scholarly journals Increased Inpatient Mortality for Cardiovascular Patients During the First Wave of the COVID‐19 Epidemic in New York

2021 ◽  
Author(s):  
Stavros E. Mountantonakis ◽  
Parth Makker ◽  
Moussa Saleh ◽  
Kristie M. Coleman ◽  
Gregg Husk ◽  
...  
Keyword(s):  
New York ◽  
Cardiovascular Mortality ◽  
Healthcare Access ◽  
Inpatient Mortality ◽  
Epidemic Outbreak ◽  
Principal Diagnosis ◽  
Cardiovascular Pathology ◽  
Delivery Of Care ◽  
Cardiovascular Patients ◽  
Common Clinical Practice

Background The acuity and magnitude of the first wave of the COVID‐19 epidemic in New York mandated a drastic change in healthcare access and delivery of care. Methods and Results We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID‐19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID‐19 positive) were admitted for an acute cardiovascular syndrome during the first COVID‐19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P <0.001). During this time, patients with cardiovascular disease presented later to the hospital (360 versus 120 minutes for acute myocardial infarction), underwent fewer procedures (34.6% versus 45.6%, P <0.001), were less likely to be treated in an intensive care unit setting (8.7% versus 10.8%, P <0.001), and had a longer hospital stay (2.91 [1.71–6.05] versus 2.87 [1.82–4.95] days, P =0.033). Inpatient cardiovascular mortality during the first epidemic outbreak increased by 111.1% (3.8 versus 1.8, P <0.001) and was not related to COVID‐19‐related admissions, all cause in‐hospital mortality, or incidence of out‐of‐hospital cardiac deaths in New York. Admission during the first COVID‐19 surge along with age and positive COVID‐19 test independently predicted mortality for cardiovascular admissions (odds ratios, 1.30, 1.05, and 5.09, respectively, P <0.0001). Conclusions A lower rate and later presentation of patients with cardiovascular pathology, coupled with deviation from common clinical practice mandated by the first wave of the COVID‐19 pandemic, might have accounted for higher in‐hospital cardiovascular mortality during that period.

scholarly journals INCREASED INPATIENT MORTALITY FOR CARDIOVASCULAR PATIENTS DURING THE FIRST WAVE OF THE COVID-19 EPIDEMIC IN NEW YORK

2021 ◽  
Vol 77 (18) ◽  
pp. 3042
Author(s):  
Parth Makker ◽  
Moussa Saleh ◽  
Kristie Coleman ◽  
Gregg Husk ◽  
Rajiv Jauhar ◽  
...  
Keyword(s):  
New York ◽  
Inpatient Mortality ◽  
Cardiovascular Patients

scholarly journals COVID-19–Related Ethics Consultations at a Cancer Center in New York City: A Content Review of Ethics Consultations During the Early Stages of the Pandemic

2020 ◽  
pp. OP.20.00440
Author(s):  
Danielle Novetsky Friedman ◽  
Liz Blackler ◽  
Yesne Alici ◽  
Amy E. Scharf ◽  
Martin Chin ◽  
...  
Keyword(s):  
New York ◽  
Health Care Providers ◽  
Ethical Issues ◽  
Cancer Center ◽  
Care Providers ◽  
Delivery Of Care ◽  
Code Status ◽  
Patients With Cancer ◽  
Early Stages ◽  
Content Review

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient’s concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.

A Transformative Impact of Theory in Clinical Practice: A Study in a Cardiogenetics Clinic

2020 ◽  
Vol 34 (2) ◽  
pp. 129-143
Author(s):  
Esma D. Paljevic
Keyword(s):  
New York ◽  
Lived Experience ◽  
Family Member ◽  
Phenomenological Study ◽  
Family Members ◽  
Phenomenological Approach ◽  
Genetic Profile ◽  
Delivery Of Care ◽  
Qualitative Phenomenological ◽  
Qualitative Phenomenological Study

Background and PurposeThis qualitative phenomenological study explored the lived experiences of family members who have been referred to a cardiogenetics clinic following the loss of a family member to sudden cardiac death (SCD). These family members were evaluated in a Cardiogenetics Clinic in a Children's Hospital in the New York region, which utilizes an interprofessional approach to care.MethodsA qualitative phenomenological approach was used to explore the lived experience of family members that were referred following the SCD of a family member. The researcher used hermeneutic dialectics and interviewed family members that attended the Cardiogenetics Clinic.ResultsInsights gained through discussion were discussed in the following themes: stories of feelings being heard, stories of meaningfulness, and stories of mutual process. This led to the transformation of the typical linear clinic process to a transformative and dynamic model for integrated delivery of care.Implications for PracticeThis interprofessional model of care offers information regarding SCD, a genetic profile to determine risk for SCD, an integrative collaborative approach to care as well as nursing, medical interventions, psychological support, and counseling for families.

scholarly journals Cardiovascular mortality of Chinese in New York City

1999 ◽  
Vol 76 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Jing Fang ◽  
Shantha Madhavan ◽  
Michael H. Alderman
Keyword(s):  
New York ◽  
New York City ◽  
Cardiovascular Mortality ◽  
York City

scholarly journals An Online Risk Calculator for Rapid Prediction of In-hospital Mortality from COVID-19 Infection

2021 ◽  
Author(s):  
Daniel S. Evans ◽  
Kyoung Min Kim ◽  
Xiaqing Jiang ◽  
Jessica Jacobson ◽  
Warren Browner ◽  
...  
Keyword(s):  
New York ◽  
Vital Signs ◽  
Inpatient Mortality ◽  
Operating Characteristics ◽  
Online Risk ◽  
Prediction Of Mortality ◽  
Receiver Operating Characteristics Curve ◽  
Rapid Prediction ◽  
Online Calculator ◽  
Boosted Decision Trees

AbstractPrediction of mortality from COVID-19 infection might help triage patients to hospitalization and intensive care. To estimate the risk of inpatient mortality, we analyzed the data of 13,190 adult patients in the New York City Health + Hospitals system admitted for COVID-19 infection from March 1 to June 30, 2020. They had a mean age 58 years, 40% were Latinx, 29% Black, 9% White and 22% of other races/ethnicities and 2,875 died. We used Machine learning (Gradient Boosted Decision Trees; XGBoost) to select predictors of inpatient mortality from demographics, vital signs and lab tests results from initial encounters. XGBoost identified O2 saturation, systolic and diastolic blood pressure, pulse rate, respiratory rate, age, and BUN with an Area Under the Receiver Operating Characteristics Curve = 94%. We applied CART to find cut-points in these variables, logistic regression to calculate odds-ratios for those categories, and assigned points to the categories to develop a score. A score = 0 indicates a 0.8% (95% confidence interval, 0.5 – 1.0%) risk of dying and ≥ 12 points indicates a 98% (97-99%) risk, and other scores have intermediate risks. We translated the models into an online calculator for the probability of mortality with 95% confidence intervals (as pictured):Abstract Figuredanielevanslab.shinyapps.io/COVID_mortality/

scholarly journals 1645. High Seroprevalence and Seroconversion Rate of Borrelia burgdorferi Infection Among Hispanic/Latino Immigrant Workers in Eastern Suffolk County, New York: A Longitudinal-Based Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S600-S601
Author(s):  
Stalin Vilcarromero ◽  
Ana M Nunez ◽  
Katherine Vivas ◽  
Julianna Russo ◽  
Saadia Mahmood ◽  
...  
Keyword(s):  
New York ◽  
Borrelia Burgdorferi ◽  
Seroconversion Rate ◽  
Healthcare Access ◽  
Significant Risk ◽  
The United States ◽  
Suffolk County ◽  
Immigrant Worker ◽  
Latino Immigrant ◽  
Field Workers

Abstract Background Lyme disease, caused by Borrelia burgdorferi, continues to be the most commonly reported vector-borne disease in the United States (US) affecting the public health and the economy. Suffolk County, New York (NY) has one of the highest incidences in NY State affecting primarily the Hispanic/Latino population working in gardening, landscaping, and agriculture (field workers). However, there is a paucity of research among this population. Thus, the aim of this longitudinal study was to assess the current seroprevalence and seroconversion of the Borrelia burgdorferi infection and its risk factors such as sociodemographic, symptoms, tick encounter, and use of the Fatigue Severity Scale, associated with seropositivity in the Hispanic/Latino immigrant worker population of Eastern Suffolk County. Methods Recruitment of participants was based on several towns of this County. Following signed informed consent, participants completed a questionnaire and had their blood drawn. Samples were tested using the conventional 2-tiered serological testing for Borreliosis. Results Between June 2016 and October 2018, 660 (83.5%) completed Visit 1; 58.8% of them completed elementary school or less, and 56.7% reported earning = or <$20,000 annually, 344 were field workers, from which, 82.3% and 55.2% were male and from Guatemala, respectively. The overall seroprevalence was 7.2% (48/660) but was significantly higher among gardener/Landscapers (11.5%) having an adjusted odds ratio (OR) = 2.02 with a CI = 1.02–4.03. Another significant risk factor was experiencing fevers after a tick-bite (Adjusted OR: 2.08, CI:1.42–5.63). 2.7% (8/292) seroconverted and were gardener/landscaper. Conclusion Several barriers to healthcare access, health literacy, and prevention were identified. Gardening/landscaping has an occupational risk in this population. Efforts to educate about tick-borne infections and preventive methods such as vaccinations are warranted for this population. Disclosures All authors: No reported disclosures.

scholarly journals SARS-CoV-2 Vaccine Hesitancy in a Sample of US Adults: Role of Perceived Satisfaction With Health, Access to Healthcare, and Attention to COVID-19 News

2021 ◽  
Vol 9 ◽  
Author(s):  
Sarah Bauerle Bass ◽  
Maureen Wilson-Genderson ◽  
Dina T. Garcia ◽  
Aderonke A. Akinkugbe ◽  
Maghboeba Mosavel
Keyword(s):  
Public Health ◽  
New York ◽  
San Francisco ◽  
Healthcare Access ◽  
The United States ◽  
Vaccine Hesitancy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccination Rates

Understanding which communities are most likely to be vaccine hesitant is necessary to increase vaccination rates to control the spread of SARS-CoV-2. This cross-sectional survey of adults (n = 501) from three cities in the United States (Miami, FL, New York City, NY, San Francisco, CA) assessed the role of satisfaction with health and healthcare access and consumption of COVID-19 news, previously un-studied variables related to vaccine hesitancy. Multilevel logistic regression tested the relationship between vaccine hesitancy and study variables. Thirteen percent indicated they would not get vaccinated. Black race (OR 2.6; 95% CI: 1.38–5.3), income (OR = 0.64; 95% CI: 0.50–0.83), inattention to COVID-19 news (OR = 1.6; 95% CI: 1.1–2.5), satisfaction with health (OR 0.72; 95% CI: 0.52–0.99), and healthcare access (OR = 1.7; 95% CI: 1.2–2.7) were associated with vaccine hesitancy. Public health officials should consider these variables when designing public health communication about the vaccine to ensure better uptake.

scholarly journals Dynamic coupling between the COVID-19 epidemic timeline and the behavioral response to PAUSE in New York State counties

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255236
Author(s):  
Anca Rǎdulescu ◽  
Shelah Ballard ◽  
Kaitlyn Gonzalez ◽  
Johnathan Linton
Keyword(s):  
New York ◽  
Behavioral Response ◽  
New York State ◽  
The State ◽  
Social Response ◽  
Epidemic Outbreak ◽  
Dynamic Coupling ◽  
York State ◽  
Epidemic Dynamics ◽  
Epidemic Wave

Behavioral epidemiology suggests that there is a tight dynamic coupling between the timeline of an epidemic outbreak, and the social response in the affected population (with a typical course involving physical distancing between individuals, avoidance of large gatherings, wearing masks, etc). We study the bidirectional coupling between the epidemic dynamics of COVID-19 and the population social response in the state of New York, between March 1, 2020 (which marks the first confirmed positive diagnosis in the state), until June 20, 2020. This window captures the first state-wide epidemic wave, which peaked to over 11,000 confirmed cases daily in April (making New York one of the US states most severely affected by this first wave), and subsided by the start of June to a count of consistently under 1,500 confirmed cases per day (suggesting temporary state-wide control of the epidemic). In response to the surge in cases, social distancing measures were gradually introduced over two weeks in March, culminating with the PAUSE directive on March 22nd, which mandated statewide shutdown of all nonessential activity. The mandates were then gradually relaxed in stages throughout summer, based on how epidemic benchmarks were met in various New York regions. In our study, we aim to examine on one hand, whether different counties exhibited different responses to the PAUSE centralized measures depending on their epidemic situation immediately preceding PAUSE. On the other hand, we explore whether these different county-wide responses may have contributed in turn to modulating the counties’ epidemic timelines. We used the public domain to extract county-wise epidemic measures (such as cumulative and daily incidence of COVID-19), and social mobility measures for different modalities (driving, walking, public transit) and to different destinations. Our correlation analyses between the epidemic and the mobility time series found significant correlations between the size of the epidemic and the degree of mobility drop after PAUSE, as well as between the mobility comeback patterns and the epidemic recovery timeline. In line with existing literature on the role of the population behavioral response during an epidemic outbreak, our results support the potential importance of the PAUSE measures to the control of the first epidemic wave in New York State.

scholarly journals TMA, A Forgotten Uremic Toxin, but Not TMAO, Is Involved in Cardiovascular Pathology

Toxins ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 490 ◽  
Author(s):  
Kinga Jaworska ◽  
Dagmara Hering ◽  
Grażyna Mosieniak ◽  
Anna Bielak-Zmijewska ◽  
Marta Pilz ◽  
...  
Keyword(s):  
Estimated Glomerular Filtration Rate ◽  
Correlation Spectroscopy ◽  
Uremic Toxin ◽  
Negative Effects ◽  
Rat Cardiomyocytes ◽  
Cardiovascular Pathology ◽  
Fluorescence Correlation ◽  
Healthy Humans ◽  
Cardiovascular Patients

Trimethylamine-N-oxide (TMAO) has been suggested as a marker and mediator of cardiovascular diseases. However, data are contradictory, and the mechanisms are obscure. Strikingly, the role of the TMAO precursor trimethylamine (TMA) has not drawn attention in cardiovascular studies even though toxic effects of TMA were proposed several decades ago. We assessed plasma TMA and TMAO levels in healthy humans (HH) and cardiovascular patients qualified for aortic valve replacement (CP). The cytotoxicity of TMA and TMAO in rat cardiomyocytes was evaluated using an MTT test. The effects of TMA and TMAO on albumin and lactate dehydrogenase (LDH) were assessed using fluorescence correlation spectroscopy. In comparison to HH, CP had a two-fold higher plasma TMA (p < 0.001) and a trend towards higher plasma TMAO (p = 0.07). In CP plasma, TMA was inversely correlated with an estimated glomerular filtration rate (eGFR, p = 0.002). TMA but not TMAO reduced cardiomyocytes viability. Incubation with TMA but not TMAO resulted in the degradation of the protein structure of LDH and albumin. In conclusion, CP show increased plasma TMA, which is inversely correlated with eGFR. TMA but not TMAO exerts negative effects on cardiomyocytes, likely due to its disturbing effect on proteins. Therefore, TMA but not TMAO may be a toxin and a marker of cardiovascular risk.

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