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1.
Eur Heart J ; 43(23): 2237-2246, 2022 Jun 14.
Article in English | MEDLINE | ID: covidwho-2188653

ABSTRACT

Heart transplantation is advocated in selected patients with advanced heart failure in the absence of contraindications. Principal challenges in heart transplantation centre around an insufficient and underutilized donor organ pool, the need to individualize titration of immunosuppressive therapy, and to minimize late complications such as cardiac allograft vasculopathy, malignancy, and renal dysfunction. Advances have served to increase the organ donor pool by advocating the use of donors with underlying hepatitis C virus infection and by expanding the donor source to use hearts donated after circulatory death. New techniques to preserve the donor heart over prolonged ischaemic times, and enabling longer transport times in a safe manner, have been introduced. Mechanical circulatory support as a bridge to transplantation has allowed patients with advanced heart failure to avoid progressive deterioration in hepato-renal function while awaiting an optimal donor organ match. The management of the heart transplantation recipient remains a challenge despite advances in immunosuppression, which provide early gains in rejection avoidance but are associated with infections and late-outcome challenges. In this article, we review contemporary advances and challenges in this field to focus on donor recovery strategies, left ventricular assist devices, and immunosuppressive monitoring therapies with the potential to enhance outcomes. We also describe opportunities for future discovery to include a renewed focus on long-term survival, which continues to be an area that is under-studied and poorly characterized, non-human sources of organs for transplantation including xenotransplantation as well as chimeric transplantation, and technology competitive to human heart transplantation, such as tissue engineering.


Subject(s)
Heart Diseases , Heart Failure , Heart Transplantation , Heart-Assist Devices , Heart Failure/therapy , Heart Transplantation/methods , Humans , Tissue Donors
2.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.17.23284647

ABSTRACT

The rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a global overextension of healthcare. Both Chest X-rays (CXR) and blood test have been demonstrated to have predictive value on Coronavirus Disease 2019 (COVID-19) diagnosis on different prevalence scenarios. With the objective of improving and accelerating the diagnosis of COVID-19, a multi modal prediction algorithm (MultiCOVID) based on CXR and blood test was developed, to discriminate between COVID-19, Heart Failure (HF) and Non-Covid Pneumonia (NCP) and healthy (Control) patients. This retrospective single-center study includes CXR and blood test obtained between January 2017 and May 2020. Multi modal prediction models were generated using opensource DL algorithms. Performance of the MultiCOVID algorithm was compared with interpretations from five experienced thoracic radiologists on 300 random test images using the McNemar-Bowker test. A total of 8578 samples from 6123 patients (mean age 66 +/- 18 years of standard deviation, 3523 men) were evaluated across datasets. For the entire test set, the overall accuracy of MultiCOVID was 84%, with a mean AUC of 0.92 (0.89-0.94). For 300 random test images, overall accuracy of MultiCOVID was significantly higher (69.6%) compared with individual radiologists (range, 43.7%-58.7%) and the consensus of all five radiologists (59.3%, P<.001). Overall, we have developed a multimodal deep learning algorithm, MultiCOVID, that discriminates among COVID-19, heart failure, non-covid pneumonia and healthy patients using both CXR and blood test with a significantly better performance than experienced thoracic radiologists.


Subject(s)
Pneumonia , Heart Failure , Coronavirus Infections , COVID-19 , Learning Disabilities
3.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.16.23284620

ABSTRACT

Background There is growing body of literature on the long-term cardiac symptoms following COVID-19. We conducted a systematic review and meta analysis to synthesize and evaluate related evidence to inform clinical management and future studies. Methods We searched two preprint and seven peer reviewed article databases from January 1, 2020 to January 8, 2022 for studies investigating cardiac symptoms that persisted for at least 4 weeks among individuals who survived COVID-19. A customized Newcastle Ottawa scale was used to evaluate the quality of included studies. Random effects meta analyses were performed to estimate the proportion of symptoms with 95% confidence intervals (CI), and stratified analyses were conducted to quantify the proportion of symptoms by study characteristics and quality. Results A total of 101 studies describing 49 unique long-term cardiac symptoms met the inclusion criteria. Based on quality assessment, only 15.8% of the studies (n=16) were of high quality, and most studies scored poorly on sampling representativeness. The two most examined symptoms were chest pain and arrhythmia. Meta-analysis showed that the proportion of chest pain was 10.1% (95% CI: 6.4, 15.5) and arrhythmia was 9.8% (95% CI: 5.4, 17.2). Stratified analyses showed that studies with low-quality score, small sample size, unsystematic sampling method, and cross-sectional design were most likely to report high proportions of symptoms. For example, the proportion of chest pain was 21.3% (95% CI: 10.5, 38.5), 9.3% (95% CI: 6.0, 14.0), and 4.0% (95% CI: 1.3, 12.0) in studies with low, medium, and high-quality scores, respectively. Similar patterns were observed for other cardiac symptoms including hypertension, cardiac abnormalities, myocardial injury, thromboembolism, stroke, heart failure, coronary disease, and myocarditis. Discussion There is a wide spectrum of long-term cardiac symptoms following COVID-19. Findings of existing studies are strongly related to study quality, size and design, underscoring the need for high-quality epidemiologic studies to characterize these symptoms and understand their etiology.


Subject(s)
Chest Pain , Heart Failure , Heart Diseases , COVID-19 , Myocarditis , Hypertension , Thromboembolism , Cardiomyopathies , Coronary Disease , Stroke , Arrhythmias, Cardiac
4.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2458970.v1

ABSTRACT

Background Infection is a well-known contributor to developing cardiac arrythmias such as atrial fibrillation (AF), which contributes to over 25% of all ischaemic stroke. We wanted to quantify the incidence of first-diagnosed (new) AF (nAF) during hospitalisation with COVID-19 compared to a lower respiratory tract infection (LRTI), as well as compare anticoagulation rates at discharge, reasons for non-prescription of anticoagulation and determine factors associated with developing nAF with COVID-19. Methods We analysed a comprehensive hospital coding database on patients hospitalised due to COVID-19+/-AF or LRTI +/-AF, between 1/3/2020 and 31/12/2020 at a large tertiary hospital in the UK. Incidence of nAF during COVID-19 or LRTI, and the proportions of nAF patients discharged on anticoagulation and reasons for non-prescription from both cohorts were quantified. Results 2243 patients were hospitalised with LRTI and 488 with COVID-19. nAF was diagnosed in significantly more COVID-19 patients compared to LRTI (7.0% vs 3.6%, P=0.003). However, significantly less COVID-19 patients were discharged on anticoagulation compared to LRTI (19.2% vs 55.9%, P=0.003) despite similar CHA2DS2-VASc scores, and lower ORBIT scores. 14/26 LRTI +nAF patients had documented contraindication not to be anticoagulated, whereas only 1/12 patients with COVID-19 +nAF did. Patients who developed nAF during hospitalisation with COVID-19 were older (P<0.001), had pre-existing congestive cardiac failure (P=0.004), ischaemic heart disease (IHD) or peripheral vascular disease (PVD) (P<0.001), and a higher CHA2DS2-VASc score (P=0.02). Older age (Odds ratio (OR) 1.03, P=0.007) and IHD/PVD (OR 2.87, P=0.01) increased the odds of developing nAF with COVID-19. Conclusion Higher incidence of nAF and lower anticoagulation rates in COVID-19 patients were observed, compared to LRTI. A larger proportion of COVID-19 +nAF patients did not have a clear documented reason for non-prescription of anticoagulation in their notes. Whilst we await further research and clear guidelines, a pragmatic approach would be to holistically consider anticoagulation in all patients with COVID-19+nAF and a high ischaemic stroke risk.


Subject(s)
Heart Failure , Respiratory Tract Infections , COVID-19 , Cerebral Infarction , Atrial Fibrillation , Myocardial Ischemia , Peripheral Vascular Diseases , Arrhythmias, Cardiac
5.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.04.23284174

ABSTRACT

Background: The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. Methods We conducted a cohort study using OpenSAFELY (2018-2022). We grouped ethnicity (exposure), into five categories: White, South Asian, Black, Other, Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (e.g., blood pressure measurements) before and after 23rd March 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to: diabetes, cardiovascular disease, respiratory disease, and mental health before and after 23rd March 2020. Findings Of 14,930,356 adults in 2020 with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to White. There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in White ethnicity. Relatively, ethnic differences narrowed for heart failure admission in those of Asian and Black ethnicity compared to White. For other outcomes the pandemic had minimal impact on ethnic differences. Interpretation Our study suggests ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. Funding LSHTM COVID-19 Response Grant (DONAT15912).


Subject(s)
Cardiovascular Diseases , Diabetic Ketoacidosis , Heart Failure , COVID-19 , Respiratory Tract Diseases , Diabetes Mellitus
6.
Circ Heart Fail ; 14(3): e007767, 2021 03.
Article in English | MEDLINE | ID: covidwho-2153215

ABSTRACT

BACKGROUND: The expense of clinical trials mandates new strategies to efficiently generate evidence and test novel therapies. In this context, we designed a decentralized, patient-centered randomized clinical trial leveraging mobile technologies, rather than in-person site visits, to test the efficacy of 12 weeks of canagliflozin for the treatment of heart failure, regardless of ejection fraction or diabetes status, on the reduction of heart failure symptoms. METHODS: One thousand nine hundred patients will be enrolled with a medical record-confirmed diagnosis of heart failure, stratified by reduced (≤40%) or preserved (>40%) ejection fraction and randomized 1:1 to 100 mg daily of canagliflozin or matching placebo. The primary outcome will be the 12-week change in the total symptom score of the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes will be daily step count and other scales of the Kansas City Cardiomyopathy Questionnaire. RESULTS: The trial is currently enrolling, even in the era of the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) is deploying a novel model of conducting a decentralized, patient-centered, randomized clinical trial for a new indication for canagliflozin to improve the symptoms of patients with heart failure. It can model a new method for more cost-effectively testing the efficacy of treatments using mobile technologies with patient-reported outcomes as the primary clinical end point of the trial. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04252287.


Subject(s)
Canagliflozin/therapeutic use , Heart Failure/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Telemedicine , Actigraphy/instrumentation , Canagliflozin/adverse effects , Double-Blind Method , Exercise Tolerance/drug effects , Fitness Trackers , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Mobile Applications , Quality of Life , Randomized Controlled Trials as Topic , Recovery of Function , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Stroke Volume/drug effects , Telemedicine/instrumentation , Time Factors , Treatment Outcome , United States , Ventricular Function, Left/drug effects
7.
Hypertension ; 76(5): 1526-1536, 2020 11.
Article in English | MEDLINE | ID: covidwho-2153220

ABSTRACT

ACE2 (angiotensin-converting enzyme 2) is a key component of the renin-angiotensin-aldosterone system. Yet, little is known about the clinical and biologic correlates of circulating ACE2 levels in humans. We assessed the clinical and proteomic correlates of plasma (soluble) ACE2 protein levels in human heart failure. We measured plasma ACE2 using a modified aptamer assay among PHFS (Penn Heart Failure Study) participants (n=2248). We performed an association study of ACE2 against ≈5000 other plasma proteins measured with the SomaScan platform. Plasma ACE2 was not associated with ACE inhibitor and angiotensin-receptor blocker use. Plasma ACE2 was associated with older age, male sex, diabetes mellitus, a lower estimated glomerular filtration rate, worse New York Heart Association class, a history of coronary artery bypass surgery, and higher pro-BNP (pro-B-type natriuretic peptide) levels. Plasma ACE2 exhibited associations with 1011 other plasma proteins. In pathway overrepresentation analyses, top canonical pathways associated with plasma ACE2 included clathrin-mediated endocytosis signaling, actin cytoskeleton signaling, mechanisms of viral exit from host cells, EIF2 (eukaryotic initiation factor 2) signaling, and the protein ubiquitination pathway. In conclusion, in humans with heart failure, plasma ACE2 is associated with various clinical factors known to be associated with severe coronavirus disease 2019 (COVID-19), including older age, male sex, and diabetes mellitus, but is not associated with ACE inhibitor and angiotensin-receptor blocker use. Plasma ACE2 protein levels are prominently associated with multiple cellular pathways involved in cellular endocytosis, exocytosis, and intracellular protein trafficking. Whether these have a causal relationship with ACE2 or are relevant to novel coronavirus-2 infection remains to be assessed in future studies.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks/statistics & numerical data , Disease Progression , Heart Failure/enzymology , Heart Failure/physiopathology , Peptidyl-Dipeptidase A/blood , Pneumonia, Viral/epidemiology , Academic Medical Centers , Analysis of Variance , Angiotensin-Converting Enzyme 2 , Biomarkers/metabolism , COVID-19 , Cohort Studies , Coronavirus Infections/prevention & control , Female , Humans , Linear Models , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Prognosis , Proportional Hazards Models , Proteomics/methods , Retrospective Studies , Sensitivity and Specificity , Severity of Illness Index , United States
8.
Heart ; 108(4): 258-265, 2022 02.
Article in English | MEDLINE | ID: covidwho-2137872

ABSTRACT

Ramadan fasting is observed by most of the 1.8 billion Muslims around the world. It lasts for 1 month per the lunar calendar year and is the abstention from any food and drink from dawn to sunset. While recommendations on 'safe' fasting exist for patients with some chronic conditions, such as diabetes mellitus, guidance for patients with cardiovascular disease is lacking. We reviewed the literature to help healthcare professionals educate, discuss and manage patients with cardiovascular conditions, who are considering fasting. Studies on the safety of Ramadan fasting in patients with cardiac disease are sparse, observational, of small sample size and have short follow-up. Using expert consensus and a recognised framework, we risk stratified patients into 'low or moderate risk', for example, stable angina or non-severe heart failure; 'high risk', for example, poorly controlled arrhythmias or recent myocardial infarction; and 'very high risk', for example, advanced heart failure. The 'low-moderate risk' group may fast, provided their medications and clinical conditions allow. The 'high' or 'very high risk' groups should not fast and may consider safe alternatives such as non-consecutive fasts or fasting shorter days, for example, during winter. All patients who are fasting should be educated before Ramadan on their risk and management (including the risk of dehydration, fluid overload and terminating the fast if they become unwell) and reviewed after Ramadan to reassess their risk status and condition. Further studies to clarify the benefits and risks of fasting on the cardiovascular system in patients with different cardiovascular conditions should help refine these recommendations.


Subject(s)
Cardiovascular Diseases , Heart Failure , Cardiovascular Diseases/therapy , Fasting/adverse effects , Heart Failure/therapy , Humans , Islam
9.
Front Immunol ; 13: 1052850, 2022.
Article in English | MEDLINE | ID: covidwho-2142039

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a contemporary hazard to people. It has been known that COVID-19 can both induce heart failure (HF) and raise the risk of patient mortality. However, the mechanism underlying the association between COVID-19 and HF remains unclear. The common molecular pathways between COVID-19 and HF were identified using bioinformatic and systems biology techniques. Transcriptome analysis was performed to identify differentially expressed genes (DEGs). To identify gene ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways, common DEGs were used for enrichment analysis. The results showed that COVID-19 and HF have several common immune mechanisms, including differentiation of T helper (Th) 1, Th 2, Th 17 cells; activation of lymphocytes; and binding of major histocompatibility complex class I and II protein complexes. Furthermore, a protein-protein interaction network was constructed to identify hub genes, and immune cell infiltration analysis was performed. Six hub genes (FCGR3A, CD69, IFNG, CCR7, CCL5, and CCL4) were closely associated with COVID-19 and HF. These targets were associated with immune cells (central memory CD8 T cells, T follicular helper cells, regulatory T cells, myeloid-derived suppressor cells, plasmacytoid dendritic cells, macrophages, eosinophils, and neutrophils). Additionally, transcription factors, microRNAs, drugs, and chemicals that are closely associated with COVID-19 and HF were identified through the interaction network.


Subject(s)
COVID-19 , Heart Failure , Humans , Systems Biology , Computational Biology , SARS-CoV-2 , Molecular Targeted Therapy , Heart Failure/genetics
10.
J Dr Nurs Pract ; 15(3): 144-149, 2022 11 01.
Article in English | MEDLINE | ID: covidwho-2141073

ABSTRACT

Background: Family health plays a vital role in the self-care and lifestyle modifications in families living with heart failure. Objective: To investigate the family health of patients with heart failure and their family members before and during the first COVID-19 lockdown. Method: This was a cross-sectional study design. We included 34 participants before and 34 participants during the first COVID-19 lockdown. Independent t-tests were conducted for comparison of the mean scores of the family health and its dimensions. Results: There was no significant difference between the total score of family health during the first COVID-19 lockdown compared to before the first COVID-19 lockdown in patients and family members. However, the values and ill-being dimensions of family health in patients and ill-being dimension in family members were significantly decreased during the first COVID-19 lockdown. Conclusion: This study indicated the positive and negative impacts of COVID-19 lockdown on family health. Implications for Nursing: Our results may help nurses to identify vulnerable patients with a low level of family health to tailor the best support to them.


Subject(s)
COVID-19 , Heart Failure , Humans , COVID-19/epidemiology , Cross-Sectional Studies , Family Health , Communicable Disease Control , Family , Heart Failure/epidemiology
11.
J Am Soc Nephrol ; 33(3): 613-627, 2022 03.
Article in English | MEDLINE | ID: covidwho-2141043

ABSTRACT

BACKGROUND: The mechanisms underlying long-term sequelae after AKI remain unclear. Vessel instability, an early response to endothelial injury, may reflect a shared mechanism and early trigger for CKD and heart failure. METHODS: To investigate whether plasma angiopoietins, markers of vessel homeostasis, are associated with CKD progression and heart failure admissions after hospitalization in patients with and without AKI, we conducted a prospective cohort study to analyze the balance between angiopoietin-1 (Angpt-1), which maintains vessel stability, and angiopoietin-2 (Angpt-2), which increases vessel destabilization. Three months after discharge, we evaluated the associations between angiopoietins and development of the primary outcomes of CKD progression and heart failure and the secondary outcome of all-cause mortality 3 months after discharge or later. RESULTS: Median age for the 1503 participants was 65.8 years; 746 (50%) had AKI. Compared with the lowest quartile, the highest quartile of the Angpt-1:Angpt-2 ratio was associated with 72% lower risk of CKD progression (adjusted hazard ratio [aHR], 0.28; 95% confidence interval [CI], 0.15 to 0.51), 94% lower risk of heart failure (aHR, 0.06; 95% CI, 0.02 to 0.15), and 82% lower risk of mortality (aHR, 0.18; 95% CI, 0.09 to 0.35) for those with AKI. Among those without AKI, the highest quartile of Angpt-1:Angpt-2 ratio was associated with 71% lower risk of heart failure (aHR, 0.29; 95% CI, 0.12 to 0.69) and 68% less mortality (aHR, 0.32; 95% CI, 0.15 to 0.68). There were no associations with CKD progression. CONCLUSIONS: A higher Angpt-1:Angpt-2 ratio was strongly associated with less CKD progression, heart failure, and mortality in the setting of AKI.


Subject(s)
Acute Kidney Injury , Heart Failure , Renal Insufficiency, Chronic , Acute Kidney Injury/complications , Aged , Angiopoietins , Female , Heart Failure/complications , Humans , Male , Prognosis , Prospective Studies , Renal Insufficiency, Chronic/complications , Risk Factors
13.
J Cardiovasc Nurs ; 36(6): 609-617, 2021.
Article in English | MEDLINE | ID: covidwho-2113475

ABSTRACT

BACKGROUND: Difficulties in coping with and self-managing heart failure (HF) are well known. The COVID-19 pandemic may further complicate self-care practices associated with HF. OBJECTIVE: The aim of this study was to understand COVID-19's impact on HF self-care, as well as related coping adaptations that may blunt the impact of COVID-19 on HF health outcomes. METHODS: A qualitative study using phone interviews, guided by the framework of vulnerability analysis for sustainability, was used to explore HF self-care among older adults in central Texas during the late spring of 2020. Qualitative data were analyzed using directed content analysis. RESULTS: Seventeen older adults with HF participated (mean [SD] age, 68 [9.1] years; 62% female, 68% White, 40% below poverty line, 35% from rural areas). Overall, the COVID-19 pandemic had an adverse impact on the HF self-care behavior of physical activity. Themes of social isolation, financial concerns, and disruptions in access to medications and food indicated exposure, and rural residence and source of income increased sensitivity, whereas adaptations by healthcare system, health-promoting activities, socializing via technology, and spiritual connections increased resilience to the COVID-19 pandemic. CONCLUSIONS: The study's findings have implications for identifying vulnerabilities in sustaining HF self-care by older adults and empowering older adults with coping strategies to improve overall satisfaction with care and quality of life.


Subject(s)
COVID-19 , Heart Failure , Aged , Female , Heart Failure/therapy , Humans , Male , Pandemics , Quality of Life , SARS-CoV-2 , Self Care
14.
Int J Environ Res Public Health ; 19(22)2022 Nov 19.
Article in English | MEDLINE | ID: covidwho-2116143

ABSTRACT

BACKGROUND: This study aimed to compare well-being and physical activity (PA) before and during COVID-19 confinement in older adults with heart failure (HF), to compare well-being and PA during COVID-19 confinement in octogenarians and non-octogenarians, and to explore well-being, social support, attention to symptoms, and assistance needs during confinement in this population. METHODS: A mixed-methods design was performed. Well-being (Cantril Ladder of Life) and PA (International Physical Activity Questionnaire) were assessed. Semi-structured interviews were performed to assess the rest of the variables. RESULTS: 120 participants were evaluated (74.16 ± 12.90 years; octogenarians = 44.16%, non-octogenarians = 55.83%). Both groups showed lower well-being and performed less PA during confinement than before (p < 0.001). Octogenarians reported lower well-being (p = 0.02), higher sedentary time (p = 0.03), and lower levels of moderate PA (p = 0.04) during confinement. Most individuals in the sample considered their well-being to have decreased during confinement, 30% reported decreased social support, 50% increased their attention to symptoms, and 60% were not satisfied with the assistance received. Octogenarians were more severely impacted during confinement than non-octogenarians in terms of well-being, attention to symptoms, and assistance needs. CONCLUSIONS: Well-being and PA decreased during confinement, although octogenarians were more affected than non-octogenarians. Remote monitoring strategies are needed in elders with HF to control health outcomes in critical periods, especially in octogenarians.


Subject(s)
COVID-19 , Heart Failure , Humans , Aged , Aged, 80 and over , COVID-19/epidemiology , Social Support , Heart Failure/therapy , Exercise , Sedentary Behavior
15.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 34(9): 900-904, 2022 Sep.
Article in Chinese | MEDLINE | ID: covidwho-2115859

ABSTRACT

OBJECTIVE: To investigate the clinical characteristics and prognosis of coronavirus disease 2019 (COVID-19) patients with Omicron variant combined with atrial fibrillation (AF). METHODS: From March 23, 2022 to May 15, 2022, 2 675 aged ≥ 50 years old COVID-19 patients with AF were admitted to Zhoupu Hospital, the designated hospital for COVID-19 in Shanghai. Patients were divided into mild symptoms group, normal group, and serious/critical group according to the symptoms. The clinical data, imaging examination and laboratory results and prognosis of the three group patients were compared. RESULTS: The median age of 2 675 COVID-19 patients was 69.0 (60.0, 81.0) years old, the incidence of AF was 5.05% (135/2 675), the age range of AF patients were from 55 to 101 years old, with a median age of 84.0 (74.0, 89.0), and the number of mild symptoms, normal, serious/critical patients were 68, 30, 37, respectively, including 9 of serious and 28 of critical patients. In the serious/critical patients, aged 55-75 years old accounted for 43.2%, the rate of 2019 novel coronavirus vaccination was 32.4%. The identified new-onset AF was the highest among the three groups, but the rate of persistent AF was the highest in the mild symptoms group (58.8%). The severe/critical group complicated with fever (29.7%), hepatic insufficiency (13.5%), renal insufficiency (46.0%), type 2 diabetes (46.0%), and heart failure were higher in NYHA classification [compared with the mild symptoms and normal group (score): 1.8±1.1 vs. 1.1±0.8, 1.2±0.7, respectively, all P < 0.05]. In term of laboratory examinations, C-reactive protein (CRP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were significantly higher in serious/critical patients compared to the mild symptoms and normal groups [CRP (mg/L): 27.2 (6.0, 60.8) vs. 7.6 (3.1, 19.3), 12.8 (4.9, 26.3), ALT (U/L): 31.3±15.4 vs. 15.4±9.3, 19.3±11.7, AST (U/L): 78.0±21.7 vs. 34.7±15.6, 38.1±24.4, all P < 0.05]. The hemoglobin (Hb) and albumin (ALB) levels were significantly lower than those in the mild symptoms and normal groups [Hb (g/L): 105.3±22.5 vs. 125.8±25.4, 123.0±20.4, ALB (g/L): 33.7±6.0 vs. 39.0±5.5 and 39.6±13.1, all P < 0.05]. In addition, MB isoenzyme of creatine kinase (CK-MB) was significantly higher in the serious/critical group than that in the mild symptoms group [µg/L: 2.5 (1.5, 3.4) vs. 2.2 (1.2, 2.8), P < 0.05]. In terms of the treatment, the percentage of antiplatelet agents and low-molecular heparin ratio compared among the three groups were statistically significant, with the serious/critical group using the lowest percentage of antiplatelet agents (27.0%) and a higher percentage of low-molecular heparin usage than that in mild symptoms group [81.1% (30/37) vs. 51.5% (35/68), P < 0.05]. In terms of prognosis, the mortality of patients with AF was 18.5% (25/135), all of whom were critical ill, including 32.0% (8/25) with cerebral embolism, pulmonary embolism and cerebral hemorrhage. Among them, 40.0% (10/25) died of multiple organ failure (40.0% combined with gastrointestinal hemorrhage), 20.0% (5/25) died of heart failure, and 12.0% (3/25) died of respiratory failure; while there were no death cases recorded in the mild symptoms, normal group and 9 serious patients. CONCLUSIONS: The serious/critical patients infected with COVID-19 Omicron variant with AF, have a worse prognosis and high mortality. Multiple organ failure, heart failure, sudden cardiac death, respiratory failure and embolic disease are the major causes of death.


Subject(s)
Atrial Fibrillation , COVID-19 , Diabetes Mellitus, Type 2 , Heart Failure , Respiratory Insufficiency , Humans , Middle Aged , Aged , Aged, 80 and over , SARS-CoV-2 , Multiple Organ Failure , Platelet Aggregation Inhibitors , Retrospective Studies , China/epidemiology , C-Reactive Protein , Heparin
16.
Medicine (Baltimore) ; 101(39): e30799, 2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-2113721

ABSTRACT

The coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, of which 5% required intensive care, especially mechanical ventilation. The prognosis depends on several factors including comorbidities. This study was conducted to identify the comorbidities associated with the intensive care unit (ICU) admission in elderly with COVID-19 admitted to a tertiary academic hospital. A retrospective cross-sectional study was conducted at KSUMC including all hospitalized patients (age ≥ 65 years) with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection admitted between March 2020 and August 2021. Data collection included sociodemographic characteristics, underlying comorbidities, and the Charlson comorbidity index. Comorbidities were compared between the elderly patients with COVID-19 admitted to the ICU and those not admitted to the ICU. The odds ratios were calculated and a P value of < .05 and 95% confidence intervals were used to report the statistical significance A total of 444 patients (ICU = 147, non-ICU = 297) were included in the study. The study revealed that elderly patients with COVID-19 admitted to ICU had a higher rate of mortality (n = 64, 67.4%; P < .0001) and a higher proportion of them had shortness of breath (n = 97, 38.3%; P = .007) compared to the elderly patients not admitted to ICU. The mean length of stay (P < .0001), and weight (P = .02) among ICU patients were higher than the values for the non-ICU group, while the mean oxygen saturation (SpO2; P = .006) was lower among the ICU group. The comorbidities that demonstrated a statistically significant association with ICU admission were heart failure (P = .004, odd ratio (OR) = 2.02, 95% confidence intervals (CI) [1.263, 3540]), chronic obstructive pulmonary disease (COPD; P = .027, OR = 3.361, 95% CI [1.080, 10.464]), and chronic kidney disease (P = .021, OR = 1.807, 95% CI [1.087, 3.006]). The current study identified that the comorbidities such as COPD, heart failure, and factors like SpO2 and length of stay are associated with an increased risk of ICU admission in elderly patients with COVID-19. These findings highlight the clinical implications of comorbidity among geriatric population.


Subject(s)
COVID-19 , Heart Failure , Pulmonary Disease, Chronic Obstructive , Aged , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Cross-Sectional Studies , Heart Failure/complications , Humans , Intensive Care Units , Retrospective Studies , Saudi Arabia/epidemiology , Tertiary Care Centers
17.
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
18.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2373181.v1

ABSTRACT

The involvement of the heart in COVID-19 infection appears to have a major negative influence on patient prognosis and survival. Myocarditis is caused by COVID-19, which can lead to heart failure and arrhythmias. On October 11, 2022, a 60-year-old middle-aged black African female widow was admitted with history of muscular weakness for two days and lack of appetite, and occasional vomiting for one day. She arrived at the emergency room after complaining for two days of peeing less than usual, weakness, a fast heartbeat, swelling in the feet, pink blood-tinged mucus, fever, headache, dehydration, a non-productive cough, and shortness of breath. Her neurological assessment to determine her level of consciousness indicated a Glasgow coma rating of 10/15. Routine reverse transcription polymerase chain reaction (COVID-19) testing was performed in the emergency room; she tested positive. To treat her proven COVID-19 infection, she was received subcutaneous enoxaparin 80 mg every 12 hours as prophylaxis of deep venous thromboembolism. Because of a probable lung bacterial superinfection, 1 g of ceftriaxone and 500 mg of azithromycin were given orally once a day for five days to reduce her hospital-acquired infectious diseases.


Subject(s)
Heart Failure , Communicable Diseases , COVID-19 , Coma , Headache , Venous Thromboembolism , Dyspnea , Fever , Vomiting , Myocarditis , Muscle Weakness , Dehydration , Arrhythmias, Cardiac , Edema
19.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.06.22283117

ABSTRACT

Introduction The increasing use of digital health solutions to monitor heart failure (HF) outpatients has been driven by the COVID-19 pandemic. An ideal technology should answer the specific needs of a public healthcare system: easy integration and proof of clinical benefit to justify investment in its long-term use. Through a consortium bringing together patients, physicians, industry, and hospital organizations, we developed a digital solution called “Continuum,” targeting patients with HF and other comorbidities. Hypothesis A digital health solution combining remote patient monitoring (RPM) and digital therapeutics (DTx) was developed to ensure a better follow-up of patients and to rapidly optimize their medication and subsequently avoid future severe adverse events. Methods A pilot intervention/control study with a three-month follow-up was conducted. Patients in the intervention group (remote patient monitoring group, RPM + ) had a smartphone or tablet and entered in their mobile app their vital signs, weight, and HF symptoms daily. HF patients who either did not have a mobile device or the skills to use the app were enrolled in the control group (RPM - ). The HealthCare Professionals (HCPs) used a web-based dashboard to follow the RPM + patients. They could access the results of a DTx solution to help them optimize the HF treatment according to Canadian guidelines. Results 52 HF patients were enrolled in this study, 32 in the RPM + 69±9y age, 75% male, ejection fraction 42 ± 14%. In the RPM - group, more patients had at least one hospitalization (all-cause) compared to the RPM + group (35% versus 6% respectively; p=0.008). Similarly, the number of patients with at least one HF hospitalization was more significant in the RPM + group compared to the RPM - (25% versus 6%, p=0.054). Finally, the intervention showed a medium effect on HF treatment optimization (w=0.26) and quality of life for the most compliant patients to the intervention (g=0.48). Conclusion The results of this pilot study demonstrated the feasibility of an intervention combining RPM and DTx solutions for HF patients. Preliminary results suggest promising impacts on quality of life, hospitalizations, and patients’ medication optimization. However, they need to be confirmed in a more extensive study.


Subject(s)
COVID-19 , Heart Failure
20.
authorea preprints; 2022.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.167041263.36399991.v1

ABSTRACT

During the COVID-19 pandemic, a 32-year-old front line health-worker tested positive for COVID-19 in RT-PCR and was admitted to the Japan East West Medical College Hospital in Bangladesh. In the ICU, the patient was in coma for 5 days. The Patient’s condition was improved after taking fresh frozen plasma.


Subject(s)
Respiratory Distress Syndrome , Heart Failure , COVID-19 , Coma , Churg-Strauss Syndrome , Kidney Diseases
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