Impact of COVID-19 Pandemic on Hospital Admissions of Acute Coronary Syndrome: A Beijing Inpatient Database Study

Abstract Background The obesity paradox – indicating improved short term mortality in obese individuals has been widely explored in a number of cardiovascular conditions. However, its validity in an elderly population and the possible physiological impact of aging on this phenomenon in Acute Coronary syndrome (ACS) remain unclear. In this study, we aim to determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in this cohort of patients. Methods A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Elderly adults (≥65 years) with a principal diagnosis of ACS and a secondary diagnosis of obesity were identified using ICD-9 diagnosis codes as described in the literature. The primary outcome of in-hospital mortality and secondary outcomes like length of hospital stay (LOS), and total hospitalization costs were analyzed. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model. Results In total, 1,137,108 hospital admissions with a primary diagnosis of ACS were identified, of which 7.46% were obese. In-hospital morality during the index admission was lower among obese patients with ACS compared to non-obese patients (4.62 vs 6.87%, p<0.001) with significantly lower 30-day readmission rates as well (p<0.001). However, in-hospital mortality rates during readmission were statistically equivalent between the obese and non-obese groups (5.6 vs 8.3%, p=0.72). LOS during the index admission was longer for obese patients (6.39 vs 5.36 days, p=0.65) but equivalent to non-obese patients during subsequent readmissions (p=0.12). The total cost of these admissions was significantly more in the obese cohort as well (p<0.001). Conclusion In this study, obese elderly patients admitted with ACS were found to have significantly reduced in-hospital mortality and 30-day readmission rates when compared to non-obese patients - reinforcing the obesity paradox independent of patient age. Funding Acknowledgement Type of funding source: None

Download Full-text

Global effect of COVID-19 pandemic on the rate of acute coronary syndrome admissions: a comprehensive review of published literature

Open Heart ◽

10.1136/openhrt-2021-001645 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001645

Author(s):

Ayman Helal ◽

Lamis Shahin ◽

Mahmoud Abdelsalam ◽

Mokhtar Ibrahim

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Admissions ◽

Absolute Risk ◽

Pearson Correlation ◽

Absolute Risk Reduction ◽

Healthcare Systems ◽

Global Effect ◽

Coronary Syndrome ◽

Admission Data ◽

St Elevation

BackgroundThe COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly.ObjectivesThe purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country.MethodSearch engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions.ResultsA total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175).ConclusionThere was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.

Download Full-text

Effect of cardiac rehabilitation on 24-month all-cause hospital readmissions: A prospective cohort study

European Journal of Cardiovascular Nursing ◽

10.1177/1474515118820176 ◽

2018 ◽

Vol 18 (3) ◽

pp. 234-244 ◽

Cited By ~ 8

Author(s):

Emma Thomas ◽

Mojtaba Lotfaliany ◽

Sherry L Grace ◽

Brian Oldenburg ◽

C Barr Taylor ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cohort Study ◽

Length Of Stay ◽

Cardiac Rehabilitation ◽

Hospital Readmission ◽

Hospital Admissions ◽

P Value ◽

Post Discharge ◽

Coronary Syndrome

Background: Ageing populations and increasing survival following acute coronary syndrome has resulted in large numbers of people living with cardiovascular disease and at high risk of hospitalizations. Rising hospital admissions have a significant financial cost to the healthcare system. Aim: The purpose of this study was to determine whether cardiac rehabilitation is protective against long-term hospital readmission (frequency and length) following acute coronary syndrome. Methods: Data from 416 Australian patients with acute coronary syndrome enrolled in the Anxiety Depression and heart rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) prospective cohort study between January 2013–June 2014 was analyzed secondarily. Participants self-reported cardiac rehabilitation attendance over the 12 months post-discharge. All-cause readmission data were extracted from hospital records 24 months post-index event. The association between cardiac rehabilitation and all-cause readmission, frequency of readmissions, and length of stay was assessed using three methods (a) regression analysis, (b) propensity score matching, and (c) inverse probability treatment weighting. Results: Overall, 416 patients consented (53% of eligible patients), of which 414 (99.5%) survived the first 30 days post-discharge and were included in the analysis. Medical records were located for 409 participants after 24 months (98% follow-up rate). In total, 267 (65%) reported attending cardiac rehabilitation; there were 392 readmissions by 239 patients. Cardiac rehabilitation attendance was not associated with all-cause hospital readmission; however, it was associated with lower frequency of hospital admissions (odds ratio 0.53, 95% confidence interval: 0.31–0.91 p-value:0.022) and length of stay (coefficient –1.21 days, 95% confidence interval: –2.46–0.26; marginally significant p-value: 0.055) in adjusted models. Conclusion: This study substantiates the long-term benefits of cardiac rehabilitation on readmissions, including length of stay, which would result in lower costs to the healthcare system.

Download Full-text

Photonic Crystal Sensors for the Rapid Detection of Myocardial Ischemia

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-176582 ◽

2007 ◽

Author(s):

Justin T. Baca ◽

David N. Finegold ◽

Sanford A. Asher

Keyword(s):

United States ◽

Coronary Heart Disease ◽

Acute Coronary Syndrome ◽

Myocardial Ischemia ◽

Rapid Detection ◽

Biochemical Markers ◽

Hospital Admissions ◽

Rapid Test ◽

The United States ◽

Coronary Syndrome

Coronary Heart Disease is the leading cause of death in the United States and was responsible for approximately one of every five deaths in 2003 [1]. Unnecessary admissions to US Hospitals of patients with suspected Acute Coronary Syndrome (ACS) is estimated to cost about 12 billion dollars a year [2]. The earliest biochemical markers currently assayed do not appear in the blood for hours after the onset of chest pain; a rapid test for myocardial ischemia would help to expedite treatment and avoid unnecessary hospital admissions [3].

Download Full-text

Orthopaedic corticosteroid injections and risk of acute coronary syndrome: a cohort study

British Journal of General Practice ◽

10.3399/bjgp20x713945 ◽

2020 ◽

pp. bjgp20X713945

Author(s):

Katharine Thomas ◽

Yochai Schonmann

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Cohort Study ◽

Cardiovascular Risk ◽

Hospital Admission ◽

Cardiovascular Risk Factors ◽

Hospital Admissions ◽

Musculoskeletal Conditions ◽

Coronary Syndrome ◽

Corticosteroid Injections

BackgroundCorticosteroid injections (CSIs) are a common treatment for arthritis and other musculoskeletal conditions.AimTo determine whether there is an increased incidence of acute coronary syndrome (ACS) following intra-articular and soft-tissue CSI.Design and settingCohort study in an urban primary care orthopaedic clinic.MethodData were reviewed from all patients aged ≥50 years and seen by orthopaedic specialists between April 2012 and December 2015, including CSI, hospital admission in the week following the orthopaedic visit, and cardiovascular risk factors. The incidence of an ACS-associated hospital admission was compared between visits in which patients received CSIs and visits in which patients did not.ResultsA total of 60 856 orthopaedic visits were reviewed (22 131 individual patients). The mean age was 70.9 years (standard deviation [SD] = 10.8), and 66.5% were female. Injections were administered in 3068 visits (5.1%). In the week following the visit there were 25 ACS hospital admissions (41 per 100 000 visits); seven events were after visits with an injection, and 18 were after non-injection visits. Patients who had received an injection were more likely to experience a subsequent ACS. (227 versus 31 events per 100 000 visits, odds ratio [OR] = 7.3; 95% confidence interval [CI] = 2.8 to 19.1). The association between receiving a CSI and ACS remained similar when the analysis was restricted to subgroups defined by age, sex, and cardiovascular risk factors.ConclusionCSI for musculoskeletal conditions may substantially increase the risk of ACS in the week following the injection. Although the absolute risk of ACS is small, the effect size appears to be clinically significant.

Download Full-text

Baseline thrombocytopenia in women with coronary heart disease increases incident acute coronary syndrome: insights from national inpatient database

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-020-02096-6 ◽

2020 ◽

Vol 50 (2) ◽

pp. 462-467

Author(s):

Sharan P. Sharma ◽

Rahul Chaudhary ◽

Priya Gupta ◽

Snigdha Kondur ◽

Nitya Gatla ◽

...

Keyword(s):

Coronary Heart Disease ◽

Acute Coronary Syndrome ◽

Heart Disease ◽

Coronary Syndrome ◽

Inpatient Database

Download Full-text

PM136 Predictors of mortality in patients with Acute Coronary Syndrome - A hospital admissions study: 2000-2013

Global Heart ◽

10.1016/j.gheart.2014.03.1529 ◽

2014 ◽

Vol 9 (1) ◽

pp. e88-e89

Author(s):

Mohammed Wasim ◽

Niece Khouw ◽

Jason S. McMinn ◽

Mudassar Baig ◽

Sarah Rose ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Admissions ◽

Predictors Of Mortality ◽

Coronary Syndrome

Download Full-text

Acute coronary syndrome in COVID-19 times: could it be business as usual?

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.070 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

J Ferreira ◽

M Fonseca ◽

JM Farinha ◽

AF Esteves ◽

A Pinheiro ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Admissions ◽

District Hospital ◽

Control Period ◽

Clinical Activity ◽

Class Iii ◽

Killip Class ◽

Coronary Syndrome ◽

Low Prevalence ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background In an attempt to cope with the COVID-19 pandemic, several measures of social distancing and reorganization of health care systems have been adopted. In Portugal, these included suspending elective clinical activity and a temporary national lockdown. Data from multiple centres, including central hospitals in Portugal, has shown a reduction in hospital admissions for acute coronary syndrome (ACS) during the COVID-19 outbreak. Fear of going to the hospital and physical inactivity have been pointed as possible explanations. Purpose to assess the impact of this pandemic and the measures taken against it on the pattern of admissions and treatment of patients with ACS in a district hospital. Methods A single-centre retrospective study was conducted in the Cardiology Department of a Portuguese district hospital, capable of performing 24h percutaneous coronary intervention. We analyzed the admissions for ACS during the peak of the first COVID-19 outbreak in Portugal (16th of March to 3rd of May 2020, coinciding with the suspension of elective activity) and compared it with two control periods: one immediately preceding the study period (27th of January to 15th of March - 2020 control) and one exactly one year before (16th of March to 3rd of May 2019 - 2019 control). Results During the 7 weeks of the first COVID-19 outbreak, 46 patients were hospitalized for ACS in our department, while 54 had been admitted during the 2020 control period and 40 in the 2019 control period, with a mean of 7 admissions/week (vs 8 and 6, respectively; p > 0.05). There were no significant differences between the study group and both controls regarding basal characteristics. Their presentation did not differ: the majority of patients (57%) was admitted for ST-elevation myocardial infarction and median time from symptom onset to admission to the emergency room was 3 hours, with 4% of patients presenting in Killip class ≥III (p > 0.05 for all). We also found no significant differences in the treatment administered nor in the outcomes (96% submitted to coronary angiography, median length of hospitalization of 4 days and in-hospital mortality rate of 2%, p > 0.05 for all). Conclusions Our study suggests that the reduction in admissions for ACS during the COVID-19 outbreak is not universal. Additionally, severity at presentation, treatment administered and outcomes did not seem to differ. The relatively low prevalence of COVID-19 in our hospital"s region might be the cause, since people might fear and refrain less from going to the hospital. Larger studies with other centres in low-prevalence regions are needed to confirm this hypothesis.

Download Full-text