Demographics, clinical characteristics and outcomes among 197 patients with COVID-19 in the Gold Coast area.

BACKGROUND: Clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients have been varied internationally but have not been studied in an Australian cohort. AIM: To describe characteristics and outcomes of approximately the first 200 documented COVID-19 cases during the first outbreak in the Gold Coast. METHODS: Retrospective observational cohort study of COVID-19 patients managed by Gold Coast Hospital and Health Service (GCHHS). Demographics, clinical characteristics and outcomes data were collected. RESULTS: One hundred and ninety-seven patients were included (mean age 45 years); 52.3% were female and 9.1% were healthcare workers. Most were overseas travellers (53.8%), contacts of a local confirmed case (25.4%) or cruise ship passengers (17.3%). The commonest comorbidities were hypertension (14.2%) and asthma (11.2%). The commonest symptoms were cough (74.1%), fever (58.9%), sore throat (48.7%), headache (48.7%) and rhinorrhoea (46.2%). Sixty-three patients were hospitalised and the rest admitted to a 'virtual ward'. Of 63 hospitalised patients, 5 (7.9%) required intensive care unit (ICU) admission and 3 (4.8%) required intubation. No patients died. Due to low numbers of accurate exposure dates, the incubation period could not be reliably calculated for a significant proportion of the cohort. Average duration of symptoms was 14 days, time from first symptom to hospitalisation was 5.3 days and time from first symptom to ICU admission was 11.6 days. The majority (88%) experienced mild disease and achieved complete symptom resolution (97%). Nasopharyngeal swab polymerase chain reaction was the main diagnostic method (99%). Twenty-four patients received anti-viral pharmacotherapy, with 87.5% getting hydroxychloroquine. CONCLUSIONS: The present study provides characteristics and outcomes of the first 197 patients with COVID-19 in the Gold Coast.

Enhancing the quality of medicine handover at hospital discharge: a priority setting workshop.

BACKGROUND: When a patient is discharged from hospital it is essential that their general practitioner (GPs) and community pharmacist are informed of changes to their medicines. This necessitates effective communication and information-sharing between hospitals and primary care clinicians. OBJECTIVE: To identify priority medicine handover issues and solutions to inform the co-design and development of a multifaceted intervention. METHOD: A modified nominal group technique was used to reach consensus on medicine handover priority areas. The first hour of an interactive 2-hr workshop focused on ranking pre-identified issues drawn from literature. In the second hour, participants identified solutions that they then ranked from highest to lowest priority through an online platform. Descriptive statistics were used to analyse workshop data. RESULTS: In total 32 participants attended the workshop including hospital doctors (n = 8, 25.0%), GPs and hospital pharmacists (n = 6 each, 18.8%), consumers and community pharmacists (n = 4 each, 12.5%), and both hospital and aged care facility nurses (n = 2 each 6.3%). From the list of 23 issues, the highest ranked issue was high workload and time pressures impacting the discharge process (22/32). From the list of 36 solutions, the participants identified two solutions that were equally ranked highest (12/27 each). They were mandating that patients leave hospital with a discharge summary, including medication reconciliation information and, developing an integrated information technology system where medication summary and notes are accessible for primary, secondary and tertiary health provider. CONCLUSION: The consensus process highlighted challenges in hospital procedures where potential solutions may be implemented through co-design of a multifaceted intervention to improve medicine handover quality.

Impact of ethnic variation and residential segregation on long-term survival following myocardial perfusion SPECT.

BACKGROUND: Ethnic characteristics of a neighborhood may impact upon all-cause mortality (ACM). It is not known whether this consideration remains a risk modifier among those being evaluated for CAD. METHODS: 6,477 pts (60 ± 13 years, male 38%) residing in NYC with normal or abnormal stress SPECT studies were assessed for ACM during a mean follow-up of 9 ± 3.8 years. Baseline CAD risk factors and ethnic characteristics of patient neighborhoods were considered. Zip-codes with >70% of one ethnicity was considered to be predominant of that ethnicity. RESULTS: There were 573 (20%) Hispanics (HS), 765 (27%) African-Americans (AA), and 250 (30%) Caucasians (CC) residing in areas >70% of their own ethnicity. Compared to CC, the risk for ACM was lower in HS (hazard ratio (HR) 0.68, 95% CI 0.57-0.8, P < .0001) and similar among AA (HR 1.1, 95% CI 0.95-1.41, P = .2). Among HS, there was a lower ACM among those residing in HS areas compared to those residing in a non-HS areas (HR 0.7 95% CI 0.56-0.9, P = .03) despite a lower median household income ($27,838 ± 3,328 vs $37,751 ± 17,036; P < .0001). This survival difference was not seen in CC and AA. CONCLUSION: Among patients referred for nuclear SPECT studies for suspected CAD, HS ethnicity was an independent predictor of a favorable prognosis. Among HS, the ethnic characteristic of patients' neighborhoods was an independent predictor of ACM. These results imply that ethnic social support is a potentially powerful modifier of patient outcomes among certain patient groups.

Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies.

BACKGROUND: Normal exercise single-photon emission computed tomography (SPECT) studies are associated with a low event rate (<1.0%/year) during short-term follow-up. The influence of cardiac risk factors on long-term outcomes in such patients has not been well studied. MATERIAL AND METHODS: 2,597 patients (55 ± 12 years, male 41%) without a history of heart disease and a normal exercise SPECT between the years 1995 and 2006 were followed for a mean 6.8 ± 3.1 years for all-cause mortality assessed for using the Social Security Death Index. Baseline clinical risk factors and other clinical information were recorded for each patient and compared to outcomes. RESULTS: The mortality rate was 0.9%/year for our overall study population but varied according to individual baseline risk factors. Three coronary artery disease (CAD) risk factors were significant predictors of all-cause mortality: hypertension, diabetes, and smoking. When all three were absent, long-term all-cause mortality rate averaged 0.2%/year and when all three were present, all-cause mortality averaged 1.8%/year, constituting a 5.7-fold adjusted increase in risk (95% CI 2.7-12.8, P < .0001). CONCLUSIONS: During follow-up, annualized mortality rate varies markedly according to the number of CAD risk factors in patients without known heart disease and a normal exercise SPECT stress. Despite overall excellent long-term prognosis of a normal exercise SPECT, the burden of traditional CAD risk factors exert a strong synergistic influence on long-term survival and warrant aggressive treatment in this patient population.

An effect of left ventricular hypertrophy on mild-to-moderate left ventricular diastolic dysfunction.

OBJECTIVES: Left ventricular diastolic dysfunction (LVDD) is associated with a variety of medical conditions. Left ventricular hypertrophy (LVH) is one of the most common abnormalities that induce LVDD. However, it is unclear whether LVH is a predictor of future LVDD deterioration that leads to diastolic heart failure in patients who already have mild-to-moderate LVDD. In this study, we investigated the effect of LVH on LV diastolic function in mild-to-moderate LVDD patients. METHODS: Of the patients with mild-to-moderate LVDD (Grade I and II) with preserved left ventricular ejection fraction (EF), 225 with LVH (LVH group) and 225 without LVH (non-LVH group) were consecutively selected. LVDD was defined by the abnormal patterns of Doppler mitral inflow and tissue Doppler. Left ventricular filling pressure (FP) was estimated by the following formula: 1.9 +1.24× [early mitral inflow velocity (E)/early mitral annular velocity (e')]. The Tei index was implemented to assess global (both systolic and diastolic) left ventricular function. Echocardiographic parameters for LVDD, such as isovolumic relaxation time (IVRT), were compared between the two groups. RESULTS: FP and Tei index were significantly higher in the LVH group compared to the non-LVH group [15.68 mmHg vs. 14.07 mmHg, P < 0.0001, and 0.58 vs. 0.53, P < 0.003, respectively]. IVRT was significantly longer in the LVH group than in the non-LVH group [103.93 ± 23.93 vs. 95.94 ± 20.16, P < 0.0001]. CONCLUSIONS: In mild-to-moderate LVDD patients, both FP and the Tei index were significantly higher when LVH was present. This may suggest LVH as a possible predictor for the future development of severe LVDD and diastolic heart failure.

Physiological correlates of densely calcified coronary lesions on coronary computed tomography angiography among patients with low-to-intermediate coronary artery disease likelihood.

OBJECTIVES: Coronary computed tomography angiography (CCTA) is often used to assess the extent and severity of atherosclerosis. A major limitation of CCTA are densely calcified coronary plaques that obscure the underlying lumen rendering assessment difficult. The purpose of this study was to evaluate the hemodynamic importance of densely calcified coronary lesions on CCTA in patients with low-to-intermediate likelihood of coronary artery disease. METHODS: We studied 92 patients (64±10 years, 75% men) who underwent CCTA and stress perfusion cardiovascular magnetic resonance (CMR). Coronary stenoses were categorized as none, less than 50%, 50-70%, and greater than 70%, or densely calcified. Coronary arteries were considered densely calcified if the artery had a calcified lesion obscuring the underlying lumen and did not have another stenosis of greater than 50%. CMR was considered abnormal if there was reversible ischemia or myocardial scar determined by the presence of late gadolinium enhancement. RESULTS: Among the 92 patients, 271 vessels were analyzed of which 44 (16%) were considered densely calcified. Among these 44 coronary territories, six (14%) had abnormal CMR findings. On a per-vessel analysis, a proportional increase in the number of myocardial segments with reversible ischemia or the presence of late gadolinium enhancement was associated with an increase of CCTA stenosis ranging from 2% in patients without coronary plaque to 70% in patients with a greater than 70% stenosis (P<0.0001). CONCLUSION: In conclusion, the vast majority (86%) of densely calcified lesions were not hemodynamically significant in our study. As our study was in patients with relatively low-to-intermediate likelihood of coronary artery disease, a prospective study is warranted to assess if our findings are generalizable to other patient populations.