Introduction
Coronavirus disease 2019 (COVID‐19) has become a major global crisis. Preliminary reports have, in general, indicated worse outcomes in diabetes mellitus (DM) patients, but the magnitude of cardiovascular (CV) complications in this subgroup has not been elucidated.
Methods
We included 142 patients admitted with laboratory‐confirmed COVID‐19 from April 1st to May 30th 2020; 71 (50%) had DM. We compared baseline demographics and study outcomes between those with or without DM using descriptive statistics. Multivariate logistic regression was used to estimate the adjusted odds ratio for the study outcomes in DM patients, compared to those without DM, stratified by age, sex and glycaemic control. CV outcomes of interest include acute myocarditis, acute heart failure, acute myocardial infarction, new‐onset atrial fibrillation and composite cardiovascular end‐point consisting of all individual outcomes above.
Result
Mean age was 58 years. The unadjusted rates were higher in DM patients compared to non‐diabetics for the composite cardiovascular end‐point (73.2% vs. 40.6%
p
< .0001), acute myocarditis (36.6% vs. 15.5%
p
= .004), acute heart failure (25.3% vs. 5.6%
p
= .001), acute myocardial infarction (9.9% vs. 1.4%
p
= .03) and new‐onset atrial fibrillation (12.7% vs. 1.4%
p
= .009). After controlling for relevant confounding variables, diabetic patients had higher odds of composite cardiovascular end‐point, acute heart failure and new‐onset atrial fibrillation.
Background: To adapt during the coronavirus disease 2019 (COVID-19) pandemic, a large safety-net hospital in Atlanta, Georgia and other hospitals across the United Sates, increased telemedicine (TM) for outpatient visits. The impact on resident physicians, including minority providers, had not yet been reported. We aimed to assess how primary care residents perceived increased TM in clinics during the pandemic, and assess resident burnout. Materials and Methods: An online survey was sent to 60 internal medicine (IM) and 18 family medicine (FM) residents who used TM to treat underserved patients, from March to May 2020, at the onset of the COVID-19 pandemic. The questionnaire included questions on resident demographics, satisfaction with TM, screening capability for COVID-19, effectiveness for patient education on COVID-19, impact on patient interactions and time management. Burnout was assessed with the Abbreviated Maslach Burnout Inventory. Results: A majority (62 of 78) eligible residents (79.5%) responded to the survey. Ninety-one percent of residents agreed that TM was a secure alternative to face-to-face encounters. Seventy-nine percent used it to screen for signs/symptoms of COVID-19 and 93% provided patient education on COVID-19. Average visit length decreased by 10-20 min with TM. Post-TM, scores for overall burnout were decreased (p = 0.0003) and less residents in total exhibited burnout (p = 0.0156). Discussion and Conclusions: IM and FM residents viewed TM as an efficient way to screen for and provide education on COVID-19, as well as a secure alternative to face-to-face encounters. With increased used of TM during COVID-19, there was decreased burnout among primary care residents.
Background Data on the incidence, predictors, and outcomes of sudden cardiac arrest (SCA) in the immediate post-percutaneous coronary intervention (PCI) period for ST-elevation myocardial infarction (STEMI) are limited.
ObjectivesThe study aimed to investigate the trends and predictors of SCA occurring within 48 h post PCI for STEMI.
MethodsWe systematically reviewed data from the electronic medical records of 403 patients who underwent PCI for STEMI between January 2014 and December 2019. Trends in the incidence of SCA 48 h post PCI for STEMI were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to determine the predictors of SCA within 48 h post PCI for STEMI.
ResultsOf the 403 patients who underwent PCI for STEMI, 44 (11%) had SCA within 48 h post PCI. The incidence of SCA within 48 h post PCI decreased from 22% in 2014 to 8% in 2019; P = 0.03. After adjusting for underlying confounding variables in the multivariable logistic regression models, out of hospital cardiac arrest [adjusted odds ratio (aOR), 23.9; confidence interval (CI), 10.2-56.1], left main coronary artery disease (aOR, 3.1; CI, 1.1-9.4), left main PCI (aOR, 6.6; CI: 1.4-31.7), newonset heart failure (aOR, 2.0; CI, 4.3-9.4), and cardiogenic shock (aOR, 5.8; CI,2) were statistically significant predictors of SCA within 48 h post PCI for STEMI.
ConclusionWe identified essential factors associated with SCA within 48 h post PCI for STEMI. Future studies are needed to devise effective strategies to decrease the risk of SCA in the early post-PCI period.
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