Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.324
Filtrar
1.
Med J Aust ; 214(7): 310-317, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33792058

RESUMEN

OBJECTIVE: To determine whether the availability of invasive coronary angiography at the hospital of presentation influences catheterisation rates for patients with acute coronary syndrome (ACS), and whether presenting to a catheterisation-capable hospital is associated with better outcomes for patients with ACS. DESIGN, SETTING: Retrospective cohort study; analysis of Cooperative National Registry of Acute Coronary Events (CONCORDANCE) data. SETTING, PARTICIPANTS: Adults admitted with ACS to 43 Australian hospitals (including 31 catheterisation-capable hospitals), February 2009 - October 2018. MAIN OUTCOME MEASURES: Major adverse cardiovascular events (myocardial infarction, stroke, congestive heart failure, cardiogenic shock, cardiovascular death) and all-cause deaths in hospital and by six and 12- or 24-month follow-up. RESULTS: The proportion of women among the 5637 patients who presented to catheterisation-capable hospitals was smaller than for the 2608 patients who presented to hospitals without catheterisation facilities (28% v 33%); the proportion of patients diagnosed with ST elevation myocardial infarction was larger (32% v 20%). The proportions of patients who underwent catheterisation (81% v 70%) or percutaneous coronary intervention (49% v 35%) were larger for those who presented to catheterisation-capable hospitals. The baseline characteristics of patients who underwent catheterisation were similar for both presentation hospital categories, as were rates of major adverse cardiovascular events and all-cause death in hospital and by 6- and 12- or 24-month follow-up. CONCLUSIONS: Although a larger proportion of patients who presented to catheterisation-capable hospitals underwent catheterisation, patients with similar characteristics were selected for the procedure, independent of the hospital of presentation. Major outcomes for patients were also similar, suggesting equitable management of patients with ACS across Australia.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Cateterismo Cardíaco/estadística & datos numéricos , Angiografía Coronaria/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Cateterismo Cardíaco/métodos , Angiografía Coronaria/métodos , Muerte , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/estadística & datos numéricos , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/fisiopatología , Choque Cardiogénico/epidemiología , Accidente Cerebrovascular/epidemiología , Resultado del Tratamiento
2.
Circ Heart Fail ; 14(4): e007957, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813838

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to afflict millions of people worldwide. Patients with end-stage heart failure and left ventricular assist devices (LVADs) may be at risk for severe COVID-19 given a high prevalence of complex comorbidities and functional impaired immunity. The objective of this study is to describe the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs. METHODS: The Trans-CoV-VAD registry is a multi-center registry of LVAD and cardiac transplant patients in the United States with confirmed COVID-19. Patient characteristics, exposure history, presentation, laboratory data, course, and clinical outcomes were collected by participating institutions and reviewed by a central data repository. This report represents the participation of the first 9 centers to report LVAD data into the registry. RESULTS: A total of 40 patients were included in this cohort. The median age was 56 years (interquartile range, 46-68), 14 (35%) were women, and 21 (52%) were Black. Among the most common presenting symptoms were cough (41%), fever, and fatigue (both 38%). A total of 18% were asymptomatic at diagnosis. Only 43% of the patients reported either subjective or measured fever during the entire course of illness. Over half (60%) required hospitalization, and 8 patients (20%) died, often after lengthy hospitalizations. CONCLUSIONS: We present the largest case series of LVAD patients with COVID-19 to date. Understanding these characteristics is essential in an effort to improve the outcome of this complex patient population.


Asunto(s)
/epidemiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Pandemias , Anciano , /diagnóstico , Comorbilidad , Femenino , Insuficiencia Cardíaca/mortalidad , Ventrículos Cardíacos , Corazón Auxiliar/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estados Unidos/epidemiología
3.
Glob Heart ; 16(1): 14, 2021 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-33833938

RESUMEN

Background: Infection caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) exhibits a strong infectivity but less virulence compared to severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). In terms of cardiovascular morbidity, susceptible population include elderly and patients with certain cardiovascular conditions. This infection has been associated with cardiac injury, cardiovascular complications and higher mortality. Objectives: The main objective of the CARDIO COVID 19-20 Registry is to determine the presence of cardiovascular comorbidities and cardiovascular complications in COVID-19 infected patients that required in-hospital treatment in different Latin American institutions. Methods: The CARDIO COVID 19-20 Registry is an observational, multicenter, ambispective, and hospital-based registry of patients with confirmed COVID-19 infection who required in-hospital treatment in Latin America. Enrollment of patients started on May 01, 2020 and was initially planned to last three months; based on the progression of pandemic in Latin America, enrollment was extended until December 2020, and could be extended once again based on the pandemic course in our continent at that moment. Conclusions: The CARDIO COVID 19-20 Registry will characterize the in-hospital population diagnosed with COVID-19 in Latin America in order to identify risk factors for worsening of cardiovascular comorbidities or for the appearance of cardiovascular complications during hospitalization and during the 30-day follow up period.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Sistema de Registros , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , /fisiopatología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Comorbilidad , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Enfermedad Coronaria/fisiopatología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , América Latina , Miocarditis/epidemiología , Miocarditis/etiología , Miocarditis/fisiopatología , Trombosis/epidemiología , Trombosis/etiología , Trombosis/fisiopatología
5.
Mymensingh Med J ; 30(2): 514-522, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33830137

RESUMEN

Both of heart failure and chronic obstructive pulmonary diseases are in the elderly. They have an important impact on quality of life and functional status, show high morbidity and mortality rates and lead to extensive health-care costs. Although both diseases have been studied extensively, information about the prevalence of heart failure in stable chronic obstructive pulmonary disease (COPD) patients is lacking. For people who have both the diseases, identifying the cause of breathing symptoms can be challenging. It seems therefore plausible that a considerable proportion of patients with a diagnosis of COPD have concomitant heart failure, which remains unrecognized by primary care physicians or pulmonologists. The main aim of this study was to assess the prevalence of heart failure in patients with a diagnosis of chronic obstructive pulmonary disease. The prevalence of previously unknown heart failure was assessed in 100 patients ≥40 years with a GP (General physician) diagnosis of COPD, in a stable phase of their disease. This descriptive cross sectional study was carried out in the Department of Medicine, Shaheed Ziaur Rahman Medical College hospital, Bogra, Bangladesh from November 2011 to April 2012. A total of 100 cases of chronic breathlessness coming into out patient department and admitted into Department of Medicine of Shaheed Ziaur Rahman Medical College Hospital, Bogra were included based on inclusion & exclusion criteria. After taking informed written consent data was collected by a questionnaire and relevant investigations were done. Then collected data was analyzed and were expressed as mean ±SE and statistical significance of difference among the group was calculated by unpaired students 't' test. In this study we founded among 100 participating patients with a diagnosis of COPD by their physician, in 24 (24%) patients had previously unrecognized heart failure. Therefore, by this study we recommend that evaluation and assessment of cardiac status is very important in elderly patients with COPD.


Asunto(s)
Insuficiencia Cardíaca , Enfermedad Pulmonar Obstructiva Crónica , Anciano , Bangladesh , Estudios Transversales , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Calidad de Vida
6.
Georgian Med News ; (311): 85-88, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33814397

RESUMEN

The aim of our study was to study prevalence and clinical importance of Hyperuricemia (HU) in patients with heart failure (HF). 126 patients with HF were involved in a study. Main group included 75 patients with HF and HU. 51 patients with HF without HU were included in the control group. All patients underwent to a standardized clinical evaluation, including physical examination, determination of NYHA class and laboratory studies; namely, full blood count, serum uric acid, creatinine and ferritin. Assessment of exercise capacity was performed using a 6-min walk test. Echocardiographic assessment included interventricular septum thickness, left ventricular systolic and diastolic dimensions, left ventricular diastolic function, posterior wall thickness, left ventricular mass index and LVEF. Patients with HU had higher prevalence of diabetes mellitus than patients without HU. Patients with HU had significantly lower LVEF (38.2±7.0 and 44.5±5.1; respectively. P<0.05). No differences were recorded for body weight, diastolic blood pressure, platelets, serum creatinine, or presence of chronic obstructive pulmonary disease. Patients with HU had significantly thicker IVS, than those without it (10.49±2.9 vs 10.93 ±1.64mm; respectively. P<0.006). LV mass index was larger in patients with HU (P<0.001); There were no significant differences in LV end-systolic (LVESd) and end-diastolic (LVEDd) dimensions. Additionally, there were no differences in LV diastolic functional parameters. In both groups was decreased average distance walked and percentage of expected distance for healthy persons. Study results point out that female gender, higher NYHA class, low level of LVEF, the presence of hyperuricemia, lower than normal eGFR predict lower exercise capacity. Presented study demonstrates high prevalence of HU in patients with chronic heart failure. Despite high prevalence, historically the meaning of HU was underestimated in patients with HF. Taken into account the clinical relevance, treatability, and independent association with reduced exercise capacity, it is highly recommended to define HU level in all the patients with chronic heart failure to avoid future complications.


Asunto(s)
Insuficiencia Cardíaca , Hiperuricemia , Disfunción Ventricular Izquierda , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Humanos , Hiperuricemia/complicaciones , Hiperuricemia/epidemiología , Prevalencia , Ácido Úrico , Función Ventricular Izquierda
7.
Kardiologiia ; 61(3): 42-51, 2021 Mar 30.
Artículo en Ruso, Inglés | MEDLINE | ID: mdl-33849418

RESUMEN

Aim    To present clinical characteristics of patients after hospitalization for acute decompensated heart failure (ADHF) and to analyze hemodynamic indexes and compliance with the treatment at two years depending on the conditions of outpatient follow-up.Material and methods    The study included 942 patients with chronic heart failure (CHF) older than 18 years who had been hospitalized for ADHF. Based on patients' decisions, two groups were isolated: patients who continued the outpatient follow-up at the Center of CHF (CCHF) (group 1, n=510) and patients who continued the follow-up in outpatient multidisciplinary clinics (OMC) at their place of residence (group 2, n=432). The clinical portrait of patients was evaluated after ADHF, and hemodynamic parameters were evaluated on discharge from the hospital. Also, the patient compliance with the treatment was analyzed during two years of follow-up. Statistical analysis was performed with Statistica 7.0 for Windows.Results    The leading causes for CHF included arterial hypertension, ischemic heart disease, atrial fibrillation, and type 2 diabetes mellitus. With the mean duration of hospitalization of 11 inpatient days, 88.1 % and 88.4 % of patients of groups 1 and 2 were discharged with complaints of shortness of breath; 62 % and 70.4 % complained of palpitations; and 73.6 % and 71.8 % complained of general weakness. On discharge from the hospital, the following obvious signs of congestion remained: peripheral edema in 54.3 % and 57.9 %; pulmonary rales in 28.8 % and 32.4 %; orthopnea in 21.4 % and 26.2 %; and cough in 16,5 % and 15.5 % of patients of groups 1 and 2, respectively. For the time of hospitalization, CHF patients did not achieve their targets of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR). Patients of group 1 achieved the recommended values of SBP, DBP and HR already at one year of the follow-up at CCHF. Patients of group 2 had no significant changes in hemodynamic indexes. At one and two years of the follow-up, group 2 showed a considerable impairment of the compliance with the basis therapy for CHF compared to group 1.Conclusions    During the short period of hospitalization (11 inpatient days), the patients retained pronounced symptoms of HF and clinical signs of congestion and did not achieve their hemodynamic targets. The patients who were followed up for a long time at CCHF were more compliant with the basis therapy, which resulted in improvement of hemodynamic indexes, compared to the patients who were managed in OMS at the place of residence.


Asunto(s)
Diabetes Mellitus Tipo 2 , Insuficiencia Cardíaca , Virus de la Fiebre Hemorrágica de Crimea-Congo , Fiebre Hemorrágica de Crimea , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Federación de Rusia/epidemiología
9.
Artículo en Inglés | MEDLINE | ID: mdl-33668276

RESUMEN

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.


Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Caracteres Sexuales
10.
J Med Internet Res ; 23(3): e26516, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33656440

RESUMEN

BACKGROUND: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). OBJECTIVE: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. METHODS: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. RESULTS: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.


Asunto(s)
Atención Ambulatoria , Análisis de Datos , Insuficiencia Cardíaca/epidemiología , Método de Montecarlo , Telemedicina/economía , Telemedicina/métodos , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Estudios de Cohortes , Análisis Costo-Beneficio , Hong Kong/epidemiología , Humanos , Cadenas de Markov , Pandemias , Años de Vida Ajustados por Calidad de Vida
15.
BMJ ; 372: n461, 2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33758001

RESUMEN

OBJECTIVE: To assess age differences in risk factors for incident heart failure in the general population. DESIGN: Pooled population based cohort study. SETTING: Framingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis. PARTICIPANTS: 24 675 participants without a history of heart failure stratified by age into young (<55 years; n=11 599), middle aged (55-64 years; n=5587), old (65-74 years; n=5190), and elderly (≥75 years; n=2299) individuals. MAIN OUTCOME MEASURE: Incident heart failure. RESULTS: Over a median follow-up of 12.7 years, 138/11 599 (1%), 293/5587 (5%), 538/5190 (10%), and 412/2299 (18%) of young, middle aged, old, and elderly participants, respectively, developed heart failure. In young participants, 32% (n=44) of heart failure cases were classified as heart failure with preserved ejection fraction compared with 43% (n=179) in elderly participants. Risk factors including hypertension, diabetes, current smoking history, and previous myocardial infarction conferred greater relative risk in younger compared with older participants (P for interaction <0.05 for all). For example, hypertension was associated with a threefold increase in risk of future heart failure in young participants (hazard ratio 3.02, 95% confidence interval 2.10 to 4.34; P<0.001) compared with a 1.4-fold risk in elderly participants (1.43, 1.13 to 1.81; P=0.003). The absolute risk for developing heart failure was lower in younger than in older participants with and without risk factors. Importantly, known risk factors explained a greater proportion of overall population attributable risk for heart failure in young participants (75% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 1%) were higher in young compared with elderly participants. CONCLUSIONS: Despite a lower incidence and absolute risk of heart failure among younger compared with older people, the stronger association and greater attributable risk of modifiable risk factors among young participants highlight the importance of preventive efforts across the adult life course.


Asunto(s)
Insuficiencia Cardíaca/etiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/epidemiología , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Estados Unidos/epidemiología
16.
Heart Fail Clin ; 17(2): 195-206, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673945

RESUMEN

Anemia is common in heart failure with preserved and reduced ejection fraction. It is independently associated with poor functional status, hospitalization, and reduced survival. Its etiology is complex and multifactorial. Hemodynamic and nonhemodynamic compensatory mechanisms have been discussed as a response to chronic anemia. Whether anemia is a risk marker of advanced disease or a risk factor for progressive heart failure is debated. Current guidelines recommend a diagnostic workup as a part of standard management. Studies investigating intravenous iron administration reported beneficial effects on clinical outcomes. This article reviews current information on anemia.


Asunto(s)
Anemia Ferropénica/epidemiología , Manejo de la Enfermedad , Insuficiencia Cardíaca/terapia , Comorbilidad , Salud Global , Insuficiencia Cardíaca/epidemiología , Humanos , Prevalencia , Factores de Riesgo
18.
Medicine (Baltimore) ; 100(10): e25121, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725910

RESUMEN

BACKGROUND: It is unclear whether there are false positive or negative results in the effects of sodium-glucose transporter 2 (SGLT2) inhibitors on various cardiovascular and renal outcomes in patients with type 2 diabetes. We aimed to explore this issue by a meta-analysis with trial sequential analysis. METHODS: We included randomized trials evaluating the effects of SGLT2 inhibitors on cardiorenal endpoints in type 2 diabetic patients. Eight endpoints evaluated in the study were fatal or nonfatal myocardial infarction (MI), fatal or nonfatal stroke, major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure (CVD or HHF), all-cause death (ACD), cardiovascular death (CVD), hospitalization for heart failure (HHF), and kidney function progression (KFP). Meta-analysis and trial sequential analysis was conducted for each endpoint. RESULTS: Seven randomized trials of SGLT2 inhibitors were included for pooled analysis. Compared with placebo, SGLT2 inhibitors significantly reduced the risk of MACE (HR 0.89, 95% confidence interval [CI] 0.84-0.94), MI (HR 0.91, 95% CI 0.84-0.99), CVD (HR 0.86, 95% CI 0.79-0.93), CVD or HHF (HR 0.77, 95% CI 0.73-0.82), HHF (HR 0.67, 95% CI 0.62-0.74), KFP (HR 0.63, 95% CI 0.56-0.70), and ACD (HR 0.88, 95% CI 0.83-0.94), whereas SGLT2 inhibitors did not have significant effects on stroke (HR 0.98, 95% CI 0.88-1.09). Trial sequential analyses for MI and stroke showed that cumulative Z curve did not cross trial sequential monitoring boundary and required information size, whereas those for the other 6 endpoints showed that cumulative Z curve crossed trial sequential monitoring boundary and/or required information size. CONCLUSIONS: Compared with placebo, SGLT2 inhibitors conclusively reduce the risk of MACE, CVD or HHF, ACD, CVD, HHF, and KFP in patients with type 2 diabetes, whereas the effects of SGLT2 inhibitors on MI and stroke are not conclusive and need to be further assessed in future studies with the adequate sample size to reject or accept the effect size.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/diagnóstico , Tasa de Filtración Glomerular/efectos de los fármacos , Insuficiencia Cardíaca/epidemiología , Infarto del Miocardio/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Accidente Cerebrovascular/epidemiología , Causas de Muerte , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/prevención & control , Progresión de la Enfermedad , Tasa de Filtración Glomerular/fisiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
19.
Cochrane Database Syst Rev ; 3: CD013879, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33704775

RESUMEN

BACKGROUND: A small minority of people with coronavirus disease 2019 (COVID-19) develop a severe illness, characterised by inflammation, microvascular damage and coagulopathy, potentially leading to myocardial injury, venous thromboembolism (VTE) and arterial occlusive events. People with risk factors for or pre-existing cardiovascular disease may be at greater risk. OBJECTIVES: To assess the prevalence of pre-existing cardiovascular comorbidities associated with suspected or confirmed cases of COVID-19 in a variety of settings, including the community, care homes and hospitals. We also assessed the nature and rate of subsequent cardiovascular complications and clinical events in people with suspected or confirmed COVID-19. SEARCH METHODS: We conducted an electronic search from December 2019 to 24 July 2020 in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, covid-19.cochrane.org, ClinicalTrials.gov and EU Clinical Trial Register. SELECTION CRITERIA: We included prospective and retrospective cohort studies, controlled before-and-after, case-control and cross-sectional studies, and randomised controlled trials (RCTs). We analysed controlled trials as cohorts, disregarding treatment allocation. We only included peer-reviewed studies with 100 or more participants, and excluded articles not written in English or only published in pre-print servers. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results and extracted data. Given substantial variation in study designs, reported outcomes and outcome metrics, we undertook a narrative synthesis of data, without conducting a meta-analysis. We critically appraised all included studies using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the JBI checklist for case series. MAIN RESULTS: We included 220 studies. Most of the studies originated from China (47.7%) or the USA (20.9%); 9.5% were from Italy. A large proportion of the studies were retrospective (89.5%), but three (1.4%) were RCTs and 20 (9.1%) were prospective. Using JBI's critical appraisal checklist tool for prevalence studies, 75 studies attained a full score of 9, 57 studies a score of 8, 31 studies a score of 7, 5 studies a score of 6, three studies a score of 5 and one a score of 3; using JBI's checklist tool for case series, 30 studies received a full score of 10, six studies a score of 9, 11 studies a score of 8, and one study a score of 5 We found that hypertension (189 studies, n = 174,414, weighted mean prevalence (WMP): 36.1%), diabetes (197 studies, n = 569,188, WMP: 22.1%) and ischaemic heart disease (94 studies, n = 100,765, WMP: 10.5%)  are highly prevalent in people hospitalised with COVID-19, and are associated with an increased risk of death. In those admitted to hospital, biomarkers of cardiac stress or injury are often abnormal, and the incidence of a wide range of cardiovascular complications is substantial, particularly arrhythmias (22 studies, n = 13,115, weighted mean incidence (WMI) 9.3%), heart failure (20 studies, n = 29,317, WMI: 6.8%) and thrombotic complications (VTE: 16 studies, n = 7700, WMI: 7.4%). AUTHORS' CONCLUSIONS: This systematic literature review indicates that cardiometabolic comorbidities are common in people who are hospitalised with a COVID-19 infection, and cardiovascular complications are frequent. We plan to update this review and to conduct a formal meta-analysis of outcomes based on a more homogeneous selected subsample of high-certainty studies.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Arritmias Cardíacas/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/epidemiología , Incidencia , Isquemia Miocárdica/epidemiología , Obesidad/epidemiología , Prevalencia , Trombosis/epidemiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...