Impact of the COVID-19 pandemic on gender disparities in acute coronary syndrome patterns.

Background: Global evidence has emerged showing fewer Acute Coronary Syndrome (ACS) cases than expected during the COVID-19 pandemic. Our study aims to evaluate the incidence of ACS before and after the onset of the COVID-19 pandemic and analyze differences in gender distribution, and type of presentation. Methods: This is a retrospective study of 997 patients who presented to Huntsville Hospital's catheterization lab for elective and emergency catheterization for ACS and non-ACS during a four-week period from February 26, 2020, to March 10, 2020, and from March 25, 2020, to April 8, 2020, and compared with the equivalent weeks in 2019. Results: We report a 45.5% decrease in ACS cases presenting during the COVID-19 pandemic between March 25, 2020, to April 8, 2020 compared to equivalent weeks in 2019, with a significant drop in percentage of female patients presenting by 30.6%. Upsurge in STEMI cases and a drop in NSTEMI cases was observed during the COVID pandemic compared to 2019. Conclusions: Patients presenting after the onset of the pandemic had elevated cardiac markers, representing higher severity and potentially presenting later in the disease course. The number of total ACS cases and percentage of females presenting to the catheterization lab before the COVID surge (February/March 2019 and 2020) almost remained stable. This comparison data provides validity that the drop in ACS case volume and females in March/April 2020 is more likely due to the pandemic and not due to improvements in overall cardiovascular health metrics. Reasons for this disparity are likely multifaceted and deserve further investigation.

The Impact of Atrial Fibrillation on Hospitalization Outcomes of Endovascular Repair of Abdominal Aortic Aneurysm.

OBJECTIVE: We aimed to study the impact of atrial fibrillation (AF) on hospitalization outcomes of abdominal aortic artery (AAA) endovascular aneurysm repair (EVAR) at a large-scale sample size representative of the entire United States (U.S.) population. METHODS: We included all adults who were hospitalized in the U.S. for AAA repair with EVAR between 2016 and 2017 using the International Classification of Diseases-10th Revision, Clinical procedural diagnosis codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were stroke, myocardial infarction, respiratory failure, acute kidney injury (AKI), bleeding event, vascular complications, aortic dissection, length of stay (LOS), and hospitalization cost. Hospitalization outcomes were modeled using logistic regression for binary outcomes and Poisson or log-gamma regression for count or right-skewed numeric outcomes, respectively. RESULTS: We included a total of 39,330 records for patients with AAA who underwent EVAR. There were 5.940 patients with AF. On multivariable analysis, EVAR patients with AF had significantly higher odds for mortality with adjusted OR 2.06 (95%CI: 1.09-3.91). They also had significantly higher odds for AKI (A-OR: 1.79 (95%CI: 1.38-2.32), p < 0.001), acute myocardial infarction (A-OR: 2.72 (95%CI: 1.39-5.32), p = 0.004), post procedural bleedings (A-OR: 1.51 (95%CI: 1.20-1.89), p < 0.001), LOS (1.35 (95%CI: 1.24-1.47) p < 0.001) and higher cost (A-OR: 1.06 (9% CI, 1.03-1.09) p < 0.001). There was no significant difference in risk of stroke, vascular complications, and aortic dissection. CONCLUSION: AF is an important independent predictor for mortality and adverse outcomes in patients with AAA undergoing EVAR.

Impact of Atrial Fibrillation on Hospitalization Outcomes of Heart Failure in Patients ≥ 60 Years with Implantable Cardioverter Defibrillator.

The impact of atrial fibrillation (AF) on the hospitalization outcomes in patients ≥ 60 years of age with implantable cardioverter defibrillators (ICD) is not well studied. We queried the National Inpatient Sample database for all patients aged ≥ 60 who had a history of ICD placement, and were admitted with a primary diagnosis of heart failure (HF) during the years 2016-2017. Patients were stratified into 2 groups based on their history of AF. The primary outcome of the study was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock, myocardial infarction (MI), ventricular fibrillation (VF), stroke and acute kidney injury (AKI). The association between different age strata and outcomes was investigated. The hospitalization outcomes were modeled using logistic regression. A total of 178,045 patients were included, of whom 56.2% had AF. AF correlated with increased mortality (A-OR 1.22 (95% CI: 1.06-1.4), p=0.005), cardiogenic shock (A-OR 1.21 (95%CI: 1.08-1.36), p<0.001), AKI (A-OR 1.12 (95%CI: 1.06-1.17), p<0.001 and lower risk for MI (A-OR 0.79 (95% CI: 0.68-0.9), p<0.001. There was no correlation between AF and risk for VF or stroke. A significant correlation between AF and higher risk for mortality, cardiogenic shock and AKI was demonstrated in ages ≤ 75, ≤ 75, and ≤ 80 years, respectively. In contrast, a significant correlation between AF and lower risk for MI is only demonstrated at age > 70 years. We conclude that AF is an independent predictor for increased all-cause in-hospital mortality and cardiogenic shock. Such risk is influenced by age.

Relation of Age to Survival in Patients with Obstructive Sleep Apnea who Develop an Acute Coronary Event (from the National Inpatient Sample).

This study was undertaken to investigate whether obstructive sleep apnea (OSA) produces a survival advantage in acute coronary syndrome (ACS), and to evaluate the mechanism of any benefit, including the impact of age and other risk factors. The National Inpatient Sample was queried for all patients who were admitted for ACS during the years 2013 to 2014. The primary outcomes were all-cause in-hospital mortality and cardiogenic shock (CS). Multivariable logistic regression was used for analysis. A total of 1,080,340 patients with ACS were included, 63,255 patients had OSA. The majority of patients were males (60.3%) and of Caucasian race (75%). The mean age was 67 years (SEM: 0.1). Despite a higher burden of risk factors and older age, OSA patients had a lower risk for mortality and cardiogenic shock adjusted OR 0.68 (95%CI 0.61-0.75), p <0.001 and 0.81 (95%CI: 0.74 to 0.89), p <0.001 respectively. Age was an important effect modifier. Survival advantage and lower risk for CS arises at the age above 55 and become more apparent with increasing age. In conclusion, despite a higher CV risk profile, and older age, OSA produces a survival benefit in ACS. Age is a significant modifier of risk in OSA patients with ACS. Ischemic preconditioning might explain these results.

Hereditary Hemorrhagic Telangiectasia in a Sudanese Patient.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu syndrome is a rare autosomal dominant disorder, which results in vascular dysplasia affecting mainly visceral and mucocutaneous organs. Case Presentation. A 65-year-old woman with a 12-year history of recurrent spontaneous epistaxis presented with shortness of breath, easy fatigability, and bilateral lower limb edema. Her family history was significant for definite hereditary hemorrhagic telangiectasia in first-degree relatives. During the previous 15 days, she has experienced three episodes of recurrent nasal bleeding. She has a background of chronic mitral regurgitation. Physical examination revealed telangiectases in her tongue, lower lip, and hand in addition to signs of congestive heart failure. The patient met 3\4 Curacao criteria and had a definite HHT. Her laboratory workup revealed a hemoglobin count of 5.4 g/dl. Echocardiography revealed a left systolic ejection fraction of 51% with left atrial dilatation and severe mitral regurgitation. Chest X-ray showed features of cardiomegaly and pulmonary edema. The abdominal ultrasonography showed enlarged liver size with homogenous texture and congested hepatic veins without features of hepatic AVMs. She was treated with intravenous frusemide, iron supplement, tranexamic acid, blood transfusion, and nasal packing. CONCLUSIONS: HTT usually passes unnoticed in Sudan. The rarity of HHT, difficulties in affording diagnostic imaging studies, and low clinical suspicion among doctors are important contributing factors. Anemia resulting from recurrent epistaxis might have an influential role in precipitating acute heart failure in those with chronic rheumatic valvular disease.