The Penn State Heart Assistant, a web-based, tablet computer-accessed, secure application was developed to conduct a proof of concept test, targeting patient self-care activities of heart failure patients including daily medication adherence, weight monitoring, and aerobic activity. Patients (n = 12) used the tablet computer-accessed program for 30 days-recording their information and viewing a short educational video. Linear random coefficient models assessed the relationship between weight and time and exercise and time. Good medication adherence (66% reporting taking 75% of prescribed medications) was reported. Group compliance over 30 days for weight and exercise was 84 percent. No persistent weight gain over 30 days, and some indication of weight loss (slope of weight vs time was negative (-0.17; p value = 0.002)), as well as increased exercise (slope of exercise vs time was positive (0.08; p value = 0.04)) was observed. This study suggests that mobile technology is feasible, acceptable, and has potential for cost-effective opportunities to manage heart failure patients safely at home.

Background: Previous studies have suggested that the use of heated high-flow nasal canula (HHFNC) may reduce intubation rates in severely hypoxemic patients (PaO 2 /FiO 2 <200). Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, HHFNC was underutilized due to concern for viral aerosolization. Studies have since shown that HHFNC has a similar aerosolization risk as a standard oxygen mask prompting increased usage of HHFNC in patients with SARS-CoV-2. We sought to determine if the usage of HHFNC reduced the odds of intubation or the number of ventilator days for patients with acute hypoxemic respiratory failure due to SARS-CoV-2 pneumonia (COVID-19). Methods: We conducted a retrospective cohort study utilizing electronic health record data from the University of Colorado Health System. We included all adult patients admitted to intensive care units between February 1st, 2020 and May 3rd, 2020 with a diagnosis of acute hypoxemic respiratory failure and COVID-19. We divided patients into two groups: patients who received HHFNC and patients who did not receive HHFNC. Patient demographics, clinical characteristics and clinical outcomes were compared. Results: A total of 193 patients were included, of which 41 (21.2%) received HHFNC support. Age, sex, ethnicity, BMI, and comorbidities were similar between both groups. CRP was slightly higher and creatinine lower in the HHFNC group. We found that patients who used HHFNC were 76.5% less likely to receive mechanical ventilation (p<0.001). Patients who were supported with HHFNC spent an average of 5.1 more days on mechanical ventilation (p=0.025). The odds of death were estimated to be 39.4% lower for those who used HHFNC after adjusting for confounders (age, sex, BMI, ethnicity, smoking, alcohol use, prone positioning, corticosteroid use and Remdesivir use) however this effect estimate was not statistically significant. Conclusions: We found that patients with COVID-19 who received HHFNC were less likely to be intubated, which is consistent with previously published data. Those who did require intubation remained on mechanical ventilation for a longer duration. Our study did not detect any differences in mortality between the HHFNC group and the non-HHFNC group. These findings suggest HHFNC may be a useful modality for treatment of acute hypoxemic respiratory failure due to SARS-CoV-2 that may reduce the need for mechanical ventilators during local shortages.

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Older patients represent an inordinate proportion of intensive care unit (ICU) admissions and ICU mortality associated with coronavirus disease 2019 (COVID-19). In this retrospective cohort study, we examine 198 patients, aged 18 years or older, admitted to the ICU from March to June 2020. We aim to understand the relationships between age, number of comorbidities, and independent living prior to admission on outcomes of mortality, length of stay, renal failure, respiratory failure, and shock. In this cohort, we find that overall mortality was associated with respiratory failure severity (for every decrease of P:F by 50, odds ratio (OR) 2.98 (1.65–6.08)), acute renal failure (OR 4.61 (1.2–19.7)), and age 65 or greater (OR: 3.7 (1.86–7.36)). Surprisingly, increasing age was associated with less severe respiratory failure (R = 0.22, p < 0.01). When adjusting for pre-existing chronic kidney disease, age was not associated with development of acute kidney injury (OR: 1.01 (0.99–1.03)). While chronologic age is associated with mortality, it is not associated independently with severe end organ damage. This is consistent with growing evidence suggesting that a complex interplay between multimorbidity, immunosenescence, and physiologic age is primarily responsible for the vulnerability to COVID-19.