Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 425
Filtrar
1.
Med Clin (Barc) ; 2022 Jul 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: covidwho-2159538

RESUMO

OBJECTIVE: To evaluate the effect of drug interactions with chronic direct oral anticoagulants (DOAC) on mortality in older atrial fibrillation (AF) patients during the Coronavirus disease 2019(COVID-19) pandemic. METHODS: We followed a total of 601 elderly patients (65 years of age) from the NOEL-Drug Registry cohort who were referred to a tertiary outpatient clinic between 9 March 2020 and 1 March 2021. We recorded clinical characteristics and medications for the last 3 months. In addition, all drug interactions were identified using Lexicomp®. Finally, we recorded retrospectively all death events, COVID-19 diagnosis, and relevant deaths from the database at the end of the study. According to logistic regression, we performed propensity score (PS) matching to reduce potential bias. Factors associated with total mortality in the 12 months were analyzed using multivariable Cox proportion hazard analysis. RESULTS: The mean age [standard deviation (SD)] was 74.5 (±6.9), and the male/female ratio was 337/264. The prevalence of total mortality was 16.9% (n=102). A total of 4472 drugs were analyzed for DOAC interaction. 81.8% of older AF patients were not at risk in terms of potential interaction. In the Cox proportional hazard model after PS-matching, previous DOAC use with class X interaction was associated with significantly higher mortality risk (adjusted hazard ratio: 2.745, 95% confidence interval: 1.465-5.172, p=0.004). CONCLUSIONS: Our study showed that while most co-medications do not have significant interactions with DOACs, few serious drug interactions contribute to mortality in elderly patients with AF during the pandemic.

2.
J Electrocardiol ; 75: 1-9, 2022 Oct 12.
Artigo em Inglês | MEDLINE | ID: covidwho-2150049

RESUMO

BACKGROUND: The electrocardiography (ECG) has short-term prognostic value in coronavirus disease 2019 (COVID-19), yet its ability to predict long-term mortality is unknown. This study aimed to elucidate the predictive role of initial ECG on long-term all-cause mortality in patients diagnosed with COVID-19. METHODS: In this prospective cohort study, adults with COVID-19 who underwent ECG testing within a 17-hospital health system in Northeast Ohio and Florida between 03/2020-06/2020 were identified. An expert ECG reader analyzed all studies blinded to patient status. The associations of ECG characteristics with long-term all-cause mortality and intensive care unit (ICU) admission were assessed using Cox proportional hazards regression model and multivariable logistic regression models, respectively. Status of long-term mortality was adjudicated on 01/07/2022. RESULTS: Of 837 patients (median age 65 years, 51% female, 44% Black), 683 (81.6%) were hospitalized, 281 (33.6%) required ICU admission, 67 (8.0%) died in-hospital, and 206 (24.6%) died at final follow-up after a median (IQR) of 21 (9-103) days after ECG. Overall, 179 (20.7%) patients presented with sinus tachycardia, 12 (1.4%) with atrial flutter, and 45 (5.4%) with atrial fibrillation (AF). After multivariable adjustment, sinus tachycardia (E-value for HR=3.09, lower CI=2.2) and AF (E-value for HR=3.13, lower CI=2.03) each independently predicted all-cause mortality. At final follow-up, patients with AF had 64.5% probability of death compared with 20.5% for those with normal sinus rhythm (P<.0001). CONCLUSIONS: Sinus tachycardia and AF on initial ECG strongly predict long-term all-cause mortality in COVID-19. The ECG can serve as a powerful long-term prognostic tool in COVID-19.

3.
Circ Arrhythm Electrophysiol ; : e009911, 2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: covidwho-2138303

RESUMO

Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.

4.
World J Clin Cases ; 10(32): 12056-12058, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: covidwho-2145354

RESUMO

Coronavirus disease 2019 (COVID-19) complicates clinical management in elderly population. There is an additional need to properly treat and monitor elderly COVID-19 patients. This paper discusses the inappropriate medication prescribing in the elderly and suggests an updated valid assessment tool considering COVID-19 and its treatment.

5.
J Am Soc Nephrol ; 33(2): 442-453, 2022 02.
Artigo em Inglês | MEDLINE | ID: covidwho-2141040

RESUMO

BACKGROUND: Atrial fibrillation (AF) is highly prevalent in CKD and is associated with worse cardiovascular and kidney outcomes. Limited data exist on use of AF pharmacotherapies and AF-related procedures by CKD status. We examined a large "real-world" contemporary population with incident AF to study the association of CKD with management of AF. METHODS: We identified patients with newly diagnosed AF between 2010 and 2017 from two large, integrated health care delivery systems. eGFR (≥60, 45-59, 30-44, 15-29, <15 ml/min per 1.73 m2) was calculated from a minimum of two ambulatory serum creatinine measures separated by ≥90 days. AF medications and procedures were identified from electronic health records. We performed multivariable Fine-Gray subdistribution hazards regression to test the association of CKD severity with receipt of targeted AF therapies. RESULTS: Among 115,564 patients with incident AF, 34% had baseline CKD. In multivariable models, compared with those with eGFR >60 ml/min per 1.73 m2, patients with eGFR 30-44 (adjusted hazard ratio [aHR] 0.91; 95% CI, 0.99 to 0.93), 15-29 (aHR, 0.78; 95% CI, 0.75 to 0.82), and <15 ml/min per 1.73 m2 (aHR, 0.64; 95% CI, 0.58-0.70) had lower use of any AF therapy. Patients with eGFR 15-29 ml/min per 1.73 m2 had lower adjusted use of rate control agents (aHR, 0.61; 95% CI, 0.56 to 0.67), warfarin (aHR, 0.89; 95% CI, 0.84 to 0.94), and DOACs (aHR, 0.23; 95% CI, 0.19 to 0.27) compared with patients with eGFR >60 ml/min per 1.73 m2. These associations were even stronger for eGFR <15 ml/min per 1.73 m2. There was also a graded association between CKD severity and receipt of AF-related procedures (vs eGFR >60 ml/min per 1.73 m2): eGFR 30-44 ml/min per 1.73 (aHR, 0.78; 95% CI, 0.70 to 0.87), eGFR 15-29 ml/min per 1.73 m2 (aHR, 0.73; 95% CI, 0.61 to 0.88), and eGFR <15 ml/min per 1.73 m2 (aHR, 0.48; 95% CI, 0.31 to 0.74). CONCLUSIONS: In adults with newly diagnosed AF, CKD severity was associated with lower receipt of rate control agents, anticoagulation, and AF procedures. Additional data on efficacy and safety of AF therapies in CKD populations are needed to inform management strategies.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Insuficiência Renal Crônica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Insuficiência Renal Crônica/fisiopatologia , Índice de Gravidade de Doença , Varfarina/uso terapêutico
6.
Journal of the American Society of Nephrology ; 33:315, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2125602

RESUMO

Background: End stage kidney disease (ESKD) patients are particularly susceptible to poor outcomes from Covid-19 infection (C19). Vaccination has been the cornerstone of mortality prevention. We examine the efficacy of C19 vaccine in ESKD patients. Method(s): All patients dialyzed at Emory dialysis centers from December 1, 2020 until February 2022 represent the study population. Date of completed vaccines series was recorded. Confirmed C19 cases were also registered. Time from vaccination to C19 and from C19 to death was recorded. Mortality risk was compared between vaccinated and unvaccinated patients. Patients that received vaccination after an episode of C19 were excluded from the analysis (n=89). Result(s): 935 patients received maintenance dialysis during the study period. 68% completed 2 doses of C19 vaccine. 46% of vaccinated patients received a booster dose after 294 days (IQR: 251-273) of completing the primary vaccination series. Non-vaccinated patients were younger (55 vs 60y/o), with shorter dialysis vintage (1.0 vs 2.8 years). The proportion of home and in-center dialysis was similar among vaccinated and unvaccinated patients. The prevalence of diabetes, CHF, PVD, COPD, atrial fibrillation, and previous transplants was also similar. 71 vaccinated patients died during follow up (11%) after 196 days (IQR 122-290), compared to 70 in the non-vaccinated group (24%) after 86 days (IQR 39-166), p<0.001. Adjusting for age, dialysis vintage, diabetes and CHF, ESKD vaccinated patients had a 78% reduction in mortality risk (A). 73 vaccinated patients (11%) acquired C19 after 250 days (IQR 150-288) compared to 48 unvaccinated patients (16%) who acquired C19 after 64 days (IQR 30-215), p<0.001. The mortality odds ratio after C19 infection was 3.9 [CI: 1.3-11.9] for unvaccinated patients 30 days post infection, 4.7 [CI: 1.7-14.2] at 60 days and 4.1 [CI: 1.6-11.5] at 90 days (B). Conclusion(s): Vaccination against C-19 infection resulted in a 78% reduction of mortality risk in patients receiving dialysis. Non-vaccinated patients diagnosed with C19 had higher mortality rates than vaccinated patients (OR 4.1 at 90 days post infection).

7.
European Journal of Molecular and Clinical Medicine ; 9(7):2827-2839, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2124671

RESUMO

Background: Chronic obstructive pulmonary disease (COPD) is a prominent cause of illness and mortality on a global scale. In 2019, it was predicted to rank as the sixth largest cause of mortality. COPD is one of the most prevalent non-communicable illnesses in the field of pulmonology. The DECAF score (Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation) is a risk stratification tool for patients with AECOPD that can be used at the bedside to guide treatment, such as hospital at home for low-risk patients. The purpose of this study is to predict the in-hospital mortality in acute exacerbation of COPD patients with modified DECAF scores. Modified DECAF score includes Dyspnea, Eosinopenia, Consolidation, Acidemia and Frequency of Hospitalization. Material(s) and Method(s): A total of 50 patients attending Emergency Medicine Department with Acute Exacerbation of COPD were recruited to this hospital based observational study. This study was conducted at the Department of Emergency medicine & Pulmonary medicine, at APOLLO GLENEAGLES HOSPITALS, Kolkata. Result(s): COPD was more prevalent in the age groups of 41-50 years (28%) and 61-70 years (28%) followed by those having age between 51-60 years (22%). Majority of the COPD patients were males (88%) compared to (12%) females. Majority of the COPD patients were males (88%) compared to (12%) females. Most common co-morbid condition associated with COPD washypertension (16%) followed by IHD (8%), pulmonary hypertension (6%) and diabetes mellitus (4%). Out of 50 patients with COPD, 11 (22%) had previous history of AECOPD, 38 (76%) were regular user of inhaler, 33 (66%) had history of influenza vaccination, 16 (32%) had Pneumococcal Vaccination and 2 (4%) patients had COVID-19 pneumonia. Out of 50 patients, 24 (48%) had Dyspnea (eMRCD) score of 5a whereas 26 (52%) had Dyspnea (eMRCD) score of 5b as well as 7 (14%) had Eosinopenia (<50 cells/mm3) and 20 (40%) had Consolidation. Conclusion(s): We conclude that the Modified DECAF score is both sensitive and specific in predicting in-hospital mortality in AECOPD patients. Modified DECAF is a simple tool that predicts mortality that incorporates routinely available indices. It effectively stratifies COPD patients admitted with acute exacerbations into mortality risk categories. Copyright © 2022 Ubiquity Press. All rights reserved.

8.
Rational Pharmacotherapy in Cardiology ; 18(5):502-509, 2022.
Artigo em Russo | EMBASE | ID: covidwho-2145929

RESUMO

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry. Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 - in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards - from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0+/-1.5 months. Results. The age of post-COVID patients with CVMM was 73.7+/-9.6 years, without CVD - 49.4+/-12.4 years (p<0.001), the proportion of men was 53.9% and 58.4% (p=0.34). In the group with CVMM the majority of patients had AH (92.3-93.3%), CHD (90.4-91.4%), and minority - CHF (42.7-46.0%) and AF (42.9-43.4%). The combination of 3-4 CVDs prevailed (58.9-60.3%). The proportion of cases of chronic non-cardiac pathologies was higher in the CVMM group (80.9%) compared to the group without CVD (36.7%;p<0.001). The frequency of proper cardiovascular pharmacotherapy during the follow-up period decreased from 56.8% to 51.3% (p for trend = 0.18). The frequency of anticoagulant therapy in AF decreased significantly: from 89.1% at the discharge from the hospital to 56.4% after 30-60 days (p=0.001), 57.1% and 53.6% after 6 and 12 months of monitoring (p for a trend <0.001). There were no other significant changes in the frequency of other kinds of the proper cardiovascular pharmacotherapy (p>0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p<0.001) as well as rates of hospitalization (34.7% and 9.9%, p<0.001) and non-fatal myocardial infarction (MI) - 2.5% vs 0.5% (p=0.048). The proportion of new cases of CVD in the groups with CVMM and without CVD was 5.5% and 3.7% (p=0.33). The incidence of acute respiratory viral infection (ARVI)/influenza was higher in the group without CVD - 28.3% vs 19.0% (p=0.02). The proportion of cases of recurrent COVID-19 in groups with CVMM and without CVD was 3.7 % and 1.8% (p=0.19). Conclusion. Post COVID-19 patients with CVMM were older and had the bigger number of chronic non-cardiac diseases than patients without CVD. The quality of cardiovascular pharmacotherapy in patients with CVMM was insufficient at the discharge from the hospital with following non-significant decrease during 12 months of follow-up. The frequency of anticoagulant therapy in AF decreased by 1.6 times after 30-60 days and by 1.7 times during the year of follow-up. The proportion of new cases of CVD was 5.5% and 3.7% with no significant differences between compared groups. The rate of all-cause mortality, hospitalizations and non-fatal MI was significantly higher in patients with CVMM, but the frequency of ARVI/influenza was significantly higher in patients without CVD. Recurrent COVID-19 was registered in 3.7% and 1.8% of cases, there were no significant differences between compared groups. Copyright © 2022 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.

9.
Southern Medical Journal ; 115(12):921-925, 2022.
Artigo em Inglês | Web of Science | ID: covidwho-2145446

RESUMO

Since the advent of severe acute respiratory syndrome-coronavirus-2 in December 2019, millions of people have been infected and succumbed to death because of this deadly virus. Cardiovascular complications such as thromboembolism and arrhythmia are predominant causes of morbidity and mortality. Different scores previously used for atrial fibrillation (AF) identification or prediction of its complications were investigated by physicians to understand whether those scores can predict in-hospital mortality or AF among patients infected with the severe acute respiratory syndromecoronavirus-2 virus. Using such scores gives hope for early prediction of atrial arrhythmia and in-hospital mortality among coronavirus disease 2019-infected patients. We have discussed the mechanisms of AF and cardiovascular damage in coronavirus disease 2019 patients, different methods of AF prediction, and compared different scores for prediction of in-hospital mortality after this viral infection.

10.
REC: CardioClinics ; 2022.
Artigo em Inglês, Espanhol | EMBASE | ID: covidwho-2132200

RESUMO

This paper shows a selection of the most relevant articles in congenital heart diseases in the last year. About intervencional procedures, we comment the latest guidelines in 2021, as well as some interesting papers on the implementation of materials and techniques in the field of percutaneous treatment of congenital heart diseases. In cardiac imaging, we focus on articles related to the revolutionary advance of 4D-NMR and 3D echo in the study of these congenital diseases. Respect pediatrics, there are interesting studies about multisystem inflammatory syndrome linked to SARS-CoV-2 (MIS-C) and also in the field of hypertrophic cardiomyopathy. Related to surgery, we comment the hybrid technique for treating hypoplastic left ventricle. Finally, regarding arrhythmias in congenital heart disease, we focus our attention on atrial fibrillation, due to the peculiarities that exist in this type of patients. Copyright © 2022 Sociedad Espanola de Cardiologia

11.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2128222

RESUMO

Background: During the first wave of the SARS-CoV- 2 pandemic, management of anticoagulation therapy in hospitalized patients with atrial fibrillation (AF) was simplified to low-molecular- weight heparin (LMWH), mainly due to the risk of drug-drug interactions. However, not all potential drug-drug interactions are clinically relevant. The metabolism of edoxaban by CYP3A4 is less than 4%, the risk of drug-drug interactions with edoxaban is low. There are few data on the interaction between edoxaban and ritonavir. Aim(s): To determine whether the effectiveness and safety of edoxaban or LMWH differed between patients with AF who had been hospitalized for COVID-19 infection and received empirical treatment with ritonavir. In addition, we analyzed length of stay, the proportion of patients requiring admission to the intensive care unit, and mortality. Method(s): Observational, retrospective, and multicenter study that consecutively included hospitalized patients with non-valvular AF who received anticoagulant treatment with LMWH or edoxaban concomitantly with empirical therapy for COVID-19 infection. Result(s): From March 5th to April 27th, 2020, 464 patients were included (80.3+/-7.7 years, 50.0% men, CHA2DS2-VASc 4.1 +/- 1.4;HAS-BLED 2.6 +/- 1.0). Regarding COVID-19 therapy during hospitalization, patients were taking azithromycin (98.7%), hydroxychloroquine (89.7%), and ritonavir/lopinavir (81.5%). The mean length of hospital stay was 14.6 +/- 7.2 days and mean total follow-up (from admission to the last visit) was 31.6 +/- 13.4 days. Furthermore, 12.9% of patients required admission to the intensive care unit, 18.5% of patients died, and 9.9% had a bleeding complication (34.8% major bleeding). Except for length of hospital stay, which was longer in patients taking LMWH (16.0 +/- 7.7 vs. 13.3 +/- 6.5 days;p = 0.005), data for the remaining outcomes were similar in patients treated with edoxaban and those treated with LMWH. Conclusion(s): No significant differences were found between patients treated with edoxaban and patients treated with LMWH in terms of the percentage admitted to the intensive care unit, mortality rates, arterial and venous thromboembolic complications, and bleeds. (Figure Presented).

12.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2128184

RESUMO

Background: Coronavirus disease 2019 (COVID-19) is a systemic disease with cardiovascular involvement, including cardiac arrhythmias. Notably, new-onset atrial fibrillation (AF) and atrial flutter (AFL) during hospitalisation in COVID-19 patients have been associated with increased mortality. However, how this risk is impacted by sex and age is still poorly understood. Aim(s): The aim of this study was to explore the relation of AF and AFL to in-hospital mortality, with specific attention for sex-and age-related differences. Method(s): For this multicentre cohort study, we extracted demographics, medical history, occurrence of electrical disorders and in-hospital mortality from the large international patient registry CAPACITY-COVID. For each electrical disorder, prevalence during hospitalisation was calculated. Subsequently, we analysed the incremental prognostic effect of developing AF/AFL on in-hospital mortality, using multivariable logistic regression analyses, stratified for sex and age. Result(s): In total, 5,782 patients (64% male;median age 67) were included. Of all patients 11.0% (95% CI 10.2-11.8) experienced AF and 1.6% (95% CI 1.3-1.9) experienced AFL during hospitalisation. Ventricular arrhythmias were rare (< 0.8% (95% CI 0.6-1.0)) and a conduction disorder was observed in 6.3% (95% CI 5.7-7.0). An event of AF/AFL appeared to occur more often in patients with pre-existing heart failure. After multivariable adjustment for age and sex, new-onset AF/AFL was significantly associated with a poorer prognosis, exemplified by a two-to three-fold increased risk of in-hospital mortality in males aged 60-72 years, whereas this effect was largely attenuated in older male patients and not observed in female patients (Figure 1). Conclusion(s): In this large COVID-19 cohort, new-onset AF/AFL was associated with increased in-hospital mortality, yet this increased risk was restricted to males aged 60-72 years.

13.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2128172

RESUMO

Background: Venous thromboembolism remains a major complication associated with a high incidence of mortality in COVID-19 patients. Prophylactic anticoagulation utilizing either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) remains an area of further investigation. Aim(s): To evaluate the incidence of thrombotic, clinical outcomes of interest and safety of LMWH versus UFH in critically ill COVID-19. Method(s): This is a multicenter, retrospective cohort study including adult critically ill patients with confirmed COVID-19 and admitted to the ICU. Included patients were grouped based on the anticoagulation agent. The primary outcome was conformed arterial or venous thrombosis. Secondary outcomes included bleeding (major or minor), 30-day mortality, hospital length of stay (LOS), ICU LOS, ventilator-free days (VFDs) at 30 days, and ICU-acquired complications.We adjusted comparisons for potential confounders using regression analysis. A p-value < 0.05 will indicate statistical significance and all analyses will be performed using STATA version 9.4. Result(s): 305 patients were included, 142 received UFH and 164 received LMWH. A statistical significant decrease in hospital LOS with the use of LMWH compared to UFH was observed (hazard ratio [HR] -0.28, p = 0.001).The incidence of thrombosis (odd ratio [OR] 0.24, p = 0.03) , new atrial fibrillation (odd ratio [OR] -0.17, p = 0.04) , acute kidney injury (odd ratio [OR] 0.25, p = 0.0005) and the need for transfusion (odd ratio [OR] 0.26, p = 0.02) was statistically significant as well favoring the LMWH group recipients. Major bleeding and minor bleeding were similar between groups (p = 0.90, p = 0.47) respectively. Conclusion(s): LMWH might be linked with favorable outcomes in thrombosis and ICU complications reduction in critically ill patients with COVID-19.

14.
Cardiovascular Research ; 118(Supplement 2):ii112, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2125777

RESUMO

A healthy 32-years-old man was admitted in emergency department after cardiac arrest at home. He had complaints of fatigue and general malaise after Pfizer-BioNTech Coronavirus disease-2019 (COVID-19) first dose vaccine 48 hours earlier. Upon hospital admission, patient scored 3 points in Glasgow Coma Scale. Electrocardiogram showed atrial fibrillation with rapid ventricular response and a point-of-care ultrasound demonstrated severe left ventricular dysfunction with global hypokinesia. Blood tests were remarkable for elevation of high-sensitivity cardiac troponin-T and inflammatory parameters, normal platelet and fibrinogen levels and slightly increased D-dimer. A computed tomography (CT) with angiography of the cerebral arteries revealed acute ischemic posterior circulation stroke with total occlusion of the basilar artery and partial occlusion of the left vertebral artery. Life-saving systemic thrombolysis was performed but there was no clinical benefit. Pulmonary embolism was excluded. Transesophageal echocardiography showed severe left ventricular dysfunction (LVEF 30%), global hypokinesia and an apical thrombus with no other significant abnormalities. De novo multiple ischemic injuries were shown in 24h control brain CT. Once autoimmunity, thrombophilia study, PCR and serologic tests for viral infections including SARS-CoV-2 were negative, cardioembolic stroke following post-vaccinal myocarditis was suspected. Brain stem death was verified 72h later and a post-mortem endomyocardial biopsy was performed, although no signal of myocarditis was found. COVID-19 mRNA vaccination is associated with increased risk of myocarditis. We report the first known case of cardioembolic stroke and probable myocarditis after BNT162b2 first dose. This highlights that, although rare and with a predominantly favorable course, vaccine-related myocarditis can have life-threatening complications. (Figure Presented).

15.
Heart Rhythm O2 ; 2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: covidwho-2130965

RESUMO

Background: Atrial fibrillation (AF) has been reported to occur with coronavirus disease 2019 (COVID-19), but whether it is related to myocarditis or lung injury is unclear. Objectives: The purpose of this study was to compare incident AF in patients with pneumonia/adult respiratory distress syndrome (ARDS) with and without COVID. Methods: This retrospective multicenter cohort study from 17 hospitals (March 2020 to December 2021) utilizing the University of California COVID Research Data Set (CORDS) included patients aged ≥18 years with primary diagnosis of pneumonia or ARDS during hospitalization. Patients with a history of AF were excluded. All subjects had documented COVID test results. Cohorts were compared using the χ2 test for categorical variables and the Wilcoxon rank test for continuous variables. Multivariable logistic regression models were used to investigate the association between COVID and development of new AF. Results: Of the 39,415 subjects, 12.2% had COVID. The COVID+ cohort consisted predominantly of younger males with more comorbidities. Incident AF was lower in the COVID+ group than in the non-COVID group (523 [10.85%] vs 4899 [14.16%]; odds ratio [OR] 0.74; P <.001), which remained significant after adjustment for demographics and comorbidities (OR 0.71; P <.001). Patients had normal cardiac troponin levels. AF was related to intensive care unit care, pressor support, and mechanical ventilation, and was associated with higher mortality (26.2% vs 10.21%; P <.001) and longer hospitalization (22.5 vs 15.1 days; P <.001) in the COVID+ group compared to the controls. Conclusion: Incident AF is lower in COVID+ compared to non-COVID pneumonia/ARDS patients and seems to be related to severity of illness rather cardiac injury. AF was associated with higher mortality and prolonged hospitalization.

16.
Health Sci Rep ; 5(6): e813, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: covidwho-2127716

RESUMO

Background and Aims: We focused on determining the risk factors, thromboembolic events, and clinical course of New-Onset Atrial Fibrillation (NOAF) among hospitalized coronavirus disease (COVID-19) patients. Methods: This retrospective study was conducted in the major referral centers in Tehran, Iran. Of 1764 patients enrolled in the study from January 2020 until July 2021, 147 had NOAF, and 1617 had normal sinus rhythm. Univariate and multivariate Logistic regressions were employed accordingly to evaluate NOAF risk factors. The statistical assessments have been run utilizing SPSS 25.0 (SPSS) or R 3.6.3 software. Results: For the NOAF patients, the age was significantly higher, and the more prevalent comorbidities were metabolic syndrome, heart failure (HF), peripheral vascular disease, coronary artery disease, and liver cirrhosis. The multivariate analysis showed the established independent risk factors were; Troponin-I (hazard ratio [HR] = 3.86; 95% confidence interval [CI] = 1.89-7.87; p < 0.001), HF (HR = 2.54; 95% CI = 1.61-4.02; p < 0.001), bilateral grand-glass opacification (HR = 2.26; 95% CI = 1.68-3.05; p = 0.002). For cases with thromboembolic events, NOAF was the most important prognostic factor (odds ratio [OR] = 2.97; 95% CI = 2.03-4.33; p < 0.001). While evaluating the diagnostic ability of prognostic factors in detecting NOAF, Troponin-I (Area under the curve [AUC] = 0.85), C-Reactive Protein (AUC = 0.72), and d-dimer (AUC = 0.65) had the most accurate sensitivity. Furthermore, the Kaplan-Meier curves demonstrated that the survival rates diminished more steeply for patients with NOAF history. Conclusion: In hospitalized COVID-19 patients with NOAF, the risk of thromboembolic events, hospital stay, and fatality are significantly higher. The established risk factors showed that patients with older age, higher inflammation states, and more severe clinical conditions based on CHADS2VASC-score potentially need subsequent preventive strategies. Appropriate prophylactic anticoagulants, Initial management of cytokine storm, sufficient oxygen support, and reducing viral shedding could be of assistance in such patients.

17.
Ann Pharmacother ; : 10600280221136874, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: covidwho-2116957

RESUMO

BACKGROUND: Warfarin, a commonly prescribed anticoagulant, requires frequent lab monitoring. Lab monitoring puts patients at risk of COVID-19 exposure and diverts medical resources away from health care systems. Direct oral anticoagulants (DOACs) do not require routine therapeutic monitoring and are indicated first line for nonvalvular atrial fibrillation (NVAF) stroke prevention and venous thromboembolism (VTE) prevention/treatment. OBJECTIVE: The purpose of the study was to determine the proportion of patients who qualify for DOACs and assess for predictors of qualification. METHODS: This cross-sectional study investigated patients on warfarin managed by Michigan Medicine Anticoagulation Service. Direct oral anticoagulant eligibility criteria were established using apixaban, dabigatran, and rivaroxaban package inserts. Patient eligibility was determined through chart review. The primary outcome was the proportion of patients who qualify for DOACs based on clinical factors. Predictors of DOAC qualification were assessed. RESULTS: This study included 3205 patients and found 51.8% (n = 1661) of patients qualified for DOACs. Qualifying patients were older (71.9 vs 59.4 years, P < 0.0001) with a higher CHA2DS2 VASc (3.7 vs 3.4, P < 0.0007). The primary disqualifying factor was extreme weight, high and low. Accounting for a patient's sex and referral source, age > 65 (odds ratio [OR] = 1.9, P < 0.0001) and NVAF indication (OR = 5.6, P < 0.0001) were significant predictors for DOAC qualification. CONCLUSION AND RELEVANCE: Approximately 52% of patients on warfarin were eligible for DOACs. This presents an opportunity to reduce patient exposure to health care settings and health care utilization in the setting of COVID-19. Increased costs of DOACs need to be assessed.

18.
Med Clin (Engl Ed) ; 158(12): 569-575, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: covidwho-2117684

RESUMO

Introduction and purpose: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. Methods: We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. Results: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. Conclusions: AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.


Antecedentes y objetivos: La fibrilación auricular (FA) es frecuente en pacientes ingresados por COVID-19 grave. Sin embargo, los datos sobre el manejo de la anticoagulación crónica en estos pacientes son escasos. Analizamos la anticoagulación y la incidencia de episodios cardiovasculares mayores en pacientes con FA ingresados por la COVID-19. Métodos: Retrospectivamente, se identificaron todos los pacientes con FA ingresados por la COVID-19 entre marzo y mayo de 2020, en 9 hospitales españoles. Se seleccionó un grupo control de pacientes ingresados consecutivamente por la COVID-19 sin FA. Se compararon las características basales, incidencia de hemorragias mayores, episodios trombóticos y mortalidad. Para reducir potenciales factores de confusión se realizó un emparejamiento por puntuación de propensión, así como un análisis multivariante para predecir hemorragia mayor y mortalidad. Resultados: Se incluyeron 305 pacientes con FA ingresados por la COVID-19. Tras el emparejamiento por puntuación de propensión, 151 pacientes con FA fueron emparejados con 151 controles. Durante el ingreso, la heparina de bajo peso molecular fue el principal anticoagulante y la incidencia de hemorragia mayor y mortalidad fue mayor en el grupo de FA (16[10,6%] vs. 3[2%], p = 0,003; 52[34,4%] vs. 35[23,2%], p = 0,03, respectivamente). El análisis multivariante demostró la presencia de FA como predictor independiente de sangrados y mortalidad intrahospitalaria en los pacientes con la COVID-19. En el grupo de FA, un segundo análisis multivariante identificó valores elevados de dímero-D como predictor independiente de hemorragia mayor intrahospitalaria. Conclusiones: Los pacientes con FA ingresados por la COVID-19 representan una población de alto riesgo de sangrado y mortalidad durante el ingreso. Parece recomendable individualizar la anticoagulación durante el ingreso, considerando el riesgo específico de sangrado y trombosis.

19.
United European Gastroenterology Journal ; 10(Supplement 8):209, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2114637

RESUMO

Introduction: Proton pump inhibitors (PPIs) play an indispensable role in the treatment of acid-secretion disorders and are one of the most widely used drugs. This study aimed to investigate the association between proton pump inhibitors (PPI) use and COVID-19-related mortality and hospitalizations. Aims & Methods: This population-based matched cohort study included all individuals diagnosed with the first episode of COVID-19 up to August 15, 2021, in Croatia. We classified patients based on exposure to PPIs and burden of PPI-requiring conditions as: 1. Non-users (patients without issued PPI prescriptions and treatmentrequiring conditions), 2. Possible users (patients without issued PPI prescriptions but with recorded treatment-requiring conditions), and;3. Users (patients with issued PPI prescriptions). Users were further divided into three groups based on the intensity of PPI prescriptions to investigate the dose effect of PPIs. In addition to the comparison of users to non-users, we compared: 1. Users to possible users to isolate the effect of PPIs and 2. Possible users to non-users to isolate the effect of comorbidities treated with PPIs on COVID-19-related mortality and hospitalization. Log-binomial regression with robust sandwich variance estimation was used to calculate relative risk and 95% confidence intervals after exact matching in respect to a range of pre-COVID-19 characteristics (in primary analysis: age (binned to 5 years), sex, vaccination status, time period in the course of the pandemic, Charlson comorbidity index, presence of ACE inhibitor therapy and comorbidities: atrial fibrillation, autoimmune diseases, cancer, chronic heart failure, chronic obstructive lung disease, ischemic or cerebrovascular diseases, chronic renal disease and immunocompromised state;in sensitivity analysis with an alternative set of covariates). Result(s): Among 433609 COVID-19 patients, 332389 were identified as nonusers, 18170 as possible users, and 55098 as users of PPIs. Users to non-users, users to possible users, and possible users to non-users were matched 48453 to 325005, 41195 to 17334, and 17466 to 316168 subjects per group, respectively. A small difference in COVID-19 related mortality and hospitalizations was observed after matching users to non-users [RRmortality = 1.23 (95%CI 1.16 - 1.30) and RRhospitalization = 1.46 (95%CI 1.38 - 1.54)] and possible users to non-users [RRmortality = 1.24 (95%CI 1.13 to 1.37) and RRhospitalization = 1.26 (95%CI 1.16 - 1.37)]. However, there was no relevant difference between users and possible users in COVID-19-related mortality [RR= 0.93 (95%CI 0.85 - 1.02)] or hospitalizations [RR = 1.04 (0.97 - 1.13)]. Dose effect was not observed in any comparison involving users. Sensitivity analysis yielded comparable results. Conclusion(s): The comparison of possible to non-users, and users to possible users indicates that the risk observed in the comparison of users and non-users of PPI is likely attributable to the burden of comorbidities treated with PPIs and not the effect of the PPIs.

20.
Heart ; 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: covidwho-2119271

RESUMO

OBJECTIVE: We aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL). METHODS: Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy. RESULTS: Trial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61-71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000). CONCLUSION: Cryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF. TRIAL REGISTRATION NUMBER: NCT03401099.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA