Association of hypertension with mortality in patients hospitalised with COVID-19

ObjectiveTo assess whether hypertension is an independent risk factor for mortality among patients hospitalised with COVID-19, and to evaluate the impact of ACE inhibitor and angiotensin receptor blocker (ARB) use on mortality in patients with a background of hypertension.MethodThis observational cohort study included all index hospitalisations with laboratory-proven COVID-19 aged ≥18 years across 21 Australian hospitals. Patients with suspected, but not laboratory-proven COVID-19, were excluded. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs.Results546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (adjusted OR (aOR) 1.09, 95% CI 1.07 to 1.12, p<0.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13 to 6.53, p=0.026), chronic kidney disease (aOR 2.33, 95% CI 1.02 to 5.32, p=0.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06 to 4.85, p=0.035). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48 to 1.77, p=0.81). Among patients with hypertension, ACE inhibitor (aOR 1.37, 95% CI 0.61 to 3.08, p=0.61) and ARB (aOR 0.64, 95% CI 0.27 to 1.49, p=0.30) use was not associated with mortality.ConclusionsIn patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.

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Impact of pulmonary hypertension in patients with acute exacerbation of chronic obstructive pulmonary disease and its effect on healthcare utilization

Pulmonary Circulation ◽

10.1177/20458940211046838 ◽

2021 ◽

Vol 11 (4) ◽

pp. 204589402110468

Author(s):

Rezwan F. Munshi ◽

James R. Pellegrini ◽

Pranavi Patel ◽

Maxim Kashin ◽

James Kang ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Hospital Mortality ◽

Pulmonary Disease ◽

Chest Tube ◽

Tube Placement ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Chest Tube Placement ◽

The Impact

We aim to study the impact of pulmonary hypertension on acutely exacerbated chronic obstructive pulmonary disease (AECOPD). We used the 2016 and 2017 National Readmission Database with an inclusion criterion of AECOPD as a primary and pulmonary hypertension as a secondary diagnosis using ICD 10-CM codes. Exclusion criteria were age under 18 years, non-elective admission, and discharge in December. The primary outcome was in-hospital mortality during the index admission. Secondary outcomes were 30-day readmission rate, resource utilization, and instrument utilization including intubation, prolonged invasive mechanical ventilation >96 h (PIMV), tracheostomy, chest tube placement, and bronchoscopy during the index admission. A total of 627,848 patients with AECOPD were included in the study, and 68,429 (10.90%) patients had a diagnosis of pulmonary hypertension. Pulmonary hypertension was more common among females (61.14%) with a mean age of 71 ± 11.66, Medicare recipients (79.5%), higher Charlson comorbidity index, and treatment in an urban teaching hospital. Pulmonary hypertension was associated with greater mortality (adjusted odds ratio (aOR) 1.89, p < 0.001), higher 30-day readmission (aOR 1.24, p < 0.001), higher cost (adjusted mean difference (aMD) $2785, p < 0.01), length of stay (aMD 1.09, p < 0.001), and higher instrument utilization including intubation (aOR 199, p < 0.001), PIMV (aOR 2.12, p < 0.001), tracheostomy (aOR 2.1, p < 0.001), bronchoscopy (aOR 1.46, p = 0.007), and chest tube placement (aOR 1.39 p < 0.004). We found that pulmonary hypertension is related to higher in-hospital mortality, length of stay, increased instrument utilization, readmission, and costs. Our study aims to shed light on the impact of pulmonary hypertension on AECOPD in hopes to improve future management.

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The impact of the involvement of a healthcare professional on the usage of an eHealth platform: a retrospective observational COPD study

Respiratory Research ◽

10.1186/s12931-021-01685-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Cathelijne M. van Zelst ◽

Marise J. Kasteleyn ◽

Esther M. J. van Noort ◽

Maureen P. M. H. Rutten - van Molken ◽

Gert-Jan Braunstahl ◽

...

Keyword(s):

Primary Care ◽

Healthcare Professional ◽

Self Management ◽

Care Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Observational Cohort ◽

Blended Care ◽

The Impact

Abstract Background Ehealth platforms, since the outbreak of COVID-19 more important than ever, can support self-management in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of this observational study is to explore the impact of healthcare professional involvement on the adherence of patients to an eHealth platform. We evaluated the usage of an eHealth platform by patients who used the platform individually compared with patients in a blended setting, where healthcare professionals were involved. Methods In this observational cohort study, log data from September 2011 until January 2018 were extracted from the eHealth platform Curavista. Patients with COPD who completed at least one Clinical COPD Questionnaire (CCQ) were included for analyses (n = 299). In 57% (n = 171) of the patients, the eHealth platform was used in a blended setting, either in hospital (n = 128) or primary care (n = 29). To compare usage of the platform between patients who used the platform independently or with a healthcare professional, we applied propensity score matching and performed adjusted Poisson regression analysis on CCQ-submission rate. Results Using the eHealth platform in a blended setting was associated with a 3.25 higher CCQ-submission rate compared to patients using the eHealth platform independently. Within the blended setting, the CCQ-submission rate was 1.83 higher in the hospital care group than in the primary care group. Conclusion It is shown that COPD patients used the platform more frequently in a blended care setting compared to patients who used the eHealth platform independently, adjusted for age, sex and disease burden. Blended care seems essential for adherence to eHealth programs in COPD, which in turn may improve self-management.

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The Burden of Illness Related to Chronic Obstructive Pulmonary Disease Exacerbations in Québec, Canada

Canadian Respiratory Journal ◽

10.1155/2017/8184915 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Tam Dang-Tan ◽

Shiyuan Zhang ◽

Ruben V. Tavares ◽

Melissa Stutz ◽

Afisi S. Ismaila ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Burden Of Illness ◽

Care Utilization ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Observational Cohort ◽

Hospital Visits ◽

The Impact ◽

Respiratory Specialist

Background. Chronic obstructive pulmonary disease (COPD) prevalence in Canada has risen over time. COPD-related exacerbations contribute to the increased health care utilization (HCU) in this population. This study investigated the impact of exacerbations on COPD-related HCU. Methods. This retrospective observational cohort study used patient data from the Québec provincial health insurance databases. Eligible patients with a new HCU claim with a diagnostic billing for COPD during 2001–2010 were followed until March 31, 2011. Exacerbation rates and time to first exacerbation were assessed. Unadjusted analyses and multivariable models compared the rate of HCU by exacerbation classification (any [moderate/severe], moderate, or severe). Results. The exacerbation event rate in patients with an exacerbation was 34.3 events/100 patient-years (22.7 for moderate exacerbations and 11.6 for severe exacerbations). Median time to first exacerbation of any classification was 37 months. In unadjusted analyses, COPD-related HCU significantly increased with exacerbation severity. In the multivariable, HCU rates were significantly higher after exacerbation versus before exacerbation (p<0.01) for patients with an exacerbation or moderate exacerbations. For severe exacerbations, general practitioner, respiratory specialist, emergency room, and hospital visits were significantly higher after exacerbation versus before exacerbation (p<0.001). Conclusions. Exacerbations were associated with increased HCU, which was more pronounced for patients with severe exacerbations. Interventions to reduce the risk of exacerbations in patients with COPD may reduce disease burden.

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ACE Inhibitor—Induced Bronchial Reactivity in Patients with Respiratory Dysfunction

Annals of Pharmacotherapy ◽

10.1345/aph.1a332 ◽

2002 ◽

Vol 36 (6) ◽

pp. 1058-1067 ◽

Cited By ~ 21

Author(s):

Kathleen A Packard ◽

Richard L Wurdeman ◽

Amy J Arouni

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Congestive Heart Failure ◽

Ace Inhibitors ◽

Ace Inhibitor ◽

Chronic Obstructive ◽

Angiotensin Ii Receptor ◽

Obstructive Pulmonary Disease ◽

Bronchial Responsiveness ◽

Increased Risk

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors are often associated with an increased incidence of cough and bronchial responsiveness that may cause further deterioration of patients with impaired pulmonary function. OBJECTIVE: To review the available literature on the incidence of cough and bronchial responsiveness associated with ACE-inhibitor therapy in patients with asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF). DATA SOURCES: Literature was accessed through MEDLINE (1985–September 2001). Key search terms included cough, bronchospasm, asthma, congestive heart failure, chronic obstructive pulmonary disease, ACE inhibitors, and angiotensin II receptor blockers. DATA SYNTHESIS: The literature reports several cases of increased bronchial responsiveness associated with ACE inhibitors. Larger, controlled studies evaluating the increased risk in patients with pulmonary dysfunction are limited. Data from these trials are summarized in this article. CONCLUSIONS: The literature shows that patients with primary airway disease such as asthma and COPD are not at an increased risk of developing cough or bronchoconstriction as a result of ACE-inhibitor therapy. Despite the ability of ACE inhibitors to improve exercise tolerance, perfusion, and gas transfer, patients with CHF may be at higher risk of developing cough than the general population. Whether this cough is attributed to ACE inhibition or increased left-ventricular dysfunction remains uncertain. If increased bronchial responsiveness does occur, angiotensin II receptor antagonists are another reasonable option.

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Chronic Obstructive Pulmonary Disease Is Associated With Decreased Quality of Life in Bronchiectasis Patients: Findings From the KMBARC Registry

Frontiers in Medicine ◽

10.3389/fmed.2021.722124 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sang Hyuk Kim ◽

Changhwan Kim ◽

Ina Jeong ◽

Seung Jun Lee ◽

Tae Hyung Kim ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Research Collaboration ◽

Multivariable Analysis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Observational Cohort ◽

The Impact

Most studies have evaluated the impact of non-cystic fibrosis bronchiectasis (hereafter referred to as bronchiectasis) on quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) using COPD cohorts. Accordingly, the impact of COPD on QoL in patients with bronchiectasis is not well-elucidated. We used the Korean Multicenter Bronchiectasis Audit and Research Collaboration (KMBARC) registry between August 2018 and December 2019, a prospective observational cohort that enrolled patients with bronchiectasis in Korea. We evaluated co-occurrence exposure to COPD in bronchiectasis patients, and the primary outcome was QoL according to the Bronchiectasis Health Questionnaire (BHQ). We also investigated factors associated with decreased QoL, defined as the lowest quartile of the total BHQ score. Of 598 patients with bronchiectasis, 372 (62.2%) had COPD. Bronchiectasis patients with COPD had a significantly lower total BHQ score compared with those without COPD [median = 63.1 (interquartile range: 54.8–68.6) vs. 64.8 (57.4–70.8), p = 0.020]. Multivariable analysis revealed that dyspnea [adjusted odds ratio (aOR) = 3.21, 95% confidence interval (CI) = 1.21–8.60], depression (aOR = 1.28, 95% CI = 1.16–1.44), and fatigue (aOR = 1.05, 95% CI = 1.01–1.09) were significantly associated with decreased QoL in bronchiectasis patients with COPD. In conclusion, bronchiectasis patients with COPD had significantly decreased QoL than patients without COPD. In bronchiectasis patients with COPD, dyspnea, depression, and fatigue were associated with decreased QoL.

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General outcomes and risk factors for minor and major amputations in Brazil

Vascular ◽

10.1177/1708538117736677 ◽

2017 ◽

Vol 26 (3) ◽

pp. 291-300 ◽

Cited By ~ 1

Author(s):

Jose O Leite ◽

Leandro O Costa ◽

Walter M Fonseca ◽

Debora U Souza ◽

Barbara C Goncalves ◽

...

Keyword(s):

Risk Factors ◽

Blood Cell ◽

Hospital Mortality ◽

White Blood Cell ◽

Postoperative Infection ◽

Major Amputation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Minor Amputation ◽

The Impact

Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.

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Hazards for Construction Workers

10.1093/oso/9780190662677.003.0036 ◽

2017 ◽

Author(s):

Gavin H. West ◽

Laura S. Welch

Keyword(s):

Heavy Metals ◽

Prevention And Control ◽

Respiratory Diseases ◽

Noise Exposure ◽

Engineered Nanomaterials ◽

Construction Workers ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

And Control ◽

The Impact

This chapter describes the hazards for construction workers, with a particular focus on injuries as well as exposures to hazardous chemicals and dusts. A section describes hazardous exposures to lead and other heavy metals. Another section describes noise exposure. The impact of musculoskeletal disorders among construction workers is then discussed. A section on respiratory diseases focuses on asbestosis, silicosis, chronic obstructive pulmonary disease, and asthma. Exposures known to cause dermatitis and cancer are reviewed. There is a discussion of engineered nanomaterials as a potential emerging hazard. Various approaches to prevention and control, including regulations and health services, are described.

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The Impact of the COVID-19 Pandemic on Self-Reported Management of Chronic Conditions

Journal of Patient Experience ◽

10.1177/23743735211007693 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110076

Author(s):

Hyllore Imeri ◽

Erin Holmes ◽

Shane Desselle ◽

Meagen Rosenthal ◽

Marie Barnard

Keyword(s):

Locus Of Control ◽

Chronic Conditions ◽

Online Survey ◽

Health Locus Of Control ◽

Patient Activation ◽

Survey Study ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

The Impact

Chronic conditions (CCs) management during the COVID-19 pandemic and the impact of the pandemic on patient activation (PA) and health locus of control (HLOC) remain unknown. This cross-sectional online survey study examined the role of COVID-19 pandemic-related worry or fear in PA and HLOC among patients with CCs. Individuals with CCs (n = 300) were recruited through MTurk Amazon. The questionnaire included sociodemographic questions, the Patient Activation Measure, and the Multidimensional Health Locus of Control–Form B. Out of the 300 participants, 9.7% were diagnosed with COVID-19, and 7.3% were hospitalized. Patients with cancer, chronic kidney disease, chronic obstructive pulmonary disease, drug abuse/substance abuse, and stroke reported significant difficulties in managing their CCs due to worry or fear because of COVID-19. More than half of the sample (45.7%) reported COVID-19-related worry or fear about managing their CCs, and these patients had lower PA and lower external HLOC compared to patients not affected by COVID-19-related worry or fear. Health professionals should provide more support for patients facing difficulties in managing their CCs during the COVID-19 pandemic.

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Characteristics and outcomes in acute patients receiving mechanical ventilation in a Coronary Care Unit (CCU)

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.165 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Rivadeneira Ruiz ◽

DF Arroyo Monino ◽

T Seoane Garcia ◽

MP Ruiz Garcia ◽

JC Garcia Rubira

Keyword(s):

Mechanical Ventilation ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Coronary Care Unit ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Funding Sources ◽

Copd Patients ◽

The Mean ◽

Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Mechanical ventilation is the short-term technical support most widely used and cardiac arrest its main indication in a Coronary Care Unit (CCU). However, the knowledge about the specific moment and ventilator mode of onset to avoid the acute lung injury is still equivocal. Our objective is to determine the survival rate and the prognostic factors in patients supported by mechanical ventilation. Methods We conducted a retrospective cohort study of adult patients admitted to the CCU between January 2018 and November 2020 that received mechanical ventilation during the hospital stay. Results We collected 94 patients, 28% females with a median age of 68 ± 11,9. 43% were diabetics and almost one quarter of them had some degree of chronic obstructive pulmonary disease (COPD). Ischemic cardiopathy (33%) and heart failure (31%) were frequent pathologies as well as renal injury (29% patients a filtration rate below 45 mL/min/1,73m2). The reason for initiating mechanical ventilation was cardiac arrest in the half of the patients. Volume-controlled ventilation (73%) was the initial setting mode in most cases. The support with vasoactive drugs were highly necessary in these patients (Infection rate of 48%). In the subgroup analysis, we realized that the number of reintubations and the necessity of non-invasive ventilation were higher in the COPD group (p = 0,01), as well as tracheostomy (p = 0,03). COPD patients also needed higher maintaining PEEP, though this was not statistically significant. The mean length of stay in the intensive care unit of our cohort was 11 days (range: 1-78 days; median: 8 days) and the mean length of mechanical ventilation 6 days (range: 1-64 days; median: 3 days). The in-hospital mortality was 41,4%. Conclusions Cardiac arrest is the most common reason of mechanical ventilation support. Our study showed that COPD patients presented more complications during the weaning and the period after extubation. In-hospital mortality remains high in intubated patients.

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‘I’m fine!’: Assertions of lack of support need among patients with chronic obstructive pulmonary disease: A mixed-methods study

Chronic Illness ◽

10.1177/17423953211000386 ◽

2021 ◽

pp. 174239532110003

Author(s):

A Carole Gardener ◽

Caroline Moore ◽

Morag Farquhar ◽

Gail Ewing ◽

Efthalia Massou ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Mixed Method ◽

Self Report ◽

Design Stage ◽

Chronic Obstructive ◽

Support Needs ◽

Obstructive Pulmonary Disease ◽

Stage 1 ◽

The Impact

Objectives To understand how people with Chronic Obstructive Pulmonary Disease (COPD) disavow their support needs and the impact on care. Methods Two stage mixed-method design. Stage 1 involved sub-analyses of data from a mixed-method population-based longitudinal study exploring the needs of patients with advanced COPD. Using adapted criteria from mental health research, we identified 21 patients who disavowed their needs from the 235 patient cohort. Qualitative interview transcripts and self-report measures were analysed to compare these patients with the remaining cohort. In stage 2 focus groups (n = 2) with primary healthcare practitioners (n = 9) explored the implications of Stage 1 findings. Results Patients who disavowed their support needs described non-compliance with symptom management and avoidance of future care planning (qualitative data). Analysis of self-report measures of mental and physical health found this group reported fewer needs than the remaining sample yet wanted more GP contact. The link between risk factors and healthcare professional involvement present in the rest of the sample was missing for these patients. Focus group data suggested practitioners found these patients challenging. Discussion This study identified patients with COPD who disavow their support needs, but who also desire more GP contact. GPs report finding these patients challenging to engage.

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