Background We aimed to evaluate the impact of coronavirus disease 2019 (COVID-19)-related lockdown on adherence to lifestyle and drug regimens in stay-at-home chronic coronary syndromes patients living in urban and rural areas. Methods A cross-sectional population-based study was perfomed in patients with chronic coronary syndromes. A sample of 205 patients was randomly drawn from the RICO (Observatoire des infarctus de Côte d'Or) cohort. Eight trained interviewers collected data by phone interview during week 16 (April 13 to April 19), i.e. 4 weeks after implementation of the French lockdown (start March 17, 2020). Results Among the 195 patients interviewed (of the 205, 3 had died, 1 declined, 6 lost), mean age was 65.5 ± 11.1 years. Only six patients (3%) reported drug discontinuation, mainly driven by media influence or family members. All 166 (85%) patients taking aspirin continued their prescribed daily intake. Lifestyle rules were less respected since almost half (45%) declared >25% reduction in physical activity, 26% of smokers increased their tobacco consumption by >25%, and 24% of patients increased their body weight > 2 kg. The decrease in physical activity and the increase in smoking were significantly greater in urban patients (P < .05). Conclusions The COVID-19-related lockdown had a negative impact on lifestyle in a representative sample of stay-at-home CCS patients.

Aims Cardiovascular co‐morbidities like congestive heart failure (CHF) alter the course of coronavirus disease 2019. Factors associated with the outbreak and lockdown can exacerbate CHF. Methods and results We analysed the answers of 124 randomly selected CHF outpatients (mean age 71.0 ± 14.0 years, 60.5% male) interviewed by phone during the sixth and seventh weeks of the lockdown. Most patients were treated for New York Heart Association class II (38.7%) and reduced ejection fraction HF (70.2%). Psychological distress (Kessler 6 score ≥ 5) was common (18.5%), and 21.8% felt worse than before the lockdown. Few patients ( n = 10) adjusted their intake of HF medications, always on medical prescription. Decreased physical activity was common (41.9%) and more frequent in women ( P = 0.025) and urban dwellers ( P = 0.009). Almost half of respondents (46.0%) declared increased screen time, but only few declared more alcohol intake (4.0%). Weight gain was common (27.4%), and 44.4% of current smokers increased tobacco consumption. Adherence to recommended salt or fluid intake restrictions was reduced in 14.5%. Increase in HF symptoms was commonly reported (21.8%) and tended to be higher in women than in men ( P = 0.074). Of the 23 patients who had a phone teleconsultation during the pandemic, 16 had initially planned an in‐person consultation that they switched for teleconsultation. Conclusions During the lockdown, psychological distress and decreased well‐being were common in CHF outpatients, and there was an increase in unhealthy lifestyle behaviours. These changes may negatively impact short‐term and long‐term prognoses. Medication adherence was maintained, and limitations in access to care were partly counterbalanced by use of telehealth.

Background Congestive heart failure (CHF) alters the course of COVID-19 (C19); pandemic and lockdown can destabilize CHF. Purpose To evaluate impact of lockdown in CHF patients. Methods 150 out patients from the HF Clinic of our hospital were invited to answer t o a phone-call interview during the 7th week of first C19 lockdown. Results 124 questionnaires were fit for analysis. Almost all patients declared to respect the nationwide lockdown policies. More than one fifth felt worse than before the lockdown and almost one fourth declared a significant psychologic distress (Kessler-6 score≥ 5). Approximately 10% declared modifications of their CHF medications, always on medical prescription. No patients declared a medication supply failure. Decrease in physical activity was common, almost twice as much in urban than in rural population (50.0 vs 26.2%, P = 0.009). Almost half declared increased screen time and 4 of the 9 smokers increased tobacco consumption. Adherence to dietary counselling was reduced by 17.7% of patients. Increase in weight and HF symptoms were commonly reported. During lockdown time frame, 23 patients who benefitted from a teleconsultation, of whom 16 switched from a planned physical examination they cancelled ( Fig. 1 ). Conclusions Our patients with CHF exhibited weel-being impairment and unhealthy behaviours, thus suggesting increased risk of future events. Medication adherence was not diminished and the reduction in care access was counterbalanced by a switch toward telehealth. This work was supported by a grant from Dijon Football Côte d’Or and CHU Dijon Bourgogne.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Dijon University Hospital France OnBehalf CLEO-CD Background   Lockdown can affect tobacco smoking (TS) behaviours.  Purpose To evaluate the impact of lockdown on (TS) and associated lifestyle behaviours in patients with Chronic coronary syndrome (CCS) and congestive heart failure (CHF) Methods CCS and CHF patients were invited to answer to a phone-call questionnaire during the 1st COVID-19 lockdown start  Results (Table) 343 questionnaires were fit for analysis, 43 (12.5%) were current smokers (CS). CS were younger (p &lt; 0.001), none stopped and 13 increased their consumption (main reasons were stress and boredom). CS felt more often cramped (p = 0.023). CS who increased their TS consumption showed a trend toward a higher rate of unhealthy lifestyle behaviours Conclusions During the lockdown, more than ¼ of CS with CCS or CHF increased their TS consumption and none quitted. Moreover, TS was often associated with other deleterious behaviours increasing their risk for short and long term Main results Total Non-Smokers Smokers p* N(%) 344 301 43 Age, years 67.7 ± 12.8 69.2 ± 12.2 57.2 ± 12.1 &lt;0.001 Men/Women 229/115 197/104 32/11 0.300 CCS/CHF 220/124 185/116 36/7 0.004 Urban/Rural 163/181 137/164 26/17 0.073 Living alone at home 83(24.3) 68(22.7) 15(34.9) 0.089 COVID screening (PCR) 11(3.2) 7(2.3) 4(9.3) 0.037 Feeling cramped 19(5.5) 13(4.4) 6(14.0) 0.023 Feeling less well 75(21.9) 65(21.7) 10(23.8) 0.842 K6 ≥ 5 81(23.7) 70(23.5) 11(25.6) 0.845 Physical activity decrease 146(42.6) 125(42.1) 21(48.8) 0.323 Screen time increase 154(45.0) 130(43.5) 24(55.8) 0.100 Alcohol consumption increase 14(5.5) 11(4.9) 3(7.5) 0.419 Sleep change 83(24.6) 68(22.5) 15(39.5) 0.083 Weight increase 77(22.4) 64(21.3) 13(30.2) 0.242 Smokers (n = 43) Smoking increase No smoking increase p** Feeling less well 5(38.5) 5(17.2) 0.238 Screen time increase 10(76.9) 14(46.7) 0.104 Weight increase 6(46.2) 7(23.3) 0.173 n(%) or mean ± SD. *p value: Smokers vs non smokers. **p value: Smoking increase vs no smoking increase

Background Healthy lifestyle, which are keystones in management of chronic cardiac patients, could be challenged during the lockdown. Purpose In patients with Chronic coronary syndrome (CCS) or congestive heart failure (CHF), to evaluate the impact of the place of residence during the Covid-19 lockdown on lifestyle behaviours. Methods Randomly selected subjects among 250 patients with CCS (from RICO survey) and 150 patients with CHF (from a HF clinic) were invited to answer to a phone-call questionnaire during the 1st COVID-19 lockdown. Urban zone was defined as ≥ 2000 inhabitants. Psychological distress was assessed by Kessler-6 score. Results 344 questionnaires were fit for analysis (220 CCS and 124 CHF), including 66.6% male, with median (IQR) age at 70(59-78) y ( Table 1 ). Rural location of lockdown residence was frequent (53%), and associated with less lifestyle impairment (i.e. decrease in physical activity and increase in screen-time). In contrast, patients living in urban area felt more often cramped and had a higher psychologic distress. Conclusions During the 1st lockdown, chronic cardiac subjects from rural areas reported less unhealthy behaviors and lower rate of psychological impairment. These data may help to implement preventive action targeting urban patients.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Dijon Football Côte d"Or OnBehalf CLEO-CD Background Lifestyle behaviours (LB) are keystones of coronary prevention and might be impacted during Covid-19 (C19) lockdown. Purpose To compare the LB in urban and rural patients suffering from chronic coronary syndrom (CCS) Methods 250 outpatients suffering from CCS were invited during the 6th week of the 1st C19 lockdown to answer to a phone-call questionnaire. Results 220 questionnaires were fit for analysis, of whom about 1/4 declared a psychologic impairment; people staying at home in urban zones trended to be more impacted. Unhealthier behaviours including cigarette smoking, decrease in physical activity and increase in screentime were common, especially in patients from urban zones. Telehealth partially counterbalanced limitation in care access and none declared discontinuation of medications. Conclusion The lockdown impacted wellbeing of CCS patients; living in rural zone was associated with a healthier LB. Main results TOTAL URBAN RURAL N (%) 220 107 113 p * Age (years, SD) 66.4+/-12.0 64.5+/-14.0 68.2+/-9.5 0.02 Male/Female 154/66 76/31 78/35 0.77 Alone at home 47(21.7) 28(26.2) 19(17.3) 0.13 Feeling cramped 16(7.6) 13(12.5) 3(2.8) 0.008 Feeling less well 50(22.9) 29(27.1) 21(18.9) 0.19 Kessler-6 score ≥ 5 57(26.8) 33(32.0) 24(21.8)) 0.12 Sleep impairment 53(24.5) 30(28.6) 23(20.7) 0.20 Angina pectorisdestabilization 13(6.6) 8(7.9) 5(5.3) 0.57 Cancelled physical examination** 67(63.8) 40(65.6) 27(61.4) 0.68 Switched to Telehealth*** 16(17.0) 7(17.5) 9(16.7) 1 Coronavirus testing 7(3.2) 3(2.8) 4(3.6) 1 Lifestyle behaviours Cigarette smoking 36(16.4) 26(23.3) 10(9.3) 0.006 Cigarette smoking increase 11(30.6) 8(40.0) 3(18.8) 0.27 Decreased physical activity 96(44.2) 56(53.3) 40(35.7) 0.009 Screentime increase 98(45.0) 59(55.1) 39(35.1) 0.004 Alcohol intake increase 10(5.2) 5(5.3) 5(5.2) 1 Weight increase ≥ 2 kg 52(24.5) 28(26.9) 24(22.2) 0.52 * between Urban and Rural **from scheduled physical examination ***from cancelled scheduled physical examination

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Dijon Football Côte d"Or OnBehalf CLEO-CD Background Congestive heart failure (CHF) can be destabilized by Covid-19 (C19) lockdown. Purpose To evaluate the impact of lockdown in CHF patients. Methods 150 out-patients from the HF Clinic of our hospital were invited to answer to a phone-call interview during the 7th week of first C19 lockdown . Results From 124 questionnaires, more than 1/5 felt worse and almost 1/4 declared a psychologic distress. CHF medications were modified in 10%. Decrease in physical activity was observed in 2/5. Almost 1/2 declared increased screen time;  smokers often increased consumption. Adherence to dietary counselling was reduced by 1/6, increase in weight and HF symptoms were common. Some patients benefitted from a teleconsultation. Conclusions Our patients exhibited well-being impairment and unhealthy behaviours. Medication adherence was not diminished and the reduction in care access was counterbalanced by a switch toward telehealth. Main results 124 patients 75 Male (M) 49 Female (F) p value between M and F Age, years 71.0 ± 14.0 68.9 ± 13.7 74.3 ± 14.0 0.03 Urban/Rural 82/42 49/26 33/16 0.84 HFrEF* 87 62 25 &lt;0.001 Dilated cardiomyopathy 50 37 13 0.02 Ischemic 23 18 5 0.06 Other 51 20 31 &lt;0.0001 Current NYHA class I/II/III/IV 39/48/28/9 29/29/14/3 10/19/14/6 0.66 History of NYHA III-IV class 94 62 32 0.03 Electronic device/Telemonitoring 77/28 54/18 23/10 &lt;0.001/0.66 Increase in dyspnea or edema or fatigue 27 13 14 0.07 Decrease in well-being 27 12 15 0.07 Psychological distress (#) 23 15 (20.0) 8 0.64 Weight gain &gt; 2 kg 34 22 (29.3) 12 0.68 Switch for teleconsultation (##) 16 11 (34.4) 5 1 Teleconsultation (total) 23 14 9 1 Decrease in physical activity 52 25 (33.3) 27 0.02 Increase in screen time 57 31 (41.3) 26 0.27 Increase in cigarette consumption (9 smokers) 4 3 1 1 Decrease in dietary adherence (###) 22 (17.7) 15 (20.0) 7 (14.3) 0.47 *HFrEF; # Kessler-6 score ≥ 5; ## from planned physical examination; ### salt, water, alcohol