Disease Hospital Research Articles

A152 NATURAL HISTORY OF SMALL BOWEL STRICTURES IN CROHN’S DISEASE

BackgroundCrohn’s disease (CD) is a progressive inflammatory disease that often results in intestinal complications such as small bowel (SB) strictures. SB strictures are frequently associated with substantial morbidity and may require surgery. The natural history of SB strictures in the era of biologic treatments has not been well characterized.AimsTo determine the proportion of patients with SB strictures who develop complicated stricturing disease and to identify clinical factors associated with this outcome.MethodsWe performed a retrospective observational study between January 1, 2009, and May 31, 2019. Adults (>17 years) with CD who underwent an abdominal CT scan or MRI were identified from our institutional data warehouse using the ICD-10 code K50* and local imaging codes. Reports were reviewed to determine the imaging protocol and the presence of SB strictures. We included CT or MR enterography studies that reported SB strictures and excluded encounters with incomplete records, diverting ostomies, ileal J-pouches, and patients evaluated for pre-surgical planning. Each imaging study was included as a separate encounter in our analysis. Our primary endpoint was the development of complicated stricturing disease defined as stricture-related hospitalization or surgery. Time to event was estimated using Kaplan–Meier analysis and associated factors were assessed by multivariable Cox proportional hazard models adjusted for age, sex, exposure to biologics and corticosteroids.ResultsA total of 6583 unique imaging studies were identified: 926 (14%) studies reported SB strictures without penetrating complications, and 568 (9%) studies reported penetrating complications. A total of 503 (8%) studies, performed on 330 patients, met our inclusion criteria: mean age 42 (SD, 15.1) years and 166 (50%) males. Overall, 144 (44%) patients developed complicated stricturing disease: 106 (32%) patients required surgery and 132 (40%) patients were hospitalized for stricture related complications. Of the patients who underwent surgery, the mean time to surgery was 13 months (SD, 18.3) and among patients who required hospitalization, mean time to hospitalization was 15 months (SD, 17.8) (Figure 1). On multivariable analysis, exposure to corticosteroids (aHR 2.11; 95% CI, 1.54–2.90; p<0.001) but not biologics (aHR 1.1; 95% CI, 0.84–1.43; p<0.48) at the time of the imaging study was independently associated with the development of complicated stricturing disease.ConclusionsIn our single center study, complicated stricturing disease occurred in 44% of patients with CD who had a SB stricture and was associated with corticosteroids but not biologics.These findings, along with additional clinical and radiologic factors may help in the development of clinical support tools to identify patients at highest risk of developing complicated stricturing disease. Figure 1. Kaplan-Meier estimates of the time to complicated stricturing disease (surgery or hospitalization) after an imaging encounter documenting SB stricture(s).Funding AgenciesNone

The short-term effects and burden of particle air pollution on hospitalization for coronary heart disease: a time-stratified case-crossover study in Sichuan, China

BackgroundCoronary heart disease (CHD), the leading cause of death globally, might be developed or exacerbated by air pollution, resulting high burden to patients. To date, limited studies have estimated the relations between short-term exposure to air pollution and CHD disease burden in China, with inconsistent results. Hence, we aimed to estimate the short-term impact and burden of ambient PM pollutants on hospitalizations of CHD and specific CHD.MethodsPM10 and PM2.5 were measured at 82 monitoring stations in 9 cities in Sichuan Province, China during 2017-2018. Based on the time-stratified case-crossover design, the effects of short-term exposure to particle matter (PM) pollution on coronary heart disease (CHD) hospital admissions were estimated. Meanwhile, the linked burden of CHD owing to ambient PM pollution were estimated.ResultsA total of 104,779 CHD records were derived from 153 hospitals from these 9 cities. There were significant effects of PM pollution on hospital admissions (HAs) for CHD and specific CHD in Sichuan Province. A 10 μg/m3 increase of PM10 and PM2.5 was linked with a 0.46% (95% CI: 0.08, 0.84%), and 0.57% (95% CI: 0.05, 1.09%) increments in HAs for CHD at lag7, respectively. The health effects of air pollutants were comparable modified by age, season and gender, showing old (≥ 65 years) and in cold season being more vulnerable to the effects of ambient air pollution, while gender-specific effects is positive but not conclusive. Involving the WHO’s air quality guidelines as the reference, 1784 and 2847 total cases of HAs for CHD could be attributable to PM10 and PM2.5, separately. The total medical cost that could be attributable to exceeding PM10 and PM2.5 were 42.04 and 67.25 million CNY from 2017 to 2018, respectively.ConclusionsThis study suggested that the short-term exposure to air pollutants were associated with increased HAs for CHD in Sichuan Province, which could be implications for local environment improvement and policy reference.

Etiologies of fever of unknown origin in HIV/AIDS patients, Hanoi, Vietnam

BackgroundFever of unknown origin (FUO) is a challenge for clinicians treating patients with HIV/AIDS. CD4 counts can be helpful in the diagnosis and treatment. This study aimed to determine several common etiologies of FUO stratified by CD4 count levels in HIV/AIDS patients.MethodsA cross-sectional retrospective and prospective study was conducted in 195 HIV/AIDS patients with FUO admitted to the National Hospital for Tropical Diseases from January 2016 to June 2019. Clinical parameters, immune status, and etiologies for each patient were recorded. Odds ratios were calculated to compare the distributions of common etiologies in groups with two different CD4 count levels: < 50 cells/mm3 and ≥ 50 cells/mm3.ResultsThe proportions of opportunistic infections and noninfectious etiologies were 93.3% and 3.6%, respectively. Tuberculosis was the most common opportunistic infection (46.7%), followed by talaromycosis (29.2%) and Pneumocystis jiroveci (PCP) infection (20.5%). Tuberculosis was predominant in all CD4 level groups. Most patients with talaromycosis had CD4 counts below 50 cells/mm3. In total, 53.8% of the patients were infected by one pathogen. The risks of tuberculosis and talaromycosis in FUO-HIV patients were high when their CD4 counts were below 50 cells/mm3.ConclusionsOpportunistic infections, especially tuberculosis, are still the leading cause of FUO in HIV/AIDS patients. Tuberculosis and Talaromyces marneffei (TM) infection should be considered in patients with CD4 cell counts < 50 cells/mm3. This study implies that guidelines for appropriate testing to identify the etiology of FUO in HIV/AIDS patient based on the CD4 cell count should be developed, thereby reducing resource waste.

Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland

BackgroundIn Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation.The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF).MethodsA multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006–2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO2, PM10, PM2.5, and SO2, with adjustment for H2S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4.ResultsDuring the study period 9536 cases of AF were identified. The 24-h mean NO2 was 20.7 μg/m3. Each 10 μg/m3 increase in NO2 was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012–1.034) at lag 0. Each 10 μg/m3 increase in NO2 was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011–1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019–1.083) at lag 0, and OR 1.050 (95% CI 1.019–1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025–1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern.ConclusionsShort-term increase in NO2 concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution.

COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis.

BackgroundClinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described. The average US veteran is a male older than the general US population. SARS-CoV-2 infection is known to cause poorer outcomes among men and older adults, making the veteran population an especially vulnerable group for COVID-19.ObjectiveThis study aims to evaluate clinical and virologic factors impacting COVID-19 outcomes.MethodsThis retrospective chart review included 476 veterans in six New England states with confirmed SARS-CoV-2 infection between April and September 2020. Whole genome sequencing was performed on SARS-CoV-2 RNA isolated from these veterans, and the correlation of genomic data to clinical outcomes was evaluated. Clinical and demographic variables were collected by manual chart review and were correlated to the end points of peak disease severity (based on oxygenation requirements), hospitalization, and mortality using multivariate regression analyses.ResultsOf 476 veterans, 274 had complete and accessible charts. Of the 274 veterans, 92.7% (n=254) were men and 83.2% (n=228) were White, and the mean age was 63 years. In the multivariate regression, significant predictors of hospitalization (C statistic 0.75) were age (odds ratio [OR] 1.05, 95% CI 1.03-1.08) and non-White race (OR 2.39, 95% CI 1.13-5.01). Peak severity (C statistic 0.70) also varied by age (OR 1.07, 95% CI 1.03-1.11) and O2 requirement on admission (OR 45.7, 95% CI 18.79-111). Mortality (C statistic 0.87) was predicted by age (OR 1.06, 95% CI 1.01-1.11), dementia (OR 3.44, 95% CI 1.07-11.1), and O2 requirement on admission (OR 6.74, 95% CI 1.74-26.1). Most (291/299, 97.3%) of our samples were dominated by the spike protein D614G substitution and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sublineages, with none representing more than 8.7% (26/299) of the cases.ConclusionsIn a cohort of veterans from the six New England states with a mean age of 63 years and a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-White veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York State with D614G mutation.

Racial disparities in hospitalization expenditures of older adults in Singapore

Caring for persons with dementia places a significant physical, emotional, and financial burden on caregivers. Although dementia caregivers may be exposed to more challenging caregiving environment than caregivers of those with other chronic conditions, little is known about how specific factors related to respite service use differ between dementia and nondementia caregivers. Thus, this study first examined factors related to respite service use among caregivers and further tested the moderating effect of dementia caregiver status in these relationships using nationally representative U.S. data. Logistic regression analyses were conducted among 1,203 caregivers (276 dementia and 927 nondementia caregivers) from the national Caregiving in the U.S. 2015 data. Caregivers’ race and ethnicity as a predisposing factor, caregivers’ self-rated health as an enabling factor, and care recipients’ living arrangement and functional limitations as need factors were significantly related to respite service use among caregivers. Moreover, dementia caregiver status moderated the association between enabling factors (i.e., household income, work status, and self-rated health) and respite service use. Our findings imply that dementia caregivers may be more in need of respite service use than nondementia caregivers when they have limited enabling factors (e.g., lower household income, nonworking status, poorer health). Policy and practice efforts that specifically support enabling factors are suggested to promote more respite service use among dementia caregivers.

Disparities in COPD Hospitalizations: A Spatial Analysis of Proximity to Toxics Release Inventory Facilities in Illinois.

Disproportionate distribution of air pollution is a major burden on the health of people living in proximity to toxic facilities. There are over 1000 Toxics Release Inventory (TRI) facilities distributed across the state of Illinois. This study investigates and spatially analyzes the relationship between chronic obstructive pulmonary disease (COPD) hospitalizations and toxic emissions from TRI facilities. In addition, this study investigates the connection between COPD hospitalizations and socioeconomic variables. Accounting for dispersion of air pollution beyond the TRI facilities source was attained using the inverse distance weighting interpolation approach. Multiple statistical methods were used including principal components analysis, linear regression, and bivariate local indicators of spatial association (BiLISA). The results from the linear regression model and BiLISA clustering maps show there is a strong connection between COPD hospitalizations and socioeconomic status along with race. TRI emissions were not statistically significant, but there are three major clusters of high COPD hospitalizations with high TRI emissions. Rural areas also seem to carry a higher burden of pollution-emitting facilities and respiratory hospitalizations.

311. Impact of Non-alcoholic Fatty Liver Disease on Clinical Outcomes in Patients with COVID-19

BackgroundNon-alcoholic fatty liver disease (NAFLD) is the most common liver disease with a prevalence up to 30%. NAFLD is strongly associated with components of metabolic syndrome, already recognized as risk factors for worse outcomes in COVID-19. However, the impact of NAFLD on COVID-19 is not well characterized. The aim of this study was to investigate a possible association between NAFLD and COVID-19 severity and outcomes.MethodsA prospective observational study included consecutively hospitalized adult patients with severe COVID-19 at the University Hospital for Infectious Diseases in Zagreb, Croatia between March and June 2021. On admission patients were screened for fatty liver by the ultrasound and subsequently diagnosed with NAFLD according to current guidelines. Demographic, clinical and laboratory data was collected and correlated to clinical outcomes. ResultsOf the 112 patients included in the study, 77 (68.7%) had NAFLD (59.7% males; median age of 62, IQR 54-66 years). Except for higher prevalence of obesity in NAFLD group (61.0% vs 17.1%) there were no differences in other comorbidities. NAFLD group had higher inflammatory markers CRP (96, IQR 51-138 vs 59, IQR 29-99mg/L) and IL-6 (129, IQR 44-169 vs 25, IQR 8-56pg/mL). Steatosis stage showed positive correlation with BMI, waist/hip ratio, CRP, PCT, IL-6, AST, ALT, LDH and fibrinogen. Steatosis stage correlated with clinical status at the 7-category scale on admission and at days 7, 14 and 28. Patients with NAFLD had longer duration of hospitalization (9, IQR 6-15 vs 6, IQR 5-11 days, p=0.024), more frequently required noninvasive ventilation or high-flow oxygen (24.7% vs 5.7%, p=0.018) and had higher rate of pulmonary embolism (22.1% vs 5.7%, p=0.024). There was no difference in mortality. The median value for clinical status on the ordinal scale at day 7 was significantly higher in NAFLD group at days 7 and 14, as presented in Fig. 1. Multivariable analysis identified age > 65 (OR 3.6, 95%CI 1.3-10.9), LDH > 350 (OR 8.1, 95%CI 2.7-29.4), NAFLD (OR 3.9, 1.1-20.5) and pulmonary embolism (OR 10.4, 2.7-48.3) associated with adverse outcomes at day 28. The figure shows the patients’ clinical status as assessed on the seven-category ordinal scale on admission and at day 7, 14 and 28, according to the presence of NAFLD. Categories on the ordinal scale were as follows: 1, discharged or ready for discharge; 2, hospitalization in a non–intensive care unit (ICU) without supplemental oxygen; 3, non–ICU hospitalization with supplemental oxygen; 4, ICU or non–ICU hospitalization with noninvasive ventilation or high-flow oxygen; 5, ICU hospitalization with mechanical ventilation; 6, ICU hospitalization with extracorporeal membrane oxygenation or mechanical ventilation and additional organ support; and 7, death.ConclusionOur data suggests that NAFLD is associated with COVID-19 severity and might be linked to adverse outcomes in hospitalized patients. Disclosures All Authors: No reported disclosures

92. Clinical Decision-Making about Chronic Antibiotic Suppression after Prosthetic Joint Infection Treatment: Qualitative Insights for Antibiotic Stewardship

BackgroundPatients who develop prosthetic joint infections (PJI) may be prescribed chronic antibiotic suppression (CAS) ( > 6 months of antibiotics) after initial antibiotic treatment for the PJI. Patients at low risk of recurrent infection may be good targets for antibiotic stewardship. De-implementation of CAS could potentially reduce the emergence of antibiotic resistant organisms and decrease antibiotic-associated adverse events. Our ongoing study aims to characterize clinical decision-making processes about CAS prescribing and identify points for antibiotic stewardship interventions to stop CAS prescribing for patients who will not benefit.MethodsWe conducted semi-structured interviews with 33 physicians and nurses at 8 Veterans Affairs hospitals, chosen for variation in hospital size, complexity, region, and CAS prescribing. Interviewees included orthopedic surgeons, infectious disease (ID) physicians, hospital epidemiologists, nurses, nurse managers, and primary care physicians (PCPs). We conducted inductive, consensus-based thematic analysis on interview transcripts, using the program MAXQDA.ResultsParticipants reported a complex decision-making process that included a range of collaborative approaches with other clinicians and patients. Their risk-benefit calculation for CAS usually included the type of revision surgery performed, the evidence base, the organism, and patient factors. Surgeons and ID physicians, the primary CAS prescribers, collaborated variably and sometimes consulted pharmacists or antibiotic stewards. Participants emphasized the importance of clinician autonomy and buy-in to order to effect practice change based on evidence, rather than top-down policies. They identified other significant time points that occurred before or after the CAS prescribing decision (initial PJI treatment decisions, follow-up appointments) and identified other decision makers about CAS maintenance (e.g., patients, PCPs). (See Figure 1).Figure 1. Decision Points Relevant to Prescribing or Maintenance of Chronic Antibiotic Suppression after PJI. PJI, prosthetic joint infection; ID, Infectious Diseases physician; PCP, primary care physician; IV, intravenous ConclusionInterventions to optimize CAS prescribing should incorporate clinician concerns about prescriber autonomy and a preference for collaborative decision-making as well as understanding the range of decision makers across time.Disclosures Daniel Suh, MS MPH, General Electric (Shareholder)Merck (Shareholder)Moderna (Shareholder)Smile Direct Club (Shareholder) Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor) Andrew Pugely, MD, MBA, Globus Medical (Research Grant or Support)Medtronic (Consultant)United Healthcare (Consultant) Marin Schweizer, PhD, 3M (Grant/Research Support)PDI (Grant/Research Support)

512. Does Time From COVID-19 Symptom Onset to Administration of Anti-spike Protein Monoclonal Antibody Predict Response?

BackgroundCasirivimab/imdevimab is a monoclonal antibody (mAb) cocktail with emergency use authorization for mild-to-moderate coronavirus disease 2019 (Covid-19) in patients at high risk for severe disease progression and/or hospitalization. Little is known about the importance of early administration of this product. The objective of this study was to determine if early administration (within 3 days of symptom onset) of casirivimab/imdevimab is associated with better outcomes. MethodsSingle-center, retrospective cohort study including all consecutive patients who received casirivimab/imdevimab at our institution through May 2021. The primary outcome was 30-day post-infusion hospital admission rate in patients who received mAb ≥ 3 days (later) or < 3 days (early) in relation to patient reported symptom onset. Secondary outcomes included any hospital revisit within 30-days. Adverse events were also captured. Chi-square and independent samples t-test were used to compare categorical and continuous data, respectively. Multivariable logistic regression was used to adjust for confounders.Results270 patients met the inclusion criteria and were included in the analysis. There were 80 patients with early administration and 190 with later administration. Baseline characteristics for both groups were similar. Mean age was approximately 64 years and BMI 31 mg/m2. Table 1 provides a summary of patient characteristics. Late and early administration of casirivimab/imdevimab were similar in terms of hospital admission for any therapy related failure within 30 days of mAb administration after adjusting for age and Charlson comorbidity index (3.7% vs. 7.5%; adjusted odds ratio 0.69, 95% confidence interval, 0.20 – 2.39; p=0.561). Similarly, there were no significant differences in any hospital revisit.ConclusionWe did not find any difference in outcomes between early and late administration of casirivimab/imdevimab.Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker's Bureau)Merck (Grant/Research Support, Speaker's Bureau)

Hospital costs of immunopreventable diseases in the economically active population in Brazil

BackgroundImmunopreventable diseases are a public health reality in Brazil and worldwide, a reality that is not exclusive to children, but affects the adult population.ObjectivesDiscriminating the total costs of hospitalizations from immunopreventable diseases in the population aged 20 to 59 years.MethodsA population, observational, descriptive, retrospective study was conducted with secondary information from DATASUS to discriminate the hospitalizations associated with immunopreventable diseases in Brazil and their care costs, within the Scope of the SUS, between 2008 and 2018, in the economically active population (20 to 59 years).ResultsIt was analyzed 127,746 hospitalizations for immunopreventable diseases, (27.92% of all hospitalizations) were observed in the adult population, totaled R$115,682,097.54 (29.72% of the total costs). Of this population studied, 51.48% were registered as male; 66.74% were associated with influenza disease; 16.05% to chickenpox/herpes zoster infection and 7.55% to acute hepatitis B infections. The trend analysis of the time series of hospitalizations in this population showed a stationary trend.ConclusionsThe 127,746 hospitalizations could be avoided with immunization, and 127,746 workers who could be working and not hospitalized. There were also R$115,682,097.54 that could be invested in other public health needs, which became necessary for the treatment of preventable diseases.

P5‐128: Study on lung abscess: A single centre experience in national hospital for respiratory diseases Sri Lanka

P5‐128: Study on lung abscess: A single centre experience in national hospital for respiratory diseases Sri Lanka

In-Hospital Mortality and Glycemic Control in Patients with Hospital Hyperglycemia

BACKGROUNDStress-induced hyperglycemia is a phenomenon that occurs typically in patients hospitalized for acute disease and resolves spontaneously after regression of the acute illness. However, it can also occur in diabetes patients, a fact that is sometimes overlooked. It is thus important to make a proper diabetes diagnosis if hospitalized patients with episodes of hyperglycemia with and without diabetes are studied.AIMSTo estimate the extent of the association between stress-induced hyperglycemia and in-hospital mortality in patients with hospital hyperglycemia (HH), and to explore potential differences between patients diagnosed with diabetes (HH-DBT) and those with stress-induced hyperglycemia (SH), but not diagnosed with diabetes.METHODSA cohort of adults with hospital hyperglycemia admitted to a tertiary, university hospital in Buenos Aires, Argentina, was analyzed retrospectively.RESULTSIn the study, 2,955 patients were included and classified for analysis as 1,579 SH and 1,376 HH-DBT. Significant differences were observed in glycemic goal (35.53% SH versus 25.80% HH-DBT, p < 0.01), insulin use rate (26.66% SH versus 46.58% HH-DBT, p < 0.01), and severe hypoglycemia rate (1.32% SH versus 1.74% HH-DBT, p < 0.01). There were no differences in hypoglycemia rate (8.23% SH versus 10.53% HH-DBT) and hospital mortality. There was no increase in risk of mortality in the SH group adjusted for age, non-scheduled hospitalization, major surgical intervention, critical care, hypoglycemia, oncological disease, cardiovascular comorbidity, and prolonged hospitalization.CONCLUSIONSIn this study, we observed better glycemic control in patients with SH than in those with HH-DBT, and there was no difference in hospital mortality.

Cost of hospitalization for ischaemic heart and cerebrovascular diseases in Belgium

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of global mortality and a major contributor to disability. According to European Cardiovascular Disease Statistics, in 2017 there were 108.7 million people living with CVDs in Europe resulting in about 4,681 disability-adjusted life years per 100,000 inhabitants. Among these, ischaemic heart and cerebrovascular diseases (IH&amp;CBD) represent the highest burden in terms of morbidity, mortality and health care costs. CVDs were estimated to cost the EU €210 billion a year, where 28% was attributable to IH. The aim of this study was to assess the financial burden at societal level of IH&amp;CBD in Belgium based on hospital discharge data, considering that inpatient hospital care costs accounted for about 51% of the total healthcare costs in CVDs. Methods IH&amp;CBD were identified based on ICD-10 codes following the definition provided in the Global Burden of Disease study in 2017. IH: angina pectoris (AP) I20 and I25, acute myocardial infarction (AMI) I21-I24; CBD I60-I68. Mean annual number of patients and direct hospitalization costs from 2016 to 2018 were retrieved from the Belgian hospital discharge dataset, considering both primary and secondary diagnoses. Results Within the observed diseases, AP was the most common reason for hospitalizations with an average of 41,439 hospitalized patients per year. Yearly, 27,630 patients were hospitalized for CBD and 14,928 patients were hospitalized for AMI. The yearly hospitalization cost for AP and AMI in Belgium was on average respectively €219,688,254 and €133,343,881. CBDs accounted for the largest direct hospitalization cost with €301,900,539 per year. Conclusions In Belgium, on average almost 84,000 people are hospitalized yearly due to IH&amp;CBD; On average, Belgium spends around €655 million a year for these hospitalizations. Key messages IH&amp;CBD represent a high health and financial burden in Belgium. Since IH&amp;CBD can be linked to several behavioral risk factors, this burden could be reduced with target health interventions.

The Indirect Impact of Covid-19 Pandemic on Hospitalizations for Cardiovascular Diseases in Abruzzo

BackgroundIn 2020 the Covid-19 pandemic influenced the organization of all health systems, imposing new rules for accessing the hospitals and delaying or reducing the ability to cope with all the population needs. In addition, people with life-threatening conditions deferred care for their fear of contagion. The study aimed to evaluate the indirect impact of Covid-19 on hospitalization rates for cardiovascular diseases in 2020 in Abruzzo.MethodsData were obtained from the hospital discharge records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 5 (cardiovascular diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage.ResultsA huge reduction in hospitalization in MCD 5 contest was observed in each subgroup. Specifically, ordinary regimen had a peak of -56,4% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of -84% in April. The largest reduction in hospitalizations occurred in private hospitals, in both ordinary (-81% in April) and DH admissions (-100% in April). A rebound in admissions was reported only for ordinary private regime between June and September, with a peak of + 24% in August.ConclusionsCovid-19 had a severe impact on Abruzzo hospitalizations. The medical conditions that we examined needed effective hospital treatment to avoid adverse outcomes or death. Subsequently, fewer hospitalizations for such medical conditions were almost certainly associated with patient harm. Despite the pandemic, health system leaders should manage to provide subjects with hospital care, when necessary.Key messages Covid-19 had a significant indirect impact on the rate of hospitalizations for cardiovascular disease in Abruzzo.Despite the pandemic, regional health systems should manage to provide effective hospital care for patients with cardiovascular conditions that require hospitalization.

Reduction in Neurological Disease Hospitalization Rate During Covid-19 Pandemic in Abruzzo

BackgroundAs a consequence of the Covid-19 outbreak, Italy has adopted unprecedented preventive measures such as large-scale application of social isolation and hospital rearrangements. These measures have led to difficulty in managing diseases and hospitalizations, particularly acute and severe conditions such as neurological morbidities. The aim of the present analysis is to investigate the change in hospital admissions for neurological diseases over the first nine months of 2020 in Abruzzo region.MethodsData were obtained from the Hospital Discharge Records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 1 (neurological diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage.ResultsA huge reduction in MCD 1 series hospitalizations was observed in each subgroup. Specifically, ordinary regimen had a peak of -47,3% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of more than 90% in April both in public and private hospitals. The largest reduction occurred in private hospitals, both in ordinary (-75% in April) and DH admissions (-93,8% in March).ConclusionsDespite the severity of the diseases included in MDC 1 (i.e. ischemic stroke, intracranial hemorrhage), a significant decline was detected in hospital admissions in Abruzzo. Subsequently, a high number of subjects might have not received the necessary health assistance leading to an increase in mortality and morbidity for these severe pathologies. Additionally, patients might have avoided seeking hospital care in response to the fear of contagion triggered either by media or as a result of the stay-at-home government recommendations.Key messages An alarming reduction in all types of hospitalizations for neurological diseases occurred over the first months of pandemic in Abruzzo.Greater management efforts are needed to reduce the morbidity and mortality rates associated with the reduced hospital admissions during the pandemic.

Persistent symptoms after three months follow-up of in and out-patient COVID-19 cases

Abstract Background and aim There is limited research on how common the longer-term effects of COVID-19. This study aimed to describe changes in symptoms of COVID-19 patients at the 1st and 3rd months after diagnosis. Methods Patients older than 18-years who tested positive for SARS-CoV-2 RNA in Dokuz Eylül University Hospital-Turkey in December 2020 (n = 1434) were included in this prospective cohort study. Overall, 1029 patients (71.8%) completed the 1st month and 3rd-month follow-up. Data on demographic characteristics, chronic disease history, symptom history and hospitalization were collected via telephone interviews. Based on the relapsing nature of the disease, the presence or absence of any COVID-19 related symptoms within a week before the 1st and 3rd-month interview was questioned. Categorical variables (n, %) were compared using the chi-square test. Results Of the 1029 patients, 92.8% were symptomatic. The most common initial symptoms were muscle or body aches (58.5%), fatigue (57.8%) and loss of smell (53.1%). Among the symptomatic patients, 40.8% and 27.6% reported at least one symptom in the 1st and 3rd months, respectively. Mean number of symptoms was 4.5±2.6 at diagnosis, 2.3±1.7 at the 1st month and 2.5±2.3 at the 3rd month. The most common persistent symptoms by the 1st month were muscle or body aches (11.1%), heart palpitations (6.4%), and shortness of breath (5.8%). Muscle or body aches (9.5%), shortness of breath (4.2%) and fatigue (4.2%) were reported as persistent by the 3rd month. Persistent symptoms up to the 3rd month were more common in women (33.3% vs 21.3%, p &amp;lt; 0.001), in the patients aged &amp;gt;50 years (32.8% vs 25%, p = 0.01) and in the patients with comorbidities (31.8% vs 25.1%, p = 0.03). Conclusions Over a quarter of patients (27.6%) reported persistent symptoms even after 3 months of diagnosis. Rehabilitation and long-term monitoring programs for patients aged &amp;gt;50 years with comorbidities could be useful in responding to this problem. Key messages Over a quarter of patients report persisting symptoms even after 3 months of initial diagnosis. Follow-up programs could be useful in appropriately managing any persistent or emerging long-term sequelae.

Crowding at hospitals- the main reason for not seeking medical care when affected by an acute myocardial infarction during the first wave of COVID-19

Abstract Background Delay in seeking treatment for AMI reduces the success rate of reperfusion therapy and affects both morbidity and mortality. During the outbreak of COVID-19 pandemic, rates of hospitalization for cardiovascular diseases has decreased nationally as well as internationally and a reduction of STEMI patients with 25–48% was reported in European and US registries. The reasons for this change in health care seeking behaviour in AMI are still unknown. Purpose To evaluate possible behavioral changes in patients seeking medical care when affected by an acute myocardial infarction during the first wave on ongoing COVID-19 pandemic. Methods This was a cross sectional study in a Region in Sweden during the first wave of the COVID-19 pandemic (March-June) with patients selected from the national registry (SWEDEHEART). Eligible were patients with AMI and totally 602 patients were invited. A self-administrated psychometric evaluated queastionnaire (PA-AMI) was sent to the patientes by post and questions regarding COVID-19 were added. PA-AMI includes 14 items regarding thoughts, feelings and actions prior to care-seeking. All items are answered on a Likert-type rating scale with six grades from 1 'do not agree at all' to 6 'totally agree'. Additionally, there were questions about age, gender, country of birth, when symptoms started and when decide to seek medical care. COVID-19 questions were 'would you have sought medical care earlier if the pandemic COVID-19 would not have existed', 'if yes, why did you not seek medical care' with follow-up questions. From SWEDEHEART the following were obtained, e.g. type of AMI, history of: AMI, diabetes and percutaneous coronary intervention (PCI), date and time of first symptoms to arrival at hospital/ward or PCI lab. Results A total of 326 patients answered the questionnaire. Of these, 17% hesitated to seek medical care due to the pandemic. Patients characteristics are shown in Table 1. These patients mainly hesitated due to a fear that the healthcare was overcrowded with patients with COVID-19, followed by a fear of becoming infected by COVID-19 at the hospital (Fig 1). Women and patients not born in SWEDEN were significant more represented in this group. The self-assessed patient delay was 22 h (median) versus 4.5 h registered in SWEDEHEART. PA-AMI displayed that symptom perception and seriousness of symptoms, unsureness where to turn and difficulties to decide seek medical care, was ssociated to those who hesitated to seek medical care due to the pandemic. Conclusions During the first wave of the COVID-19 pandemic, women and patients not born in SWEDEN, as well as patients with more than one risk factor (smoking, diabetes) had a longer delay in seeking medical care for AMI due to fear of overcrowded hospitals. Therefore, these patients should be encouraged to seek medical care and there is an importance of information about how and when to seek medical care, especially in the light of COVID-19. Funding Acknowledgement Type of funding sources: None. Table 1Figure 1

S822 Sex Differences in Outcomes of Inflammatory Bowel Disease (IBD) Hospitalizations: A Retrospective Cohort Study

S822 Sex Differences in Outcomes of Inflammatory Bowel Disease (IBD) Hospitalizations: A Retrospective Cohort Study

Characteristics of Cases Hospitalized in a Mental Health and Diseases Hospital within the scope of Article 432 of the Turkish Civil Code

Objective: The aim of this study was to investigate the sociodemographic and clinical characteristics of cases hospitalized in Elazığ Mental Health and Diseases Hospital (MHDH) within the scope of article 432 of the Turkish Civil Code (TCC 432).&#x0D; Method: The records of the cases hospitalized in Elazığ MHDH with the decision of TCC 432 were retrospectively analysed. Sociodemographic and clinical information of the cases were obtained from the hospital registry system. The Brief Psychiatric Rating Scale (BPRS) scores on admission and discharge were used. &#x0D; Results: The mean age of cases (n=101) was 32.79±9.63 years. There were 50 cases (50.5%) who actively used alcohol and/or drugs (16 cases with methamphetamine, 17 cases with mixed substance use). In 75 (74.3%) cases, family members applied for the TCC 432 decision themselves. Thirty-two (31.7%) cases were diagnosed with schizophrenia, 20 (19.8%) cases were diagnosed with bipolar disorder and 37 (36.6%) cases were diagnosed with substance use disorder. &#x0D; Conclusion: The most important finding of this study is the high number of cases (36.63%) with a diagnosis of substance use disorder hospitalized within the scope of the TCC 432 decision. Involuntary hospitalization of the cases to psychiatry departments will continue to be discussed ethically unless necessary steps are taken.