Treatment of patients hospitalized for COVID-19 with remdesivir is associated with lower likelihood of 30-day readmission: a retrospective observational study.

Aim: This observational study investigated the association between remdesivir treatment during hospitalization for COVID-19 and 30-day COVID-19-related and all-cause readmission across different variants time periods. Patients & methods: Hospitalization records for adult patients discharged from a COVID-19 hospitalization between 1 May 2020 to 30 April 2022 were extracted from the US PINC AI Healthcare Database. Likelihood of 30-day readmission was compared among remdesivir-treated and nonremdesivir-treated patients using multivariable logistic regression models adjusted for age, corticosteroid treatment, Charlson comorbidity index and intensive care unit stay during the COVID-19 hospitalization. Analyses were stratified by maximum supplemental oxygen requirement and variant time period (pre-Delta, Delta and Omicron). Results: Of the 440,601 patients discharged alive after a COVID-19 hospitalization, 248,785 (56.5%) patients received remdesivir. Overall, remdesivir patients had a 30-day COVID-19-related readmission rate of 3.0% and all-cause readmission rate of 6.3% compared with 5.4% and 9.1%, respectively, for patients who did not receive remdesivir during their COVID-19 hospitalization. After adjusting for demographics and clinical characteristics, remdesivir treatment was associated with significantly lower odds of 30-day COVID-19-related readmission (odds ratio 0.60 [95% confidence interval: 0.58-0.62]), and all-cause readmission (0.73 [0.72-0.75]). Significantly lower odds of 30-day readmission in remdesivir-treated patients was observed across all variant time periods. Conclusion: Treating patients hospitalized for COVID-19 with remdesivir is associated with a statistically significant reduction in 30-day COVID-19-related and all-cause readmission across variant time periods. These findings indicate that the clinical benefit of remdesivir may extend beyond the COVID-19 hospitalization.

Remdesivir for the Treatment of COVID-19: A Narrative Review.

Despite the wide availability of effective vaccines, COVID-19 continues to be an infectious disease of global importance. Remdesivir is a broad-spectrum antiviral and was the first US Food and Drug Administration-approved treatment for COVID-19. In clinical guidelines, remdesivir is currently the only recommended antiviral for use in hospitalized patients with COVID-19, with or without a supplemental oxygen requirement. It is also recommended for nonhospitalized patients with COVID-19 and hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who are at high risk of progression to severe disease. This narrative review explores the evidence for remdesivir across various clinical outcomes and evolution of clinical guidelines through a survey over time of randomized controlled trials, observational studies, and meta-analyses. Remdesivir, compared to standard of care, appears to improve survival and disease progression in a variety of patient populations with COVID-19 across a spectrum of disease severity and SARS-CoV-2 variant periods. Remdesivir also appears to improve time to clinical recovery, increase rate of recovery, and reduce time on supplemental oxygen and readmission rates. More recent large, real-world studies further support the early use of remdesivir in a range of patient populations, including those with immunocompromising conditions.

When people get sick with COVID-19, which is caused by the SARS-CoV-2 virus, treatment with an antiviral may be needed to prevent serious illness. Remdesivir is an antiviral and was the first US Food and Drug Administration-approved treatment for COVID-19. Studies have found that treating COVID-19 with remdesivir can save lives and keep patients from getting sicker. Remdesivir appears to help patients get better faster, need oxygen treatment for less time, and avoid having to go back to the hospital. Newer studies with patients treated in real-world settings, outside of controlled research environments, show that early treatment with remdesivir is likely to help many different groups of patients, including those with health conditions that weaken their body's ability to fight infection. Because of this research, guidelines recommend that remdesivir should be given to some patients with COVID-19 outside of the hospital and to those who need to stay in the hospital for COVID-19. Remdesivir should also be given to those who need to stay in the hospital for other reasons but have COVID-19 and a health condition that puts them at risk of serious illness.

Patient Perceptions of their COVID-19 Inpatient Hospital Experience: a Survey Exploring Inequities in Healthcare Delivery.

BACKGROUND: Compared with White patients, Black and Latinx patients have higher infection, hospitalization, and mortality rates from COVID-19; yet, little is known about their perspective before, during, and after a COVID-19 hospitalization. The objective of this study conducted in White, Black, and Latinx patients was to assess perceptions of their COVID-19-related hospitalization from onset of symptoms through the post-discharge period to identify disparities in their perceived care. METHODS: A cross-sectional observational study using an online survey from May 19 to June 23, 2021, was conducted by The Harris Poll in 200 White, 200 Black, and 201 Latinx patients hospitalized for COVID-19 in the US. Main measures obtained included baseline demographic variables, socioeconomic status, and social determinants of health. Survey questions were specific to key aspects of the patient experience before, during, and after a COVID-19-related hospitalization. RESULTS: Compared with White patients, Latinx and Black patients faced unique challenges in their healthcare journey including higher likelihood of delaying their hospitalization (10% Black vs. 4% White patients, respectively, P = 0.025), lower perceived satisfaction with care (82% Latinx vs 91% White patients, P = 0.002), and lower trust in providers following their hospitalization (85% White vs. 65% Latinx [P = 0.027] and 73% Black [P = 0.050] patients). CONCLUSIONS: Patient perceptions of their COVID-19 hospitalization experience revealed disparities in perceived quality of care among minority groups. These findings offer insights that health inequities still exist, and strategies need to be taken to make health care delivery more equitable.

Role of clopidogrel in unstable angina and non-ST-segment elevation myocardial infarction: from literature and guidelines to practice.

Clinical trials are the backbone of treatment paradigm shifts and guideline development. In terms of acute coronary syndromes, the American College of Cardiology and the American Heart Association (ACC-AHA) have developed extensive guidelines to assist the practitioner in the appropriate use of drugs including antiischemic, anticoagulant, and antiplatelet agents. Clopidogrel, an adenosine 5'-diphosphate antagonist, is one such drug. Unfortunately, consensus guidelines are limited by the design of the clinical trials they reference. Clopidogrel trials have examined various outcomes in patients for a limited time frame, making longer term use of the drug difficult to justify. An ongoing study, estimated to be completed in 2005, is evaluating the long-term use of clopidogrel in high-risk patients. Aspirin, however, has become a lifelong therapy for many patients, based on clinical trials and medical experience. Patient-specific risk factors, the drugs' safety profiles, and costs, in addition to the ACC-AHA guidelines, must all be considered by clinicians when selecting the appropriate agent and its duration of use.

Better living through chemistry: does it still apply to patients after myocardial infarction?

Sudden cardiac death is an elusive process that claims a significant number of lives annually in the United States. It is often associated with increased mortality within the first year after myocardial infarction, with the highest frequency occurring among patients with left ventricular dysfunction. Therefore, increasing survival rates in patients with a history of both disorders is an important goal of therapy. Recent trials suggested that an implantable cardioverter-defibrillator (ICD) in these patients may be superior to medical intervention in reducing the high mortality rate. Four major trials measured the benefits of an ICD for patients at risk for life-threatening ventricular arrhythmias. We assessed whether patients in these trials received adequate drug therapy as directed by American College of Cardiology-American Heart Association guidelines. One aim was to determine if medicated patients who served as controls in the trials were fairly represented. Furthermore, the need for improved overall guideline adherence was apparent.

Nesiritide treatment of noncardiogenic pulmonary edema.

OBJECTIVE: To report the efficacy of nesiritide in treating noncardiogenic pulmonary edema. CASE SUMMARY: A 50-year-old African American woman with a complex medical history including morbid obesity, acute bronchitis, obstructive sleep apnea, hypertension, and numerous hospitalizations for volume overload presented to the emergency department with severe dyspnea. A portable chest X-ray displayed perihilar congestion and bilateral pulmonary edema. An echocardiogram demonstrated normal left-ventricular systolic and diastolic function. She was aggressively treated with nitrates, diuretics, bronchodilators, and oxygen. Despite these efforts, the patient's arterial blood gas (ABG) continued to show respiratory acidosis, the oxygen saturation was significantly depressed, and the dyspnea continued. Since standard therapies were failing after 12 hours, the patient was treated with intravenous nesiritide. The results were profound in terms of rapid symptomatic and prognostic improvement (i.e., ABG) beginning within 45 minutes of administration, and the patient was discharged after a 5-day hospital course. DISCUSSION: Nesiritide is a human B-type natriuretic peptide that has been shown to improve hemodynamic function and symptoms associated with decompensated heart failure. This is primarily due to the actions of this medication, including diuresis, decreased mean arterial pressure, and improvement of pulmonary arterial occlusion pressure as determined by published clinical trial outcomes. This case describes the use of nesiritide as an effective adjunctive therapy in treating a patient with noncardiogenic pulmonary edema. CONCLUSIONS: Nesiritide appears to be an efficacious treatment for acute pulmonary edema, resistant to standard-of-care therapies, in the presence of normal left-ventricular function.