients admitted to ICCU in three specific time intervals: from February 8 to March 9, 2020 [before national lockdown (pre-LD)], from March 10 to April 9, 2020 [during the first period of national lockdown (in-LD)] and from May 18 to June 17, 2020 [soon after the end of all containment measures (after-LD)]. Compared to pre-LD, in-LD was associated with a significant drop in the admission to ICCU for all causes (- 35%) and acute coronary syndrome (ACS; - 49%), with a rebound soon after-LD. The in-LD reduction was greater for women (- 49%) and NSTEMI (- 61%) compared to men (- 28%) and STEMI (- 33%). Length-of-stay, and in-hospital mortality did not show any significant change from to pre-LD to in-LD in the whole population as well as in the ACS group. This study confirms a notable reduction in the admissions to ICCUs from pre-LD to in-LD followed by an increment in the admission rates after-LD. These data strongly suggest that people, particularly women and patients with NSTEMI, are reluctant to seek medical care during lockdown, possibly due to the fear of viral infection. Such a phenomenon, however, was not associated with a rise in mortality among patients who get hospitalization.


Subject(s)
COVID-19/epidemiology , Coronary Care Units , Non-ST Elevated Myocardial Infarction/epidemiology , Patient Admission/trends , Acute Coronary Syndrome/epidemiology , Adult , Aged , COVID-19/therapy , Comorbidity , Female , Humans , Intensive Care Units , Italy/epidemiology , Male , Middle Aged , Non-ST Elevated Myocardial Infarction/therapy , Patient Admission/statistics & numerical data , Risk Assessment
5.
J Invasive Cardiol ; 33(2): E71-E76, 2021 02.
Article in English | MEDLINE | ID: covidwho-1063668

ABSTRACT

In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.


Subject(s)
COVID-19 , Cardiac Catheterization/methods , Cardiology Service, Hospital , Coronary Care Units , Critical Care , Infection Control , Laboratories, Hospital/organization & administration , Organizational Innovation , ST Elevation Myocardial Infarction , COVID-19/epidemiology , COVID-19/therapy , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Coronary Care Units/methods , Coronary Care Units/organization & administration , Critical Care/methods , Critical Care/organization & administration , Critical Care/trends , Humans , Infection Control/methods , Infection Control/organization & administration , New York City/epidemiology , Patient Care Team/organization & administration , Perioperative Care/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy
6.
Acta Otorrinolaringol Esp (Engl Ed) ; 71(6): 386-392, 2020.
Article in Spanish | MEDLINE | ID: covidwho-1002943

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
7.
Med Intensiva (Engl Ed) ; 44(8): 493-499, 2020 Nov.
Article in Spanish | MEDLINE | ID: covidwho-1002891

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain/epidemiology , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
8.
J Invasive Cardiol ; 33(2): E71-E76, 2021 02.
Article in English | MEDLINE | ID: covidwho-984012

ABSTRACT

In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.


Subject(s)
COVID-19 , Cardiac Catheterization/methods , Cardiology Service, Hospital , Coronary Care Units , Critical Care , Infection Control , Laboratories, Hospital/organization & administration , Organizational Innovation , ST Elevation Myocardial Infarction , COVID-19/epidemiology , COVID-19/therapy , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Coronary Care Units/methods , Coronary Care Units/organization & administration , Critical Care/methods , Critical Care/organization & administration , Critical Care/trends , Humans , Infection Control/methods , Infection Control/organization & administration , New York City/epidemiology , Patient Care Team/organization & administration , Perioperative Care/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy
9.
Eur Rev Med Pharmacol Sci ; 24(23): 12510-12515, 2020 12.
Article in English | MEDLINE | ID: covidwho-995009

ABSTRACT

OBJECTIVE: Almost all countries announced social restrictions and distancing measures which could unintentionally lead to a decline in admissions to hospital for acute disorders other than signs of pneumonia. We aimed to evaluate lipid profile, neutrophil to lymphocyte ratio (NLR) and cardiovascular admissions to the coronary care unit (CCU) of a tertiary center in Turkey during the COVID-19 era and to compare these results with admissions in the same time interval of the previous year. MATERIALS AND METHODS: We retrospectively analyzed CCU admissions due to new-onset atrial fibrillation, ST-elevation myocardial infarction, non-ST elevation acute coronary syndrome (NSTEACS) and acute heart failure during the COVID-19 outbreak and the same time interval of the past year. Laboratory measurements including lipid profile and NLR values were retrieved from the institutional digital database. RESULTS: Compared to the same time interval of 2019 (March-April, 2019), the number of patients admitted to the CCU with acute cardiovascular disorders (atrial fibrillation, STEMI, NSTEACS and acute heart failure) were lower in the COVID-19 period. The levels of NLR, total cholesterol, and low-density lipoprotein (LDL) cholesterol were significantly higher and high-density lipoprotein (HDL) cholesterol was significantly lower in subjects admitted to the CCU during March-April 2020 compared to subjects admitted in March-April 2019. CONCLUSIONS: Our findings show that subjects admitted to the CCU in the COVID-19 era have an unfavorable lipid profile and elevated NLR compared to those admitted in 2019. These patients appear to be at high risk for future cardiovascular events.


Subject(s)
Acute Coronary Syndrome/blood , Atrial Fibrillation/blood , COVID-19 , Dyslipidemias/blood , Heart Failure/blood , Lymphocyte Count , Neutrophils , ST Elevation Myocardial Infarction/blood , Acute Coronary Syndrome/epidemiology , Aged , Atrial Fibrillation/epidemiology , Cholesterol/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Cohort Studies , Communicable Disease Control , Coronary Care Units , Dyslipidemias/epidemiology , Female , Heart Failure/epidemiology , Humans , Leukocyte Count , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , Turkey/epidemiology
10.
Chest ; 159(2): 657-662, 2021 02.
Article in English | MEDLINE | ID: covidwho-928873
12.
Rev Esp Anestesiol Reanim (Engl Ed) ; 67(9): 504-510, 2020 Nov.
Article in English, Spanish | MEDLINE | ID: covidwho-592287

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain/epidemiology , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
13.
Am Heart J ; 226: 60-68, 2020 08.
Article in English | MEDLINE | ID: covidwho-589490

ABSTRACT

There is much debate on the use of angiotensin receptor blockers (ARBs) in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-infected patients. Although it has been suggested that ARBs might lead to a higher susceptibility and severity of SARS-CoV-2 infection, experimental data suggest that ARBs may reduce acute lung injury via blocking angiotensin-II-mediated pulmonary permeability, inflammation, and fibrosis. However, despite these hypotheses, specific studies on ARBs in SARS-CoV-2 patients are lacking. METHODS: The PRAETORIAN-COVID trial is a multicenter, double-blind, placebo-controlled 1:1 randomized clinical trial in adult hospitalized SARS-CoV-2-infected patients (n = 651). The primary aim is to investigate the effect of the ARB valsartan compared to placebo on the composite end point of admission to an intensive care unit, mechanical ventilation, or death within 14 days of randomization. The active-treatment arm will receive valsartan in a dosage titrated to blood pressure up to a maximum of 160 mg bid, and the placebo arm will receive matching placebo. Treatment duration will be 14 days, or until the occurrence of the primary end point or until hospital discharge, if either of these occurs within 14 days. The trial is registered at clinicaltrials.gov (NCT04335786, 2020). SUMMARY: The PRAETORIAN-COVID trial is a double-blind, placebo-controlled 1:1 randomized trial to assess the effect of valsartan compared to placebo on the occurrence of ICU admission, mechanical ventilation, and death in hospitalized SARS-CoV-2-infected patients. The results of this study might impact the treatment of SARS-CoV-2 patients globally.


Subject(s)
Angiotensin II Type 1 Receptor Blockers/therapeutic use , Betacoronavirus , Coronary Care Units , Coronavirus Infections/complications , Pneumonia, Viral/complications , Randomized Controlled Trials as Topic , Respiratory Distress Syndrome/prevention & control , Valsartan/therapeutic use , Adult , Angiotensin II Type 1 Receptor Blockers/administration & dosage , COVID-19 , Coronavirus Infections/mortality , Double-Blind Method , Drug Administration Schedule , Humans , Inpatients , Multicenter Studies as Topic , Netherlands , Pandemics , Placebos/therapeutic use , Pneumonia, Viral/mortality , Respiration, Artificial , Respiratory Distress Syndrome/mortality , SARS-CoV-2 , Time Factors , Valsartan/administration & dosage
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