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Background
Patients with underlying heart failure (HF) in the setting of COVID-19 who require admission to the intensive care unit (ICU) might present with a unique set of challenges. This study aims to extensively describe the characteristics and outcomes of patients with HF who were admitted to ICU with COVID-19.
Methods
We conducted a multicent...
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Citations
... The first case of COVID-19 was diagnosed in 2019 in Wuhan, China, and the number of cases continued to increase, with the highest risk of mortality observed among patients with comorbid conditions. [1][2][3] Patients with a history of heart failure had a higher risk of death, mechanical ventilation, and longer hospitalization. [3,4] Management modalities, including drug therapy and devices for patients with advanced heart failure, have evolved significantly over the years, with a focus on improving survival, reducing hospitalizations, and enhancing quality of life. ...
... [1][2][3] Patients with a history of heart failure had a higher risk of death, mechanical ventilation, and longer hospitalization. [3,4] Management modalities, including drug therapy and devices for patients with advanced heart failure, have evolved significantly over the years, with a focus on improving survival, reducing hospitalizations, and enhancing quality of life. Mechanical ...
Rationale
Management of coronavirus disease 2019 (COVID-19) has been the subject of extensive research and study, leading to the development of strategies and treatments. Nonetheless, there remains a dearth of information concerning patients who require mechanical circulatory system support. This case report presents one of the first documented cases of successful utilization of nirmatrelvir/ritonavir (Paxlovid) and dexamethasone in the treatment of a patient with a total artificial heart.
Patient concerns
The patient in this case study was a 28-year-old male who had been experiencing severe heart failure. In need of a heart transplant, he underwent a procedure for implantation of a total artificial heart as a bridge to transplantation.
Diagnoses
Unfortunately, after the surgical intervention, the patient contracted COVID-19, as confirmed by polymerase chain reaction.
Interventions
The therapeutic approach involved a 5-day regimen of nirmatrelvir/ritonavir at a dosage of 300/100 mg administered twice daily, along with a daily dosage of 6 mg of dexamethasone.
Outcomes
Remarkably, the patient oxygenation level improved on the second day of therapy. Consequently, he was transferred from the intensive care unit to the general floor. After 71 days with the total artificial heart, the patient successfully underwent heart transplantation.
Lessons
This case report provides a compelling example of the successful application of nirmatrelvir/ritonavir and dexamethasone in the treatment of a COVID-19 patient with a total artificial heart. The positive outcome observed in this case underscores the potential use of these therapeutic agents in this specific patient population. However, it is imperative to conduct further research to corroborate and validate these initial findings. This study lays the foundation for further exploration of the efficacy of these drugs in patients with mechanical circulatory support systems.
... This disease, also called coronavirus disease 2019 (COVID- 19), initially emerged as an infectious disease, currently has been known to promote a multiorgan response (1). COVID-19 is associated with several cardiovascular complications (2). ...
Background
Coronary artery disease (CAD) has been frequently recognized as a risk factor for poor prognosis in COVID-19 patients. Syntax score is an invasive coronary angiographic-based tool used to determine the severity of CAD. In this study, we aim to investigate the prognostic significance of syntax score for mortality and morbidity among COVID-19 patients.
Methods
In this cross-sectional study, we have included patients with confirmed COVID-19 diagnosis who underwent percutaneous coronary intervention (PCI). Based on angiographic records, the CAD complexity was measured by Syntax score, and echocardiographic variables were documented. The laboratory data were obtained from the HISS database of the hospital. All patients were followed up one month after discharge for new cardiovascular events, rehospitalization, heart failure (HF), stent thrombosis, cerebrovascular accidents, and death.
Results
In one month, 108 patients were included in the study. The mean age was 64.8 ± 11.6, and 74% were male. The Cox regression model found no association between the Syntax score and the composite outcomes. In the univariate cox proportional HR model, MPV, LDH, and ESR were found to have predictive significance for in-hospital death. AKI was resulted to be significantly associated with rehospitalization in multivariate analysis.
Conclusion
The present study did not find a significant association between adverse outcomes and syntax score in COVID-19 patients referred for PCI. Acute kidney injury and duration of ICU stay was found to be the main factor predicting rehospitalization and HF. Future studies are needed to confirm these findings.
... Age ≥60 years had a consistently strong adverse influence on prognosis, and there was a notable association between age ≥60 years and male sex. These findings are compatible with those in various other reports, including those of Saleh et al., 15 Alvarez-Garcia et al., 16 the SEMI-COVID-19 registry 17 (which included 1718 patients and reported an overall mortality rate of 47.6%), and Belarte-Tornero et al. 11 Also of note is the study by Bhatt et al., 18 whose retrospective analysis of 8383 HF patients hospitalized with COVID-19 identified male sex, morbid obesity, and greater age as being associated with higher risk of mortality. Mortality in that database analysis of patients with HF plus COVID-19 approached 25%, a value even higher than that in our registry. ...
Aims
To study all-cause mortality in patients hospitalized with COVID-19 with or without chronic heart failure (CHF) during hospitalization and at 3 and 6 months of follow-up.
Methods and results
The international registry Analysis of Comorbid Disease Dynamics in Patients with SARS-CoV-2 Infection (ACTIV) was conducted at 26 centres in seven countries: Armenia, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russian Federation, and Uzbekistan. The primary endpoints were in-hospital all-cause mortality and all-cause mortality at 3 and 6 months of follow-up.
Of the 5616 patients hospitalized with COVID-19, 917 (16.3%) had CHF. Total in-hospital mortality was 7.6%. In-hospital mortality was higher in patients with CHF than in patients without a history of CHF [17.7% vs. 4.0%, P < 0.001; odds ratio (OR) 4.614, 95% confidence interval (CI) 3.633–5.859; P < 0.001]. The risk of in-hospital all-cause mortality correlated significantly with the severity of CHF; specifically, the risk of in-hospital all-cause mortality was greater for patients in New York Heart Association functional classes III and IV (OR 6.124, 95% CI 4.538–8.266; P < 0.001 vs. patients without CHF) than for patients in functional classes I and II (OR 2.446, 95% CI 1.831–3.267, P < 0.001 vs. patients without CHF). The risk of mortality in patients with ischemic CHF was 58% higher than in patients with non-ischaemic CHF [OR 1.58 (95% CI 1.05–2.45), P = 0.030]. In the first 3 months of follow-up, the all-cause mortality rate in patients with CHF was 10.32%, compared with 1.83% in patients without CHF (P < 0.001). At 6 months of follow-up, NYHA classes II–IV was a strong risk factor for all-cause mortality [OR 5.343 (95% CI 2.717–10.508); P < 0.001].
Conclusions
Hospitalized COVID-19 patients with CHF have an increased risk of in-hospital all-cause mortality, which remains high 6 months after discharge.
... A doença afeta diversos órgãos e tem gerado uma série de dúvidas quanto às novas formas de apresentação. Ainda que grande parte do foco tenha sido nas complicações pulmonares, é importante que os profissionais de saúde estejam cientes das complicações cardiovasculares, que podem contribuir significativamente para a mortalidade associada a esta doença (14)(15)(16)(17)(18)(19)(20)(21) . ...
... A prevalência de doença cardiovascular em pacientes com COVID-19 não é totalmente clara, mas a doença cardiovascular preexistente pode estar associada a uma infecção mais grave por COVID-19 (21,24,(33)(34)(35) . Além disso, pacientes com a infecção por COVID-19, podem evoluir para complicações cardiovasculares resultando em óbito, mesmo aqueles sem comorbidades prévias (17,18,(36)(37)(38)(39) . Uma meta-análise de 1.527 pacientes com COVID-19 descobriu que a prevalência de hipertensão foi 17,1% e doença cardíaca foi de 16,4%, e que esses pacientes eram mais propensos a necessitar de cuidados intensivos (34) . ...
A COVID-19 é uma doença que surgiu no final do ano de 2019, na China, e rapidamente disseminou por outros países, causando uma pandemia a nível mundial. As manifestações da COVID-19 incluem principalmente, problemas respiratórios, mas também pode causar complicações graves em diversos outros órgãos. Complicações cardiovasculares são comuns e afetam, majoritariamente, indivíduos com cardiopatias prévias. O objetivo desta revisão foi fornecer evidências com uma visão geral sobre as complicações cardiovasculares associadas à COVID-19. Trata-se de uma revisão integrativa da literatura, com estudos publicados de janeiro de 2020 a dezembro de 2021. Foram considerados artigos completos publicados em revistas indexadas disponíveis nas bases de dados online como Scientific Electronic Library Online (SCIELO), Pubmed e Google Scholar. Identificamos que a lesão miocárdica e miocardite, infarto agudo do miocárdio, insuficiência cardíaca aguda e cardiomiopatia, disritmias e evento tromboembólico venoso são as principais complicações cardiovasculares associadas à COVID-19. Essas complicações podem significar o risco vital grave para pacientes com COVID-19 e é importante que profissionais emergencistas estejam cientes para tratá-las.
... Hypoxia plays a major role in COVID-19 mortality (8,9), and can trigger cardiorespiratory compensation which may fail causing lactic acid elevation, cardiovascular failure and death (10,11). Moreover, pre-existing cardiovascular diseases (CVD) or cardiovascular risk factors in subjects with COVID-19 can confer a higher risk of poor prognosis and increased mortality (12)(13)(14). ...
Background
The cardiovascular complications of Coronavirus Disease 2019 (COVID-19) may be attributed to the hyperinflammatory state leading to increased mortality in patients with COVID-19. HMG-CoA Reductase Inhibitors (statins) are known to have pleiotropic and anti-inflammatory effects and may have antiviral activity along with their cholesterol-lowering activity. Thus, statin therapy is potentially a potent adjuvant therapy in COVID-19 infection. This study investigated the impact of statin use on the clinical outcome of critically ill patients with COVID-19.
Methods
A multicenter, retrospective cohort study of all adult critically ill patients with confirmed COVID-19 who were admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on the statin use during ICU stay and were matched with a propensity score based on patient's age and admission APACHE II and SOFA scores. The primary endpoint was in-hospital mortality, while 30 day mortality, ventilator-free days (VFDs) at 30 days, and ICU complications were secondary endpoints.
Results
A total of 1,049 patients were eligible; 502 patients were included after propensity score matching (1:1 ratio). The in-hospital mortality [hazard ratio 0.69 (95% CI 0.54, 0.89), P = 0.004] and 30-day mortality [hazard ratio 0.75 (95% CI 0.58, 0.98), P = 0.03] were significantly lower in patients who received statin therapy on multivariable cox proportional hazards regression analysis. Moreover, patients who received statin therapy had lower odds of hospital-acquired pneumonia [OR 0.48 (95% CI 0.32, 0.69), P < 0.001], lower levels of inflammatory markers on follow-up, and no increased risk of liver injury.
Conclusion
The use of statin therapy during ICU stay in critically ill patients with COVID-19 may have a beneficial role and survival benefit with a good safety profile.
... Ao analisarmos a mortalidade, 39% dos pacientes incluídos evoluíram para óbito, outros estudos também encontraram um risco aumentado de morte em pacientes com diagnóstico de SARS-CoV-2 e doenças cardiovasculares (Ruan et al. 2020;Sokolski et al. 2022;Tomasoni et al. 2020). A mortalidade hospitalar na UTI foi maior nos pacientes com IC em comparação com pacientes sem IC (Saleh et al. 2021;Sokolski et al.2021). Apesar da maioria masculina entre os pacientes que faleceram, não houve diferença entre os sexos no número de óbitos. ...
Objetivo: Analisar o desenvolvimento de complicações durante a internação de pacientes com COVID-19 e IC. Método: Trata-se de um estudo observacional, quantitativo, a partir da revisão dos prontuários dos pacientes internados na Unidade de Doenças Respiratórias (UDR) de um Hospital Universitário do nordeste brasileiro, com RT-PCR reagente para SARS-COV2 e diagnóstico de IC. Resultados: Dos 77 pacientes, 51 (66,2%) apresentavam uma insuficiência cardíaca crônica agudizada (ICCa) enquanto os demais (n = 26; 33,8%) não tinham história de cardiopatia prévia e estavam apresentando o primeiro episódio de insuficiência cardíaca aguda (ICA). Aqueles com a classificação NYHA IV tiveram maior risco de desenvolver choque (p = 0,001), parada cardiorrespiratória (PCR) (p = 0,01), síndrome do desconforto respiratório agudo (SDRA) (p < 0,0001), bacteremia (p = 0,008), hemorragia e dano hepático (p = 0,04) como complicações. A taxa de mortalidade intra-hospitalar foi de 39% (n= 30). Ao analisar a relação entre o tipo de complicação desenvolvida com o desfecho óbito, choque, PCR, SDRA (p < 0,0001), pneumonia (p = 0,009), bacteremia (p = 0,0003), hemorragia, anemia (p = 0,02), arritmia cardíaca (p = 0,03) e dano hepático (p = 0,04) tiveram associação significante. Conclusão: A associação entre IC e COVID-19 na internação leva a uma alta taxa de mortalidade intra-hospitalar. Pacientes com a classe funcional NYHA IV possuem maior risco de desenvolver complicações e óbito durante internação. Além disso, os pacientes com IC e COVID-19 que desenvolvem pneumonia, SDRA, choque, PCR, anemia, hemorragia, arritmia, dano hepático e/ou bacteremia possuem maior taxa de mortalidade.
... 9,10 In critically ill patients with COVID-19, the risk of in-hospital and ICU mortality in patients with heart disease failure was significantly higher. 11 Most of the mortality in COVID-19 patients was attributed to respiratory-related complications. 12 However, a shred of growing evidence finds that increased mortality and morbidity related to cardiac complications, including new or worsening heart failure, new or worsening arrhythmia, myocardial infarction. ...
Purpose
Coagulation abnormalities are one of the most important complications of severe COVID-19, which might lead to venous thromboembolism (VTE). Hypercoagulability with hyperfibrinogenemia causes large vessel thrombosis and major thromboembolic sequelae. Statins are potentially a potent adjuvant therapy in COVID-19 infection due to their pleiotropic effect. This study aims to evaluate the effectiveness of statins in reducing the risk of thrombosis among hospitalized critically ill patients with COVID-19.
Methods
A multicenter, retrospective cohort study of all critically ill adult patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were categorized based on their usage of statins throughout their ICU stay and were matched with a propensity score. The primary endpoint was the odds of all cases of thrombosis; other outcomes were considered secondary.
Results
A total of 1039 patients were eligible; following propensity score matching, 396 patients were included (1:1 ratio). The odds of all thrombosis cases and VTE events did not differ significantly between the two groups (OR 0.84 (95% CI 0.43, 1.66), P = 0.62 and OR 1.13 (95% CI 0.43, 2.98), P = 0.81, respectively. On multivariable Cox proportional hazards regression analysis, patients who received statin therapy had lower 30-day (HR 0.72 (95 % CI 0.54, 0.97), P = 0.03) and in-hospital mortality (HR 0.67 (95 % CI 0.51, 0.89), P = 0.007). Other secondary outcomes were not statistically significant between the two groups except for D-dimer levels (peak) during ICU stay.
Conclusion
The use of statin therapy during ICU stay was not associated with thrombosis reduction in critically ill patients with COVID-19; however, it has been associated with survival benefits.
... Worsening of clinical symptoms can be related to various degrees of endothelial dysfunction, coagulopathy, platelet dysfunction, and hypercytokinemia. 2 Therefore, complications can occur in situ, such as acute respiratory distress syndrome, septic shock, thromboembolism, and multiple organ failure. 3 The prothrombotic state described in COVID-19 patients does not seem to stem from the classic pathophysiology associated with venous thromboembolism (VTE). 4,5 Anticoagulation has been extensively studied. ...
Background
Aspirin is widely used as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. The literature has assessed and evaluated its role in hospitalized COVID-19 patients. However, no data are available regarding its role in COVID-19 critically ill patients. This study aimed to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in critically ill patients with COVID-19.
Method
A multicenter, retrospective cohort study of all critically ill adult patients with confirmed COVID-19 admitted to intensive care units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome was in-hospital mortality, and other outcomes were considered secondary. Propensity score matching was used (1:1 ratio) based on the selected criteria.
Results
A total of 1033 patients were eligible, and 352 patients were included after propensity score matching. The in-hospital mortality (HR 0.73 [0.56, 0.97], p = 0.03) was lower in patients who received aspirin during stay. Conversely, patients who received aspirin had a higher odds of major bleeding than those in the control group (OR 2.92 [0.91, 9.36], p = 0.07); however, this was not statistically significant. Additionally, subgroup analysis showed a possible mortality benefit for patients who used aspirin therapy prior to hospitalization and continued during ICU stay (HR 0.72 [0.52, 1.01], p = 0.05), but not with the new initiation of aspirin (HR 1.22 [0.68, 2.20], p = 0.50).
Conclusion
Continuation of aspirin therapy during ICU stay in critically ill patients with COVID-19 who were receiving it prior to ICU admission may have a mortality benefit; nevertheless, it may be associated with an increased risk of significant bleeding. Appropriate evaluation for safety versus benefits of utilizing aspirin therapy during ICU stay in COVID19 critically ill patients is highly recommended.
... Worsening of clinical symptoms can be related to various degrees of endothelial dysfunction, coagulopathy, platelet dysfunction, and hypercytokinemia. 2 Therefore, complications can occur in situ, such as acute respiratory distress syndrome, septic shock, thromboembolism, and multiple organ failure. 3 The prothrombotic state described in COVID-19 patients does not seem to stem from the classic pathophysiology associated with venous thromboembolism (VTE). 4,5 Anticoagulation has been extensively studied. ...
Background
Aspirin is widely used as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. The literature has assessed and evaluated its role in hospitalized COVID-19 patients. However, no data are available regarding its role in COVID-19 critically ill patients. This study aimed to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in critically ill patients with COVID-19.
Method
A multicenter, retrospective cohort study of all critically ill adult patients with confirmed COVID-19 admitted to intensive care units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome was in-hospital mortality, and other outcomes were considered secondary. Propensity score matching was used (1:1 ratio) based on the selected criteria.
Results
A total of 1033 patients were eligible, and 352 patients were included after propensity score matching. The in-hospital mortality (HR 0.73 [0.56, 0.97], p = 0.03) was lower in patients who received aspirin during stay. Conversely, patients who received aspirin had a higher odds of major bleeding than those in the control group (OR 2.92 [0.91, 9.36], p = 0.07); however, this was not statistically significant. Additionally, subgroup analysis showed a possible mortality benefit for patients who used aspirin therapy prior to hospitalization and continued during ICU stay (HR 0.72 [0.52, 1.01], p = 0.05), but not with the new initiation of aspirin (HR 1.22 [0.68, 2.20], p = 0.50).
Conclusion
Continuation of aspirin therapy during ICU stay in critically ill patients with COVID-19 who were receiving it prior to ICU admission may have a mortality benefit; nevertheless, it may be associated with an increased risk of significant bleeding. Appropriate evaluation for safety versus benefits of utilizing aspirin therapy during ICU stay in COVID19 critically ill patients is highly recommended.
... In critically ill patients with COVID-19, the risks of ICU and in-hospital mortality in patients with underlying heart failure were signi cantly higher, reaching 44.6% and 39%, respectively. [10] The use of statin therapy has been associated with reduced CV risk and CV death in non-COVID-19 patients [11]. Therefore, the international guidelines recommend using statin therapy in patients with atherosclerotic vascular disease (ASCVD) risk factors or existing ASCVD/CVD as primary or secondary prevention or cholesterol-lowering [12][13][14]. ...
Purpose
The complications of Severe Corona Virus Disease 2019 (COVID-19) are attributed to the overproduction of early response proinflammatory cytokines, causing a systemic hyperinflammatory state. Statins are potentially a potent adjuvant therapy in COVID-19 infection due to their pleiotropic and anti-inflammatory effects, which are independent of their cholesterol-lowering activity. This study investigates the impact of statin use on the outcome of critically ill patients with COVID-19.
Methods
A multicenter, retrospective cohort study of all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on statin use during ICU stay and were matched with a propensity score which was based on patient’s age and admission APACHE II and SOFA scores. The primary endpoint was in-hospital mortality. Other outcomes were considered secondary...
Results
A total of 1049 patients were eligible; 502 patients were included after propensity score matching (1:1 ratio). The 30-day (hazard ratio 0.75 (95% CI 0.58, 0.98), P = 0.03) and in-hospital mortality (hazard ratio 0.69 (95% CI 0.54, 0.89), P = 0.004) were significantly lower in patients who received statin therapy on multivariable cox proportional hazards regression analysis. Moreover, patients who received statin have a lower risk of hospital-acquired pneumonia (OR 0.48(95% CI 0.32, 0.69), P = < 0.001), lower levels of markers of inflammation on follow up and no increased risk of liver injury.
Conclusion
The use of statin during ICU stay in COVID-19 critically ill patients may have a beneficial role and survival benefits with a good safety profile.
