Background Cardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in coronavirus disease-2019 (COVID-19). Objectives To assess the frequency of arterial and venous thromboembolic disease, risk factors, prevention and management patterns, and outcomes in patients with COVID-19, the authors designed a multicenter, observational cohort study. Methods We analyzed a retrospective cohort of 1,114 patients with COVID-19 diagnosed through our Mass General Brigham integrated health network. The total cohort was analyzed by site of care: intensive care (n = 170); hospitalized nonintensive care (n = 229); and outpatient (n = 715). The primary study outcome was a composite of adjudicated major arterial or venous thromboembolism. Results Patients with COVID-19 were 22.3% Hispanic/Latinx and 44.2% non-White. Cardiovascular risk factors of hypertension (35.8%), hyperlipidemia (28.6%), and diabetes (18.0%) were common. Prophylactic anticoagulation was prescribed in 89.4% of patients with COVID-19 in the intensive care cohort and 84.7% of those in the hospitalized nonintensive care setting. Frequencies of major arterial or venous thromboembolism, major cardiovascular adverse events, and symptomatic venous thromboembolism were highest in the intensive care cohort (35.3%, 45.9%, and 27.0 %, respectively) followed by the hospitalized nonintensive care cohort (2.6%, 6.1%, and 2.2%, respectively) and the outpatient cohort (0% for all). Conclusions Major arterial or venous thromboembolism, major adverse cardiovascular events, and symptomatic venous thromboembolism occurred with high frequency in patients with COVID-19, especially in the intensive care setting, despite a high utilization rate of thromboprophylaxis.
Court-ordered redistricting in the mid-1960s eradicated severe disparities in the populations of U.S. state legislative districts. We examine the geographic distribution of money by states to counties. Cross-sectional analysis shows that counties with relatively more legislativeseats per person prior to redistricting received relatively more transfers from the state per person. Over time, counties that lost legislative seats subsequently received a smaller share of state funds per capita. We calculate that population equalization significantly altered the flow of state transfers to counties, diverting approximately $7 billion annually from formerly overrepresented to formerly underrepresented counties, an effect missed by past studies. For those concerned with the design of democratic institutions around the world today, the American experience provides clear evidence of the political consequences of unequal representation.
Simple, inexpensive interventions can increase physical activity. Research is needed to identify effective motivators to promote activity among black persons.
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