Fast track triage for COVID-19 based on a population study: The soda score.

BACKGROUND: Healthcare systems are under prominent stress due to the COVID-19 pandemic. A fast and simple triage is mandatory to screen patients who will benefit from early hospitalization, from those that can be managed as outpatients. There is a lack of all-comers scores, and no score has been proposed for western-world population. AIMS: To develop a fast-track risk score valid for every COVID-19 patient at diagnosis. METHODS: Single-center, retrospective study based on all the inhabitants of a healthcare area. Logistic regression was used to identify simple and wide-available risk factors for adverse events (death, intensive care admission, invasive mechanical ventilation, bleeding > BARC3, acute renal injury, respiratory insufficiency, myocardial infarction, acute heart failure, pulmonary emboli, or stroke). RESULTS: Of the total healthcare area population, 447.979 inhabitants, 965 patients (0.22%), were diagnosed with COVID-19. A total of 124 patients (12.85%) experienced adverse events. The novel SODA score (based on sex, peripheral O2 saturation, presence of diabetes, and age) demonstrated good accuracy for adverse events prediction (area under ROC curve 0.858, CI: 0.82-0.98). A cut-off value of ≤2 points identifies patients with low risk (positive predictive value [PPV] for absence of events: 98.9%) and a cut-off of ≥5 points, high-risk patients (PPV 58.8% for adverse events). CONCLUSIONS: This quick and easy score allows fast-track triage at the moment of diagnosis for COVID-19 using four simple variables: age, sex, SpO2, and diabetes. SODA score could improve preventive measures taken at diagnosis in high-risk patients and also relieve resources by identifying very low-risk patients.

Acute pulmonary edema in patients with decompensated heart failure. Role of underlying cardiopathy on the prognosis.

AIMS: To investigate the impact of acute pulmonary edema (APE) on the prognosis of patients hospitalized with congestive heart failure (CHF) and if the underlying cardiopathy influences the survival of these patients. METHOD AND RESULTS: All patients admitted to the cardiology department of a tertiary hospital with CHF between 1991 and 2002 were included in the present study. APE was diagnosed in 176 of 1659 patients. 60.2% of them were of ischaemic etiology, 48.6% and 42.9% of hypertensive and valvular origin, respectively. Survival analysis carried out in April 2003 has shown that APE patients have higher mortality rates, with a median survival of 3.1 years as against 4.8 years. This difference was due only to the behaviour of patients with ischaemic CHF as among patients with non-ischaemic CHF, the difference in median survival between patients with and without APE was insignificant. Within the APE group the survival of ischaemic patients was lower than that of non-ischaemic (median survival of 2.3 years vs 4.5 years, respectively). The difference was more pronounced between APE patients with CHF of ischaemic and hypertensive origin (median survival of 5.6 years for the latter). Among patients without APE, there was no significant difference between different etiological groups. CONCLUSION: In this study we found that the survival time of CHF patients is significantly shortened by the concurrence of APE and ischaemic etiology but not by either of these factors without the other.

Angiotensin-converting enzyme inhibitors prescription is associated with longer survival among patients hospitalized for congestive heart failure who have preserved systolic function: a long-term follow-up study.

BACKGROUND: The use of inhibitors of angiotensin-converting enzyme (ACE) is strongly indicated by a diagnosis of congestive heart failure (CHF) with deteriorated systolic function (SF), but their effects on patients with CHF but no systolic deterioration have not been clarified. We focused this study on the evaluation of the influence of ACE inhibitors on survival among CHF patients with preserved SF, but also determined the effect of these drugs on the prognosis of our patients with deteriorated SF. METHOD AND RESULTS: We studied 416 patients, aged 72.7 +/- 10.2 years, who between January 1, 1991, and December 31, 2001, were admitted to the cardiology service of a tertiary hospital for CHF and who fulfilled the requirements that left ventricular SF that had been evaluated echocardiographically during hospitalization was preserved and that data were available on medication at the time of their release from hospital. Two hundred four patients (49.0%) were men, 250 (60.8%) were hypertensive, and, in 171 (41.1%) cases, ischemic cardiopathy was the primary cause of the CHF. ACE inhibitors were prescribed to 210 patients (50.5%) on hospital release. Kaplan-Meier survival curve analysis showed that, among patients with preserved SF, a longer survival was associated with ACE inhibitors use (mean survival 6.14 years as compared with 4.57 years in the control group, P < .001; adjusted hazard ratio = 0.63, P = .012). Similar results were obtained in CHF patients with deteriorated SF in whom those taking ACE inhibitors had significantly longer life with mean survival 6.42 years compared with 5.03 years in the control group (P < .001; adjusted hazard ratio = 0.62, P = .001). CONCLUSION: ACE inhibitors prescription is associated with a better prognosis of patients with CHF and preserved SF.

Atrial fibrillation in patients hospitalized for congestive heart failure: the same prognostic influence independently of left ventricular systolic function?

UNLABELLED: Atrial fibrillation (AF) was described to be associated with an adverse prognosis in several studies of heart failure (HF). However, it is not clear whether it directly increased mortality or is only a marker for severity of HF. AIMS: To determine the influence of AF on mortality of HF patients distinguishing between patients with preserved and deteriorated systolic function (SF). METHOD AND RESULTS: 1636 patients who, between 1991 and 2002 had been hospitalized in a Cardiology Service for HF, were studied. Survival (SV) data (mean follow-up time: 3.14 years) has shown that there was no difference in SV between patients with (540 patients of the whole group) and without AF in the group with preserved SF (presented in 38.7% of cases), however, in the group of patients with deteriorated SF (AF presented in 31.0% of cases), SV time was significantly (p=0.01) shorter among patients with AF, this association being independent of age, sex, aetiology, risk factors, clinical signs and pharmacological treatment; relative risk: 1.831(1.120-2.994). CONCLUSION: AF is more prevalent among HF patients with preserved SF than among those with deteriorated SF, but only increases the risk of death among the latter.

The death rate among hospitalized heart failure patients with normal and depressed left ventricular ejection fraction in the year following discharge: evolution over a 10-year period.

AIMS: To investigate whether changes in clinical characteristics and treatment strategies between 1991 and 2001 have had an impact on the survival of patients hospitalized with congestive heart failure (CHF) and whether those with normal left ventricular ejection fraction (LVEF> or =50%) differ in this respect from those with depressed LVEF. METHODS AND RESULTS: We studied 1482 patients who had been admitted to the Cardiology Service of a tertiary Spanish hospital in the last 10 years with CHF. Among the 1110 for whom LVEF was evaluated, the prevalence of normal LVEF rose from 37% in the period 1991-96 (Period 1) to 47% in the period 2000-2001 (Period 3). The intensity of both diagnostic and therapeutic measures also increased during this 10-year period. The 1-year survival rate remained virtually unchanged in the whole group of patients, being 82, 84, and 82% in Periods 1, 2 (1997-99), and 3, respectively, even though the prognosis of patients with depressed LVEF (<50%) improved significantly, with 1-year survival rates of 76, 77, and 84% in Periods 1, 2, and 3, respectively; the normal LVEF group had decreasing 1-year survival rates of 88, 86, and 81% in Periods 1, 2, and 3, respectively, although the increased risk of death was not statistically significant. CONCLUSION: Although in our centre the death rate among hospitalized CHF patients with depressed LVEF during the first year after discharge has tended to fall over the past 10 years, application of current clinical guidelines has led to no such decrease for patients with normal LVEF. This situation points to a need to reconsider the diagnostic and therapeutic strategy to be employed with this latter group of patients.

Long-term improvement of QT dispersion is unaffected by short-term changes in blood pressure during treatment of systemic hypertension with enalapril.

BACKGROUND: We report the reduction of QT and QTc dispersion in patients treated for 7 years with enalapril for systemic hypertension with left ventricular (LV) hypertrophy. We assess the correlation between QT dispersion and LV mass during this period and at the end of an 8-week period of suspension of enalapril treatment after 5 years. METHODS: Twenty-four previously untreated patients with this condition took enalapril (20 mg twice daily) for 7 years, except during an 8-week period following 5-year follow-up. Cardiovascular parameters were determined by two-dimensional guided M-mode echocardiography, and QT interval was measured, in a pretreatment placebo phase, 8 weeks and 1, 3, 5, and 7 years after the start of the therapy, at the end of the 8-week suspension effected after 5 years, and 8 weeks after the end of the suspension. RESULTS: Therapy rapidly reduced blood pressure (BP) from 156/105 mmHg to normal values: 134/84 mmHg after 8 weeks' treatment, 130-84 mmHg at 7-year follow-up (P < 0.001 with respect to the placebo phase). LV mass index decreased progressively until at 5-year follow-up the reduction had reached 39% (P < 0.001), after which neither LV mass nor any other structural parameter underwent any further significant change. During this time, QT dispersion (DeltaQT) and the dispersion of "corrected" QT (DeltaQTc) decreased significantly: DeltaQT (from 61 +/- 21 to 37 +/- 13 ms) and DeltaQTc (from 67 +/- 27 to 41 +/- 16 ms). After suspension of treatment for 8 weeks following 5-year follow-up, DeltaQT was 40 +/- 14 ms and DeltaQTc was 44 +/- 17 ms; there were no significant changes either in DeltaQT and DeltaQTc or LV hypertrophy although BP had returned to pretreatment values (BP: 150 +/- 16; 101 +/- 10 mmHg). CONCLUSIONS: Long-term enalapril treatment of hypertensive patients with LV hypertrophy induces marked regression of LV mass and improvement of QT dispersion. These improvements occur on a longer timescale than improvement in BP, and are not affected by transient changes in BP values.