Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic

Abstract

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.

Systematic review of the effects of pandemic confinements on body weight and their determinants

“…There was increased alcohol consumption (25,47,56,62,68) during the lockdown, while a decrease in alcohol consumption was also noted compared with pre-COVID-19 in another study (21,47) . There was an increase in cigarette smoking generally (47,51,56,64) while in contrast, 3.3% of the smokers surveyed reported reduced smoking during quarantine (20) .…”

“…We excluded 10 studies based on a quality assessment of the results, and 27 studies were excluded based on reasons presented in the PRISMA flow diagram (Figure 1). The range of observations covered dietary choices (14,21–26,33–36,36–47) , lifestyle changes in children (24,36,48–51) , physical activity levels (33–35,37,38,38–41,43,46,47,49,52,53,53–60) , psychosocial factors (22,23,26,38,44,45,51,52,55,56,58,61,62) , socioeconomic factors (23,37,48,52,54,61) and sleeping patterns (26,46,51,63) .…”

“…The included studies had the following countries of origin: Brazil (59) , China (40,57) , Croatia (51,64) , France (47,52,56) , Jordan (58) , India (48,55) , Iraq (61) , Italy (21,23,24,35,36,45,45,53) , Korea (50) , Lithuania (39) , Netherlands (60) , Poland (25,42,51) , Spain (44,46,63) , Turkey (43,49,65,66) , United Arab Emirates (33) , United Kingdom (54) and the United States of America (26,38,41,67) . Furthermore, multi-regional studies conducted intercontinentally (22) , among eighteen countries in the Middle East and North Africa (MENA) region (34) , and Paraguay and Italian based multinational research (62) are included in our analysis.…”

Psychological Distress in Patients with Autoimmune Arthritis during the COVID-19 Induced Lockdown in Italy

“…The psychological distress observed in autoimmune arthritis seems to be shared with some chronic diseases, including cardiovascular diseases [ 50 ], asthma and COPD [ 51 ], cancer [ 52 , 53 ], and psychiatric disorders [ 44 , 54 , 55 ]; whereas patients with other chronic conditions, such as multiple sclerosis [ 56 ] and, surprisingly, patients with diabetes, do not seem to have particularly suffered from the negative psychological consequences of COVID-19-induced lockdown, even though, for diabetes patients, their levels of adherence to treatment and lifestyle habits were reported to be significantly reduced [ 57 ]. The reason for these discrepancies among chronic conditions is difficult to interpret and may be ascribed to differences in study populations, such as age (i.e., older in arthritis than in multiple sclerosis or type I diabetes), gender (i.e., predominance of the female gender in arthritis than in type I diabetes), but also on the illness itself, such as severe inflammatory joint pain, stiffness and, consequently, functional limitation pathognomonic of autoimmune arthritis, which are closely dependent on tight medical monitoring, and can quickly impact the psychological well-being of these patients.…”

Remote monitoring in heart failure: current and emerging technologies in the context of the pandemic

“…In a telephone survey of 124 patients with HF from the Dijon University Hospital Heart Failure Clinic during the sixth and seventh weeks of the lockdown in France, 18.5% reported greater psychological distress, 41.9% had decreased physical activity, 14.5% reduced their adherence to salt and fluid restriction, and 44.4% of smokers had increased their tobacco consumption. 27 In a multicentre survey of US clinicians in May 2020, 100% reported a decline in inperson office visits and almost 50% reported having a higher threshold for recommending admission for management of decompensated HF. 28 The pandemic has impacted HF hospitalisations: in a large tertiary care centre in Mississippi, cases of HF averaged 30 per week in the months prior to the pandemic, 15 per week after the first COVID-19 case was diagnosed in Mississippi, and declined to 5 per week after the state-wide shelter-in-place order was mandated.…”