Early predictors of intensive care unit admission among COVID-19 patients in Qatar.

Background: COVID-19 is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission among patients with COVID-19. Methods: This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29-May 29, 2020. For each case enrolled, one control was matched by age and gender. Results: A total of 1,560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (adjusted odds ratio (aOR) = 1.64, 95% confidence interval (CI): 1.16-2.32, p = 0.005), diabetes (aOR = 1.52, 95% CI: 1.08-2.13, p = 0.016), obesity (aOR = 1.46, 95% CI: 1.03-2.08, p = 0.034), lymphopenia (aOR = 2.69, 95% CI: 1.80-4.02, p < 0.001), high AST (aOR = 2.59, 95% CI: 1.53-4.36, p < 0.001), high ferritin (aOR = 1.96, 95% CI: 1.40-2.74, p < 0.001), high CRP (aOR = 4.09, 95% CI: 2.81-5.96, p < 0.001), and dyspnea (aOR = 2.50, 95% CI: 1.77-3.54, p < 0.001). Conclusion: Having cardiovascular disease, diabetes, obesity, lymphopenia, dyspnea, and increased AST, ferritin, and CRP were independent predictors for ICU admission in patients with COVID-19.

Effectiveness of Sacubitril/Valsartan in Heart Failure with Reduced Ejection Fraction Using Real-World Data: An Updated Systematic Review and Meta-Analysis.

We conducted a systematic review and meta-analysis to assess all-cause mortality and heart failure (HF) hospitalization with sacubitril/valsartan (S/V) compared to standard HF therapy in patients with HF with reduced ejection fraction (HFrEF) using real-world data. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and Google Scholar for the observational studies published in English exploring the clinical outcomes of S/V use in HFrEF till March 14, 2022. Two independent reviewers assessed the quality and risk of bias of the included studies. A random-effect model was used to combine data. The outcomes assessed were all-cause mortality and HF hospitalization associated with S/V use in comparison to standard HF therapy. A total of 9 observational studies comparing S/V to Angiotensin-converting enzyme inhibitors (ACE-I)/Angiotensin II receptor blockers (ARB) in HFrEF were included in the systematic review, with more than 32000 patients included in the final analysis. Overall, S/V use was associated with a significant reduction in all-cause mortality (Risk Ratio [RR] = 0.70, 95% CI 0.53-0.93, I2 = 83%) and HF hospitalization (RR = 0.62; 95% CI, 0.48-0.80, I2= 94%). Similar to the landmark controlled evidence, real-world data of S/V use in HFrEF demonstrated a significant reduction in all-cause mortality and HF hospitalization.

Prevalence and predictors of digoxin utilization among heart failure patients with reduced ejection fraction in Qatar.

Background Digoxin is a cardiac glycoside that is recommended by clinical practice guidelines to be used in patients with heart failure with reduced ejection fraction (HFrEF) who still have persistent symptoms despite optimal medical therapy. However, this recommendation is based on limited and old trial data. Moreover, pharmacoepidemiologic studies are important in determining the prevalence of digoxin use and factors influencing this. Objective This study aimed to determine the prevalence and the predictors of digoxin utilization among patients with HFrEF with or without atrial fibrillation (AF) in Qatar. Setting Heart Hospital, a specialized tertiary care center in Qatar. Methods A retrospective observational study was conducted using Cerner electronic medical records. Subjects included 736 patients admitted between January 1, 2013 and December 31, 2014 with the diagnosis of HFrEF with or without AF. Two groups of patients were studied: digoxin users and digoxin non-users at index hospitalization until discharge. Univariate and multivariate binary logistic regression analyses were conducted to determine the predictors of digoxin prescription. Data analyses were performed using IBM SPSS® version 23.0. Main outcome measures Prevalence and predictors of digoxin prescriptions among HFrEF patients measured in percentages and odds rations, respectively. Results A total of 736 patients who met the inclusion criteria were analyzed for digoxin prevalence, including 80 patients (11%) who were newly prescribed digoxin during the index hospitalization. After adjusting for patient demographics and clinical characteristics, the use of thiazide diuretics (aOR = 10.14, CI 2.31-44.6, p value = 0.002), concurrent AF (aOR = 8.2, CI 3.11-21.7, p < 0.001), and an ejection fraction (EF) <25% (aOR = 3.2, CI 1.5-6.8, p value = 0.002) significantly predicted digoxin prescriptions among patients with HFrEF. Conclusion The rate of digoxin prescription among patients with HFrEF in Qatar is relatively low. The strongest predictors of digoxin use in HFrEF patients were the concomitant use of thiazide diuretics and concurrent diagnosis of AF. The findings may potentially serve as useful guides for the rational utilization of digoxin in patients with HFrEF.