Decrease In Hospital Admissions Research Articles

Beta-Blockers and Mortality Reduction in Heart Failure: A Systematic Review of Randomized Controlled Trials

Background: Heart failure is a leading cause of morbidity and mortality. This systematic review evaluates beta blockers' effects on all-cause mortality, cardiovascular mortality, and hospital admissions in heart failure, synthesizing data from over 50 randomized controlled trials. Methods: Using PRISMA principles, the data regarding the effect of beta blockers on heart failure mortality and hospitalizations were synthesized. Extensive database searches (PubMed, Embase, Cochrane Library, and Web of Science) and manual reference checks were used to identify randomized controlled studies that compared beta blockers with placebo or conventional treatment in adults. The quality of data extraction process was evaluated according to the Cochrane Risk of Bias tool following the guidelines. Heterogeneity was assessed (I2), sensitivity analyses guaranteed robustness, and random-effects meta-analyses quantified results. Transparency was guaranteed via PROSPERO registration. Results: Beta-blockers were linked to a 29% decrease in cardiovascular mortality (OR 0.71, 95% CI 0.64–0.79, p< 0.05) and a 33% decrease in all cause mortality (OR 0.67, 95% CI 0.59–0.76, p < 0.05) when compared to alternative therapies. Additionally, beta-blocker-treated patients saw a 37% decrease in hospital admissions (OR 0.63, 95% CI: 0.56–0.71, p < 0.05). The class impact of beta blockers in heart failure treatment is supported by these advantages which were constant across subgroups and beta blocker types. Conclusion: This systematic review corroborates the well-established benefit of beta blockers in lowering mortality and hospitalizations in heart failure patients, particularly with HFrEF. The findings support the use of beta blockers as a cornerstone of heart failure therapy and there is a need for further research to optimize the use of beta blockers in combination with other emerging therapies.

Impact of the coronavirus disease 2019 pandemic on hospital admissions for idiopathic pulmonary fibrosis: a nationwide population-based study

BackgroundPrevious studies have consistently reported a decrease in hospital admissions for respiratory diseases during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on idiopathic pulmonary fibrosis (IPF) admissions remains unknown.MethodsThis study used data from the Korean National Health Insurance Service database. IPF was defined based on the International Classification of Diseases 10th Revision (ICD-10) and rare intractable disease (RID) codes. The rate of IPF admissions was calculated by dividing the number of IPF admissions by the prevalence of IPF. The rate of IPF admissions during the COVID-19 pandemic (2020–2021) was compared with the mean rate of admissions during the prepandemic period (2017–2019) and presented as the rate ratio (RR). A sensitivity analysis was conducted on patients treated with systemic corticosteroids during IPF admission.ResultsIn patients with IPF defined based on the ICD-10 (analysis 1), the RRs significantly decreased from March in 2020 to December 2021, except for June and September in 2020. Similarly, in patients with IPF defined based on the ICD-10 and RID (analysis 2), the RRs significantly decreased from March 2020 to December 2021, except for June and September 2020. In the sensitivity analysis of analysis 1, the RR significantly decreased in 2020 (0.93; 95%CI: 0.88–0.99; P = 0.029), whereas the RR in 2021 was not significantly different. The RRs in the sensitivity analysis of analysis 2 significantly decreased to 0.85 (0.79–0.92; P < 0.001) in 2020 and 0.82 (0.76–0.88; P < 0.001) in 2021. In the subgroup analysis, the rates of IPF admissions significantly decreased in 2020 and 2021 across both sexes, patients aged ≥ 60 years, and all household income groups.ConclusionsThe rate of IPF admissions significantly decreased during the COVID-19 pandemic. This result indicates that preventive measures against COVID-19 may effectively mitigate IPF exacerbation. Therefore, it is assumed that there is a close relationship between respiratory viral infections and IPF exacerbations.

Telemetric ICP monitoring in children: a national questionnaire-based study.

Telemetric monitoring of intracranial pressure (ICP) facilitates long-term measurements and home monitoring, thus potentially reducing diagnostic imaging and acute hospital admissions in favour of outpatient appointments. Especially in paediatric patients, telemetric ICP monitoring requires a high level of collaboration and compliance from patients and parents. In this study, we aim to systematically investigate (1) patient and parent perception of telemetric ICP system utility and (2) hospital contact history and thus the potential cost-benefit of telemetric ICP monitoring in paediatric patients with a cerebrospinal fluid disorder. We conducted a nationwide questionnaire study, including paediatric patients with either a current or previous telemetric ICP sensor and their parents. Additionally, a retrospective review of electronic health records for all included children was performed. We included 16 children (age range 3-16 years), with a total of 41 telemetric ICP sensors implanted. Following sensor implantation, the frequency of telephone contacts and outpatient visits increased. No corresponding decrease in hospital admissions or total length of stay was found.The telemetric ICP sensor provided most parents with an improved sense of security and was seen as a necessary and valuable tool in treatment guidance. The size and shape of the sensor itself were reported as disadvantages, while the external monitoring equipment was reported as easy to use but too large and heavy for a child to carry. Though, in quantitative terms, there was no cost-benefit of the telemetric ICP sensor, it contributed to extended parental involvement and a sense of improved safety.

Long-term care use, hospitalizations and mortality during COVID-19 in Finland and Sweden: A nationwide register-based study in 2020.

To describe long-term care (LTC) use in Finland and Sweden in 2020, by reporting residential entry and exit patterns including hospital admissions and mortality, compared with the 2018-2019 period and community-living individuals. From national registers in Finland and Sweden, all individuals 70+ were included. Using the Finnish and Swedish study populations in January 2018 as the standard population, we reported changes in sex- and age-standardized monthly rates of entry into and exit from LTC facilities, mortality and hospital admission among LTC residents and community-living individuals in 2020. Around 850,000 Finns and 1.4 million Swedes 70+ were included. LTC use decreased in both countries from 2018 to 2020. In the first wave (March/April 2020), Finland experienced a decrease in LTC entry rates and an increase in LTC exit rates, both more marked than Sweden. This was largely due to short-term movements. Mortality rates peaked in April and December 2020 for LTC residents in Finland, while mortality peaked for both community-living individuals and LTC residents in Sweden. A decrease in hospital admissions from LTC facilities occurred in April 2020 and was less marked in Finland versus Sweden. During the first wave of the pandemic mortality was consistently higher in Sweden. We also found a larger decrease in LTC use and, among LTC residents, a smaller decrease in hospital admissions in Finland than in Sweden. This study calls for assessing the health consequences of the differences observed between these two Scandinavian countries as part of the lessons from the COVID-19 pandemic.

Chronic Obstructive Pulmonary Disease Mortality and Hospitalization during the COVID-19 Pandemic Compared with before the Pandemic: A Systematic Review and Meta-Analysis.

This study aimed to assess the impact of the pandemic on hospitalization and mortality rates among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We conducted a systematic search across three medical databases for studies comparing the AECOPD mortality and hospitalization rates during the COVID-19 pandemic with those before the pandemic, up until December 2023. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, we performed a meta-analysis with a random-effects model to pool odds ratios (ORs), 95% confidence intervals (CIs), and heterogeneity (I2). From 4689 records, 21 studies met our inclusion criteria. Our analysis revealed a significant increase in in-hospital mortality during the pandemic (pooled OR = 1.27, 95% CI = 1.17-1.39, I2 = 50%). Subgroup analysis highlighted a more pronounced mortality risk in single-center studies and smaller populations. Conversely, hospitalization rates for AECOPD significantly declined during the pandemic (pooled OR = 0.39, 95% CI = 0.18-0.85, I2 = 99%). The study demonstrates that during the COVID-19 pandemic, there was a substantial decrease in hospital admissions for AECOPD and an increase in in-hospital deaths. This shows that better healthcare plans and pandemic preparedness are needed to help people with chronic conditions.

Impact of urban outdoor thermal conditions on selected hospital admissions in Novi Sad, Serbia

Climate change has been recognized as an important issue in public health, with particular concerns being raised about the effects of heat and cold extremes on health, and about seasonal changes over the year and their associations with increased mortality and hospitalizations. This paper explored the relationship between physiological equivalent temperature (PET) and cardiovascular and respiratory hospital admissions in Novi Sad (Serbia) with the aim of assessing the impact of urban outdoor thermal conditions on health. Analysis was performed using daily data on cardiovascular and respiratory hospital admissions by gender covering the period from January 1, 2016 to December 31, 2017. For the same period, PET was calculated using data from two urban meteorological network stations. The association between PET and hospital admissions was examined using a generalized additive model (GAM) combined with a distributed lag non-linearmodel (DLNM). The study found a non-linear relationship between PET and cardiovascular and respiratory hospital admissions, with a larger impact during the cold period of the year. The findings also indicated that under conditions of high PET, the cumulative RR increased for cardiovascular admissions (for males) and respiratory admissions (for females). People with pre-existing respiratory diseases were found to be more vulnerable under conditions of extremely low and moderately low PET, with a greater effect at lag 0–14 days. By contrast, for people with cardiovascular diseases, low PET was linked to a decrease in hospital admissions, with the risk being lowest at lag 0 and 0–3 days.

Impact of COVID-19 Lockdown on Emergency Department Visits, Hospital Admissions, and Mortality in Northern Jordan: An Interrupted Time Series Analysis

Background: The Jordanian healthcare system was significantly affected by the COVID19 pandemic, as lockdowns and infections strained the healthcare system. The impact of the ensuing national lockdown on emergency department visits, hospital admissions, and mortality is unclear. Purpose: To assess the impact of COVID-19 lockdown on the pattern of emergency department visits, hospital admissions, and mortality at a major hospital in northern Jordan. Methods: An electronic database belonging to King Abdullah University Hospital was used for a retrospective analysis, and the data was accessed in 2022. All patients who visited the emergency department before, during, and after the lockdown in 2020 and 2019 were analyzed using an interrupted time-series analysis. Descriptive statistics were calculated for categorical variables, followed by the Wilcoxon Signed-Ranks Test to detect mean differences. Results: ED visits decreased by 53.5% during the lockdown period and by 22% after the lockdown period compared to the same periods a year before. During lockdown, hospital admissions rose significantly from 11.8% in 2019 to 17.1% in 2020, with 23.96% critical care unit admissions. Post-lockdown, ED admissions increased from 11.3% in 2019 to 16.3% in 2020, with critical care admissions rising to 30.10%, and the mortality rate increased by 50%. Conclusion: The study concluded a decrease in hospital admissions and emergency visits during lockdown, but an increase in mortality rates. Future planning should focus on optimizing care for lifethreatening emergencies, improving national emergency preparedness, and developing Hospital Readiness Checklists for effective response to emergencies like COVID-19. Implications for Nursing: Nursing has faced challenges and changes due to the COVID19 lockdown. Patient admissions decreased after the 2020 lockdown, impacting nursing practice, mental health, and patient care. Nurses should be adapted to telehealth services, maintain care remotely, and address nurses’ mental health issues. Virtual tools should be utilized to connect with patients. Keywords: Jordan, COVID-19, Lockdown, Emergency department, Hospital admissions, Interrupted time series analysis.

Mediterranean Diet, Vitamin D, and Hypercaloric, Hyperproteic Oral Supplements for Treating Sarcopenia in Patients with Heart Failure-A Randomized Clinical Trial.

Malnutrition and sarcopenia frequently affect patients with heart failure (HF), in which clinical outcomes and survival is decreased. Thus, appropriate nutritional screening and early nutrition support are highly recommended. Currently, nutritional support is not a standard of care in patients with HF, and the use of commercially available oral supplements (OSs) could provide an additional benefit to medical treatment in these patients. To compare the effect of the Mediterranean diet in combination with hypercaloric, hyperproteic OS in patients with HF. An open label, controlled clinical study in which patients were randomly assigned to receive a Mediterranean diet (control group) vs. hypercaloric, hyperproteic OS (intervention group) for twenty-four weeks. Thirty-eight patients were included; epidemiological, clinical, anthropometric, ultrasound (muscle echography of the rectus femoris muscle of the quadriceps and abdominal adipose tissue), and biochemical evaluations were performed. All patients received additional supplementation with vitamin D. Baseline malnutrition according to the GLIM criteria was observed in 30% of patients, while 65.8% presented with sarcopenia. Body cell mass, lean mass, and body mass increased in the intervention group (absolute increase of 0.5, p = 0.03, 1.2 kg, p = 0.03, and 0.1 kg, p = 0.03 respectively). In contrast, fat mass increased in the control group (4.5 kg, p = 0.05). According to the RF ultrasound, adipose tissue, muscle area, and circumference tended to decrease in the intervention group; it is probable that 24 weeks was too short a period of time for evaluating changes in muscle area or circumference, as previously observed in another group of patients. In contrast, functionality, determined by the up-and-go test, significantly improved in all patients (difference 12.6 s, p < 0.001), including the control (10 s improvement, p < 0.001) and the intervention group (improvement of 8.9 s, p < 0.001). Self-reported QoL significantly increased in all groups, from 68.7 ± 22.2 at baseline to 77.7 ± 18.7 (p = 0.01). When heart functionality was evaluated, LVEF increased in the whole cohort (38.7 ± 16.6 vs. 42.2 ± 8.9, p < 0.01); this increase was higher in the intervention group (34.2 ± 16.1 at baseline vs. 45.0% ± 17.0 after 24 weeks, p < 0.05). Serum values of NT-proBNP also significantly decreased in the whole cohort (p < 0.01), especially in the intervention group (p = 0.02). After adjusting by age and sex, nutritional support, baseline LVEF, NT-proBNP, and body composition parameters of functionality tests were not associated with mortality or new hospital admissions in this cohort. Nutritional support with hypercaloric, hyperproteic OS, Mediterranean diet, and vitamin D supplementation were associated with decreased NT-proBNP and improvements in LVEF, functionality, and quality of life in patients with HF, despite a significant decrease in hospital admissions.

Impact of COVID-19 lockdown on hospital admissions for epistaxis in Germany.

Reports of a decrease in hospital admissions during the coronavirus disease 2019 (COVID-19) lockdown period have raised concerns about delayed or missed diagnoses and treatments for non-COVID-19-related illnesses. To investigate the impact of the COVID-19 pandemic-induced lockdown and its end on hospital admissions of patients with epistaxis in Germany. A retrospective analysis based on the national database of the Hospital Remuneration System was used to compare hospital admissions during defined time periods between 2019 and 2022 with the lockdown period as the reference period. This was done on a weekly basis before, during, and after the lockdown. An Interrupted Time Series was used as the analysis method. In our analysis, we included 26183 patients. The implementation of the lockdown led to a substantial reduction in the overall occurrence of epistaxis among patients (P < 0.05). This effect was most pronounced in the age group of 0-39 years, where the decrease was highly significant (P < 0.001). However, there was no change observed in patients aged 80 years and older (not significant). With the end of the lockdown period, the overall number of patients, especially in the youngest age group, increased abruptly and significantly (P < 0.01). During the lockdown period, there was a decrease in hospital admissions for younger patients with epistaxis, possibly due to the fear of COVID-19 exposure. We also conclude that the severity of epistaxis was not underestimated in the elderly during the pandemic.

Abstract 18210: Renal Denervation in Management of Heart Failure: A Systematic Review and Meta-Analysis

Introduction: Renal denervation (RDN) is a novel intervention targeting sympathetic nerves along the renal artery. Ablation of this neurohormonal pathway alters the pathophysiology of heart failure (HF) and can lead to improvements in clinical outcomes. We conducted a systematic review and meta-analysis to review the outcome of heart failure patients undergoing RDN. Methods: We performed a comprehensive search on PubMed, Cochrane, and Embase from inceptions through June 2023 using the string “(“renal denervation” OR “renal sympathetic denervation “) AND (“heart failure” OR “congestive heart failure”)”. Exclusion criteria include non-human trials, studies without a baseline and control, and studies without outcomes of interest. We collected the number of patients with HF and the resulting outcomes. Outcomes of interest include left ventricular ejection fraction (LVEF), six minute walk distance (SMWD), NT- proBNP, and systolic and diastolic pressures. The random-effects model was used to calculate the odds ratios (OR), mean differences (MD), and confidence intervals (CI). A p value &lt;0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Results: Nine randomized control trials involving a total of 513 patients were included in our analysis. We found a significant difference when comparing the RDN group to the control groups for LVEF (MD 1.39, 95% CI [0.03,2.75]), SMWD (MD 200.13 m, 95% CI [187.32,212.95]), NT-proBNP (MD -397.16 pg/ml, 95% CI [-438.90, -355.42]), SBP (MD -3.69 mmHg, 95% CI [-7.24, -0.14]) within 12 months. Interestingly, difference in DBP was insignificant (MD -1.13 mmHg, 95% CI [-3.33,1.07]). Our RDN group had a significant decrease in hospital admissions (OR 0.83, 95% CI [0.25,2.77]) for HF exacerbation within 12 month following denervation. When comparing RND to baseline, we found a significant difference in LVEF (MD 1.90, 95% CI [0.64,3.16]) and SMWD (MD 106.56 m, 95% CI [88.72,124.40]). Conclusions: Our analysis demonstrates RDN results in a significant difference in LVEF, SMWD, NT-proBNP, and SBP in patients with HF when compared to control and baseline. However, further research is needed with larger samples to establish the safety and effectiveness of RDN as a viable therapy in HF.

Abstract 16203: A Case for Cardiomems Use in Cardiac Amyloidosis to Prevent Hospitalization

Background: Patients with cardiac amyloidosis (CA) have recurrent hospital admissions for heart failure (CHF). However, CardioMEMS placement is still considered ‘investigational’ by various insurance payers, requiring peer-to-peer review for approval. Landmark CardioMEMS trials did not identify CA patients in their cohort, so the benefit is unclear. Results and Discussion: Three patients with symptomatic CA (2 with light-chain, one with transthyretin CA) are presented. All the patients had chronic kidney disease stage 3, worsening orthostatic symptoms with heart failure medical therapy and a history of ≥ 2 hospitalizations/year for CHF with acute kidney injury. To prevent further hospitalizations, CardioMEMS was planned but denied by their respective insurance companies as ‘investigational use’, which required a rigorous appeal process to overturn. One year prior to CardioMEMS, there were 8 hospitalizations due to CHF between all three candidates. After implantation, there was only 1 CHF-related hospitalization. This represents a 88% decrease in hospital admissions for CHF, saving a potential 7 CHF hospitalizations in the succeeding year and potentially adding one quality-adjusted life-year (QALY)/patient. Decompensated CHF adversely affects the quality of life of CA patients. CardioMEMs costs $20,000/device on average and $100/month of monitoring cost. The average cost of heart failure hospitalization is $14,000. Amongst the 3 patients, there was a total expenditure of $112,000 in hospitalizations prior to CardioMEMS placement. With an 88% reduction in hospitalization and correcting for the cost of device placement and monitoring, there was a $11,653/patient/year decrease in spending with CardioMEMS placement. Additionally, the cost of adding 1 QALY/patient was only $21,200 with CardioMEMS. The Institute for Clinical and Economic Review values one QALY at $50,000 to $150,000 as an acceptable cost and the expenditure with CardioMEMS comes significantly lower. Conclusion: CardioMEMs has been shown to decrease the number of hospitalizations in patients with HF and has a similar benefit in patients with CA. The CardioMEMs device has the capability to improve patient quality of life and decrease the cost of medical care of CA patients.

The indirect impact of COVID-19 on hospitalization and mortality for ischemic stroke

Abstract Background Fear of contracting COVID infection may cause delay or reduction in hospital admissions for acute cerebrovascular events. The main objective of this study was to measure the indirect impact of the pandemic on the volume of hospitalizations for ischemic stroke (IS), in-hospital and 30-day mortality, 30-day readmissions and out-of-hospital IS mortality. Methods Study design was a quasi-experimental population-based interrupted time-series. Data were drawn from the Health Information System of the Emilia-Romagna region (Italy). To evaluate volume of hospitalizations and inpatient mortality, we included all inpatient care hospitalizations with a principal diagnosis of IS (ICD-9-CM: 433.x1, 434.x1, 436) between 2015-2021. To evaluate out-of-hospital mortality, we included all patients who died at home for IS (ICD-10 cause of death: H34.1, I63.x, I64.x). Results We observed in 2020 a 13% decrease in IS hospitalizations and an increase in the proportion of in-hospital mortality (+20%), out-of-hospital mortality (2 more deaths per day on average), and 30-day mortality (+4%). Compared to 2020, 2021 showed a 16% lower in-hospital mortality and a 7% lower 30-day mortality. Change in out-of-hospital mortality was not statistically significant. Comparing 2021 to 2015-2019, almost all outcomes did not significantly differ (in-hospital mortality: +0.62%; 30-day mortality: -3.18%; 30-day readmissions: +2.34%). Wee found a significant 12% decrease in hospital admissions and an increase in out-of-hospital mortality by 1.37 deaths per day on average, in 2021 compared to 2015-2019. Conclusions COVID pandemic caused a reduction in hospital admissions, resulting in worse outcomes, mostly in 2020 and to a lesser extent in 2021. The improvement in 2021 for most outcomes may have benefitted by the vaccine indirect effect. Key messages • Reduction in IS admissions due to COVID had a negative impact on patient outcomes. • This lesson needs to be acknowledged and considered in a preparedness framework for future pandemics.

The impact of the COVID-19 pandemic on delayed care of CVD in Europe: a systematic review

Abstract Aim Cardiovascular diseases are the leading cause of death worldwide and the COVID-19 pandemic has disrupted healthcare systems, causing delays in essential medical services, including cardiovascular (CV) care. This study aims to estimate the impact of the COVID-19 pandemic on delayed cardiovascular (CV) care in Europe by providing a systematic overview of the available evidence. Methods and Results PubMed, Embase, and Web of Science were searched until mid-September 2022. This review included 132 studies. Outcomes of interest were changes in hospital admission, mortality, delays in seeking medical help, delays in treatment initiation, and changes in the number of treatment procedures. Results were presented in five disease groups: Ischemic Heart Disease (IHD), cerebrovascular diseases, Cardiac Arrests (CA), Heart Failure (HF), and others. There was a significant decrease in hospital admissions for IHD, cerebrovascular diseases, and HF, and a significant increase in CA. Mortality rates were higher for IHD and cerebrovascular diseases. Urgent and elective cardiac procedures’ rates also decreased during the pandemic. Conclusions The review's limitations include its exclusive focus on European countries, which may not generalize to other regions due to differences in containment and tracing measures. The reviewed studies did not always report consistent outcomes and were primarily conducted during or just after the first wave of the pandemic, limiting our understanding of the long-term impact. Policymakers and healthcare systems should allocate adequate resources, provide clear guidelines for accessing medical care, reduce delays in seeking medical attention, and promote healthy lifestyles to prepare for future pandemics. Future reviews should consider the longer-term impact of pandemics on delayed CV care and evaluate the long-term health and health-economic impact of the COVID-19 pandemic on delayed CV care. Key messages • The pandemic has reduced hospital admissions and caused delays in seeking medical attention, while increasing mortality rates for some cardiovascular diseases in Europe. • Prepare for pandemics: allocate resources, set guidelines for care, reduce delays, promote health, and evaluate impacts on cardiovascular care.

A-123 Increased Rate of Recurrent Hemolysis Is Associated With COVID-19 Infection and Propofol Administration in the Intensive Care Unit (ICU)

Abstract Background Hemolysis is a pre-analytic issue that challenges clinical laboratories. When a specimen with significant hemolysis is obtained in our laboratory, tests where the hemolysis threshold is exceeded are not reported and blood is recollected. Unfortunately, in a subset of patients, the recollected specimen is also hemolyzed (termed “recurrent hemolysis”). In these cases, the second recollection utilizes special collection and handling protocols (i.e., hand-carried to lab, plasma collection, etc.) to mitigate preventable causes of hemolysis. Lipemia is also a known contributor to specimen hemolysis. Mayo Clinic Rochester experienced an increased rate of hemolysis as well as recurrent hemolysis during the height of the COVID-19 pandemic (January 2022). The objective of this study was to investigate the increased rate of recurrent hemolysis and compare to a rate prior to the COVID-19 pandemic (January 2019). Methods Retrospective data analysis was performed for January 2019 (negative control) and January 2022. The number of Mayo Clinic Rochester hospital admissions, admitting diagnosis, medications administered, and number of test collections performed were obtained using reporting functionality in our Electronic Health Record (EHR), Epic. The Laboratory Information System, SoftLab, was utilized to obtain recollection rates due to hemolysis. Data were normalized to total patient admissions for the specified period to account for inter-year variability. R/R Studio was utilized to analyze and visualize the data. Pearson’s Chi-squared test for independence was performed on categorical variables (significance defined as P &amp;lt; 0.05). Results A 28% decrease in hospital admissions (n = 3958:Jan-22 vs n = 5517:Jan-19) and a 23% decrease in total specimens collected on hospitalized patients (n = 40 557:Jan-22 vs n = 52 373:Jan-19) was observed between Jan-19 to Jan-22. However, the laboratory observed a 6% increase in hemolyzed specimens (n = 256:Jan-22 vs n = 241:Jan-19). Recurrent hemolysis occurred in 24% (n = 62/256) of Jan-22 and 17% (n = 43/241) of Jan-19 hemolyzed specimens and required special handling protocols. COVID positive patients comprised 48% (n = 30/62) of those requiring special handling protocols in Jan-22. Further examination revealed 34% (n = 21/62) of Jan-22 and 12% (n = 5/43) of Jan-19 cases of recurrent hemolysis were due to lipemia (P &amp;lt; 0.01). Chart review highlighted a potential source of lipemia from the administration of propofol, a lipophilic sedative emulsion. Of those COVID positive cases with recurrent hemolysis due to lipemia (n = 15/30), 93% (n = 14/15) were receiving propofol at the time of collection (P &amp;lt; 0.001). Conclusion We observed increased rates of specimen hemolysis during the COVID-19 pandemic. While most hemolysis resolves upon specimen recollection, patients with recurrently hemolyzed specimens often require special specimen collection and handling protocols to mitigate hemolysis. Approximately half of the recurrent hemolysis cases in Jan 2022 were COVID-19 positive patients. Lipemia-induced hemolysis was also more frequent in this patient population presumably due to the administration of propofol, a lipophilic emulsion sedative commonly used for COVID positive patients requiring sedation and ICU-level care. It is critical to understand the variety of factors which may contribute to recurrent hemolysis, as intervening with specialized collection and handling protocols to reduce observed pre-analytical hemolysis is required to provide accurate and timely laboratory results.

Treatment of acute mesenteric ischemia between 2010 and 2020 – a German nation-wide study

BackgroundAim of this study was to analyze long-term trends of hospitalizations, treatment regimen and in-hospital mortality of in-patients with acute mesenteric ischemia (AMI) over the past decade and effects of the SARS-CoV2-pandemic.MethodsWe analyzed fully anonymized data from the German Federal Statistical Office of patients with AMI between 2010 and 2020. Besides descriptive analyses of age, gender, in-hospital mortality, comorbidity burden and treatment regimen, multivariable logistic regression analyses were performed to identify independent variables associated with in-hospital mortality and different treatment.ResultsA total of 278,121 hospitalizations (120,667 male [43.4%], mean age 72.1 years) with AMI were included in this study. The total number of hospitalizations increased from 2010 (n = 24,172) to 2019 (n = 26,684) (relative increase 10.4%). In-hospital mortality decreased over the past decade from 36.6% to 2010 to 31.1% in 2019 (rel. decrease 15.2%). Independent risk factors for in-hospital mortality were older age (OR = 1.03 per year), higher comorbidity burden (OR = 1.06 per point in van Walraven score [vWs]), male gender (OR = 1.07), AMI as a secondary diagnosis (OR = 1.44), and the need for surgical (visceral surgery: OR = 1.38, vascular surgery: OR = 3.33) and endovascular treatment (OR = 1.21). We report a decline in hospitalizations during the first wave of infection in spring 2020 (rel. decrease 9.7%).ConclusionIn-hospital mortality rate has declined over the past decade, but remains high at above 30%. Older age, increased comorbidity and male gender are independent factors for in-hospital mortality. Hospitalizations requiring vascular surgery are associated with high in-hospital mortality, followed by visceral surgery and endovascular approaches. The first wave of the SARS-CoV2-pandemic in spring 2020 implied a decrease in hospital admissions.

The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review.

Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.

Examining the impact of COVID-19 on health care utilization among persons with chronic spinal cord injury/dysfunction: a population study.

A retrospective longitudinal cohort time-series analysis study. To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with spinal cord injury/dysfunction (SCI/D). Health administrative database in Ontario, Canada. In 5754 individuals with SCI/D diagnosed from 2004-2014 and living in the community, healthcare utilization (physician visits, primary care visits, specialist visits, urologist visits, physiatrist visits, emergency department (ED) visits, and hospital admissions) and delivery (total, in-person, virtual) were determined at the (1) pre-pandemic period (March 2015 to February 2020), (2) initial pandemic onset period (March 2020-May 2020), and (3) pandemic period (June 2020 to March 2022). Autoregressive integrated moving average (ARIMA) modelling was conducted to determine the impact of the pandemic on monthly healthcare utilization and delivery. The initial pandemic onset period had a significant reduction of 24% in physicians (p = 0.0081), 35% in specialists (p < 0.0001), and 30% in urologist (p < 0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p < 0.0001) in virtual visits for physicians, specialists, urologists, and primary care was found. The initial pandemic onset period had a 58% decrease in hospital admissions (p = 0.0011), compared to the pre-pandemic period. Healthcare utilization dropped in the initial pandemic onset period as physicians, specialists, and urologists, as well as hospitalization visits decreased significantly (p < 0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.

Post Doc Competition (Health Services, Economics and Policy Change) ID 1985179

Background/Objectives The COVID-19 pandemic has significantly impacted healthcare utilization; however, research has not investigated the impact in the spinal cord injury/dysfunction (SCI/D) population in Canada. To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with SCI/D. Methods/Overview A repeated-cross sectional retrospective longitudinal cohort study design was conducted using health administrative database in Ontario, Canada. In 5,754 individuals with SCI/D, healthcare utilization and delivery (in-person, and virtual) were determined at the 1) pre-pandemic (March 2015 to February 2020), 2) initial pandemic onset (March 2020-May 2020), and 3) pandemic (June 2020 to March 2022) phases. Autoregressive integrated moving average (ARIMA) modelling were conducted to determine pandemic impact on monthly healthcare utilization and delivery. Results The initial pandemic onset period had a significant reduction of 24% in physician (p=0.0081), 35% in specialist (p&amp;lt;0.0001), and 30% in urologist (p&amp;lt;0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p&amp;lt;0.0001) for virtual visits for physician, specialist, urologist, and primary care was found. The initial pandemic onset period had a 46% decrease in ED visits (p=0.0764) and 58% decrease in hospital admissions (p=0.0011), compared to the pre-pandemic period. Conclusion Healthcare utilization dropped in the initial pandemic onset period as physician, specialist, urologist, and ED visits, as well as hospitalization decreased significantly (p&amp;lt;0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.

Changes in Patterns of Referral for Inpatient Rehabilitation Cancer Patients Due to COVID-19: A Retrospective Study.

There is a paucity of literature on the effect of COVID-19 on hospital processes. We hypothesized that COVID-19 was associated with decreased cancer physiatry referrals in 2020. This is a retrospective cohort study of consecutive patients from April to July 2019 and 2020 admitted at an academic quaternary cancer center. The main outcomes were number of hospital admissions, rate, and characteristics of inpatient rehabilitation admissions and change in percentage of physiatry referrals as the primary endpoint. Results showed that in 2019, there were 387 referrals from 10,274 inpatient admissions (3.8%; 95% confidence interval, 2.4-4.2), compared with 337 referrals from 7051 admissions in 2020 (4.8%; 95% confidence interval, 4.3-5.3, P = 0.001). Hematology services referred more patients than neurosurgery in 2020 (20.4% vs. 31.4%; 48.2% vs. 26.5%, P = 0.01). Discharge disposition reflected an increased frequency of return to acute care service in 2020 (10.2% vs. 21.8%, P = 0.03). In conclusion, there was an increase in the rate of physiatry referrals despite a decrease in hospital admissions. There was an increase in referrals by hematology, likely due to emphasis on safe discharge and the populations hospitalized.

Impact of COVID-19 and lockdown on COPD admissions to Christchurch Hospital, New Zealand 2020-2021: a combined quantitative and qualitative study.

During the year following New Zealand's first COVID-19 lockdown, a 33% reduction in chronic obstructive pulmonary disease (COPD)-related admissions occurred and persisted beyond this period at Christchurch Hospital. To identify contributing factors which may have resulted in a persistent decrease in COPD hospitalisation rates at Christchurch Hospital following the 2020 COVID-19 lockdown. Using an explanatory sequential mixed-methods research design, we (i) retrospectively analysed hospital admissions and primary healthcare access by people with COPD (n = 1358) in Canterbury before, during and after COVID lockdown (24 March 2019 to 2021) and (ii) undertook individual interviews from a sample of patients (n = 14). Patients who were not re-admitted following the COVID-19 lockdown had fewer general practice encounters, acute primary care access, antibiotic and prednisone prescriptions. Proportionally fewer Māori and more Pacific patients were admitted with COPD following lockdown. Positive contributing factors at a primary care level included improvements in primary care interactions and medication management. At a patient and community level, there were improvements in lifestyle, self-management practices, social support and contact precautions. However, a subgroup of patients described negative effects such as social isolation. A combination of patient, primary care and community-level factors led to an overall persistent decrease in COPD admissions following the COVID-19 lockdown. Future targeted and individualised measures focusing on these modifiable factors may decrease future COPD-related hospital admissions. The study design facilitated further explanation about factors that contributed to the persistent decrease in hospital admissions among people living with COPD and has underscored the importance of social support, patient empowerment and reduction in barriers in accessing care in admission reduction.