Absence of negativization of nasal swab test and frailty as risk factors for mortality in elderly COVID-19 patients admitted in long-term care facilities.

METHODS: A limited amount of data is now available on prognostic factors and mortality among elderly people resident in Long-Term Care facilities and in post-acute units. These populations (in particular those with underlying chronic medical conditions) seem to have higher risk of morbidity and mortality related to COVID-19 disease, but further evidence is needed. The aim of our study is to investigate the impact of some well-known prognostic factors in elderly patients (≥ 65 years) with COVID-19 admitted in the Long-Term Care setting in AUSL Ferrara, Italy. We performed binary regression logistic analysis for some variables (demographic data, clinical data including nasal swab test (NST) at discharge and frailty assessments) to find potential predictors of mortality. We subsequently tested statistically significant variables using Kaplan-Meier curves and Cox-regression models to find survival outcomes and related hazard ratio. RESULTS: Risk factors associated with increased mortality resulted NST at discharge, infection, age and frailty. At a further secondary analysis carried out between NST at discharge, age and clinical frailty scale (CFS) < 5, we found a positive correlation between NST at discharge and CFS < 5. Kaplan-Meier curves showed a statistically significant difference regarding frailty and NST at discharge but not for age. CONCLUSION: Our study showed that absence of negativization of NST at discharge and frailty are strong predictors for mortality in elderly COVID-19 patients admitted in Long-Term Care facilities, while age and the comorbidity burden are less important.

Seasonal and weekly patterns of occurrence of acute cardiovascular diseases: does a gender difference exist?

BACKGROUND: Cardiovascular (CV) disease is the leading cause of death in women. It is known that acute CV events exhibit temporal patterns of onset, that is, seasonal and weekly. We aimed to verify whether such patterns show differences by gender. METHODS: We analyzed cumulative data from our previous studies dealing with hospital admissions for CV events, such as acute myocardial infarction (AMI), stroke, transient ischemic attack (TIA), aortic diseases (AD), and pulmonary embolism (PE), in the region Emilia-Romagna (RER) of Italy (ICDM9-CM codes, years 1998?2006). Total population and subgroups by gender (percentage of monthly and daily events) were tested for uniformity with the chi-square test, and a chronobiologic method was applied to monthly percentage of data for seasonal rhythmic analysis. RESULTS: Season: We considered 130,693 patients (45.1% women): 64,191 AMI, 43,642 TIA, 4,615 AD, 19,425 PE. The monthly and seasonal distribution showed respective peaks in January and in winter, with no differences by gender. Day-of-week: We considered 168,921 patients (45.6% women): 64,191 AMI, 56,453 stroke, 43,642 TIA, 4,615 AD. The weekly distribution showed a peak on Monday, with no differences by gender. A multivariate regression logistic analysis, including in the model either major CV risk factors (hypertension, dyslipidemia, diabetes mellitus) and subgroups by age, did not find any difference in the temporal distribution of events in women and men. CONCLUSIONS: The seasonal and day-of-week distribution of occurrence of CV events seems to be independent of gender.