Background COVID-19 frequently affects the cardiovascular system. Advanced age and pre-existing heart failure HF are considered risk factors for a poor prognosis. However, the cardiovascular consequences of COVID-19 in older adults with a history of HF have not been clearly depicted. Methods A retrospective review was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD codes, patients aged 65–75 and Elixhauser Comorbidity Score(ECI)>4 with a history of HF admitted for COVID-19 were identified. This cohort was propensity score matched with a group of patients without HF by age, gender, other cardiovascular diseases, and ECI. Records from both groups were reviewed for new onset of cardiovascular-related conditions, including myocardial infarction(MI), arrhythmias, and hypertension, within one year following the admission. Pearson’s chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results 4,014 members in each group were identified. A history of HF was associated with an increased risk of MI(RR=1.18, CI95% =1.005–1.37, p=0.04), and arrhythmias (RR=1.17, CI95% =1.08–1.26, p < 0.00001). No differences present in risk of myocarditis(RR=0.05, CI95%=0.12–1.99, p=50) across groups. Conclusion Older adults with a history of HF are more likely to experience MI and arrhythmias over a year after hospitalization for COVID-19.
Background Data suggest an increased incidence of myocarditis (MC) associated with the COVID-19 virus. However, the risk factors for COVID-19-related MC remains poorly understood and debated. Therefore, we sought to evaluate the correlation of a history of coronary artery disease (CAD) with MC in older adults admitted for COVID-19. Methods Data were obtained from the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). The study included patients aged 65–75, hospitalized with a primary diagnosis of COVID-19, and Elixhauser Comorbidity index(ECI) >4. History of CAD upon admission was used to split the cohort into two propensity score-matched groups considering age, gender, other cardiovascular diseases, and ECI. Records from both groups were reviewed to identify patients diagnosed with MC during and up to one month after admission. Pearson’s chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results 182,556 patients with and 218,729 without a history of CAD admitted for COVID-19 were identified. Patients with a history of CAD were more likely to be male(54.7% vs. 42% p < 0.0001), older(mean age 70.62 vs. 70.30, p < 0.001), and had more comorbidities(ECI=11 vs. 8, p < 0.0001). After propensity score matching, 0.13% of patients with CAD and 0.12% without CAD developed MC within one month of admission(RR= 1.05, CI95%=0.87–1.26, p=0.61). Conclusion One month following admission for COVID-19, the risk of MC was not significantly higher in older persons with a history of CAD.
Background Age, atrial fibrillation (AF), and COVID-19 infection predispose patients to hypercoagulability and poor outcomes. It is unclear if older adults with AF and COVID-19 infection would benefit from oral anticoagulants (OACs). Methods A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD-10 codes, adults aged 65–75 and Elixhauser Comorbidity index(ECI) >4 with a history of AF admitted for COVID-19 were identified. The use of OACs for 6 months before the index event was used to split the cohort into two propensity score-matched groups considering age, gender, and ECI. Records from both groups were reviewed for multiple outcomes during the same admission. Pearson’s chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results We compared 16,967 individuals in both anticoagulated and non-anticoagulated groups. Anticoagulated patients had a lower risk of mortality (RR=0.11, p=0.026), and a higher risk of 30-day all-cause readmission(RR=1.12, p < 0.0001). However, there were no differences in ICU admission, gastrointestinal bleeding, intracranial hemorrhage, thromboembolic events, or length of hospitalization. Conclusion Compared to non-anticoagulated patients, older adults with a history AF on chronic oral anticoagulants had a lower risk of all-cause mortality, and higher risk of 30-day all-cause readmission. This information would help clinicians decide whether to prescribe OACs to this population of patients.
Background Age increases the risk of atrial fibrillation (AF). Catheter ablation (CA) proved being safer and superior to anti-arrhythmic drugs (AADs) in maintaining sinus rhythm and preventing readmissions. However, data on the risk of developing heart failure (HF) following each treatment in older adults is limited. Methods A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD 9 and 10 codes, a cohort of patients without a history of HF, aged 65 to 75, with an Elixhauser Comorbidity Index (ECI) of >4 and new-onset AF (index event) was identified. The cohort was then divided into two groups based on treatment received following the index event and matched considering age, gender, ECI, and other cardiovascular diseases. Records from both groups were reviewed for the first episode of HF over 12 months following the initiation of treatment. Pearson’s chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results 6,446 were included in each group. The mean age, gender and ECI were indifferent. 958 (15%) of patients treated with AADs and 987 (15.3%) of patients treated with CA had a first episode of HF over a year after the treatment which was not significantly different between groups (RR=1.03, CI95% = 0.95- 1.11, p=0.49). Conclusion The modality of treatment after the first episode of AF in older population doesn’t significantly affect the risk of HF over the first year.
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