COVID-19

Introduction :

Pulmonary hypertension assessed by echocardiography in patients with COVID-19 has not been adequately studied and it is unknown precisely whether it is linked to worse outcomes.

Materials and Methods :

Retrospective study of 306 adults infected with COVID-19 by antigenic or molecular testing. The main objective was to evaluate the role of the probability of echocardiographic pulmonary hypertension and its relationship with morbidity and mortality according to the ROX index in patients with COVID-19 infection. In the inferential statistical analysis, the OR odds ratios with their confidence intervals greater than 95% were used as measures of association. Qualitative variables were evaluated using the Chi square test or Fisher's exact test, and in the case of numerical or quantitative variables, the Student's T test or Mann-Whitney test was used.

Results :

The highest frequency in gender was Male 78% and Female 22%, the ROX values were higher in survivors at 2 h 5.8 (4.7 - 6.9), in relation to the deceased 4.5 (3.6 - 5 ,6). Likewise, at 12 h the values were higher in the group of survivors 7.8 (5.2 - 8.7) in relation to the deceased 4.9 (3.8 - 6.0). The odds ratio adjusted for age and gender of the ROX index was 8.5, CI (2.0 - 91.4) at 2 h and 17.6, CI (2.8 - 93.6) at 12 h. A statistical correlation was evident between lower values of the ROX index with values of high probability of pulmonary hypertension (p=0.048) as well as higher mortality (p=0.037).

Discussion :

The present study showed a correlation between the ROX index with pulmonary pressure values estimated by transthoracic echocardiogram and older age groups, showing higher mortality in those over 70 years of age and a higher rate of comorbidities and lower ROX.

Conclusions:

A greater probability of pulmonary hypertension is linked to high mortality in COVID-19; studies with larger groups of patients are required to validate the results found here.

Objective

Ageing is associated with reduced vaccine efficacy due to immunosenescence. Severe COVID-19 outcomes are associated with comorbidities prevalent in older people. We report results from the INFORM study on severe COVID-19 outcomes in vaccinated older individuals with varying numbers of comorbidities.

Methods

A retrospective observational cohort study was conducted in England using a 25% random sample from NHS databases. COVID-19-related outcomes (hospitalisations and mortality) in fully vaccinated (≥3 doses) older individuals from 1 Jan to 31 Dec 2022 are reported.

Results

Of a reference population of 7,180,205 fully vaccinated individuals ≥12 years, 2,232,140 were ≥65 years. The proportion of older people with ≥1 COVID-19 hospitalisation increased with age (≥65, 0.6%; ≥70, 0.7%; ≥75, 0.9%; ≥80, 1.2%) compared to overall population (OP, 0.2%). Incidence rates (IR) (95% CI) per 100 person years also increased with age for hospitalisation (≥65, 0.58 [0.57-0.59]; ≥70, 0.71 [0.69-0.73]; ≥75, 0.90 [0.88-0.92]; ≥80, 1.20 [1.18-1.22] versus OP, 0.22 [0.21-0.23]) and death (≥65, 0.16 [0.15-0.17]; ≥70, 0.20 [0.18-0.22]; ≥75, 0.28 [0.26-0.30]; ≥80, 0.42 [0.39-0.45] versus OP, 0.05 [0.04-0.06]).

In those ≥65, 1,375,470 were not immunocompromised (IC) but had ≥1 high-risk comorbidity (no-IC/+Com), 586,155 had neither IC or comorbidity (noIC/noCom). An increased number of comorbidities was associated with increased hospitalisation and death IRs. In those ≥65 noIC/+Com, IRs (95% CI) were 0.63 (0.61-0.65), 0.88 (0.86-0.90) and 1.25 (1.22-1.28) for hospitalisation vs 0.20 (0.17-0.23) in noIC/noCom; and 0.16 (0.14-0.18), 0.23 (0.21-0.25) and 0.32 (0.29-0.09) vs 0.06 (0.03-0.09) for noIC/noCom for death where individuals had ≥1, ≥2 and ≥3 noIC/+Com, respectively.

Conclusions

Despite vaccination, older people are at increased risk for severe COVID-19 outcomes, with higher risk associated with more comorbidities. Even older patients with no-IC conditions have increased risk, especially those with other high-risk comorbidities. Additional interventions may be required to protect older people against severe COVID-19 outcomes.

Introduction:

Infection caused by the SARS-CoV-2 has been found to have serious consequences for the cardiovascular system. Among these, the development of heart failure (HF) has been stipulated; however, its causality has not yet been established. Therefore, the purpose of this study is to evaluate the role of clinical and laboratory parameters in determining the risk of developing HF in patients infected with SARS-CoV-2.

Methodology:

151 electronic medical records were taken from hospitalized patients with confirmed SARS-CoV-2 infection and pneumonia, from 03/11/20 to 10/02/21. HF was diagnosed by signs and symptoms, elevated NTproBNP and echocardiogram. Nonparametric statistical tests were applied due to the lack of normality in the data distribution.

Results were considered statistically significant at p<.05. uncorrelated clinical and laboratory indicators were selected to predict hf validated with separate samples. confidence intervals (95% ci) calculated for all listed metrics. oversampling was used in the training set. resulting binary classification model showed validity evaluated metrics roc curves. results: study included 46 patients 105 without hf. median age 66.2 (50-92) years, a predominance of women 91 (60.3%). most both groups had concomitant diseases, however group more ≥4 diseases (63%). significant risk predictors ≥66 years (p < 0.001), procalcitonin level ≥0.09 ng />ml (p <.001), thrombocytopenia ≤220-10^9 />l (p = 0.01), neutrophil-to-lymphocyte ratio ≥4,11% (p =0,010), history of chronic kidney disease (p =0.018).

Conclusion:

A possible predictive model including age, procalcitonin, creatinine, bilirubin, C-reactive protein, lactate dehydrogenase, platelets, international normalized ratio, neutrophil-to-lymphocyte ratio, as well as QTc interval on electrocardiogram and history of chronic kidney disease has been found that could identify patients with COVID-19 at risk of developing heart failure, which will allow more effective and earlier care

Introduction:

The presence of ischemic cerebrovascular accident in COVID 19 patients is a complication that has stood out due to its complications, the predisposing factors are the procoagulant state derived from the infection as well as cardiovascular arrhythmic causes. Patients: Describe the frequency of cerebral ischemia and cardiac rhythm disturbances in patients admitted to the emergency room from July 2020 to January 2021 and its impact on prognosis and mortality.

Methods:

Retrospective study of 306 adults infected by SARS COV2 by antigenic or molecular test. The presence of these events was examined in a follow-up and the associated complications were described.

Results:

There was a higher frequency of COVID 19 in the Male gender 78% in relation to the Female 22%, the ROX values were higher in the survivors at 2 h 5.7 (4.6 - 6.8), in relation to the deceased 3 ,2 (2.9 - 4.2), The presence of ischemic cerebrovascular events occurred in 9 patients (2.9%), occurring in 8 of the male gender and 1 of the female gender, the average age of those who presented said complication was 72, 3 years with standard deviations of 62.9 and 81.7 respectively, 3 of them presented cardiorespiratory arrest. Arrhythmic causes were found in only 1 of the patients, the rest were cryptogenic events. None of the cerebral panangiography studies showed aneurysms or vascular malformations. The mortality of patients with cerebral ischemia was 33% (3/9). It was not possible to perform thrombolysis in any patient. Only 1 patient was a candidate for mechanical thrombectomy.

Conclusions:

The present study showed that the presence of cerebral ischemia is not so uncommon, approaching what has been published in other series and reported works. Studies with larger groups of patients are required to validate the results found here.

Introduction:

Since the first wave of COVID-19, caused by SARS-CoV-2 virus, we have sought to identify possible short- and long-term complications, the so-called "post-discharge syndrome", especially in patients at higher risk, after prolonged hospitalization and intensive care.

Objective:

The aim of the study was to study the outcomes, possible adverse consequences after severe COVID-19 illness and its predictors in the 90-day post-hospitalization stage in elderly patients with asthma.

Methodology and Results:

We conducted a longitudinal observational study including 131 patients older than 60 years hospitalized for COVID-19, with a history of bronchial asthma who met the GINA 2020 criteria. The main risk factors for death in the post-hospital stage included Charlson comorbidity index values of 4 points or more, CT lung damage ≥30%, absolute number of eosinophils less than or equal to 100 cells/μl and the presence of diabetes mellitus, with the presence of diabetes mellitus being the factor with the shortest mean survival time after discharge.

Discussion:

COVID-19 usually requires hospital treatment and mortality of hospitalized patients is high, the factors for death were old age (82.1 years), a higher frequency of concomitant diseases and the presence of addiction. An increased risk of death was found in patients with asthma and heart failure. A greater number of comorbidities also correlated with worse clinical outcomes.

Background: The serious outcomes of outbreaks of COVID-19 in care homes have been described internationally. The experiences of professionals working through outbreaks has received less attention, missing opportunities to acknowledge and learn lessons. Our aim was to explore the experiences of care home staff in Scotland of managing COVID-19 within their homes to help inform understanding and future practice.

Methods: From April to August 2022, 34 individual semi-structured interviews were conducted with care home staff working in homes which experienced an outbreak(s) of COVID-19. Reflexive thematic methods were used to analyse verbatim deidentified transcripts.

Findings: There was no singular experience of COVID-19 outbreaks within care homes. We identified four broad groupings of homes with outbreaks (significant outbreaks, managed outbreaks, outbreaks in remote/rural homes & outbreaks in homes supporting younger adults), with overlaps in timing and severity and variation in the support received and impact. The national response to the COVID-19 pandemic resulted in fundamental change to care home relationships. Staff responded by adaptation in uncertainty. However, they were challenged by emerging inequalities influencing residents’ care. There were tensions between staff experience and evolving external approaches to regulation and oversight. All this change resulted in psychological impacts on staff. However, there was also widespread evidence of compassionate leadership and teamwork in their responses. Effective sources of support were underpinned by respectful relationships and continuity, tailored to individual contexts.

Conclusions: The lived experiences of care home staff during the COVID-19 pandemic provide valuable insights applicable beyond the pandemic context. This includes: recognition of the specialism, complexity and diversity of care home practice; the value afforded by embedding genuine representation and involvement in planning, policy-making and research; the need for individualising to people in their contexts and the value of fostering respectful relationships across professional groups to support residents.

Introduction

The Covid19 pandemic represents an unprecedented challenge to global health and care services and necessitated a rapid shift towards healthcare being provided remotely.¹ A quality improvement project was conducted in Cardiff CRT to improve staff confidence in relation to remote-working to optimise the care of older patients in the community.

Objectives

• To integrate the use of technology in intermediate care in Cardiff CRT

Method

A survey was sent to Cardiff CRT staff in May 2020. The plan-do-study-act (PDSA) model was used to implement improvement interventions whilst allowing continuous service delivery. These included investment in hardware, updated software, a daily team huddle, increased transparency throughout the Multidisciplinary Team and stricter referral criteria. A follow-up survey was conducted in February 2022.

Results

Three key areas for improvement were identified: i) access to resources ii) team communication and iii) access to information.

The majority of respondents (62%) had no experience of remote-working prior to the Covid19 pandemic. Now, telephone consultation (50%), video consultation (19%), email (23%) and other technology (8%) are regularly employed. Self-reported confidence has improved in relation to remote-working.

Most respondents (56%) reported improved time-management and flexible working (30%) as the primary advantages of remote-working. Isolation from team members (44%) and barriers to communication (44%) were cited as the main disadvantages. 75% of respondents anticipate changing the way they work due to skills learnt during remote-working. Job satisfaction is now lower, however many recognised this was due to pandemic sequelae and other extraneous factors.

Conclusion

• Majority of staff have learnt additional skills and improved confidence in remote-working
• All staff now employ remote-working in Cardiff CRT and most plan to continue post-pandemic
• Further training needs have been identified in the virtual intermediate care setting
• Team communication and isolation remain an issue
• Job satisfaction has declined during the pandemic

References

¹ Nuffield Trust

Disclosure of interests: None

Key Words:

Covid19, Frailty, Older People, Community, Intermediate Care, Technology

Introduction

The Scottish Care of Older People (SCoOP) collaborative regularly reports outcomes of acute geriatric medicine admissions across Scottish hospitals. The covid pandemic caused major and highly variable restructuring of acute services across the country. Their impact on activity and outcomes is unknown.

Methods

We collated all SMR01/SMR01E hospital episodes from Public Health Scotland from 1^st April 2017 to 31^st March 2022 where over 50% of the total episode was spent under acute geriatric medicine (code AB) and the diagnosis was not stroke. Activity and outcomes in 19 major hospitals were compared across financial years 2017-19 (before-), 2020/21 (during-) and 2021/22 (after lockdowns). 

Results

Admissions fell 15% to 36954 in 2020/21 from an average 42566 before recovering to 41971 in 2021/22. Age, sex and social deprivation profiles differed between hospitals (p<0.001) but remained similar within each hospital at all timepoints. Few hospitals were busier than ever in 2020/21 but some saw large reductions in activity. Mortality at 30 days post-admission was 10% higher in 2020/21 (17.9% v 16.5% in other years, p<0.001), with 2-fold differences across hospitals. Mean median length of stay (LOS) across hospitals was 11.7 days, compared to 12.8 days in 2017-20, p<0.001. There were up to 17-fold differences in median LOS between hospitals (2-34 days) in 2020/21, p<0.001. The impact of the pandemic on LOS within each hospital was also highly variable. Readmission rates at 7 days post-discharge were broadly similar across all years but two-fold differences between hospitals were also seen (4.8%-9.8%, mean 6.8%, p<0.001).

Conclusion

The year 2020/21 saw a 15% fall in acute geriatric medicine admissions overall, with 10% increase in mortality and shorter lengths of stay. However, the impact on the activity and outcomes of individual hospitals were widely disparate, probably reflecting variation in how each hospital service responded to the pandemic.   

Introduction

Objectives of this retrospective study were to describe clinical presentations and mortality outcome of hospitalised patients with COVID-19 omicron variant within two acute district general hospitals and to evaluate demographic factors associated with these presentations and mortality.

Methods

Data was obtained over a month in 2021-22 from a retrospective survey of all patients hospitalised and detected to have SARS-COV-2 omicron variant infection. The trust serves a diverse multi-ethnic inner-city population. Data included socio-demographic details, vaccination status, admitting specialty and mortality outcome. Patients were sub-divided into three groups; Group 1 were admitted with ‘true’ COVID pneumonitis; Group 2 were found to have ‘incidental’ COVID on admission screening; Group 3 were negative for COVID on admission but developed COVID >7days after admission.

Results

Of 553 patients, only 24.1% [133/553] were in Group 1; 322[58.2%] in Group 2; 98[17.7%] in Group 3. Patients with Group 1 and Group 3 were significantly older than those in Group 2 (p<.001). 30% patients from BAME ethnicity had covid pneumonitis compared to 19% white ethnicity[p="0.002]." 20% were admitted within non-medical specialties i.e., Surgical specialties, Paediatrics and Obstetrics. of 36 requiring critical care, only 21 in group 1; 20 />21[95%] of these were unvaccinated;7/21 who died were all unvaccinated [100%]. This study showed that common COVID presentations included delirium, falls (and fractures), seizures, COPD, and antenatal problems. 13.7% [76/553] patients died; only 21 were in Group 1[27.6%]. Only 26 deaths were directly attributable to COVID: 4.7% [26/553] of all patients.

Discussion

This large multi-ethnic study has described clinical presentations and mortality of hospitalised patients with omicron. It has determined socio-demographic factors associated with these presentations including ethnicity and vaccination rates. The study useful information for future COVID studies examining outcomes and presentations of omicron and future COVID variants.

Introduction The decision to admit an older patient to the intensive care unit (ICU) should reflect shared goals of care. Resource limitations during the Covid-19 pandemic highlighted challenges in selecting candidates for escalation. Patients and next of kin (NoK) who have experienced ICU are well-placed to reflect on whether the admission was right for them. Objective: To explore older patients’ (65 years) and their loved ones’ views on escalation decision making. Methods Qualitative study involving semi-structured interviews with patients, NoK of survivors and NoK of deceased who experienced UK ICU admission with Covid-19 respiratory failure between March 2020 and February 2021. A preliminary questionnaire was used to maximise sample diversity of age, sex, ethnicity, survival, decision regret and impact of event scores. Interview data were collected via video conferencing or telephone. Transcripts were analysed using framework analysis. Results 30 participants were interviewed. Five themes were identified: ‘Inevitability’ - a sense that the illness and its management are out of the control of the patient or their loved one; ‘Disconnect’ - differences between hospital and lay person narratives; challenges to bridging that gap included effective communication aided by technology; ‘Acceptance’ - of the consequences, good or bad, of an intensive care admission as unalterable; ‘Beyond comprehension’ - participants had not contemplated ill health or ICU prior to admission and even with the benefit of hindsight struggled to describe which potential outcomes would be acceptable or unacceptable if they needed to be involved in similar decision-making around escalation in the future; ‘Covid-19’ - unique impact of a pandemic. Conclusion This study, which includes bereaved NoK as well as patients and NoK of survivors, adds perspective to inform decision making regarding treatment escalation of older people.