684 Contribution of Pulmonary Diseases to COVID-19 Mortality in a Diverse Community of New York City

Abstract Introduction New York City has been one of the largest epicenters of the COVID-19 pandemic. This provided a wealth of data to examine the characteristics of COVID-19 patients in this multi-ethnic city, while assessing the contributions of cardio-metabolic burden and pulmonary conditions as potential “at-risk” conditions for COVID-19. We assessed the relative contribution of common upper and lower airway pulmonary diseases in determining the likelihood of COVID-19-related mortality independent of other medical conditions, health risks, and sociodemographic factors. Methods We analyzed data from one of the largest US-based case series of patients with COVID-19, captured from an academic health network in NYC. A total of 11,512 hospitalized patients (March 2-May 24, 2020) were tested with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. EHR queries yielded age at time of testing, sex, race/ethnicity aggregated as non-Hispanic black, Asian and Hispanic referenced to non-Hispanic white; cardio-metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity, peripheral artery disease, and coronary artery disease); pulmonary disease (e.g., COPD, sleep apnea, or asthma); autoimmune disease; and cancer. Mortality was based on the patient state (alive or deceased) at the moment of discharge. We included only patients who had been discharged alive or had expired. Anaconda Python 3.7 was used to perform all analyses. Results Among patients testing positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR=1.05; 95%CI:1.04–1.05), ethnic minority (HR=1.26; 95%CI:1.10–1.44), low household income (HR=1.29; 95%CI:1.11, 1.49), and male sex (HR=0.85; 95%CI:0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR=1.27; 95%CI:1.02–1.58), obesity (HR=1.19; 95%CI:1.04–1.37) and peripheral artery disease (HR=1.33; 95%CI:1.05–1.69). We observed a significantly higher rate of COVID-19 cases (43.8% vs 39.6%, p<0.05) among patients with sleep apnea (7.72%). However, they did not have a significantly higher mortality rate (13.0% vs 11.8%, NS), although they experienced a longer hospital stay (7.1±7.7 vs 6.1±7.5, p<0.01). Conclusion Patients with COPD had the highest odds of COVID-19 mortality. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks. Support (if any) K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453

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Contribution of pulmonary diseases to COVID-19 mortality in a diverse urban community of New York

Chronic Respiratory Disease ◽

10.1177/1479973120986806 ◽

2021 ◽

Vol 18 ◽

pp. 147997312098680

Author(s):

Jean-Louis Girardin ◽

Azizi Seixas ◽

Jaime Ramos Cejudo ◽

Ricardo S Osorio ◽

George Avirappattu ◽

...

Keyword(s):

New York ◽

Ethnic Minority ◽

Household Income ◽

Case Series ◽

Sociodemographic Factors ◽

Cox Proportional Hazards ◽

Pulmonary Diseases ◽

Chronic Obstructive ◽

Mortality Risks ◽

Male Sex

We examined the relative contribution of pulmonary diseases (chronic obstructive pulmonary disease, asthma and sleep apnea) to mortality risks associated with Coronavirus Disease (COVID-19) independent of other medical conditions, health risks, and sociodemographic factors. Data were derived from a large US-based case series of patients with COVID-19, captured from a quaternary academic health network covering New York City and Long Island. From March 2 to May 24, 2020, 11,512 patients who were hospitalized were tested for COVID-19, with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. Among those who tested positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR = 1.05; 95% CI: 1.04–1.05), ethnic minority (Asians, Non-Hispanic blacks, and Hispanics) (HR = 1.26; 95% CI, 1.10–1.44), low household income (HR = 1.29; 95% CI: 1.11, 1.49), and male sex (HR = 0.85; 95% CI: 0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR = 1.27; 95% CI: 1.02–1.58), obesity (HR = 1.19; 95% CI: 1.04–1.37), and peripheral artery disease (HR = 1.33; 95% CI: 1.05–1.69). Findings indicate patients with COPD had the highest odds of COVID-19 mortality compared with patients with pre-existing metabolic conditions, such as obesity, diabetes and hypertension. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.

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Considerations for Patients With Peripheral Artery Disease During the COVID-19 Pandemic

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620986877 ◽

2021 ◽

Vol 27 ◽

pp. 107602962098687

Author(s):

Serdar Farhan ◽

Haroon Kamran ◽

Birgit Vogel ◽

Karan Garg ◽

Ajit Rao ◽

...

Keyword(s):

New York ◽

New York City ◽

Peripheral Artery Disease ◽

York City ◽

Health Care Systems ◽

Medical Personnel ◽

Peripheral Artery ◽

Care Systems ◽

Artery Disease ◽

Case Based

New York City was one of the epicenters of the COVID-19 pandemic. The management of peripheral artery disease (PAD) during this time has been a major challenge for health care systems and medical personnel. This document is based on the experiences of experts from various medical fields involved in the treatment of patients with PAD practicing in hospitals across New York City during the outbreak. The recommendations are based on certain aspects including the COVID-19 infection status as well as the clinical PAD presentation of the patient. Our case-based algorithm aims at guiding the treatment of patients with PAD during the pandemic in a safe and efficient way.

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Sex-specificity of mortality risk factors among hospitalized COVID-19 patients in New York City: prospective cohort study

10.1101/2020.07.29.20164640 ◽

2020 ◽

Author(s):

Tomi Jun ◽

Sharon Nirenberg ◽

Patricia Kovatch ◽

Kuan-lin Huang

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

New York ◽

New York City ◽

Cohort Study ◽

Coronary Artery ◽

Lactate Dehydrogenase ◽

York City ◽

Male Sex ◽

Artery Disease

Objective: To identify sex-specific effects of risk factors for in-hospital mortality among COVID-19 patients admitted to a hospital system in New York City. Design: Prospective observational cohort study with in-hospital mortality as the primary outcome. Setting: Five acute care hospitals within a single academic medical system in New York City. Participants: 3,086 hospital inpatients with COVID-19 admitted on or before April 13, 2020 and followed through June 2, 2020. Follow-up till discharge or death was complete for 99.3% of the cohort. Results: The majority of the cohort was male (59.6%). Men were younger (median 64 vs. 70, p<0.001) and less likely to have comorbidities such as hypertension (32.5% vs. 39.9%, p<0.001), diabetes (22.6% vs. 26%, p=0.03), and obesity (6.9% vs. 9.8%, p=0.004) compared to women. Women had lower median values of laboratory markers associated with inflammation compared to men: white blood cells (5.95 vs. 6.8 K/uL, p<0.001), procalcitonin (0.14 vs 0.21 ng/mL, p<0.001), lactate dehydrogenase (375 vs. 428 U/L, p<0.001), C-reactive protein (87.7 vs. 123.2 mg/L, p<0.001). Unadjusted mortality was similar between men and women (28.8% vs. 28.5%, p=0.84), but more men required intensive care than women (25.2% vs. 19%, p<0.001). Male sex was an independent risk factor for mortality (OR 1.26, 95% 1.04-1.51) after adjustment for demographics, comorbidities, and baseline hypoxia. There were significant interactions between sex and coronary artery disease (p=0.038), obesity (p=0.01), baseline hypoxia (p<0.001), ferritin (p=0.002), lactate dehydrogenase (p=0.003), and procalcitonin (p=0.03). Except for procalcitonin, which had the opposite association, each of these factors was associated with disproportionately higher mortality among women. Conclusions: Male sex was an independent predictor of mortality, consistent with prior studies. Notably, there were significant sex-specific interactions which indicated a disproportionate increase in mortality among women with coronary artery disease, obesity, and hypoxia. These new findings highlight patient subgroups for further study and help explain the recognized sex differences in COVID-19 outcomes.

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Treatment of coronary artery disease (concluded)∗∗From the Departments of Pharmacology and Medicine, Cornell University Medical College and The New York Hospital, New York City.

The American Journal of Medicine ◽

10.1016/0002-9343(46)90075-7 ◽

1946 ◽

Vol 1 (5) ◽

pp. 539-550 ◽

Cited By ~ 3

Keyword(s):

Coronary Artery Disease ◽

New York ◽

New York City ◽

Coronary Artery ◽

York City ◽

Cornell University ◽

York Hospital ◽

Medical College ◽

Artery Disease

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Abstract 16969: Burden of Cardiovascular Disease, ECG Patterns and Echocardiographic Data Among COVID-19 Survivors and Non-Survivors at a Large Health System in New York

Circulation ◽

10.1161/circ.142.suppl_3.16969 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Arvind Devanabanda ◽

Eitezaz Mahmood ◽

Avneet SINGH ◽

Perwaiz Meraj ◽

Haisam Ismail ◽

...

Keyword(s):

Risk Factors ◽

New York ◽

New York City ◽

Clinical Outcomes ◽

Inflammatory Markers ◽

Bundle Branch Block ◽

Icu Stay ◽

Prognostic Importance ◽

Artery Disease ◽

Metabolic Comorbidities

Introduction: The prognostic importance of cardiac and metabolic risk factors among COVID-19 patients is unknown. The aim of our investigation is to report clinical significance of risk factors, ECG patterns, inflammatory markers and LVEF for survival with COVID-19. Methods: 10,018 patients and ECGs, from 13 hospitals in New York City area were included in this retrospective analysis between March 1 and April 30, 2020. Survivors and non-survivors were studied for presence of comorbidities and clinical outcomes of length of stay (LOS), ICU stay, ventilator use, inotrope use and pressor use. Differences between the groups were compared with the Student t test. Results: There were 7,837 survivors and 2,181 non-survivors. Table shows more patients with age > 65 died. Hypertension, diabetes, obesity, coronary artery disease, heart failure and peripheral vascular disease, COPD, chronic kidney disease were significantly elevated in non-survivors. Admission Inflammatory markers were significantly elevated in non-survivors. Significantly increased ECG intervals of QRS, QTc, atrial fibrillation, atrial flutter, and bundle branch block were noted in non-survivors. LVEF < 40% was significantly higher in non-survivors. ICU stay, LOS, pressor use and ventilator use were significantly elevated in non-survivors. Conclusions: More patients with age > 65 were survivors. Among non-survivors, cardiac, metabolic comorbidities, burden of atrial arrhythmias, admission inflammatory markers, LVEF< 40%, and clinical outcomes were significantly worse.

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Abstract 3750: Prevalence of Coronary Artery Disease in New York City Police Officers as Predicted by Coronary Artery Calcium Scoring

Circulation ◽

10.1161/circ.116.suppl_16.ii_853 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jia Lin See ◽

Nikolas Wanahita ◽

Nir N Somekh ◽

Stephen E Nelson ◽

Albert Barrette ◽

...

Keyword(s):

Coronary Artery Disease ◽

New York ◽

New York City ◽

Coronary Artery ◽

Police Officers ◽

York City ◽

Early Exposure ◽

Gender And Age ◽

Artery Disease ◽

City Police

Background: Recent studies in police officers and firefighters have shown that physically taxing and psychologically stressful occupations may increase death from coronary artery disease (CAD). The aim of this study was to determine if there is an increased prevalence of CAD among members of the New York City Police Department (NYPD). Methods: A total of 2,068 NYPD police officers and detectives underwent electron beam computed tomography for quantitation of coronary artery calcium (CAC) using the Agatston scoring method. The CAC score is known to correlate with the extent and severity of CAD and is predictive of adverse cardiovascular events. The CAC scores were compared with a gender- and age-specific database developed by Hoff et al (also known as the Kondos database). Patients with CAC scores > 400 and those whose scores fall within the upper quartile for gender and age are generally considered to be at increased risk of adverse events. Results: Participants’ mean age was 42 ± 6 years and 86% were male. More than 50% of males < 65 and females < 60 years of age had scores below the 50 th percentile for their age group (Tables ). A subset of 75 individuals (mean age 41 ± 6; 88% male) with known early exposure to the World Trade Center (WTC) collapse were evaluated; they did not have increased CAC scores (data not shown). Conclusion: There is not an increased prevalence of CAD among members of the NYPD compared to the general population as assessed with CAC quantitation. Early exposure to the WTC collapse does not appear to increase the risk of premature CAD at five years.

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Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

BMJ ◽

10.1136/bmj.m1966 ◽

2020 ◽

pp. m1966 ◽

Cited By ~ 375

Author(s):

Christopher M Petrilli ◽

Simon A Jones ◽

Jie Yang ◽

Harish Rajagopalan ◽

Luke O’Donnell ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Mechanical Ventilation ◽

New York City ◽

Cohort Study ◽

Critical Illness ◽

Hospital Admission ◽

York City ◽

Hospice Care ◽

Male Sex

AbstractObjectiveTo describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness.DesignProspective cohort study.SettingSingle academic medical center in New York City and Long Island.Participants5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020.Main outcome measuresOutcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality.ResultsOf 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of <88% (3.7, 2.8 to 4.8), troponin level >1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.ConclusionsAge and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.

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