The Impact of COVID-19 Outbreak on Cardiovascular Admissions.

BACKGROUND: The COVID-19 pandemic has caused major disruption in the health care deliveries and activities worldwide including hospital admission. METHOD: We used hospitals discharged coded data from January 1, 2019 to June 30, 2020 to examine the impact of COVID-19 outbreak on the pattern of cardiovascular admission among Hamad Medical Corporation hospitals in the State of Qatar. RESULTS: In this retrospective observational study, we documented significant changes in the pattern of cardiovascular admissions in our hospitals. There was a significant reduction in hospitalizations of various subsets of cardiac disease. Admissions for acute myocardial infarction dropped by 31%, acute decompensated dropped by 48%, unstable angina dropped by 79% and arrythmia by 80%. Primary percutaneous coronary intervention procedures declined briefly. However, the total deaths remained the same despite the increase in mortality rate due to reduced admissions number. CONCLUSION: We postulate the fear of contracting the disease and the lock-down mentality during COVID-19 outbreak contribute to reduction of cardiovascular admission to our hospital.

Isolation Unit: A New Way to Practice at Heart Hospital, Qatar during the Corona Virus -2019 Pandemic.

BACKGROUND: The novel coronavirus disease-2019 (COVID-19) spread rapidly around the world and was declared as the second pandemic of the 21st century. The first case was detected in Qatar on February 29, 2020. In order to protect patients and staff in Heart Hospital, the only tertiary cardiac center in Qatar, new measures were implemented to reduce the spread of infection in our hospital. METHODOLOGY: A 13-bed high dependency isolation unit was allocated to receive cardiac patients with appreciate infection control measures. Another isolation unit was also established in coronary care unit for critical patients. All patients admitted to Heart Hospital were tested for COVID-19 on admission. Patients were transferred out of isolation, if result was negative. Patients with positive results were either transferred to a COVID facility before or after planned cardiac procedure depending on their cardiovascular disease risk. RESULTS: Six hundred and seven patients were admitted to both the isolation units, most of them were men (89%). Forty-four percent were diagnosed with ST elevation myocardial infarction, 22% were non-STEMI or unstable angina, 17% were decompensated heart failure, 7% were elective cases for coronary angiography or electrophysiology procedures, 8% for other diagnosis, and 1% for both cardiac arrest and post cardiac surgery. 85.2% of the patients admitted to isolation units were tested negative and transferred to normal wards to complete their treatment. Eighty percent of the patients tested positive or reactive for COVID-19 had epidemiological risk, 8.4% had suggestive symptoms, and 11.6% had abnormal chest X-ray. CONCLUSION: This study demonstrated the importance of the isolation unit with infection control measures in controlling the transmission of COVID-19 in a hospital setting such as the Heart Hospital. Epidemiological risk factors including recent travel, close contact with suspected or confirmed cases within 14 days or less, living in shared accommodation or living in lockdown area were the main risk factors for spreading COVID-19 infection which can be managed by minimizing social activities.

Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis.

BACKGROUND: Although insulin analogues are commonly prescribed for the management of diabetes mellitus, there is uncertainty regarding their optimal use. We conducted meta-analyses to compare the outcomes of insulin analogues with conventional insulins in the treatment of type 1, type 2 and gestational diabetes. METHODS: We updated 2 earlier systematic reviews of the efficacy and safety of rapid-and long-acting insulin analogues. We searched electronic databases, conference proceedings and "grey literature" up to April 2007 to identify randomized controlled trials that compared insulin analogues with conventional insulins. Study populations of interest were people with type 1 and type 2 diabetes (adult and pediatric) and women with gestational diabetes. RESULTS: We included 68 randomized controlled trials in the analysis of rapid-acting insulin analogues and 49 in the analysis of long-acting insulin analogues. Most of the studies were of short to medium duration and of low quality. In terms of hemoglobin A1c, we found minimal differences between rapid-acting insulin analogues and regular human insulin in adults with type 1 diabetes (weighted mean difference for insulin lispro: -0.09%, 95% confidence interval [CI] -0.16% to -0.02%; for insulin aspart: -0.13%, 95% CI -0.20% to -0.07%). We observed similar outcomes among patients with type 2 diabetes (weighted mean difference for insulin lispro: -0.03%, 95% CI -0.12% to -0.06%; for insulin aspart: -0.09%, 95% CI -0.21% to 0.04%). Differences between long-acting insulin analogues and neutral protamine Hagedorn insulin in terms of hemoglobin A1c were marginal among adults with type 1 diabetes (weighted mean difference for insulin glargine: -0.11%, 95% CI -0.21% to -0.02%; for insulin detemir: -0.06%, 95% CI -0.13% to 0.02%) and among adults with type 2 diabetes (weighted mean difference for insulin glargine: -0.05%, 95% CI -0.13% to 0.04%; for insulin detemir: 0.13%, 95% CI 0.03% to 0.22%). Benefits in terms of reduced hypoglycemia were inconsistent. There were insufficient data to determine whether insulin analogues are better than conventional insulins in reducing long-term diabetes-related complications or death. INTERPRETATION: Rapid-and long-acting insulin analogues offer little benefit relative to conventional insulins in terms of glycemic control or reduced hypoglycemia. Long-term, high-quality studies are needed to determine whether insulin analogues reduce the risk of long-term complications of diabetes.

Effect of cost-sharing on use of asthma medication in children.

OBJECTIVE: To examine the effect of cost-sharing on the use of asthma medications in asthmatic children. According to asthma guidelines, children with asthma may require treatment with multiple medications, including controllers and relievers, to achieve optimal control. Although families may be enrolled in drug benefit plans, impediments to access persist in the form of cost-sharing. DESIGN: Population-based retrospective cohort study of children by analysis of administrative medication insurance claims data. SETTING: Ontario, Canada. PARTICIPANTS: A cohort of 17 046 Ontario children with asthma enrolled in private drug plans. Main Exposure We used data on out-of-pocket expenses and reimbursement for medications to classify children as having zero, low (< 20%), or high (> or = 20%) levels of cost-sharing. MAIN OUTCOME MEASURES: We examined use of bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, oral corticosteroids, and combination agents. Multiple linear and logistic regressions compared medication use between cost-sharing groups, controlling for age and sex. RESULTS: The annual number of asthma medication claims per child was significantly lower in the high cost-sharing group (6.6) compared with the zero (7.0) and low (7.2) cost-sharing groups (P < .001). Children in the high cost-sharing group were less likely to purchase bronchodilators, inhaled corticosteroids, and leukotriene receptor antagonists compared with the low cost-sharing group (odds ratio, 0.76; 95% confidence interval, 0.67-0.86) and were less likely to purchase dual agents compared with the low cost-sharing group (odds ratio, 0.70; 95% confidence interval, 0.66-0.75). CONCLUSION: The cost-sharing level affected the use of asthma medication, with the highest cost-sharing group exhibiting significantly lower use of maintenance medications and newer dual agents.