This version of BIP! Finder aims to ease the exploration of COVID-19-related literature by enabling ranking articles based on various impact metrics.
Last Update: 18 - 01 - 2023 (628506 entries)
Popularity: Citation-based measure reflecting the current impact.
Influence: Citation-based measure reflecting the total impact.
Reader Attention: The current number of Mendeley readers.
Social Media Attention: The number of recent tweets related to this article.
*More details on these impact measures can be found here.
Exceptional score (in top 0.01%).
Substantial score (in top 1%).
Average score (in bottom 99%).
Score not available.
CORD-19 dataset(1) (list of papers)
LitCovid hub(2) (list of papers)
PMC & PubMed (citations)
Mendeley (number of readers)
COVID-19-TweetIDs(3) (tweets)
| Title | Venue | Year | Impact | Source | |
|---|---|---|---|---|---|
| 2401 | Gender and Racial Discrimination in Hiring Before and During the COVID-19 Pandemic: Evidence from a Field Experiment of Accountants, 2018-2020 In this article, we ask whether macro-level changes during the first year of the COVID-19 pandemic relate to changes in the levels of discrimination against women and Black job-seekers at the point of hire. We develop three main hypotheses: that discrimination against women and Black job-seekers increases due to a reduction in labor demand; that discrimination against women decreases due to the reduced supply of women employees and applicants; and that discrimination against Black job-seekers decreases due to increased attention toward racial inequities associated with the Black Lives Matter protests during the summer of 2020. We test these hypotheses using a correspondence audit study collected over two periods, before and during the early COVID-19 pandemic, for one professional occupation: accountants. We find that White women experience a positive change in callbacks during the pandemic, being preferred over White men, and this change is concentrated in geographic areas that experienced relatively larger decreases in women's labor supply. Black women experience discrimination pre-pandemic but receive similar callbacks to White men during the pandemic. In contrast to both White and Black women, discrimination against Black men is persistent before and during the pandemic. Our findings are consistent with the prediction of gender-specific changes in labor supply being associated with gender-specific changes in hiring discrimination during the COVID-19 pandemic. More broadly, our study shows how hiring decision-making is related to macro-level labor market processes. | Work Occup | 2022 | CORD-19 | |
| 2402 | Internal, Moral and Market Accountability: Leading Urban Schools During the Covid-19 Pandemic | Urban Educ (Beverly Hills Cali | 2022 | CORD-19 | |
| 2403 | Managing Tourist Risk, Grief and Distrust post-COVID-19 Tourism is one of the most important sectors for many countries and is also one of the most vulnerable to the impact of disasters. However, while tourism has proved resilient to localized or regional crisis, COVID-19 has had a universal impact on tourists, with pervasive, profound, and enduring implications. Our main objective is to explore and elucidate how such recent changes to tourism, triggered by the pandemic, affected the future travel intentions of tourists. Our exploration of these issues through in-depth interviews, finds that tourists were emotionally and psychologically affected by the sudden curb to their lives and that these emotions broadly equate to stages of grief. Furthermore, we uncover not only a general reduction in trust, but, concomitantly, an elevation in distrust towards destinations, manifest at the level of government, healthcare and tourist institutions, activities, and risk mitigation practices. Finally, we offer a discussion of the contributions and implications of our study in terms of tourism and hospitality research and practice. | N/A | 2022 | CORD-19 | |
| 2404 | The voices of parents in child protective services: A qualitative analysis of families' struggles with COVID-19 The pandemic of the Coronavirus disease 2019 (COVID-19) has affected children and families worldwide, disrupting their daily lives and well-being. A small-scale study involving 13 parents in Child Protective Services in Estonia was conducted using in-depth, semi-structured interviews to explore parents’ experiences with COVID-19 and its impact on their families’ well-being. The findings indicated that one of the areas most impacted by the COVID-19 pandemic was schooling, as the implementation of remote schooling often created tensions and conflicts at home. Parents reported regression in daily functioning, attributing this to the lack of supportive services during lockdown and additional distress resulting from increased workload at home and problems with balancing home and work life. Parents were exhausted by the various problems caused by the pandemic and questioned their ability to provide their children the support they needed. Discontinuation of services intensified existing challenges for both parents and children. Furthermore, a lack of trust in Child Protective Services was identified, serving as a barrier to asking for help in times of crisis. | Dev Child Welf | 2022 | CORD-19 | |
| 2405 | The COVID Season: US Collegiate Esports Programs' Material Challenges and Opportunities During the 2020-21 Pandemic During the COVID-19 pandemic, universities were among the first institutions to shift to an online model. As they did so, nascent collegiate esports program lost access to campus spaces and in-person connections, potentially destabilizing this rising industry. Conversely, universities also worked to provide students remote access to resources, and many components of esports already occur online. Therefore, collegiate esports may have adjusted to distancing measures, potentially strengthening their footholds on US campuses. This paper draws on in-depth interviews with collegiate esports players, student employees, program directors, and administrators to address different programs’ reactions to the pandemic, specifically the challenges and opportunities they faced. Overall, interviews reveal how COVID-19 shifted the understandings of and practices around gaming and esports, highlighted the intermittent relationship of online and offline spheres, and presented various possibilities and challenges for different stakeholders during the global pandemic. | Games Cult | 2022 | CORD-19 | |
| 2406 | Importance of Social Videogaming for Connection with Others During the COVID-19 Pandemic This study focused on the importance of social videogame play for remaining connected to others early in the COVID-19 pandemic. While social isolation and loneliness negatively affect well-being, social interaction is important for positive outcomes. During the pandemic, online videogame play has offered a safe outlet for socialization. Participants (n = 45) completed a survey rating the importance of gaming for feeling connected to family, friends, and co-workers, before, during, and after stay-at-home orders. As expected, the results indicate that social videogame play and its importance increased significantly during the stay-at-home period and decreased afterward. The importance of gaming with friends and co-workers increased significantly during the stay-at-home period but did not decrease significantly afterward. Social gaming was more important for remaining connected with friends and co-workers than family. Participants likely had more direct interaction with family members, while more effort was necessary to maintain contact with non-family members. | Games Cult | 2022 | CORD-19 | |
| 2407 | Navigating multiple pandemics: A critical analysis of the impact of COVID-19 policy responses on gender-based violence services COVID-19 illustrated what governments can do to mobilise against a global threat. Despite the strong governmental response to COVID-19 in Canada, another ‘pandemic’, gender-based violence (GBV), has been causing grave harm with generally insufficient policy responses. Using interpretive description methodology, 26 interviews were conducted with shelter staff and 5 focus groups with 24 executive directors (EDs) from GBV service organizations in Ontario, Canada. Five main themes were identified and explored, namely that: (1) there are in fact four pandemics at play; (2) the interplay of pandemics amplified existing systemic weaknesses; (3) the key role of informal partnerships and community support, (4) temporary changes in patterns of funding allocation; and (5) exhaustion as a consequence of addressing multiple and concurrent pandemics. Implications and recommendations for researchers, policy makers, and the GBV sector are discussed. | Crit Soc Policy | 2022 | CORD-19 | |
| 2408 | Wir brauchen Biomarker | N/A | 2022 | CORD-19 | |
| 2409 | Why are you offline? The issue of digital consent and discrimination of Roma communities during pandemic in Slovakia The article is focused on the issue of discrimination against Roma communities in the use of educational online platforms on account of failure to provide digital consent. The digital education model used during the COVID-19 pandemic in the Slovak Republic somehow forgot about Roma communities, thus preventing Roma students from accessing education through online platforms. This contribution is aimed to foster the discussion of discrimination against marginalized Roma communities in accessing education through online platforms and to point out the inadequacy of national legislation on the provision of digital consent. | N/A | 2022 | CORD-19 | |
| 2410 | Should EU member states help each other? How the national context shapes individual preferences for European solidarity With the outbreak of the Eurozone crisis, the idea of providing cross-national financial transfers to countries in economic and financial difficulties has exacerbated the political divide between EU member states with strong macroeconomic performances, which were only weakly hit by the crisis, and the countries of the Eurozone periphery that struggled with a harsh economic downturn. This paper aims to explain which factors drive public support for cross-national solidarity within and across countries. We argue that the national context in which citizens live affects their preferences for providing financial help to other European countries, and moderates the role played by subjective egotropic and sociotropic economic concerns, ideological predispositions, and Eurosceptic vote choices in shaping public support for European solidarity. Using the original REScEU 2016 survey, we find that subjective economic motivations provide a limited contribution in explaining support for European solidarity, and almost only in countries weakly hit by the crisis. On the contrary, left–right positions, and especially Eurosceptic vote choices, strongly polarize preferences for EU financial assistance, both within and across countries with voters from Eurosceptic parties more(less) likely to support European solidarity in countries strongly(weakly) hit by the Eurozone crisis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1057/s41295-022-00301-9. | N/A | 2022 | CORD-19 | |
| 2411 | Mitteilungen der Deutschen Gesellschaft für Neurologie | N/A | 2022 | CORD-19 | |
| 2412 | Mathematical model of the spread of COVID-19 in Plateau State, Nigeria In this research, a mathematical model consisting of non-pharmaceutical control measures is formulated. The developed model helps to examine the transmission of COVID-19 infection in Plateau State, Nigeria, using face masks [Formula: see text] and social distancing [Formula: see text] as control measures. Data used for the simulation of the developed model were obtained from Nigeria Centre for Disease Control which was fitted to the system of ordinary differential equations using nonlinear least squares method. Results at baseline values [Formula: see text] and [Formula: see text] of control measures indicate 2.3 estimation as basic reproduction number which suggests that COVID-19 in Plateau State tends towards endemic state. However, above about 40% in the use of face masks in the population and corresponding above 50% adherence to social distancing could as well bring down the basic reproduction number to a value below 1 necessary for disease eradication. The results at baseline values further indicate that the peak of the COVID-19 had been reached in less than 250 days from the first detection date after about 476,455 undetected asymptomatic individuals, 92,168 undetected symptomatic individuals and 83,801 detected quarantined individuals have been fully infectious. Therefore, the policymakers in Plateau State have the possibility of eradicating the disease with further strict non-pharmaceutical control measures provided that the present conditions of analysis remain fairly the same. | N/A | 2022 | CORD-19 | |
| 2413 | Investigating expressed RNA variants that are related to disease severity in SARS-CoV-2-infected patients with mild-to-severe disease BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to be a significant public health challenge globally. SARS-CoV-2 is a novel virus, and the understanding of what constitutes expressed RNAseq variants in healthy, convalescent, severe, moderate, and those admitted to the intensive care unit (ICU) is yet to be presented. We characterize the different expressed RNAseq variants in healthy, severe, moderate, ICU, and convalescent individuals. MATERIALS AND METHODS: The bulk RNA sequencing data with identifier PRJNA639275 were downloaded from Sequence Reads Archive (SRA). The individuals were divided into: (1) healthy, n = 34, moderate, n = 8, convalescent, n = 2, severe, n = 16, and ICU, n = 8. Fastqc version 0.11.9 and Cutadapt version 3.7 were used to assess the read quality and perform adapter trimming, respectively. STAR was used to align reads to the reference genome, and GATK best practice was followed to call variants using the rnavar pipeline, part of the nf-core pipelines. RESULTS: Our analysis demonstrated that different sets of unique RNAseq variants characterize convalescent, moderate, severe, and those admitted to the ICU. The data show that the individuals who recover from SARS-CoV-2 infection have the same set of expressed variants as the healthy controls. We showed that the healthy and SARS-CoV-2-infected individuals display different sets of expressed variants characteristic of the patient phenotype. CONCLUSION: The individuals with severe, moderate, those admitted to the ICU, and convalescent display a unique set of variants. The findings in this study will inform the test kit development and SARS-CoV-2 patients classification to enhance the management and control of SARS-CoV-2 infection in our population. | N/A | 2022 | CORD-19 | |
| 2414 | About the Annual Course of Moscow Heat Island and the Impact on It of the Quarantine Measures to Prevent the COVID-19 Pandemic in 2020 Seasonal differences in the Moscow urban heat-island intensity (UHII) have been studied in detail based on data obtained in 2018–2020 by the meteorological network of stations located in Moscow and Moscow region. It is shown that the annual cycle of this phenomenon is slightly pronounced. In most cases, the UHI is manifested stronger in summer and weaker in winter; however, in some months, the situation may be reverse. The question of the statistical significance of seasonal differences remains open. The closest statistical relationship was revealed between the UHI and lower clouds during the night hours, so that its highest intensity is observed in the least cloudy seasons (usually in summer). The UHII distribution functions are close to the normal law in summer and spring, and, in winter and fall, they are characterized by a noticeable positive asymmetry, because their values decrease and the mode approaches the lower physical limit. The period of strict quarantine restrictions during the COVID-19 pandemic in the spring and early summer of 2020 led to a rapid and statistically significant decrease in the Moscow UHII, probably due to both natural factors (increased cloudiness) and human activities (rapidly decreased anthropogenic heat fluxes and a weakened urban industrial haze creating an additional counterradiation). | N/A | 2022 | CORD-19 | |
| 2415 | In this month's Bulletin | Bull World Health Organ | 2022 | CORD-19 | |
| 2416 | P271. Risk Factors Associated With SARS-CoV-2 Infection and COVID-19 Related Depression Among Immigrant Latino Essential Workers in Suffolk County, New York Background: Coronavirus disease (COVID-19) cases and deaths remain substantially higher among Latino populations in the United States. Risk of infection may be associated with occupational exposures and a greater burden of depression. This study sought to identify factors associated with COVID-19 infection and COVID 19 related depression among immigrant Latino essential workers. Methods: A cross-sectional telephone survey to assess the prevalence of infection and COVID-19 related needs and concerns was administered. Depression was assessed with the Patient Health Questionnaire (PHQ-9). Comparisons by essential worker group: Indoor (i.e. supermarket)/Outdoor (i.e. construction) were determined using Nonparametric Mann Whitney U test, X2, and Fisher tests. Multivariable logistic regression models were estimated to determine factors associated with the probability of prior infection and COVID-19 related depression (PHQ9 score >=10). Results: 227 essential workers (median [IQR] 39.9 [32.7-47.6] years;130 [57.3%] male;213 (93.8%) foreign born) completed the survey. Seventy (30.0%) reported prior COVID-19 infection. Outdoor workers were more likely to be male, report higher housing density, and were less likely to be insured. Outdoor worker status was associated with higher odds of COVID-19 infection. Odds of depression was higher for respondents reporting prior infection, increased with the number of needs reported, and was nearly five times higher for uninsured workers. Conclusions: Data from Latino essential workers in regions with high rates of infection indicate the need for occupational precautions to mitigate risks of reinfection. Results further underscore the need for clinical screenings to identify the burden of COVID-19 related depression in at risk populations. Supported By: Steven and Alexandra Cohen Foundation, Inc. Keywords: Depression, COVID-19 pandemic, Disparities | Biol Psychiatry | 2022 | CORD-19 | |
| 2417 | P242. Anxiety Associated with Perceived Lack of Control Over Stress During the COVID-19 Pandemic Impairs Reward Learning | Biol Psychiatry | 2022 | CORD-19 | |
| 2418 | P124. Which Patients Will Have Mental Disorders After Hospitalization for COVID-19? Background: Although mental disorders are frequent after acute COVID-19, it is unclear whether they are predicted by acute COVID-19 severity. Methods: Four months after hospital discharge for acute COVID-19 (from March 1 to May 29, 2020), 177 (63.7%) benefited from a standardized psychiatric assessment in an outpatient setting. COVID-19 objective severity was assessed during hospitalization for COVID-19. Results: The mean patient age was 57.5 years (sd=13.2) and 68 (38.4%) patients were women. During acute COVID-19, 97 (54.8%) patients were admitted to the ICU, 51 (28.8%) required invasive ventilation, 29 (16.4%) had acute delirium, and 40 (22.6%) had immunomodulatory treatments. The mean length of hospitalization was 22.0 (16.2) days, the maximum C-Reactive Protein (CRP) level was 147.9 (111.5) mg/L, and the maximum creatininemia level was 127.6 (161.1) μmol/L. Four months after acute COVID-19, 36 (20.3%) patients had at least one current mental disorder. Twenty-nine (80%) of these 36 patients were diagnosed with a new-onset mental disorder. Nine (5.1%) patients had a significant suicide risk. Mental disorders, new-onset ones and significant suicide risk 4 months after acute COVID-19 were not associated with higher acute COVID-19 severity, as assessed with length of hospitalization, ICU admission, invasive ventilation, acute delirium, immunomodulatory treatments, maximum CRP, and creatininemia levels. Conclusions: In this sample of survivors after a hospitalization for acute COVID 19, we failed to show any association between acute COVID-19 objective severity and mental disorders 4 months later. Assessment of mental disorders should be proposed to patients after hospitalization for COVID-19. Keywords: COVID-19, Mental Disorders, Depression, Anxiety, Suicide | Biol Psychiatry | 2022 | CORD-19 | |
| 2419 | Birth During the COVID-19 Pandemic, but Not Maternal SARS-CoV-2 Infection in Pregnancy, is Associated With Lower Neurodevelopmental Scores at 6-Months | Biol Psychiatry | 2022 | CORD-19 | |
| 2420 | P715. Increased Hair Cortisol Levels are Associated With a Shift Towards Exploitative Decision-Making in Healthcare Workers in the COVID-19 Pandemic Background: During the COVID-19 pandemic, healthcare workers (HCWs) were required to make flexible decisions in a rapidly changing environment under significant stress. Linking subjective and physiological markers of stress to quantitative measures of decision-making is critical for understanding the resilience of healthcare workers during the pandemic. The aim of this study was to utilize an explore-exploit computational psychiatry paradigm to measure the effects of COVID-19 related stress on decision-making flexibility. Methods: We utilized biomarker and survey data to query chronic stress;123 participants completed the survey and 54 hair samples were collected. Cortisol was measured with LC/MS/MS. We evaluated explore/exploit behavior with a resting three-arm bandit task, and 66 completed the task. Results: Eighty-seven met criteria for COVID-19 related PTSD, however, we found no significant correlation between hair cortisol and symptoms measures. In contrast, we found that participants with higher hair cortisol exhibited greater exploitation (Pearsons’ r=-0.36, p=0.046). Additionally, explore-state reward-dependent switching behavior, a state-specific measure of learning from reward, significantly decreased with increasing cortisol (r=-0.49, p=0.007). Further, in a basic 3-parameter reinforcement learning model, the learning rate alpha inversely correlated with cortisol (r =-0.467, p=0.007). Conclusions: Computational model-derived decision-making variables demonstrated a robust correlation with hair cortisol concentrations. Without this task, biomarker data may appear independent of chronic stress. This study highlights the importance of quantitative behavioral tasks and physiological signals to understanding the interaction of mood and cognition with stress. Supported By: This work was supported by the University of Minnesota Office of Academic and Clinical Affairs COVID-19 Rapid Response Grant. Research in this publication was also supported in part by the Office Of The Director, National Institutes of Health under Award Number P51OD011106 to the Wisconsin National Primate Research Center, University of Wisconsin-Madison. This research was conducted in part (as applicable) at a facility constructed with support from Research Facilities Improvement Program grant numbers RR15459-01 and RR020141-01. Keywords: Cognitive Flexibility, Hair Cortisol, COVID-19 Pandemic, Computational Psychiatry | Biol Psychiatry | 2022 | CORD-19 | |
| 2421 | Prenatal Stress and the Microbiome in the Time of COVID- A Prospective Cohort Study Background: Given the emerging importance of the role of the gut microbiota-brain-axis in mediating prenatal stress-induced neurodevelopmental outcomes, a prospective cohort study was conducted. The COVID-19 Pandemic occurred halfway through study recruitment (n=35). The study aims to a) evaluate perceived stress across gestation, b) determine whether maternal microbiome composition changes with stress, and c) discern the influence of the COVID-19 pandemic on maternal stress, psychometric scores, and alterations in the microbiome. Methods: This longitudinal study design includes five time points across pregnancy and the post-partum period, at which biological samples were collected and psychometrics administered. Samples include maternal rectal and vaginal swabs. Psychometrics include measures of perceived stress, anxiety, depression, sleep, diet, and childhood adversity. Study participants identify as 62.9% White and 31.4% Black or African American. Finally, PacBio full-length 16S rRNA sequencing using SMRT Cell technology is used to identify the maternal rectal and vaginal microbial communities. Results: Participants delivering during the pandemic reporting greater perceived stress (p≤0.05). Of note, there were no significant differences in anxiety or depressive symptoms across gestation in the pre-pandemic participants as compared to participants during the pandemic. During the second trimester, increased depression associated with increased rectal alpha diversity, and increased perceived stress was associated with increased levels of Prevotella, Sneathia, and Gardnerella in the rectal samples. In contrast, participants with increased depressive symptoms during the third trimester had reduced vaginal alpha diversity measures at delivery. Conclusions: Findings suggests maternal perceived stress and depressive symptoms are associated with alterations in maternal microbiota Keywords: Gut Microbiome, Prenatal Maternal Stress, Gut-Brain Axis | Biol Psychiatry | 2022 | CORD-19 | |
| 2422 | P270. Coping During the COVID-19 Pandemic: Maternal Mental Health and Infant Temperament Background: The COVID-19 pandemic has led to increased psychological distress on a global scale, particularly for vulnerable people, including new and expecting mothers. We are still determining the magnitude of the toll on parents and their children. Methods: 516 pregnant people completed online questionnaires during the spring of 2020 (T1);296 of these people completed additional questionnaires approximately one year postpartum (T2). Participants reported on mental health, coping behaviors, and infant temperament. A principal components analysis (PCA) was conducted to identify coping factors. Linear regression analyses were conducted to evaluate associations among coping factors, maternal depressive symptoms, and infant temperament. Results: PCA revealed three factors explaining 40.53% of the variance in coping behaviors. The first factor included self-care behaviors (e.g., exercise, mediation);the second, numbing behaviors (e.g., increased screen time, eating comfort foods);and the third, reaching out for help behaviors (e.g., talking to a therapist or other parents). Engaging in reaching out for help coping behaviors was associated with a decrease in depressive symptoms from T1 to T2 (adjusted R2=.03, p=.02). This was most pronounced in participants who reported greater emotion regulation difficulties (R2=.07, p=.04). Further, increases in depressive symptoms from T1 to T2 were associated with higher levels of infant negative affect (R2=.08, p=.004). Conclusions: These findings underscore the importance of providing socially focused coping and mental health services for pregnant people to ensure the well-being of new mothers and their children. Future work should evaluate trajectories of emotional development of children who were in utero during the pandemic. Supported By: R37MH101495 Keywords: COVID-19 Pandemic, Prenatal Depression, Infant Temperament | Biol Psychiatry | 2022 | CORD-19 | |
| 2423 | The Impact of Covid-Related Stress on Maternal Sleep During Pregnancy Background: Poor sleep during pregnancy is very common and is associated with increased risk of adverse maternal and infant outcomes. Maternal psychosocial stress has been found to negatively impact sleep. The recent outbreak of COVID-19 has exposed many individuals to an unprecedented level of stress, that will continue for an unknown period of time. Studies are showing that all these factors may not only increase levels of stress, but also influence sleep health. Methods: From March 2020-May 2021, participants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) study at Columbia University. Survey data on maternal depression (PHQ-9), perceived stress (PSS), COVID-related stress, and sleep health (Pittsburgh Sleep Quality Index, PSQI) were collected. For this analysis, we excluded mothers identified as depressed based on PHQ9. Regressions analyses were implemented to estimate the associations between PSS and COVID-related stress and multiple domains of sleep, accounting for covariates (maternal age, education, gestational age covid infection in pregnancy, time of the pandemic). Results: Our sample consisted of N=155 women;Gestational age at assessment: 30.6±5.8 weeks;Age: 32.2±5.0 years;non-Hispanic White=66, non-Hispanic Black=12, Hispanic=56, Asian=16, Other=5;69% 4-year college/graduate degree. Mean PSS was 18.3±7.0 and COVID-related stress was 3.9±1.6. COVID-related stress negatively affected subjective sleep quality (β=0.3±0.1, p<0.01), latency (β=0.4±0.1, p<0.001) and sleep disturbances (β=0.5±0.2, p=0.003). Increased PSS negatively affected sleep duration (β=0.09±0.2, p<0.001), efficiency (β=0.08±0.02, p<0.001), and daytime dysfunction (β=0.08±0.03, p=0.01). Conclusions: Our results suggest that stress related to the current COVID-19 pandemic is uniquely affecting maternal sleep health during pregnancy. Funding Source: R01MH126531;Eunice Kennedy Shriver National Institute of Child Health and Human Development under grant number P2CHD058486, awarded to the Columbia Population Research Center Keywords: Sleep, Perceived Stress, COVID-19, Pregnancy | Biol Psychiatry | 2022 | CORD-19 | |
| 2424 | Chasing the Footprints of COVID-19-RELATED STRESS: Behavioral and Epigenetics Effects in Pregnant Women and Their Infants Background: During 2020, the COVID-19 pandemic dramatically hit Italy and rapidly emerged as a collective trauma. Pregnancy is a sensitive period during which prenatal stress may result in epigenetic signatures (e.g., increased DNA methylation) and altered infants’ developmental programming. The serotonin transporter gene (SLC6A4) is a well-known locus of epigenetic regulation by adverse environmental exposures. Methods: In April 2020, the MOM-COPE project was launched. One-hundred-eight mother-infant dyads were enrolled from ten neonatal units in Northern Italy. Retrospective maternal self-report measures of COVID-19-related prenatal stress were obtained at birth. SLC6A4 methylation was estimated in 13 CpG sites using NGS in buccal cells of mothers and infants obtained at from 6 to 12 hours after delivery. Infants’ temperament was assessed at 3-month-age through the IBQ-R questionnaire. Results: No effects emerged for maternal SLC6A4 methylation. COVID-19-related prenatal stress significantly and positively associated with infants’ SLC6A4 methylation in 7 out of 13 CpG sites (rs >.24, all ps <.05). These sites loaded on a single principal component (PC1) accounting for 35% of total variance. PC1 methylation was significantly and positively associated with COVID-19-related prenatal stress (RR = 0.07, F = 7.71, p = 0.007, B = 0.16) as well as with infants’ temperamental positive affect at 3 months (RR = 0.05, F = 5.05, p = 0.027, B = − 0.45). Conclusions: Prenatal pandemic-related stress was significantly associated with less-than-optimal temperament in 3-month-old infants, partly due to stress-induced epigenetic regulation of the SLC6A4 gene. Appropriate policy and clinical actions are needed to promote timely preventive strategies. Funding Source: Italian Ministry of Health;Fondazione Roche per la Ricerca Indipendente Keywords: COVID-19, Prenatal Maternal Stress, Infant Temperament, DNA methylation, Serotonin Transporter Gene | Biol Psychiatry | 2022 | CORD-19 | |
| 2425 | Impact of the COVID-19 Pandemic Environment on Early Child Brain and Cognitive Development Background: Since the first reports of the novel coronavirus in the US in early 2020, public health organizations have advocated preventative policies including stay-at-home orders that closed businesses, daycares, schools, playgrounds, and limited child learning activities. The impact of these policies on child neurodevelopment is unknown but may have significant long-term consequences. Methods: Leveraging a large and ongoing longitudinal study of child neurodevelopment, we examined general childhood cognitive scores (assessed using the Mullen Scales of Early Learning) in 672 children between 0 and 3 years of age born between 2020 and 2021 (n-118) vs. the preceding decade from 2011 to 2019 (n=554). Brain neuroimaging (MRI) was also performed on each child. Using longitudinal mixed-effects models, we compared longitudinal trends of voxel-wise brain cognitive domain measures before and during the pandemic. Results: We find that children born during the pandemic (Since July 2020) have significantly reduced verbal, motor, and overall cognitive performance compared to children born pre-pandemic;and that skills have continued to decline as the pandemic has progressed. Moreover, we find that children from lower socioeconomic families have been most affected. These neurocognitive findings are supported by neuroimaging data, which also shows reduced brain white matter development in children born since July 2020 compared to their counterparts from 2011 to 2019. Conclusions: Results highlight that even in the absence of direct SARS-CoV-2 infection and COVID-19 illness, the environmental changes associated COVID-19 pandemic is negatively affecting infant and child development. Funding Source: UG3 ODO23313 Keywords: COVID-19 Pandemic, Child Cognition, Early Neurocognitive Development, Longitudinal Neuroimaging, Developmental Neuroimaging | Biol Psychiatry | 2022 | CORD-19 | |
| 2426 | P104. Associations Among Resilient Coping Strategies, Frontolimbic Functional Connectivity and Depression and Anxiety During the COVID-19 Pandemic Background: The COVID-19 pandemic is an ongoing stressor that has resulted in millions of deaths and worsening of psychiatric health worldwide. However, we lack knowledge regarding the influence of specific behavioral and neural factors that may alleviate the impact of the pandemic on mental health. Thus, we assessed whether pre-pandemic resilient coping strategy engagement and frontolimbic circuitry influence depression and anxiety symptoms during the pandemic. Methods: In 72 young adults (72.2% female, mean age 24 years), we assessed depression and anxiety symptoms (BDI and SCARED-A), resilient coping strategies (CD-RISC), and resting-state functional connectivity (FC) of frontolimbic circuitry using fMRI. We conducted general linear models to test preregistered hypotheses that 1) less resilient coping pre-pandemic and 2) weaker frontolimbic FC pre-pandemic would predict more severe symptoms during the pandemic;and 3) coping would interact with FC to predict symptoms during the pandemic. Results: Anxiety symptoms worsened during the pandemic as compared to pre-pandemic, while depression symptoms improved (ps<0.001). Less resilient coping predicted more severe depression symptoms during the pandemic (p=0.023). Weaker frontolimbic FC pre-pandemic predicted more severe obsessive-compulsive (p=0.015) and separation anxiety symptoms (p=0.040) during the pandemic. Resilient coping interacted with frontolimbic FC to predict depression (p<0.001), obsessive-compulsive (p=0.041), panic (p=0.017), and generalized anxiety (p=0.027) symptoms during the pandemic. Conclusions: Less coping strategy engagement and weaker frontolimbic FC may represent risk factors for poor psychiatric health during the pandemic. This research may inform efforts to ameliorate the adverse psychological effects of the COVID-19 pandemic, as well as subsequent global stressful events. Supported By: This work was supported by the National Institutes of Health (NIH) Director’s Early Independence Award (DP5OD021370) to DGG;Brain and Behavior Research Foundation (National Alliance for Research on Schizophrenia and Depression;NARSAD) Young Investigator Award to DGG;and National Science Foundation Graduate Research Fellowship Program Award to BHG and JCF. Keywords: Depression, Anxiety, Brain Imaging, fMRI, Coping Strategies, COVID-19 Pandemic | Biol Psychiatry | 2022 | CORD-19 | |
| 2427 | Blood-Based Biomarkers for COVID-19 Associated Neurological Outcomes Background: There are no blood screening tests to assess brain molecular alterations linked to neurological alterations in human coronavirus disease 2019 (COVID-19). Evidence indicates long-term brain abnormalities associated with SARS-CoV-2 infection, including cognitive impairment, which may develop into an emerging health problem as many patients are emerging with cognitive abnormalities that may be associated to an increased risk of AD. Promising results from the field of blood-based biomarkers are emerging with the use of extracellular vesicles (EVs). Neuronal-derived EVs (NDEVs) can be isolated from the total pool of EVs in the blood to investigate biomarkers of brain diseases. Methods: Isolation of NDEVs was performed using the ExoQuick ULTRA EV Isolation System, followed by immunoprecipitation with L1CAM antibody. EVs were characterized by nanoparticle tracking analysis, electron microscopy, Exo-Check Array, and ELISA/immunoblotting to detect exosome proteins. Biomarker measurements in the plasma, CSF and EVs from plasma was done by ELISA. A broader analysis of isolated EVs was done by Mass spectrometry. Results: Levels of cytokines were increased in the blood samples from a cohort of 100 COVID-19 patients compared to controls. We had the opportunity to investigate biomarkers in the CSF of 38 patients and observed that the levels of cytokines and biomarkers of neurodegeneration in CSF samples were increased. Conclusions: COVID-19 was associated with increases in CSF and blood cytokines and markers of neurodegeneration. A close follow up in patients that developed COVID-19 symptoms is important to determine the long-term consequences of infection Funding Source: CNPq, FAPERJ, CIHR Keywords: Extracellular Vesicles, Biomarkers, COVID-19 | Biol Psychiatry | 2022 | CORD-19 | |
| 2428 | P635. Post-Traumatic Stress in Older Adults with Hypertension During the Early Phase of the COVID-19 Pandemic: Prevalence, Correlates and Pro-Inflammatory Biomarkers | Biol Psychiatry | 2022 | CORD-19 | |
| 2429 | P696. Suicide-Related Calls to a National Crisis Chat Hotline Service during the COVID-19 Pandemic and Lockdown | Biol Psychiatry | 2022 | CORD-19 | |
| 2430 | P409. Prenatal COVID-19 Related Stress, Maternal Emotion Regulation and Infant Temperament: Assessing the Developmental Impact of the COVID-19 Pandemic Background: Expectant mothers are experiencing unprecedented levels of stress throughout the COVID-19 pandemic. It is critical, therefore, that we examine the impact of this stressful perinatal period on infants’ development, growth, and emotional functioning. Methods: We collected data from women (N= 295) over two time periods: once while they were pregnant (T1), and again at approximately one year postpartum (T2). At T1, participants reported on their levels of stress related to COVID-19, including the overall impact of the COVID-19 outbreak on their daily life, and on their emotion regulation. At T2, participants reported on their infant’s temperament. Results: We conducted a hierarchical multiple regression predicting infant negative affect. In the first step, race, education, age, and income explained 6.3% of the variance in infant negative affect (F(10,268)=1.825, p=.058). In the second step, maternal emotion regulation explained an additional 1.3% of the variance in infant negative affect (F(1,267)=3.87, p=.050, β=.118). Adding mothers’ reported impact of COVID-19 to the model explained an additional 1.8% of the variance in infant negative affect (F(1,266)= 5.38, p=.021, β=.140), for a total of 5.4% of the variance explained. Conclusions: Our findings indicate that COVID-19-related stress is associated with infant negative affect more strongly than is maternal emotion regulation style. These findings underscore the importance of continuing to monitor pregnant women's levels of stress and distress during times of crisis in order to safeguard and mitigate against sub-optimal developmental trajectories of infant functioning. Supported By: NIH Keywords: Child Development, Prenatal Maternal Stress, COVID-19 Pandemic, Infant Temperament, Emotion Regulation | Biol Psychiatry | 2022 | CORD-19 | |
| 2431 | IT-Führungsrollen des Top-Management-Teams im öffentlichen Sektor In the meantime, even in public sector organizations, there are often several IT leadership roles in top management. So far, however, we know very little about how these IT leadership roles are designed and how they can be distinguished from one another. This article uses Job mining of job advertisements in the public sector in order to identify competencies, responsibilities and tasks of the IT management roles by means of a qualitative content analysis and to formulate recommendations for action. While the competencies required for IT management roles include a university degree, language skills, and specialist and administrative knowledge, the responsibilities show different characteristics. The tasks are formulated in a role-specific manner, but show a number of overlaps between the IT management roles. These overlaps suggest a CTO–CDO dyad with an overarching CIO role. The practical recommendations include a higher weighting of English and digital skills as well as lifelong learning. | N/A | 2022 | CORD-19 | |
| 2432 | Can active learning be asynchronous? Implementing online peer review assignments in undergraduate political science and international relations courses The phenomenon known as emergency eLearning saw many institutions of higher education switch from face-to-face learning to virtual or online course delivery in response to the COVID-19 pandemic. The transition posed a unique suite of challenges to instructors and students alike, especially in the case of active learning pedagogy. This article reflects on the experiences of a multi-institutional, multi-term pedagogical project that implemented peer review assignments as opportunities for asynchronous but nevertheless active learning. We shared instructor experiences through the course design and application stages of courses in International Relations and political economy, discuss the ability of peer review assignments to create active learning opportunities in online courses, and reflect on our own pedagogical development benefited from the community of practice. | N/A | 2022 | CORD-19 | |
| 2433 | How Brazil embraced informal organizations Brazil's foreign policy strategy traditionally focused on formal international organizations and ways to strengthen its role in them, symbolized by efforts to become a permanent UN Security Council member, and by accelerating voting reform in the Bretton Woods institutions. These goals were underpinned by a notion that the institutions that are at the heart of post-WWI order, while not providing emerging powers with the space and responsibilities that they deserved, still represented the ideal platforms for Brazil to defend its national interests. Yet despite some progress in gaining greater visibility, its overall experience over the past two decades has been frustrating, a dynamic that is crucial to understand Brazil's turn to informal organizations such as BRICS and the G20, which became the pillars of its foreign policy strategy in the 2000s. Indeed, the country's emphasis on informal structures remained even after a center-left government supportive of multilateralism has been replaced by a right-wing president who supports anti-globalism and who frequently criticizes the United Nations. This article explores Brazil's transition and the tensions that it has created between formal organizations—both globally or regionally—with the contagion dynamics of informality. It then discusses implications for global governance. | N/A | 2022 | CORD-19 | |
| 2434 | Use Of Prone Positioning In Patients With Left Ventricular Assist Devices Background Use of prone position for treatment of acute respiratory distress syndrome (ARDS) has been effective for patients with COVID-191,2. While case reports exist on proning patients on extracorporeal membrane oxygenation (ECMO) there are limited reports of the safety and efficacy in patients with durable left ventricular assist devices (LVAD). 3,4. Case Study Patient is a 76 year old Hispanic male with a past history for ischemic cardiomyopathy requiring HeartMate III (Abbott, IL) LVAD who presented to the emergency dept in January 2021 with two day history of dyspnea on exertion, chills and insomnia. He reports no known contact with COVID individuals. In the ED, noted severe hypoxia on arterial blood gas (ABG) pH 7.343, pO2 51.5. O2 saturation was 86% and chest x-ray revealed bilateral infiltrates suggestive of COVID 19 pneumonia. He was placed on a nonrebreather (NRB) mask and empiric antibiotics started. A nasopharyngeal swab was PCR positive for COVID19 and he was admitted for management. A repeat ABG on NRB had an increase of pO2 172. He was started on remdisivir and convalescent plasma. As part of management, was proned for 12 hours daily. The LVAD driveline was supported with pillows to avoid pressure and trauma. The LVAD controller was placed on the patient side for emergent access. Peripheral oxygenation saturation remained above 93% and his respiratory status continued to improve. He was cleared for discharge on day 6. No adverse events were noted on LVAD interrogation and he had no ill effects to the driveline. Discussion Prone positioning has been integral for patients with COVID 19 to decrease intubation with severe ARDS. Patients with a LVAD already have significant cardiac disease and thus important to avoid further decompensation with intubation, VA ECMO, and cardiac demise. Driveline infections can lead to high morbidity and mortality. Patients with COVID 19 are at a high risk for poor skin care and pressure injuries. Supporting the controller and driveline allowed for decrease in pressure injury and trauma at the driveline site. This allowed our ability to prone our patient and properly oxygenate which was tolerated. References 1. Coppo,A., Bellani, G., Winterton, D., DiPerro, M., Soria, A., et al. 2020. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respiratory Medicine. 8 (8) 765-774. 2. Damarla M, Zaeh S, Niedermeyer S, et al. Prone Positioning of Nonintubated Patients with COVID-19. Am J Respir Crit Care Med. 2020;202(4):604-606. doi:10.1164/rccm.202004-1331 3. LELehr, A., Smith, D., Toy, B., Goldenberg, R., Brosnahan, S. 2020. Successful use of an automated proning system to achieve prone positioning in a patient with severe ARDS requiring veno-venous ECMO. Respiratory Medicine Case Reports. 31. 101315. 4.Rajagopal, K., Keller, S., Akkanti, B., Bime, C., Loyalka, P et al. 2020. Advanced pulmonary and cardiac support of COVID-19 patients: emerging recommendations from ASAIO- a living working document. Circulation | J Card Fail | 2022 | CORD-19 | |
| 2435 | Covid-19 Associated Lymphocytic Myocarditis With Genetic Predisposition Introduction There is a possible association between lymphocytic myocarditis and COVID-19 in patients genetically susceptible to cardiomyopathy. Case A 50-year-old female with history of hypertension and a family history of sudden cardiac death in two siblings and COVID-19 related myocarditis in a brother presented with persistent shortness of breath at rest, orthopnea, exertional stabbing-type chest pain, and fatigue two weeks after diagnosis of COVID-19. Physical exam was notable for tachycardia, with no fever or signs of volume overload. Patient was found to have elevated troponin and erythrocyte sedimentation rate, with normal brain natriuretic peptide and c-reactive protein. Electrocardiogram showed sinus tachycardia. Computer tomography angiography of the chest was negative for pulmonary embolism, pneumonia, or interstitial lung disease. Echocardiogram revealed lateral wall hypokinesis with ejection fraction 50% and normal ventricular cavity size. Coronary angiogram revealed normal coronaries. Cardiac magnetic resonance revealed anterolateral wall hypokinesis and left ventricular ejection fraction 45% with no scar or edema and no evidence of myocardial or pericardial disease. The patient received treatment with NSAIDs, furosemide, carvedilol, and colchicine. Symptoms persisted over the next several months. Magnetic resonance FDG-PET revealed increased uptake in the lateral wall of the left ventricle. Subsequent biopsy of this region revealed lymphocytic myocarditis. The patient was started on prednisone 60 mg, with partial improvement of symptoms. Symptomatic treatment also required acetaminophen and aspirin, with continued use of colchicine. Genetic studies revealed a likely pathogenic variant in the MYBPC3 gene involving an altered consensus splice site associated with autosomal dominant hypertrophic cardiomyopathy and dilated cardiomyopathy. Symptoms recurred upon tapering of prednisone, requiring a longer course of treatment. The patient also developed symptoms of postural orthostatic tachycardia syndrome. With continued treatment, symptoms significantly improved. Conclusion Our case suggests that lymphocytic myocarditis could be a rare manifestation of coronavirus disease whose risk factors may include hereditary cardiomyopathies. It has potential to become a chronic condition with a challenging symptomatic management. | J Card Fail | 2022 | CORD-19 | |
| 2436 | Successful Heart Transplantation Following COVID-19 Infection Introduction With COVID-19 rampant within the heart transplant community, more direction regarding the management of these patients is needed. Case studies have described treatment of heart transplant recipients who contracted COVID-19 but no recommendations exist on management of recent COVID-19 infection in the peri-operative transplant period. Case Presentation We describe a 47-year-old Caucasian female with nonischemic dilated cardiomyopathy diagnosed in 2003 presumed to be secondary to postpartum cardiomyopathy versus doxorubicin toxicity for the treatment of non-Hodgkin lymphoma diagnosed in 2000. Other co-morbidities include bone marrow transplantation, chest radiation, hypothyroidism, and recent COVID-19 upper respiratory infection without complications and not requiring hospitalization in December 2020. Given progressive clinical decline from her cardiomyopathy, she was admitted and underwent orthotopic heart transplantation on February 5, 2021. Immunosuppression was followed per our institution's protocol and induction therapy was completed with basiliximab. SARS coronavirus-2 spike antibody was checked prior to transplantation on February 5 (47 U/mL; reference <0.8) and decreased to 19 U/mL on February 9 after immunosuppressive therapy. At our institution, actively infected patients with COVID-19 and a spike antibody <80 U/mL are considered for convalescent plasma administration. After multidisciplinary discussion with the patient and given the limited evidence available at the time, the patient opted not to receive this unless she became symptomatic from reactivation of a COVID infection.Post-transplantation, she remained asymptomatic without clinical suspicion for reactivation. Regular endomyocardial biopsies have been performed per our institution protocol with SARS coronavirus-2 PCR testing prior to presentation and have remained undetected. Biopsies have not shown evidence of allograft rejection to date. She will be eligible to receive the COVID vaccination three months post-transplant. After receiving the second dose, antibody levels will be checked to determine if she mounted an appropriate antibody response. Conclusion We have demonstrated successful heart transplantation without reactivation of COVID-19 with immunosuppression. Patient and donor selection will remain crucial to determine optimal management strategies of recipients who have recovered from COVID-19. Given the lack of data on the management of transplant patients within the COVID era, particularly in the peri-operative setting, findings from individual experiences and case reports will be useful until more guidance is established. | J Card Fail | 2022 | CORD-19 | |
| 2437 | Optimizing Face-to-face Vs. Telehealth Visits: Decision-making Regarding Medication Changes And Reliance On Data From In-person Visits Introduction The COVID 19 pandemic fueled a rapid shift for medical care to be provided in a virtual or telehealth platform. Medications changes can be challenging to implement over the phone due to lack of data from physical exam findings and vital signs to support medical decision making. In-person visits allow for complete vital signs and proper physical examination to inform medical decision making. We sought to determine which types of cardiac care are best positioned to succeed in a telehealth environment and which require greater emphasis on in-person care. Methods We sought to determine what cardiology visit type was associated with a higher rate of medication changes and what factors informed those changes. We compared medication changes made between heart failure (HF), electrophysiology (EP), and general cardiology (GC) visits completed in-person in the pre-pandemic era. Number of medication changes, type of medication change, and clinical data used to implement medication changes were compared between the three providers types. Results During February 2020 each provider completed a total of 48 HF visits, 23 EP visits and 35 GC in-person visits. A total of 116 medication changes were made. HF visits were associated with the highest rate of medication changes per visit (1.79 changes per visit) followed by EP (0.61 changes per visit) and GC (0.46 changes per visit), overall p<0.001 (See Table). Individual comparisons showed that medication changes were made more frequently in HF compared to both EP and GC (each p<0.001). There was no statistical difference between frequency of medication changes between EP and GC (p=0.50). Types of medication changes included initiations, discontinuations, and dose titrations, each of which were made more frequently in HF. Medication changes were made during most HF visits but during only a minority of visits for EP and GC. Medication changes during HF visits were based on both vital sign and physical exam assessment most (67.5%) of the time, but rarely for EP or GC visits (0 and 18%, respectively). Conclusions Our study demonstrated that HF visits incorporate a higher rate of medication changes compared to EP and GC, and that these decisions were based on physical exam and vital signs more often compared to other cardiology sub-specialties. Despite a shift towards increased telehealth due to the pandemic, these data suggest that HF management may require more in-person visits compared to EP and GC, which appear more amenable to telehealth care delivery. | J Card Fail | 2022 | CORD-19 | |
| 2438 | A Closer Look At Chronic Heart Failure Patients During The Covid-19 Pandemic Introduction During the early peak of the COVID-19 pandemic, several measures were instituted to reduce the risk of exposure among patients to the novel SARS-CoV-2 virus, including the implementation of a virtual healthcare encounter system. Unfortunately, this resulted in considerable interruptions in the dispensation of healthcare services to chronically ill patients, particularly among patients with chronic heart failure (CHF). Hypothesis We aim to study whether the patients who presented to the Kings County Hospital Emergency Department (KCH ED) with symptoms of CHF exacerbation in the months following the COVID-19 pandemic peak in New York City were impacted due to the interruption in their regular cardiology outpatient clinic visits. Methods The COVID-CHF study is a single-center, retrospective study of patients with CHF that presented to the KCH ED between 05/01/2020 - 12/31/2020 with CHF exacerbation symptoms, selected utilizing ICD-10 codes for admission diagnoses. Continuous variables are reported as mean ± standard deviations or median (interquartile range), while categorical variables are presented as numbers with frequencies. All analyses were performed on Microsoft Excel and R software. Results A total of 268 patients were included in our study, with the mean age 65.7±13.8 years and 45% female. The burden of comorbidities was high, with >50% of patients having hypertension, diabetes mellitus, and chronic kidney disease. Of the total patient population, only 61 (22.8%) patients attended a televisit appointment during the preceding pandemic months. At ED presentation, the primary presenting symptom was shortness of breath (86%), and the average hospital stay per visit was 3 (2-6) days. The projected mortality risk, according to the MAGGIC score, was 16 ± 10% at 1 year and 35 ± 17% at 3 years for our patient population. Although the gap between clinic visits and ER visits did not increase the mortality risk, patients presenting with worse New York Heart Association (NYHA) class symptoms had higher mortality risk (Figure). At discharge, 82% of patients were prescribed diuretics and 81% beta-blockers. Two patients died during admission and 3 patients died after discharge. Conclusions In our study, we noticed that despite the implementation of a virtual healthcare system during the COVID-19 pandemic, less than one-fourth of CHF patients were able to utilize it, and consequently, there was an increase in ED visits for acute CHF exacerbations in the ensuing months. Additionally, a worse grade of presenting symptoms was associated with higher mortality risk. Key Words: COVID-19, Heart Failure, Virtual Health | J Card Fail | 2022 | CORD-19 | |
| 2439 | Maskophobia As A Cause Of Non-exertional Dyspnea In The Era Of Covid-19 Introduction COVID-19 can cause dyspnea through many mechanisms, and uncovering the underlying etiology greatly affects management. Diagnostic examinations can help uncover pulmonary, cardiac, or hematologic conditions that can contribute to post-viral COVID dyspnea. Hypothesis Non-exertional dyspnea could be caused by maskophobia and not cardiopulmonary conditions. Methods A 59-year-old woman with no history of heart failure and a history of mild exercise-induced asthma, hyperlipidemia, anxiety, depression, and migraines was hospitalized for resting dyspnea. Three months prior, she tested positive for SARS-CoV-2, and a repeat test was positive a week prior to presentation. Upon exercise, oxygen saturation improves. The patient does not endorse dyspnea regularly, with shortness of breath only when wearing a mask. Orthopnea and paroxysmal nocturnal dyspnea were absent. Vital signs were normal. The patient was treated with antivirals, and because of her asthma history, was prescribed 10 days of oral steroids. Supplemental O2 was given for initial mild hypoxia, and the patient was discharged with an oxygen prescription at 1 L/min throughout the day. Upon follow-up, diagnostic testing was performed to assess the etiology of her dyspnea symptoms. D-dimer, complete blood count and basic metabolic panel were unremarkable. Electrocardiogram (EKG) did not demonstrate any evidence of infarction or cardiomyopathy. Chest X-ray did not show pulmonary infiltrate or cardiomegaly. Transthoracic echocardiogram showed normal left ventricular ejection fraction. Nuclear stress testing did not demonstrate any cardiac ischemia. Pulmonary function testing showed mild reactive airway disease consistent with prior asthma history. The symptoms of dyspnea would resolve once the patient removes her mask. Results Dyspnea can be caused by dysfunction anywhere along the pathway from environment oxygen intake to oxygen delivery to the end organs. The most common organ systems involved are pulmonary, cardiac, or hematologic. Anxiety can also cause dyspnea in the absence of a physiologic mismatch between oxygen supply and demand. Cardiopulmonary evaluation is the initial step in the workup of exertional dyspnea. Chest X-ray can assess for the presence of pneumonia, and labs such as D dimer indicate the likelihood of blood clots and pulmonary embolism. Exertional symptoms are evaluated by cardiopulmonary exercise testing. Heart failure can be suspected with abnormal systolic or diastolic function on an echocardiogram. However, if the diagnostic exams do not show any exertional abnormalities of the heart related to dyspnea, and symptoms only occur with the use of a mask, this may reflect an unusual case of non-exertional dyspnea from maskophobia. Conclusions Because masks are becoming a norm during the COVID-19 era, non-exertional dyspnea may represent maskophobia. In the absence of significant laboratory, imaging, and cardiopulmonary investigation, wearing masks could be a cause of non-exertional dyspnea during the era of COVID-19. | J Card Fail | 2022 | CORD-19 | |
| 2440 | Heartlogic Heart Failure Index As Covid Index: Predicting Severity Of Covid-19 In Patients With Advanced Heart Failure Heart Logic heart failure diagnostic is a personalized, remote heart failure diagnostic and monitoring system using multiple, novel physiologic sensors. It has been proven to have high sensitivity and low-alert burden that combines sensor data into one composite index that provides weeks of advance notice for detecting early signs of worsening heart failure. We present two cases, one with non-ischemic cardiomyopathy, the other with ischemic cardiomyopathy. In both cases, patients had reduced ejection fraction status post cardiac resynchronization therapy defibrillator who were monitored with Heart Logic heart failure diagnostics. In the first case, a rapid increase in sensors alarmed us for impending exacerbation of heart failure and retrospective analysis of differentials led us to diagnosis of COVID-19. The patient developed increase in respiratory rate, mean heart rate and S3 component of heart sound while decrease in thoracic impedance, ultimately with increased Index. Patient was admitted, intubated and successfully recovered. Heart Logic Index helped us making the diagnosis in early stage of COVID-19 and manage effectively. We present another case of ischemic cardiomyopathy with reduced ejection fraction awaiting heart transplant due to severe multi vessel coronary artery disease who tested positive for COVID-19 with milder symptoms. He was monitored prospectively to assess changes in Heart Failure Index which remained normal correlating with the milder symptoms from COVID-19 itself. All the indices including S1, S3, respiratory rate and mean heart rate remained normal. Patient recovered without any major residual effects from COVID 19. Hence, heartlogic index could serve as proactive alert tool like a “COVID index” to suspect, correlate with severity of symptoms and monitor the outcome in patients of heart failure diagnosed with COVID-19. | J Card Fail | 2022 | CORD-19 | |
| 2441 | Use Of A Disposable At-Home System To Support Contactless Sleep Apnea Testing & Therapy Initiation In A HF Clinic During The Covid-19 Pandemic Background: The COVID pandemic presented many challenges to providing care to our HF patients. One of our challenges was the closure of our sleep lab for sleep apnea testing and CPAP titration. We also encountered patient reluctance to perform sleep testing with re-usable home equipment. In attempt to address these issues, we employed the WatchPATTM ONE device (Itamar Medical) - a disposable Bluetooth-enabled technology that uses peripheral arterial tonometry - to assess patients for sleep-disordered breathing (SDB) without an in-person visit or a facemask. At-home CPAP initiation and auto-titration was performed in appropriate patients to create a fully contactless testing and treatment program. Methods: From March 2020 - March 2021 patients with suspected SDB during a virtual HF Clinic visit were referred for home sleep testing using the WatchPATTM ONE device. Suspicion for SDB breathing was based on meeting at least 1 of 5 screening criteria used in our HF Clinic and a STOP-BANG score > 3. After insurance approval, a device was mailed to the patient for overnight testing. Results were uploaded into the CloudPAT platform and read by our Center's sleep cardiologist. Patients without complex SDB, underwent remote device fitting via an online DME company followed by CPAP auto-titration. Time to therapy and compliance with CPAP was assessed using the cloud-based system. Cone Health SDB Screening Criteria Poorly-controlled HTN Recurrent/refractory AF Frequent PVCs Fatigue out of proportion to HF severity BMI > 35 Results: Patients tested 111 Positive for SDB (AHI ≥ 5) 81 (73%) Patients with significant central SA (cAHI > 5) 20% Patients with successful remote CPAP initiation 24 (30%) Mean time from virtual visit to therapy 53d Conclusions:• Sleep apnea is a common comorbidity in HF patients • The WatchPATTM ONE system was an effective way to continue to test our HF patients for SDB in a virtual setting with a disease prevalence similar to standard in-lab testing and had the ability to discern between obstructive and central sleep apnea • In our initial virtual sleep apnea program, nearly 1/3 of patients with SDB went onto CPAP treatment via a remote DME Turnkey service with a favorable time to treatment and a completely contactless workflow | J Card Fail | 2022 | CORD-19 | |
| 2442 | Right Ventricular Dysfunction Is Associated With Increased Mortality In Patients Requiring Veno-venous ECMO For The Management Of Severe Respiratory Failure In Covid-19 Infection Purpose Refractory respiratory failure caused by the coronavirus SARS-CoV-2 is associated with a significant mortality rate. Patients unresponsive to conventional medical therapy may benefit from temporary veno-venous extracorporeal membrane oxygenation (VV-ECMO), which provides complete gas exchange while allowing the patient to recover. We sought to investigate the role of right ventricular failure in the outcomes of these patients since clinical and echocardiographic characteristics that predict survival are not yet defined in patients with respiratory failure caused by SARS-CoV-2. Methods We performed a single center retrospective cohort study enrolling consecutive patients that required VV-ECMO for the management of refractory respiratory failure between January and December 2020. Seventeen consecutive patients with COVID-19 infection were included in the reported cohort. Demographics, comorbidities, laboratory parameters and echocardiographic features of left and right ventricular (LV/RV) function were compared between patients who survived and those who could not be weaned from VV-ECMO and died. Results Ten of the 17 patients failed to wean from VV-ECMO and died in the hospital on average 41.5 ± 10.9 days post admission. Seven were successfully decannulated and survived to hospital discharge on average 39.0 ± 19.8 days after admission. There were no significant differences in demographics, comorbidities, laboratory parameters between the groups. LV size and function were also similar. However, moderate to severe RV dysfunction was significantly more frequent in the group of patients who died (8/10, 80%) compared to the survivors (0/7, 0%) (p=0.0017). Conclusion Severe RV dysfunction is associated with increased mortality among patients with severe COVID-19 associated respiratory failure treated with VV-ECMO. Measures to support RV function, including temporary mechanical RV support devices, should be considered for these patients aiming to improve survival. | J Card Fail | 2022 | CORD-19 | |
| 2443 | Reds Lung Fluid Monitoring For Assessing Lung Disease In Patients With Covid-19 Infection Background Clinical manifestation of COVID-19 infection vary from asymptomatic to severe ARDS pneumonia. Chest CT is highly sensitive in detecting lung injury due to COVID-19, but is not routinely used for serial monitoring. ReDS™ is an FDA-approved, non-invasive measurement tool for monitoring lung fluid content in HF patients (normal values ranging 20-35%). ReDS has proven to have excellent correlation with CT in quantification of lung fluid and may have the potential to assess the severity of lung injury in patients infected with the SARS-CoV-2 virus. Methods Cone Health is a six-hospital system in central NC. In March 2020, the previous Women's Hospital site was converted into a 120-bed (24 ICU/96 Medical) COVID hospital. In this prospective, feasibility, pilot study we used the ReDS Clip to evaluate whether it was possible to measure bilateral lung fluid status on a daily basis in qualifying patients with COVID-19 lung infection. Secondary endpoints included correlations between the daily ReDS measurements and standard markers of clinical status. Patients were excluded if they had an implantable cardiac device, did not meet BMI criteria, were in the ICU prior to enrollment or had physical/cognitive limitations that precluded obtaining accurate readings. Results In May - June 2020, 83 patients who met the inclusion criteria were enrolled. The mean age was 56yr, 60% male. Medication regimen included 100% vitamin C and zinc, 72% steroids, 34% remdesivir, 39% tocilizmab. No patients received hydroxycholoroquine. Over the 2month study period, 78% (65/83 patients) were able to receive daily ReDS measurements. Four patients missed 1 or 2 readings during hospitalization due to oxygen saturations dropping or too weak for minimal movements in bed to place the ReDS Device. Eight patients refused to continue study after 1 reading due to weakness or shortness of breath. ReDS readings were held during ICU stay. Six patients (7.2%) were moved to ICU, of which two patients died (33%). For the studied chohort, six patients (7.2%) died during evaluation. Only 2 patients had a documented history of heart failure. For the entire cohort, the average ReDS reading was 37%. Patients with higher supplemental oxygen demand (O2 > 5 L/min or need for BIPAP) had higher ReDS readings than patients with low oxygen demands, ReDS 43% vs ReDS 35%. Patients who were referred to ICU had higher ReDS readings than patients who were discharged home, ReDS 47% vs ReDS 37%. Conclusion In this single-center feasibility study, ReDS lung fluid was able to be measured on a daily basis in 78% of the hospitalized study cohort. ReDS measurements correlated with then need for higher levels of O2 supplementation and worsening clinical status in patients with COVID-19 lung infection. More research is warranted to determine if daily monitoring with this technology can assist in early prediction of disease trajectory. | J Card Fail | 2022 | CORD-19 | |
| 2444 | Satisfaction With Access To Health Services In West Virginia Despite Covid-19 Introduction Centers for Disease Control and Prevention reported COVID-19 significantly impacts health services for chronic health conditions including patients with cardiovascular disease. This study was conducted as an immediate follow-up on study participants who enrolled in the heart failure (HF) clinical trial (1R15NR018547-01) testing home palliative care coaching for patients with HF and their family caregivers in rural Appalachia. Hypothesis COVID-19 impacts HF patients and their caregivers’ (1) overall quality of life (QoL) and health satisfaction, and (2) access to health care and community services. Methods This is a descriptive study conducted between August 2020 to March 2021, using a structured telephone survey with open-ended questions. The questions include demographic queries, frequency of health services use, overall quality of life and health during social distancing and the COVID-19 pandemic. Results Of 13 participants enrolled in the study, the majority were white (85%) and married (61.5%). HF patients were predominantly male (83%), and caregivers were female (85.7%). The mean age of HF patients was 63 (SD=16.8) and family caregivers was 60.7 (SD=12.9) years. Twenty-three percent of participant couldn't financially make ends meet, while another 23.1% reported having barely enough. On a scale of 1-5, the patients were satisfied with their overall QoL (Mean = 3.83 (SD=1.17), but half of caregivers reported average and poor QoL (Mean = 3.17 (SD=0.98). However, 70% of caregivers were satisfied with their health (Mean=3.71 (SD=1.25), while half of the patients reported neutral satisfaction or dissatisfaction with their health (Mean=3.17 (SD=0.98). All patients were able to attend in-person appointments. Notably, 50% of patients reported phone calls and 33% used telehealth for their appointments. A majority of patients reported calling (83%) and receiving calls (67%) from their doctors or nurses. The reasons for calls were related to health issues, lab reports, medications, and dose adjustments. Three patients reported emergency room (ER) visits and two had HF-related hospital admissions. One caregiver had an ER visit. Overall, a few participants (15%) used community services, including hospice and visiting nurses and found them useful. About 70% of participants reported sufficient healthcare, while one-third (30%) did not and reported difficulty in getting medications and rescheduling appointments after cancellation. Conclusions COVID-19 has an impact on QoL and health of patients with HF and their family caregivers. These families need care coordination from their healthcare providers to maintain HF home care. Many families need help with their prescriptions, monitoring and managing symptoms, scheduling appointments, and preventing unwarranted hospitalizations. | J Card Fail | 2022 | CORD-19 | |
| 2445 | Covid 19 And Pericarditis: Should We Be Worried About Tamponade? Introduction Little is known about cardiac manifestations of COVID-19 infection, yet cases of pericarditis, pericardial effusion and with tamponade due to COVID-19 have been reported. Because of the life-threatening nature of this complication, we wanted to investigate the features of pericardial effusion and the rate of occurrence of tamponade in patients with COVID-19. Methods This systematic review was conducted by searching for studies in Pubmed/Medline and Google Scholar for the search terms ‘COVID-19’, ‘SARS-COV-2’, ‘Pericarditis’, ‘Pericardial Effusion’ and ‘Cardiac Tamponade’, performed on December 7, 2020. Results A total of 47 patients with COVID-19 with pericarditis were included in the review from 39 published cases. There were 29 (62%) males and 18 (38%) females and mean age of patients was 53 years. Pulmonary infiltrates were seen in 30 (64%) patients, while 17 (36%) patients did not have pulmonary manifestations. Concomitant myocarditis was present in 16 (34%) patients. 43 (91%) had pericardial effusion- 4 (9%) had small, 10 (21%) had moderate, 3 (6%) had a large pericardial effusion and 26 (55%) patients had cardiac tamponade. 7 (15%) patients with tamponade died. Pericardiocentesis was done in 27 (57%) patients and pericardial window was created in 5 (11%) patients. Off these 13 (27%) patients had an exudative effusion while 1 (2%) patient had a transudative effusion. Conclusion We found that pericarditis in patients with COVID-19 infection can be present in patients with pulmonary infiltrates and without them, as well as with myocarditis or as an isolated feature of cardiac involvement. The effusion is predominantly exudative. More than half of the patients with pericardial involvement present with tamponade, and mortality in this subset is high. The pattern of patients presenting solely with pericarditis and effusion without pulmonary infiltrates warrants further investigation. | J Card Fail | 2022 | CORD-19 | |
| 2446 | Efficacy Of Bedside Cannulation For pVADs Abstract Percutaneous ventricular assist devices (pVAD) have become a mainstay in the treatment of cardiogenic shock, but their use is limited by the need for specialized staff, equipment, and facilities which may not be readily available. Moreover, the COVID-19 pandemic has further limited such interventions due to possible staff exposure, need for additional protective personal equipment, and efforts to limit patient transport. We have implemented a bedside intensive care unit pVAD cannulation strategy using a mobile fluoroscopy arm with transesophageal echocardiogram to guide placement. Table 1 shows characteristics and outcomes of 6 patients cannulated with a percutaneous right or left ventricular assist device (pRVAD or pLVAD). All patients were previously supported with Veno-Arterial or Veno-Venous Extracorporeal Membrane Oxygenation (VA or VV ECMO). 3 patients had pLVAD placed for worsening LV distention after VA-ECMO initiation. 3 patients had pRVAD placed for severe RV failure in the setting of severe COVID infection and hypoxia. In all cases pVADs were successfully placed and patients anticoagulated with IV heparin afterwards. Although one patient with pLVAD placement had an access site compartment syndrome that required fasciotomy, we were able to maintain pLVAD support. Hemodynamic data showed that each patient was supported by their pVAD; unfortunately, 4 of the 6 passed away due to their underlying condition. Conclusions Bedside placement of pVAD can be performed safely and effectively. Mortality remains high, though this was unrelated to device function in our patients. Our approach limits the need for specialized staff and facilities and may allow for more rapid initiation of mechanical circulatory support while decreasing healthcare costs. | J Card Fail | 2022 | CORD-19 | |
| 2447 | Bioimpedance Spectroscopy Offers An Objective Measure Of Heart Failure Stability During A Viral Pandemic Introduction : Given the ongoing Covid-19 pandemic, shortness of breath (SOB) has increased as the chief complaint reported by patients. Viral pneumonia, telehealth, and the rising incidence of heart failure (HF) have driven the need for objective measures for wellness and congestion. Misclassification of congestion and delay in diuretics have been a concern by cardiologists across a variety of health care settings. We report the likelihood of a bioimpedance spectroscopy (BIS) measurement, specifically the Heart Failure Index (HF-Dex), to match patient perceived change since previous clinic visit. Background : BIS provides an objective measure of fluid levels. A recent publication reported the median HF-Dex value for patients with HF was 48.8%, in comparison to a healthy population whose median HF-Dex was 44.8%. Further research showed that HF patients with a value >51% had an odds ratio (OR) of 4.25 for readmission within 45 days. Methods : Fifty-six (56) HF patients were enrolled, during the Covid-19 pandemic, at their routine HF clinic appointment. Perceived change in status since last visit was reported as either no change, improved, or worsening symptoms. We assessed medication changes at time of clinic visit. HF-Dex values were obtained but were not made available to the treating physician. Based on a healthy control value of 44.8%, we applied a 45% threshold below which patients were considered stable from an HF perspective. A cut-point of ≥51% was used to determine the likelihood of medication changes and diuretic up dosing in the current study. Results : Seven (7) of 56 patients had an HF-Dex of 45% or below; none of these patients had an intensification of diuretic dosing or reported worsening symptoms. Twenty-one (21) patients had a measure of 51% or more, of whom 6 reported worsening symptoms prior to their exam for an odds ratio (OR) of 6.6 (95%CI: 1.2-36, p=0.03). The OR for any medication change in the ≥51% group of HF patients was 4.5 (95%CI: 1.1-18, p=0.03). Looking strictly at diuretic change, there was an OR of 3.6 (95%CI: 1.1-12.0, p=0.03). Conclusions : BIS measures provide a unique objective data point to aid in pretest probability for congestion. Patients with a HF-Dex of ≥51% required higher rates of medication and diuretic changes. Subjectively, HF patients at ≥51% also felt worse which may help limit misclassification of congestion when SOB is the chief complaint. Conversely, patients at <45% had fewer diuretic dose changes and felt better overall. The ability to quantify congestion may assist in triage of patients presenting with SOB, as has increasingly been the case during the Covid-19 pandemic in clinic and acute care settings. | J Card Fail | 2022 | CORD-19 | |
| 2448 | Quality Of Work-Life Among Advanced Practice Nurses Who Care For Patients With Heart Failure: The Effect Of Resilience During The Covid-19 Pandemic Introduction Heart failure (HF) prevalence continues to rise while therapeutic options expand in complexity. Advanced Practice Registered Nurses (APRNs; Nurse Practitioners & Clinical Nurse Specialists) manage high burden, complex care of patients with HF. During the COVID-19 pandemic, clinician burnout, stress and job dissatisfaction have likely impacted quality of life (WR-QoL). No studies describe burnout and resilience in APRNs who provide care to individuals with HF. Aims Among APRNs who work with patients with HF, three aims include: 1) Describe the level of burnout and WR-QoL; 2) Determine the relationship between burnout and QOWL variables; 3) Examine whether resilience moderates the association between WR-QoL and burnout. Methods This descriptive correlational study employed an online survey in October, 2020 to APRNs who were members of the American Association of Heart Failure Nurses and the HFSA. Inclusion criteria: APRN's who practiced in cardiology clinics, advanced HF clinics, inpatient cardiology units, or HF home care programs, at least 8 hours weekly. Exclusion criteria: Exclusively pediatric, administrative, educational, or research-focused APRNs. Outcomes measured: Burnout (Copenhagen Burnout Inventory), WR-QoL (Work-Related QoL Scale), and Resilience (Brief Resilience Scale). Institutional review board approval and written consents were obtained. Results Participant (N=101) mean age was 50 (±10) years, 93% identified as female, 96% White, and 70% were master's prepared. Mean weekly worked hours were more than 42 and the majority of APRNs (n=75) represented community and academic health centers. APRNs reported high levels of personal (M= 51.7, norm-referenced mean: 35.9) and work-related burnout (M=50.1, norm-referenced mean: 33.0) with significant correlations between high levels of burnout and low WR-QoL (r range: -.74 — -.39 -, p<.001). APRNs who reported medium or high resilience showed negative relationships between burnout and general well-being (r = -.64, -.76, respectively, p<.001), while the low resilience group showed no relationship. Additionally, APRNs who reported no/low or work-related burnout showed a positive relationship between resilience and general well-being (r = .57, p<.001), while the moderate and severe burnout groups did not. Conclusion We found that the positive effect of resilience on general well-being decreased as work-related burnout went up, indicating the moderating role of work-related burnout. The unanticipated finding that the negative burnout-QOWL relationship was stronger with higher resilience requires more exploration. It is especially critical now, given the emphasis on supporting clinician well-being and preventing burnout, for us to better understand the role of resilience and burnout in well-being. | J Card Fail | 2022 | CORD-19 | |
| 2449 | The Effect Of COVID-19 Infection On Tacrolimus Metabolism In Heart Transplant Introduction There is limited knowledge regarding the effects of COVID-19 in heart transplant recipients. Reliance on tacrolimus levels has become a cornerstone of management strategy to balance the immune response with the potential for rejection of the graft. How COVID-19 and its treatment affect tacrolimus metabolism in solid organ transplant is not well understood. Here we present a case of a heart transplant recipient with highly elevated tacrolimus levels following COVID-19 infection despite little to no tacrolimus administration and no other known drug-drug interactions. Case Presentation The patient is a 58-year-old male with history of ischemic cardiomyopathy; status post orthotopic heart transplantation 6/17/2018. The postoperative course was complicated by two occurrences of 2R cellular rejection within 1 year, RV dysfunction, calcineurin induced renal dysfunction, and relative bradycardia. In 7/2020, the patient presented to the ED with complaints of jaw pain, symptoms of urinary retention and 3 days of diarrhea. COVID-19 PCR returned positive. Before infection, the patient had been maintained on a steady dose of tacrolimus 0.5mg BID for 8 months with associated trough levels between the goal range of 4-8ng/mL. At the time of infection, the patient's tacrolimus was held to account for elevated trough levels, and he was then maintained on a dose of 0.5mg QAD for the next 8 months. Discussion Tacrolimus metabolism is represented in Graph 1 via trough:dose (T:D) ratio (T:D ratio measured in 48-hr intervals as the patient was on QAD dosing post-infection). T:D ratio remained stable on tacrolimus 0.5mg BID before COVID-19 infection. Following infection, the ratio sharply rose and remained elevated 8 months later despite reducing the dose to 0.5mg QAD. To our knowledge, this is the first case presented of a heart transplant recipient with altered tacrolimus metabolism status post COVID-19 infection without apparent drug-drug interaction. This suggests a relationship between SARS-COV-2 viremia with tacrolimus metabolism. | J Card Fail | 2022 | CORD-19 | |
| 2450 | Effects Of Decreased Access To Outpatient Care During The Covid-19 Pandemic Introduction In 2020, the Covid-19 pandemic caused a decrease in access to routine healthcare. The question posed was if decreased clinic hours of an outpatient congestive heart failure (CHF) clinic affected admissions or readmissions. Hypothesis The hypothesis was that decreased hours of the CHF clinic would lead to increased hospital admissions and readmissions. Methods A retrospective data analysis using the Epic system slicer dicer application at an independent hospital in Phoenix, Arizona. The patient population was defined as patients seen with a heart failure diagnosis at the independent hospital.The time frames used for comparison include the years of 2019 and 2020 that were further broken down. January-March the CHF clinic operated 2 days a week in 2020, May 2020 the CHF clinic was closed and July- September 2020 the CHF clinic returned to 5 days a week. The proportion of the total patient population with at least one heart failure admission for each time period was calculated and the 2019 vs. 2020 proportions were compared using a two sample test of proportions and correspond confidence intervals.The percentage of patients readmitted for heart failure within 30 days out of the number patients who were admitted at least once were also compared for 2019 and 2020 during the time frames specified. Confidence intervals and p-values were calculated using a two sample test of proportions to determine if there was a statistically significant difference between the proportion of patients readmitted for heart failure in the years 2019 versus 2020 during the time frame specified. Results For the time periods considered, the proportions of patients admitted at least once as well as the proportion of patients readmitted were higher in 2019 compared to 2020.When the entire years of 2019 and 2020 were compared there was a 2.5% higher admission rate in 2019 compared to 2020 (p=0.003, 95% CI=[0.9%, 4.2%]) and 3.2% higher readmission rate (p=0.04, 95% CI=[0.1%, 6.3%]). January- March was compared in 2019 vs. 2020, there was a 2.5% higher admission rate in 2019 (p=0.001, 95% CI=[1.0%, 4.0%]). There was no significant statistical difference for readmissions. May of 2019 had a 1.7% higher admission rate than May of 2020 (p<0.001, 95% CI=[0.7%, 2.6%]). We observed 5.0% higher readmissions in May 2019 compared to May 2020 but was not statistically significant (p=0.31, 95% CI=[-4.5%, 14.4%]).July-September of 2019 had a 2.6% higher admission rate compared to 2020 (p<0.001, 95% CI=[1.3%, 3.9%]). The percentage of readmissions was estimated to be 3.2% higher in July- September 2019 vs 2020, but was not statistically significant. Conclusion In conclusion there was a decrease in admissions in 2020 vs 2019 despite decreased access. Factors to consider that may affect the outcome are travel and restaurant restrictions, as well as hesitancy to seek care during the 2020 pandemic. This may have led to care at different hospitals and more adherence to dietary restrictions at home. Improvement in guideline directed medical therapy and individual provider outreach also cannot be excluded. | J Card Fail | 2022 | CORD-19 |
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