Coexisting Morbidity Burden in Hospitalized Elderly Patients with New-Onset Heart Failure vs Acutely Decompensated Chronic Heart Failure

Coexisting morbidities (CM) are common in patients with heart failure (HF). This study evaluated the CM burden and its clinical significance in elderly hospitalized patients with new-onset (De-novo) HF (n = 84) and acutely decompensated chronic HF (ADCHF) (n = 122). All had HF symptoms associated with: (a) LVEF <50%, or, (b) left ventricular ejection fraction (LVEF) ≥50% and NT-proBNP ≥300 pg/mL. The primary endpoint was the composite of all-cause death/HF rehospitalization at 6 months. Age was similar between patients with new-onset HF and ADCHF [82 (12.5) vs 80 (11) years, respectively; P = .549]. The CM burden was high in both groups. However, the number of CM [3 (2) vs 4 (1.75)] and the prevalence of multimorbidity [CM ≥2; 65 (77.4%) vs 108 (88.5%)] were lower in new-onset HF ( P = .016 and P = .035, respectively). The survival probability without the primary endpoint was higher in new-onset HF than in ADCHF ( P = .001) driven by less rehospitalizations ( P = .001). In the total study population significant primary endpoint predictors were red blood cell distribution width (RDW), urea, and coronary artery disease (CAD) prevalence (AUC of the model =.7685), whereas significant death predictors were RDW, urea, and the number of CM (AUC = .7859), all higher in ADCHF. Thus, the higher CM burden in ADCHF than in new-onset HF most likely contributed to the worse outcome.

Stability of health-related quality of life and morbidity burden from 18 months after diagnosis of prostate cancer: results of a UK-wide population-based outcome cohort

Objective To evaluate the dynamic nature of self-reported health-related quality of life (HRQL) and morbidity burden in men diagnosed with prostate cancer, we performed a follow-up study of the Life After Prostate Cancer Diagnosis (LAPCD) study cohort 12 months after initial survey. Methods The LAPCD study collected information from 35,823 men across the UK who were 18–42 months post-diagnosis of prostate cancer. Men who were still alive 12 months later were resurveyed. Generic HRQL (EQ-5D-5L plus self-assessed health rating) and prostate cancer-specific outcomes (EPIC-26) were assessed. Treatment(s) received was self-reported. Previously defined clinically meaningful differences were used to evaluate changes in outcomes over time. Results A total of 28,450 men across all disease stages completed follow-up surveys (85.8% response). Of the 21,700 included in this study, 89.7% reported no additional treatments since the first survey. This group experienced stable urinary and bowel outcomes, with good function for most men at both time points. On-going poor (but stable) urinary issues were associated with previous surgery. Sexual function scores remained low (mean: 26.8/100). Self-assessed health ratings were stable over time. The largest declines in HRQL and functional outcomes were experienced by men reporting their first active treatment between surveys. Discussion The results suggest stability of HRQL and most specific morbidities by 18–42 months for men who report no further treatment in the subsequent 12 months. This is reassuring for those with good function and HRQL but re-enforces the need for early intervention and support for men who experience poor outcomes.

COVID-19 in German Nursing Homes: A Panel Study on Morbidity, Burden of Care, and Social Isolation

Germany was hit by the second wave of the pandemic much harder than by the first wave. The study aims to describe the extent to which nursing homes (NH) are affected by COVID-19. About 8,000 NHs were invited to participate in two waves of an online survey, with a share of 5-10% participating. The share of all deceased NH-residents with COVID-19 is about 50% (04/2020-02/2021). Factors that increase the risk of an outbreak in NH are the spread of the virus in the population, the size of the institution and staff-resident-ratio. The initial lack of protective equipment has decreased during the second wave, but the facilities have to cope with massive additional care needs with reduced staff. NHs have partly banned contacts between residents and relatives. As a conclusion the support of NH in their attempt to fight the impact of this and further pandemic situations requires highest attention.

Clinical characterization of a cohort of patients under treatment for systemic lupus erythematosus in Colombia v1

Introduction/objectives: To describe the clinical characteristics and health care resource utilization in a Colombian systemic lupus erythematosus (SLE) outpatient cohort. Method: Retrospective descriptive study. Clinical records and claims data of SLE patients from ten specialized primary care centers in Colombia between July 2017 and June 2018 were reviewed. Baseline clinical variables, SLE activity (SLEDAI), drugs use, and direct costs were measured. Results: A total of413 patients were included, 361 (87.4%) female; mean age was 42±14 years. Mean disease evolution was 8.9±6.0 years; 174 patients (42.1%) had a systemic manifestation at baseline, mostly lupus nephritis (105; 25.4%). 334 patients (80.9%) had at least one comorbidity, mainly antiphospholipid syndrome (90; 21.8%) and hypertension (76; 18.4%). Baseline SLEDAI score was 0 in 215 patients (52.0%), 1-5 in 154 (37.3%), 6-10 in 41 (9.9%) and 11+ in 3 (0.7%). All patients received pharmacological therapy, the most common were corticosteroids (293; 70.9%), followed by antimalarials (chloroquine 52.5%, hydroxychloroquine 31.0%), immunosuppressants (azathioprine 45.3%, methotrexate 21.5%, mycophenolate mofetil 20.1%, cyclosporine 8.0%, cyclophosphamide 6.8%, leflunomide 4.8%) and biologicals (10.9%). The mean annual costs were USD 1954 per patient/year, USD 1555 for anti-rheumatic drugs (USD 10,487 for those with biologicals), USD 86 for medical visits, USD 235 for drug infusions and USD 199 for laboratory tests. Conclusions SLE generates an important economic and morbidity burden for the Colombian health system. SLE outpatient attention costs in the observation year were mainly determined by drug therapy (especially biologics), medical visits and laboratory tests.

301 Theatre Timing Audit (TTA): HPB and Transplant theatre timing during COVID

Introduction Severe-Acute-Respiratory-Syndrome-Coronavirus-2 is a novel, highly infectious virus that has spread throughout the world causing respiratory disease (COVID-19). COVID-19 was declared a global pandemic by the World Health Organisation in March 2020. The UK has been severely affected with around 70000 deaths recorded by December 2020. Surgical practice during this pandemic has changed, as peri-operative infections carry significant mortality and morbidity burden. Method Theatre timing from a large volume hospital specifically for HPB-Transplant dedicated theatres were assessed to evaluate the impact of the national/local COVID-19 protocols on service delivery. “Pre-COVID period” was defined by auditing times from ward-to-theatre, anaesthetic induction-to-start of procedure and end of procedure-to-transfer out of theatre for 2 consecutive weeks in October/November 2019. “COVID period-1” and “COVID period-2” were defined as two consecutive weeks during the UK government-imposed lockdown in April and November 2020, respectively. Results Under the care of the HPB-Transplant team pre-COVID 56 individuals were treated in 30 sessions. Only 16 patients (28.6% of capacity) in 12 sessions were treated in COVID period-1 and 48 patients were treated (85.7% of capacity) in 30 sessions in COVID period-2. Similar times were observed in transferring patients to theatre (p-value=0.265) and induction of anaesthesia (p-value=0.698) across the 3 periods. Significant delays were observed in transferring patients out of theatre during COVID period-1, that returned to near normal timing during COVID period-2 (16.6±12.8 Vs 39.4±10.9 Vs 17.6±10.5 min; p-value = &lt;0.00001). Conclusions Despite returning to near normal theatre timings in COVID period-2, we treat fewer patients, adversely affecting waiting lists.

Abstract P176: Proportionate Cardiovascular Mortality Patterns Among Patients With Inflammatory Disease In The United States, 1999-2018

Introduction: Novel therapies have changed the clinical course of several chronic viral and inflammatory conditions over the past two decades. As the morbidity burden of these conditions has changed, competing risks for end-organ diseases including cardiovascular diseases (CVDs) may have likewise evolved. We therefore aimed to investigate changes in the relative burden of CVD mortality over the past two decades across several chronic infectious and inflammatory conditions. Hypothesis: Changes in proportionate CVD-related mortality over the past two decades differ across distinct infectious and inflammatory conditions. Methods: We analyzed 1999-2018 Multiple Causes of Death data from the Centers of Disease Control and Prevention. For several chronic infectious and inflammatory conditions, we analyzed patterns in age-adjusted cardiovascular proportionate mortality, defined as the fraction of deaths in a calendar year with CVD as the underlying cause. We compared age-adjusted proportionate CVD mortality, stratified by sex, for systemic lupus erythematosus (SLE), hepatitis C virus (HCV), human immunodeficiency virus (HIV), inflammatory bowel disease (IBD), psoriasis (PSO), rheumatoid arthritis (RA), and systemic sclerosis (SSc). Results: Proportionate CVD mortality in the general population decreased from 40.9% of 2319606 deaths (1999) to 30.6% of 2778169 deaths (2018), whereas it increased for chronic viral conditions (HCV: 7.0% to 10.2%; HIV: 1.9% to 6.7%) and changed little in SLE (15.3% to 14.4%). Patterns of decreasing proportionate CVD mortality over time were similar for IBD and RA as in the general population. Conclusions: Patterns in proportionate CVD mortality over the past 20 years vary considerably for different chronic infectious and inflammatory conditions. The underlying contributions of infectious and inflammatory burden, off-target effects of therapies, and dynamic changes in competing mortality risk merit further study.