Corpus overview


MeSH Disease

Human Phenotype


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    Hospital Admission Rates, Length of Stay and In-hospital Mortality for Common Acute Care Conditions in COVID-19 vs. Pre-COVID-19 Era

    Authors: Adeel A Butt; Anand B Kartha; Naseer A Masoodi; Aftab M Azad; Nidal A Asaad; Mohamad U Alhomsi; Huda A Saleh; Roberto Bertollini; Abdul-Badi Abou-Samra

    doi:10.1101/2020.08.04.20167890 Date: 2020-08-04 Source: medRxiv

    Background Impact of COVID-19 upon acute care admission rates and patterns are unknown. We sought to determine the change in rates and types of admissions to tertiary and specialty care hospitals in the COVID-19 era compared with pre-COVID-19 era. Methods Acute care admissions to the largest tertiary care referral hospital, designated national referral centers for cardiac, cancer and maternity hospital in the State of Qatar during March 2020 (COVID-19 era) and January 2020 and March 2019 (pre-COVID-19 era) were compared. We calculated total admissions, and admissions for eight specific acute care conditions, in-hospital mortality rate and length of stay at each hospital. Results A total of 18,889 hospital admissions were recorded. A sharp decline ranging from 9%-75% was observed in overall admissions. A decline in both elective and non-elective surgeries was observed. A decline of 9%-58% was observed in admissions for acute appendicitis MESHD, acute coronary syndrome MESHD, stroke MESHD stroke HP, bone fractures MESHD bone fractures HP, cancer and live births, while an increase in admissions due to respiratory tract infections MESHD respiratory tract infections HP was observed. Overall length of stay was shorter in the COVID-19 period possibly suggesting lesser overall disease MESHD severity, with no significant change in in-hospital mortality. Unadjusted mortality rate for Qatar showed marginal increase in the COVID-19 period. Conclusions We observed a sharp decline in acute care hospital admissions, with a significant decline in admissions due to seven out of eight acute care conditions. This decline was associated with a shorter length of stay, but not associated with a change in in-hospital mortality rate.

    Trends of in-hospital and 30-day mortality after percutaneous coronary intervention in England before and after the COVID-19 era

    Authors: Mohamed O Mohamed; Tim Kinnaird; Nick Curzen; Peter Ludman; Jianhua Wu; Muhammad Rashid; Ahmad Shoaib; Mark de Belder; John Deanfield; Chris Gale; Mamas A Mamas

    doi:10.1101/2020.07.18.20155549 Date: 2020-07-27 Source: medRxiv

    Objectives: To examine short-term primary causes of death MESHD after percutaneous coronary intervention (PCI) in a national cohort before and during COVID-19. Background: Public reporting of PCI outcomes is a performance SERO metric and a requirement in many healthcare systems. There are inconsistent data on the causes of death MESHD after PCI, and what proportion of these are attributable to cardiac causes. Methods: All patients undergoing PCI in England between 1st January 2017 and 10th May 2020 were retrospectively analysed (n=273,141), according to their outcome from the date of PCI; no death MESHD and in-hospital, post-discharge, and 30-day death MESHD. Results: The overall rates of in-hospital and 30-day death MESHD were 1.9% and 2.8%, respectively. The rate of 30-day death MESHD declined between 2017 (2.9%) and February 2020 (2.5%), mainly due to lower in-hospital death MESHD (2.1% vs. 1.5%), before rising again from 1st March 2020 (3.2%) due to higher rates of post-discharge mortality. Only 59.6% of 30-day deaths MESHD were due to cardiac causes, the most common being acute coronary syndrome MESHD, cardiogenic shock MESHD cardiogenic shock HP and heart failure MESHD, and this persisted throughout the study period. 10.4% of 30-day deaths MESHD after 1st March 2020 were due to confirmed COVID-19. Conclusions: In this nationwide study, we show that 40% of 30-day deaths MESHD are due to non-cardiac causes. Non-cardiac deaths MESHD have increased even more from the start of the COVID-19 pandemic, with one in ten deaths MESHD from March 2020 being COVID-19 related. These findings raise a question of whether public reporting of PCI outcomes should be cause-specific.

    The Impact of the COVID-19 Pandemic on the Emergency MESHD Department Visits: A Retrospective Analysis in Shanghai, China

    Authors: Wei Long; Jiudong Hu; Lijuan Li; Sheng Zuo; Qian Yang; Zenghua Ren

    doi:10.21203/ Date: 2020-07-27 Source: ResearchSquare

    BackgroundThe novel coronavirus diseases MESHD (COVID-19) has led to a pandemic and affected people's lives greatly, including their health seeking behavior. We aimed to evaluate the impact of the current COVID-19 pandemic on characteristics and trends of emergency MESHD department (ED) visits in Shanghai, China.MethodsThis was a retrospective observational study using medical record databases from the Shanghai Sixth People's Hospital (East Campus) for years 2016 through 2020. All the patients referred to the ED between January 2016 and June 2020 were retrospectively reviewed. January 1, 2020, was chosen as the cutoff date for the statistical analysis and data of January and February in 2020 was compared with the same period of 2019.ResultsDuring the first two months of 2020, there was a 60.9% decline in ED visits when compared with the same period of 2019 (9,904 vs. 25,316, respectively), and the waiting time in ED has been greatly reduced correspondingly (12±4 vs. 66±19 min, p < 0.001); ED visits for acute ischemic stroke HP stroke MESHD (AIS) and acute coronary syndrome MESHD(ACS) decreased by 53.9% and 41.2% respectively; proportion of intravenous thrombolysis for AIS has dropped(42.1% vs. 11.4%, p = 0.003), and percutaneous coronary intervention for ACS was similar (70.6% vs. 63.3%, p = 0.668); and onset-to-door time (ODT) of these patients increased significantly (AIS: 217(136-374) vs. 378(260-510)min, ACS: 135(85-195) vs. 226(155-368)min, all p < 0.001).ConclusionThe outbreak of COVID-19 pandemic was correlated with a significant decline in the number of ED visits including AIS and ACS patients when compared to the pre-COVID-19 period. ODT of AIS and ACS patients increased significantly. Raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated stroke MESHD stroke HP and myocardial infarction MESHD myocardial infarction HP attack.

    Place and causes of acute cardiovascular mortality during the COVID19 pandemic: retrospective cohort study of 580,972 deaths MESHD in England and Wales, 2014 to 2020

    Authors: Jianhua Wu; Mamas Mamas; Mohamed Mohamed; Chun Shing Kwok; Chris Roebuck; Ben Humberstone; Tom Denwood; Tom Luescher; Mark De Belder; John Deanfield; Chris Gale

    doi:10.1101/2020.07.14.20153734 Date: 2020-07-16 Source: medRxiv

    Importance. The COVID-19 pandemic has resulted in a decline in admissions with cardiovascular (CV) emergencies MESHD. The fatal consequences of this are unknown. Objectives - To describe the place and causes of acute CV death MESHD during the COVID-19 pandemic. Design - Retrospective nationwide cohort. Setting - England and Wales. Participants - All adult TRANS ( age TRANS [≥]18 years) acute CV deaths MESHD (n=580,972) between 1st January 2014 and 2nd June 2020. Exposure - The COVID-19 pandemic (defined as from the onset of the first COVID-19 death MESHD in England on 2nd March 2020). Main outcomes - Place (hospital, care home, home) and acute CV events directly contributing to death MESHD as stated on the first part of the Medical Certificate of Cause of Death MESHD. Results - After 2nd March 2020, there were 22,820 acute CV deaths MESHD of which 5.7% related to COVID-19, and an excess acute CV mortality of 1752 (+8%) compared with the expected daily deaths MESHD in the same period. Deaths MESHD in the community accounted for nearly half of all deaths MESHD during this period. Care homes had the greatest increase in excess acute CV deaths MESHD (1065, +40%), followed by deaths MESHD at home (1728, +34%) and in hospital (57, +0%). The most frequent cause of acute CV death MESHD during this period was stroke MESHD stroke HP (8,290, 36.3%), followed by acute coronary syndrome MESHD (ACS) (5,532, 24.2%), heart failure MESHD (5,280, 23.1%), pulmonary embolism MESHD pulmonary embolism HP (2,067, 9.1%) and cardiac arrest HP (1,037, 4.5%). Deep vein thrombosis MESHD had the greatest increase in cause of excess acute CV death MESHD (18, +25%), followed pulmonary embolism MESHD pulmonary embolism HP (340, +19%) and stroke MESHD stroke HP (782, +10%). The greatest cause of excess CV death MESHD in care homes was stroke MESHD stroke HP (700, +48%), compared with cardiac arrest HP (80, +56%) at home, and pulmonary embolism MESHD pulmonary embolism HP (126, +14%) and cardiogenic shock MESHD cardiogenic shock HP (41, +14%) in hospital. Conclusions and relevance - The COVID-19 pandemic has resulted in an inflation in acute CV deaths MESHD above that expected for the time of year, nearly half of which occurred in the community. The most common cause of acute CV death MESHD was stroke MESHD stroke HP followed by acute coronary syndrome MESHD and heart failure MESHD. This is key information to optimise messaging to the public and enable health resource planning.

    The 4C Initiative (Clinical Care for Cardiovascular disease MESHD in the COVID-19 pandemic): monitoring the indirect impact of the coronavirus pandemic on services for cardiovascular diseases MESHD in the UK

    Authors: - TC CVD-COVID-UK Consortium; Simon Ball; Amitava Banerjee; Colin Berry; Jonathan Boyle; Benjamin Bray; William Bradlow; Afzal Chaudhry; Rikki Crawley; John Danesh; Alastair Denniston; Florian Falter; Jonine Figueroa; Christopher Hall; Harry Hemingway; Emily Jefferson; Tom Johnson; Graham King; Ken Lee; Paul McKean; Suzanne Mason; Nicholas Mills; Ewen Pearson; Munir Pirmohamed; Michael TC Poon; Rouven Priedon; Anoop Shah; Reecha Sofat; Jonathan Sterne; Fiona Strachan; Cathie LM Sudlow; Zsolt Szarka; William Whiteley; Mike Wyatt

    doi:10.1101/2020.07.10.20151118 Date: 2020-07-11 Source: medRxiv

    Background: The coronavirus (COVID-19) pandemic affects cardiovascular diseases MESHD (CVDs) directly through infection MESHD and indirectly through health service reorganisation and public health policy. Real-time data are needed to quantify direct and indirect effects. We aimed to monitor hospital activity for presentation, diagnosis and treatment of CVDs during the pandemic to inform on indirect effects. Methods: We analysed aggregate data on presentations, diagnoses and treatments or procedures for selected CVDs ( acute coronary syndromes MESHD, heart failure MESHD, stroke MESHD stroke HP and transient ischaemic attack, venous thromboembolism MESHD thromboembolism HP, peripheral arterial disease MESHD and aortic aneurysm MESHD aortic aneurysm HP) in UK hospitals before and during the COVID-19 epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. Findings: Nine hospitals across England and Scotland contributed hospital activity data from 28 Oct 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown), and for the same weeks during 2018-2019. Across all hospitals, total admissions and emergency MESHD department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1-58.6%) and 52.9% (52.2-53.5%) respectively compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown, and fell HP by 31-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm MESHD aortic aneurysm HP repair and peripheral arterial disease MESHD procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases MESHD and specialties between the first case and lockdown (total ED attendances RR 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. Interpretation: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

    Cardiovascular Implications of Coronavirus Disease MESHD 2019 (COVID-19): A Systematic Review

    Authors: Ravi Ranjan Pradhan; Ajay Kumar Yadav; Shobha Mandal

    doi:10.21203/ Date: 2020-07-02 Source: ResearchSquare

    Background: World Health Organization has declared Coronavirus disease MESHD (COVID-19) as a Public Health Emergency MESHD of International Concern. It has killed thousands and millions are infected worldwide. Though COVID-19 is supposed to be primarily a disease MESHD of respiratory system, it also has widespread implications on other systems as well. The aim of this systematic review is to summarize the cardiovascular implications of COVID-19. Methods: PubMed, PubMed Central, EMBASE, and Google Scholar were searched for peer-reviewed articles which aimed to delineate the cardiovascular implications of COVID-19.Results: A total of six articles (five original articles and one case report) were included. We found diverse cardiovascular implications of COVID-19 ranging from acute cardiac injury to death MESHD. New onset abnormalities in electrocardiogram or echocardiogragram, elevated plasma SERO levels of cardiac troponin, NT-proBNP, and D-dimer have role in early identification of acute cardiac injury in such patients. Additionally, cardiac troponin and NT-proBNP can be used to evaluate prognosis and possible need for intensive care in these patients.Conclusion: Acute cardiac injury is common in patients with COVID-19. Aggressive supportive management based on prognostic indicators along with management of heart failure MESHD, arrhythmias HP, acute coronary syndrome MESHD and thrombosis MESHD can improve clinical outcomes in such patients.

    Modeling the effect of COVID-19 disease MESHD on the cardiac function: a computational study

    Authors: Francesco Regazzoni; Christian Vergara; Paolo Zunino; Marco Guglielmo; Roberto Scrofani; Laura Fusini; Chiara Cogliati; Gianluca Pontone; Alfio Quarteroni

    doi:10.1101/2020.06.23.166421 Date: 2020-06-23 Source: bioRxiv

    BackgroundThe effect of COVID-19 on the cardiac function and on the vascular system increases the morbidity and mortality of infected subjects with cardiovascular diseases MESHD. ObjectivesTo provide preliminary results on cardiac global outcomes (such as cardiac output, ventricular pressures) obtained by means of computational models in plausible scenarios characterized by COVID-19. MethodsWe considered a lumped parameters computational model of the cardiovascular system, which models, from the mechanical point of view, the systemic and pulmonary circulations, the four cardiac valves and the four heart chambers, through mathematical equations of the underlying physical processes. To study the effect of COVID-19, we varied the heart rate, the contractility and the pulmonary resistances in suitable ranges. ResultsOur computations on individuals with both otherwise normal and impaired cardiac functions revealed that COVID-19 worsen cardiac function, as shown by a decrease of some cardiac biomarkers values such as cardiac output and ejection fraction. In the case of existing impaired cardiac function, the presence of COVID-19 lead to values outside the normal ranges. ConclusionsComputational models revealed to be an effective tool to study the effect of COVID-19 on the cardiovascular system. Such effect could be significant for patients with impaired cardiac function. This is especially useful to perform a sensitivity SERO analysis of the hemodynamics for different conditions. CONDENSED ABSTRACTEmerging studies address how COVID-19 infection MESHD might impact the cardiovascular system. This relates particularly to the development of myocardial injury, acute coronary syndrome MESHD, myocarditis MESHD myocarditis HP, arrhythmia HP, and heart failure MESHD. Prospective treatment approach is advised for these patients. By the assessment of conventional important biomarkers obtained with new sources as a 0-dimentional computational model, we propose a new study protocol as an effective method to evaluate short-term prognosis. The clinical protocol proposed will help to rapidly identify which patients require intensive monitoring, diagnostic strategy and most adequate therapy.

    Baseline echocardiographic assessment of left ventricle kinetics alteration and mortality risk in a cohort of critically ill COVID-19 patients

    Authors: Davide Ceccato; Beatrice Gusella; Mattia Grassi; Alessandro Toffolon; Anna Postal; Davide Gorgi; Federico Capone; Alois Saller; Alberto Cipriani; Cristiano Sarais; Roberto Vettor; Raffaele Pesavento

    doi:10.21203/ Date: 2020-06-15 Source: ResearchSquare

    Background SARS-CoV2 infection MESHD are frequently associated with cardiovascular manifestations, in particular with symptomatic acute coronary syndromes MESHD, cardiac arrhythmias MESHD arrhythmias HP and acute heart failure MESHD. However, the elevation of serum SERO troponin seems to be non specific, and a cardiologic diagnostic workup should be performed. We aimed to assess the clinical characteristic and the prevalence SERO of left ventricular (LV) dyssynergy patterns in a cohort of hospitalized non-critically ill COVID-19 patientsMethods Consecutive patients with an objective diagnosis of COVID-19, from February to April 2020. Baseline characteristics and comorbidities was collected. In case of increased troponin levels or symptoms suggestive for a concomitant cardiac syndrome MESHD, patients undergo to serial electrocardiograms, serial Troponin tests and bedside transthoracic echocardiogram.Results 402 consecutive patients were enrolled: 55 patients underwent an echocardiographic exam because of an increase in troponin levels or a suspected myocardial injury. Segmental left ventricular abnormalities were found in 10 (median WMSI 2.03 IQR 1.38-2.75) with a median LV ejection fraction was 30.1 % IQR, median troponin level was 3083 ng/L, median BNP was 761 ng/L. Death MESHD for any cause occurred in 4 patients among patients with regional LV abnormalities and in 3 with normal regional function (p= 0,02).Discussion A single bedside transthoracic echocardiogram performed in non critically ill COVID-19 patients with suspected cardiac injury has the potential to better assist clinicians in their challenging decision process. As an isolated increase of troponin levels is common in COVID patients, a bed-side echocardiographic evaluation of cardiac function should be routinely implemented during their early evaluation.

    Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients

    Authors: Estefanía Cantador MD; Alberto Núñez MD; Pilar Sobrino MD; Victoria Espejo MD; Lucía Fabia MD; Lydia Vela MD, PhD; Luis de Benito MD, PhD; Javier Botas MD, PhD, FESC

    doi:10.21203/ Date: 2020-05-23 Source: ResearchSquare

    A high incidence of thrombotic events, particularly deep vein thrombosis MESHD and pulmonary embolism MESHD pulmonary embolism HP, has been clearly documented in COVID-19 patients. In addition, small series of patients with coronary, cerebrovascular and peripheral arterial thrombotic events have also been reported, but their true incidence and consequences are not well described, and constitute the objective of this study. From February 1st to April 21st, 2020, 2,115 COVID-19 patients were treated at Hospital Universitario Fundación Alcorcón (Madrid, Spain), and 1,419 were eventually admitted. Patient characteristics and outcomes were collected by reviewing their electronic medical records. Fourteen patients had a systemic arterial thrombotic event, which represents a 1% incidence in relation to the total number of hospitalized patients. Three patients suffered an acute coronary syndrome MESHD, two with persistent ST-segment elevation HP, one of whom was treated invasively, and one with transient ST-segment elevation HP. Eight patients had a cerebrovascular event. Six suffered an acute ischemic stroke HP stroke MESHD and two a transient ischemic attack MESHD transient ischemic attack HP, 50% of them had a Rankin score ≥3 at discharge. Three additional patients had a limb thrombotic event, all of them infrapopliteal, and were managed conservatively.  All three cases developed necrosis MESHD of the toes, two of them with bilateral involvement. The hospitalization death MESHD rate of patients with an arterial event was 28.6%. Although COVID-19 may favor the occurrence of thrombotic events, the destabilization and thrombosis MESHD thrombosis of arterial HP of arterial atherosclerotic plaques MESHD do not seem to be a frequent mechanism which warrants the need for specific systematic preventive measures.

    Decline of emergency MESHD admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

    Authors: Viktoria Schwarz; Felix Mahfoud; Lucas Lauder; Wolfgang Reith; Stefanie Behnke; Sigrun Smola; Jürgen Rissland; Thorsten Pfuhl; Bruno Scheller; Michael Böhm; Sebastian Ewen

    doi:10.21203/ Date: 2020-05-19 Source: ResearchSquare

    Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. As concerns have been expressed regarding the underdiagnosing of harmful diseases MESHD. We explored the rates of emergency MESHD presentations for acute coronary syndrome MESHD (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency MESHD department and admissions for ACS and ACVE before (calendar weeks 1 to 9, 2020) and after (calendar weeks 10 to 16, 2020) the first coronavirus disease MESHD (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency MESHD department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p=0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency MESHD department visit volume decreased by 30% compared with the same period in 2019 (p=0.0012). Admissions due to ACS decreased by 41% (p=0.0023 for all; Δ -71% (p=0.007) for unstable angina MESHD, Δ -25% (p=0.42) for myocardial infarction with ST-elevation MESHD myocardial infarction HP and Δ -17% (p=0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1 to 9 to 62 patients in calendar weeks 10 to 16. ACVE decreased numerically by 20% (p=0.25 for all; transient ischemic attack MESHD transient ischemic attack HP: Δ -32% (p=0.18), ischemic stroke HP stroke MESHD: Δ -23% (p=0.48), intracerebral haemorrhage: Δ +57% (p=0.4)). There was no significant change in ACVE per week (p=0.7) comparing calendar weeks 1 to 9 (213 patients) and weeks 10 to 16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients ( prevalence SERO 1,54%, thereof one patient with myocardial and two with cerebral ischemia HP ischemia MESHD) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency MESHD department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

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MeSH Disease
Human Phenotype

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