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Introduction: Heart Failure (HF) is categorized according to the AHA/ACC 2013 HF Guidelines based on Left Ventricular Ejection Fraction (LVEF); HF with Reduced Ejection Fraction (HFrEF, EF≤40%), and HF with preserved EF (HFpEF, EF ≥ 50%). There is a group of “borderline” patients with EF 41%-49%, termed Heart Failure with Mid-Range Ejection Fraction (HFmrEF). Given this category is not well understood, we sought to evaluate clinical characteristics and management patterns for patients with HFmrEF. Methods: A systematic review was performed using Ovid MEDLINE, EMBASE, Cochrane CENTRAL and LILACS (1946 – 03/2018). Search terms included HF, mid-range, borderline LVEF with several ranges (40-50 or 40-45 or 45-50). Variables characterizing clinical features and medications were extracted for each HF group and adjusted odds ratios (ORs) were pooled. Results: Of 1,131 abstracts identified, 24 met inclusion criteria (total patients 480,188). Patients with HFmrEF compared to those with HFrEF were more likely to be female (OR 1.42), have hypertension [HTN] (OR 1.34) and diabetes (OR 1.11), higher SBP (OR 1.17), better NYHA-FC (FC I OR 1.73, FC II 1.33), less likely to have coronary artery disease [CAD] (OR 0.74) and more likely to be treated with ACEI, ARB, BB, Digoxin, MRA and statins (Figure 1-2). HFmrEF patients when compared to those with HFpEF were less likely to be female (OR 0.54) or have HTN (OR 0.68), and more likely to have CAD (OR 1.25), and to be treated with HF medications and statins. Conclusions: Patients with HFmrEF have higher SBP and better NYHA-FC (I and II) compared to HFrEF patients and are less likely to be female and more likely to have CAD compared to HFpEF patients. Further research is needed to help guide management in this unique but clinically important population. Figure 1A. Forest plot of adjusted ORs comparing baseline clinical characteristics of HFrEF vs HFmrEF patients Figure 1B. Forest plot of adjusted ORs comparing baseline clinical characteristics of HFmrEF vs HFpEF patients Figure 2A. Forest plot of adjusted ORs comparing medications used in HFrEF vs HFmrEF patients Figure 2B. Forest plot of adjusted ORs comparing medications used in HFmrEF vs HFpEF patients

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Patients with the coronavirus disease 2019 (COVID-19) can develop hypoxic respiratory failure that can be further exacerbated into acute respiratory distress syndrome due to an unregulated cytokine storm. Treatments to mitigate this include dexamethasone, which is cheap and easily available but recent trials have shown reduction in mortality when interleukin-6 (IL-6) inhibitors are added. Although IL-6 inhibitors are important against COVID-19 they are cost prohibitive for low-middle income countries (LMIC). LMIC need to have readily available medications that are also affordable, especially since vaccine distribution has been disproportionately favored towards high-income countries. Amantadine is a cheap medication that has been shown to have immunomodulatory effects against the COVID-19 cytokine storm and also antiviral properties against the SARS-CoV-2 virus. This makes amantadine an possible therapeutic against the virus. We sought to evaluate the effect of amantadine when paired with standard of care as compared to standard alone.METHODS: This is a retrospective, observation cohort study carried out in a tertiary care hospital in Western Honduras. Patient's charts were reviewed from September 1 st , 2020 to October 31 st , 2021. We included patients who were above 18 years of age and were admitted to the hospital for moderate to severe COVID-19, confirmed by RT-PCR testing. We compared the clinical characteristics and outcomes of patients who received amantadine against those who received standard of care alone. We defined standard of care as Enoxaparin 1mg/kg SC daily, Dexamethasone 8 mg, Atorvastatin 80 mg and oxygen therapy. RESULTS:We found 42 patients who met inclusion criteria, 14 received amantadine plus standard of care and 28 who received standard of care alone. The median age for the amantadine group was 57 years and the control group of 58.5 years. In the Amantadine group 67.86% were men and 32.14 were women, for the control 78.57% were men and 21.43% were women. The duration of illness before administration of Amantadine was of 5.79 days. The mean oxygen saturation at the admission was 80% in both groups. The amantadine group had mean CRP value of 57.28 mg/L as compared to 101.40 mg/L in the control group. High flow nasal oxygen (HFNO) or non-invasive mechanical ventilation (NIMV) was needed in 64.29% of the Amantadine group and 67.86% of the control group. The 28-day Mortality was of 14.29% for the amantadine group and 14.28% for the control. No adverse effect was found in both groups. CONCLUSIONS:We found a total of 42 patients admitted to the hospital with moderate to severe COVID-19 with 14 patients receiving standard of care and amantadine and 28 receiving standard of care alone. We found no difference in mortality when amantadine was added to the standard of care. Larger studies are required to elucidate the impact of amantadine on moderate to severe COVID-19.CLINICAL IMPLICATIONS: Although amantadine seems like an interesting addition in therapeutics against COVID-19 we found no significan...