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1.
Eur Heart J Qual Care Clin Outcomes ; 8(2): 104-112, 2022 03 02.
Article in English | MEDLINE | ID: covidwho-1722379

ABSTRACT

AIMS: During the early phase of the COVID-19 pandemic, hospital admissions for several medical and surgical conditions declined. Few data are available with respect to elective cardiac implantable electronic device (CIED) implantation. The aim of the present study was to determine the impact of the COVID-19 pandemic on the monthly CIED implantation rates in Germany (January-September 2020 vs. 2019). METHODS AND RESULTS: The monthly rates of CIED implantation for the 2019 pre- and 2020 pandemic periods were retrieved from the Institute für das Entgeltsystem im Krankenhaus using German Operation and Procedure Classification codes to identify pacemakers (PMs), implantable cardioverter/defibrillators (ICDs), and cardiac resynchronization therapy (CRT) systems. Compared with 2019, the COVID-19 pandemic was associated with an overall decline of CIED implantation rates of -2.6%, reaching -22.9% in April 2020. Stratified by device type, the patterns of implantation were similar between PMs and ICDs, with maximal declines of -24.3% and -23.2% in April, respectively. Thereafter, the implantation rates gradually increased before stabilizing to rates similar to those observed in 2019. CRT implantation rates also declined in the early pandemic wave, but the overall 2020 rates increased by +4.3% likely driven by an increase of +16.5% (June-September). All the observed percentage differences of monthly device type related implantation rates demonstrated a statistical significance. CONCLUSION: The COVID-19 pandemic had a significant impact on the implantation of CIEDs in Germany. A differential pattern of resource utilization was observed with a catch-up effect for PMs and ICDs. The implantation rates of CRT systems also declined, but they increased rapidly and remained higher than those of 2019.


Subject(s)
COVID-19 , Defibrillators, Implantable , COVID-19/epidemiology , Electronics , Germany/epidemiology , Humans , Pandemics , SARS-CoV-2
2.
G Ital Cardiol (Rome) ; 23(1): 4-9, 2022 01.
Article in Italian | MEDLINE | ID: covidwho-1714846

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 has greatly modified outpatient follow-ups. The aim of this retrospective study was to evaluate the organizational modalities and clinical effects of rearrangements of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) outpatient visits performed in our centers at Ravenna and Lugo Hospitals, Italy, during the pandemic outbreak in 2020. METHODS: All scheduled in-person device follow-up visits in March-December 2020 have been considered. On the basis of documented past functioning of each device and of remote monitoring (RM) capabilities, in-person visits were either performed or postponed at variable times. The characteristics of the follow-ups and the device-related clinically relevant events were analyzed, the latter being further divided into serious malfunction and problems to be corrected by device reprogramming. RESULTS: Overall, 27% of in-person visits were postponed (n = 576) (36% of ICDs and 25% of PMs), peaking 62% in March-May 2020. RM compensated nearly all hold-ups in ICDs and just 63% of postponements in PMs. The postponement-caused delay between in-person visits was 5.6 ± 1.1 months for ICDs and 4.7 ± 1.2 months for PMs; in 24% of ICDs the time interval between in-person visits was ≥18 months. Clinically relevant events were 56 (18 [4.4%] in ICDs, 38 [2.1%] in PMs), with no deaths and 21 serious malfunctions (4 [1%] in ICDs, 15 [0.8%] in PMs). RM identified all ICD malfunctions, while it was not available in the affected PMs. In comparison with the year 2019, serious malfunctions increased, though the difference was not significant. Monthly RM transmissions increased by 2.3 fold. CONCLUSIONS: In our single-center experience during the COVID-19 pandemic, numerous in-person PM/ICD follow-up visits were postponed, and delays were well beyond the previously recommended time limits. However, device-related malfunctions did not increase, notably, when RM capabilities were used.


Subject(s)
COVID-19 , Defibrillators, Implantable , Pacemaker, Artificial , Electronics , Follow-Up Studies , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
5.
Pacing Clin Electrophysiol ; 45(4): 471-480, 2022 04.
Article in English | MEDLINE | ID: covidwho-1612918

ABSTRACT

BACKGROUND: Restricted outdoor activity during COVID-19 related lockdown may accelerate heart failure (HF) progression and thereby increase cardiac arrhythmias. We analyzed the impact of March/April 2020 lockdown on physical activity and arrhythmia burden in HF patients treated with cardiac resynchronization therapy (CRT) devices with daily, automatic remote monitoring (RM) function. METHODS: The study cohort included 405 HF patients enrolled in Observation of Clinical Routine Care for Heart Failure Patients Implanted with BIOTRONIK CRT Devices (BIO|STREAM.HF) registry in 16 countries, who had left ventricular ejection fraction (LVEF) ≤40% (mean 28.2 ± 6.6%) and NYHA class II/III/IV (47.9%/49.6%/2.5%) before CRT pacemaker/defibrillator implantation. The analyzed RM data comprised physical activity detected by accelerometer, mean heart rate and nocturnal rate, PP variability, percentage of biventricular pacing, atrial high rate episode (AHRE) burden, ventricular extrasystoles and tachyarrhythmias, defibrillator shocks, and number of implant interrogations (i.e., follow-ups). Intraindividual differences in RM parameters before (4-week period) versus during (4-week period) lockdown were tested for statistical significance and independent predictors were identified. RESULTS: There was a significant relative change in activity (mean -6.5%, p < .001), AHRE burden (+17%, p = .013), and follow-up rate (-75%, p < .001) during lockdown, with no significant changes in other RM parameters. Activity decreased by ≥8 min/day in 46.5% of patients; predictors were higher LVEF, lower NYHA class, no defibrillator indication, and more activity before lockdown. AHRE burden increased by ≥17 min/day in 4.7% of patients; predictors were history of atrial fibrillation, higher LVEF, higher body mass index, and activity decrease during lockdown. CONCLUSION: Unfavorable changes in physical activity, AHRE burden, and follow-up rate were observed during lockdown, but not in ventricular arrhythmia.


Subject(s)
Atrial Fibrillation , COVID-19 , Cardiac Resynchronization Therapy , Defibrillators, Implantable , Heart Failure , Atrial Fibrillation/therapy , Communicable Disease Control , Exercise , Heart Failure/epidemiology , Heart Failure/therapy , Humans , Pandemics , Stroke Volume , Treatment Outcome , Ventricular Function, Left
6.
Cardiol J ; 29(1): 27-32, 2022.
Article in English | MEDLINE | ID: covidwho-1593294

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic disorganised healthcare systems and has caused a reduction in the number of hospitalizations and procedures. Cardiac implantable electronic device (CIED) procedure rates and clinical characteristics of their recipients were compared in corresponding weeks of 2019 and 2020 were analyzed. METHODS: The database of the National Health Fund (NHF) in Poland was retrospectively analyzed. 3206 patients who underwent CIED implantation in the Silesia - a region in Southern Poland comprising an adult population of 3.8 million between 12th and 31st week of 2020. Patients were classified into groups: the recipient of an implantable cardioverter-defibrillator or cardiac resynchronization therapy group (ICD/CRT) or pacemaker group (PM). RESULTS: During the pandemic a reduction of 39.38% of implantations was observed compared to the same period in 2019 (1210 vs. 1996 patients) and had impacted both groups. Two phases lasting 10 weeks each could be distinguished: total lockdown (maximal reduction) and the recovery phase with growing numbers of procedures. Patient baseline characteristics (sex, age, comorbidities) who were implanted during the COVID-19 pandemic did not differ from the 2019 period. The rate of peri-procedural mortality was also similar. CONCLUSIONS: During COVID-19 pandemic period a reduction in CIED implantations of all types was observed. Despite the decreased number of performed CIED implants, no differences in baseline patient characteristics were observed.


Subject(s)
COVID-19 , Defibrillators, Implantable , Adult , COVID-19/epidemiology , Communicable Disease Control , Electronics , Humans , Pandemics , Poland , Retrospective Studies , SARS-CoV-2
7.
Kardiol Pol ; 80(1): 41-48, 2022.
Article in English | MEDLINE | ID: covidwho-1559234

ABSTRACT

BACKGROUND: Heart failure (HF) remains a disease with a poor prognosis. Telemonitoring is a medical service aimed at remote monitoring of patients. AIM: The study aimed to identify the clinical relevance of non-invasive telemonitoring devices in HF patients. METHODS: Sixty patients aged 66.1 (11) years, with left ventricular ejection fraction (LVEF) 26.3 (6.8)% underwent cardiac resynchronization therapy (CRT) implantation. They were randomly allocated to the control (standard medical care) or study (standard medical care + telemonitoring device) groups. During the follow-up (24 months), the patients in the study group provided body mass and blood pressure, along with electrocardiogram on a daily basis. The data were transferred to themonitoring center and consulted with a cardiologist. Transthoracic echocardiography and a 6-minute walk test were performed before and 24 months after CRT implantation. RESULTS: During the two-year observation, the composite endpoint (death or HF hospitalization) occurred in 21 patients, more often in the control group (46.8% vs. 21.4%; P = 0.026). Inunivariate analysis: the use of telemetry (hazard ratio [HR], 0.2; 95% confidence interval [CI], 0.07-0.7; P=0.004), thepresence of coronary heart disease (HR, 41.4; 95% CI, 3.1-567.7; P=0.005), hypertension (HR, 0.24; 95% CI, 0.07-0.90; P = 0.035), and patient's body mass (HR, 0.36; 95% CI, 0.14-0.92; P = 0.03) were related to the occurrence of the composite endpoint. CONCLUSIONS: The use of a telemonitoring device in CRT recipients improved theprognosis in2-year observation and contributed to the reduction of HF hospitalization.


Subject(s)
Cardiac Resynchronization Therapy , Defibrillators, Implantable , Heart Failure , Telemedicine , Aged , Cardiac Resynchronization Therapy Devices , Heart Failure/therapy , Humans , Stroke Volume , Treatment Outcome , Ventricular Function, Left
8.
Eur Heart J Qual Care Clin Outcomes ; 8(2): 104-112, 2022 03 02.
Article in English | MEDLINE | ID: covidwho-1545926

ABSTRACT

AIMS: During the early phase of the COVID-19 pandemic, hospital admissions for several medical and surgical conditions declined. Few data are available with respect to elective cardiac implantable electronic device (CIED) implantation. The aim of the present study was to determine the impact of the COVID-19 pandemic on the monthly CIED implantation rates in Germany (January-September 2020 vs. 2019). METHODS AND RESULTS: The monthly rates of CIED implantation for the 2019 pre- and 2020 pandemic periods were retrieved from the Institute für das Entgeltsystem im Krankenhaus using German Operation and Procedure Classification codes to identify pacemakers (PMs), implantable cardioverter/defibrillators (ICDs), and cardiac resynchronization therapy (CRT) systems. Compared with 2019, the COVID-19 pandemic was associated with an overall decline of CIED implantation rates of -2.6%, reaching -22.9% in April 2020. Stratified by device type, the patterns of implantation were similar between PMs and ICDs, with maximal declines of -24.3% and -23.2% in April, respectively. Thereafter, the implantation rates gradually increased before stabilizing to rates similar to those observed in 2019. CRT implantation rates also declined in the early pandemic wave, but the overall 2020 rates increased by +4.3% likely driven by an increase of +16.5% (June-September). All the observed percentage differences of monthly device type related implantation rates demonstrated a statistical significance. CONCLUSION: The COVID-19 pandemic had a significant impact on the implantation of CIEDs in Germany. A differential pattern of resource utilization was observed with a catch-up effect for PMs and ICDs. The implantation rates of CRT systems also declined, but they increased rapidly and remained higher than those of 2019.


Subject(s)
COVID-19 , Defibrillators, Implantable , COVID-19/epidemiology , Electronics , Germany/epidemiology , Humans , Pandemics , SARS-CoV-2
9.
Pediatr Cardiol ; 43(4): 784-789, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1544414

ABSTRACT

Decreased physical activity is associated with cardiovascular, metabolic and mental health disease. While decreases in physical activity during the COVID-19 pandemic have been described in the general population, there is a paucity of data regarding children with underlying cardiovascular disease. We hypothesized there would be a decrease in physical activity at the onset of the COVID-19 pandemic. Performed a single-center, retrospective cohort study of children aged < 19 years with cardiac rhythm management devices. Patients were included if they had device-measured physical activity data from > 80% of dates from February 3, 2020 through June 30, 2020. Patients with significant neurologic/neuromuscular disease were excluded. We identified 144 patients with a median age of 15.4 years. 47% were female. 34% had congenital heart disease, 20% had cardiomyopathy, 19% had an inherited arrhythmia syndrome and 5% had atrioventricular block without congenital heart disease. 47% of patients had an implantable loop recorder, 29% had a permanent pacemaker and 24% had an implantable cardioverter-defibrillator. We observed a significant decrease in device-measured physical activity from baseline (February 3-March 9), with up to a 21% decrease in physical activity during mid-March through early May. Activity levels returned to pre-pandemic levels in June. Physical activity sharply declined in children with cardiac rhythm management devices at the onset of the COVID-19 pandemic. These data highlight the importance of finding strategies to maintain physical activity during the current pandemic and future public health crises.


Subject(s)
COVID-19 , Defibrillators, Implantable , Pacemaker, Artificial , Adolescent , COVID-19/epidemiology , Child , Female , Humans , Pandemics , Retrospective Studies
12.
Card Electrophysiol Clin ; 14(1): 125-131, 2022 03.
Article in English | MEDLINE | ID: covidwho-1487632

ABSTRACT

During the coronavirus disease 2019 (COVID-19) worldwide pandemic, patients with cardiac implantable electronic device (CIED) refused scheduled follow-up visits because of the risk of infection. In this scenario, different telemedicine strategies have been implemented to ensure continuity of care to CIED patients. Patients can be monitored through dedicated applications, telephone calls, or virtual visits providing easy access to valuable information, such as arrhythmic events, acute decompensation manifestations, and device-related issues, without the need for in-person visits. This review provides a comprehensive description of the many possible applications of telemedicine for CIED patients during the COVID-19 period.


Subject(s)
COVID-19 , Defibrillators, Implantable , Pacemaker, Artificial , Telemedicine , Electronics , Humans , Pandemics , SARS-CoV-2
14.
Heart Rhythm ; 19(2): 206-216, 2022 02.
Article in English | MEDLINE | ID: covidwho-1482622

ABSTRACT

BACKGROUND: Cardiac implantable electronic device (CIED) implantation rates as well as the clinical and procedural characteristics and outcomes in patients with known active coronavirus disease 2019 (COVID-19) are unknown. OBJECTIVE: The purpose of this study was to gather information regarding CIED procedures during active COVID-19, performed with personal protective equipment, based on an international survey. METHODS: Fifty-three centers from 13 countries across 4 continents provided information on 166 patients with known active COVID-19 who underwent a CIED procedure. RESULTS: The CIED procedure rate in 133,655 hospitalized COVID-19 patients ranged from 0 to 16.2 per 1000 patients (P <.001). Most devices were implanted due to high-degree/complete atrioventricular block (112 [67.5%]) or sick sinus syndrome (31 [18.7%]). Of the 166 patients in the study survey, the 30-day complication rate was 13.9% and the 180-day mortality rate was 9.6%. One patient had a fatal outcome as a direct result of the procedure. Differences in patient and procedural characteristics and outcomes were found between Europe and North America. An older population (76.6 vs 66 years; P <.001) with a nonsignificant higher complication rate (16.5% vs 7.7%; P = .2) was observed in Europe vs North America, whereas higher rates of critically ill patients (33.3% vs 3.3%; P <.001) and mortality (26.9% vs 5%; P = .002) were observed in North America vs Europe. CONCLUSION: CIED procedure rates during known active COVID-19 disease varied greatly, from 0 to 16.2 per 1000 hospitalized COVID-19 patients worldwide. Patients with active COVID-19 infection who underwent CIED implantation had high complication and mortality rates. Operators should take these risks into consideration before proceeding with CIED implantation in active COVID-19 patients.


Subject(s)
Atrioventricular Block , COVID-19 , Infection Control , Postoperative Complications , Prosthesis Implantation , SARS-CoV-2/isolation & purification , Sick Sinus Syndrome , Aged , Atrioventricular Block/epidemiology , Atrioventricular Block/therapy , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Defibrillators, Implantable/statistics & numerical data , Female , Global Health/statistics & numerical data , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , Mortality , Outcome Assessment, Health Care , Pacemaker, Artificial/statistics & numerical data , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Prosthesis Implantation/adverse effects , Prosthesis Implantation/instrumentation , Prosthesis Implantation/mortality , Risk Factors , Sick Sinus Syndrome/epidemiology , Sick Sinus Syndrome/therapy , Surveys and Questionnaires
17.
Rev Esp Cardiol (Engl Ed) ; 74(11): 971-982, 2021 Nov.
Article in English, Spanish | MEDLINE | ID: covidwho-1442538

ABSTRACT

INTRODUCTION AND OBJECTIVES: We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2020. METHODS: The data in this registry were drawn from implantation centers, which voluntarily completed a data collection sheet. RESULTS: In 2020, 7056 implant sheets were received compared with 7106 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 99% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.8% for the field "name of the implanting hospital" to 2.6% for the variable "referral hospital". A total of 173 hospitals performed ICD implants and participated in the registry, which is a similar figure to that in 2019 (n=172). The total rate of registered implants was 149/million inhabitants (150 according to Eucomed), revealing a slight reduction in implants in Spain in 2020 as a result of the impact of the COVID-19 pandemic. This reduction was uneven among the autonomous communities. CONCLUSIONS: The Spanish Implantable Cardioverter Defibrillator Registry for 2020 shows an improvement in the rate of implants reported and a reduction in the number of ICD implants, which likely reflects the decrease in hospital activity not related to the treatment of COVID-19 infection. Similar to previous years, the total number of implants in Spain is still much lower than the average for the European Union, with an increase in the differences between Spanish autonomous communities.


Subject(s)
COVID-19 , Cardiology , Defibrillators, Implantable , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/therapy , Humans , Pandemics , Registries , SARS-CoV-2
20.
Europace ; 24(2): 256-267, 2022 02 02.
Article in English | MEDLINE | ID: covidwho-1364793

ABSTRACT

AIMS: Remote patient monitoring (RPM) systems offer a promising alternative to conventional In-Clinic check-ups, hereby reducing unnecessary clinic visits. Especially with the rise of the COVID-19 pandemic, this reduction is of paramount importance. Regarding the association between RPM and clinical outcomes, findings of previous studies have been inconsistent. The aim of this study is to elucidate the effect of partly substituting In-Clinic visits by RPM on clinical outcomes in implantable cardioverter-defibrillator (ICD) patients. METHODS AND RESULTS: The study included 595 heart failure patients (LVEF ≤35%; NYHA Class II/III) implanted with an ICD compatible with the Boston Scientific LATITUDE™ system. Participants were randomized to RPM plus an annual In-Clinic visit or 3-6 months In-Clinic check-ups alone. The investigated endpoints after 2 years of follow-up included a composite of all-cause mortality and cardiac hospitalization, mortality and cardiac hospitalization as independent endpoints and ICD therapy. The incidence of mortality and hospitalization did not differ significantly as independent, nor as composite endpoint between the RPM and In-Clinic group (all Ps <0.05). The results were similar regarding ICD therapy, except for appropriate ICD therapy (odds ratio 0.50; 95% confidence interval 0.26-0.98; P = 0.04). Exploratory subgroup analyses indicated that the effect of RPM differs between patients with specific characteristics, i.e. ≥60 years and permanent atrial fibrillation (all Ps < 0.05). CONCLUSION: RPM is non-inferior to conventional In-Clinic visits regarding clinical outcomes. Routine In-Clinic follow-up may partly be substituted by RPM without jeopardizing safety and efficiency, and thus reducing unnecessary In-Clinic visits. CLINICALTRIALS.GOV IDENTIFIER: NCT01691586.


Subject(s)
COVID-19 , Defibrillators, Implantable , Heart Failure , Heart Failure/diagnosis , Heart Failure/therapy , Humans , Pandemics , SARS-CoV-2
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