Objective To explore swallowing function and risk factors associated with delayed recovery of swallowing in COVID-19 patients post invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). Design Longitudinal cohort study. Setting 3 secondary-level hospitals. Participants Invasively ventilated patients (n=28), hospitalized with severe COVID-19 who were referred to the Speech and Language Pathology (SLP) departments post mechanical ventilation between March 5 and July 5 2020 for an evaluation of swallowing function before commencing oral diet. Interventions SLP assessment, advice and therapy for dysphagia. Main outcome measures Oral intake levels at baseline and hospital discharge according to the Functional Oral Intake Scale (FOIS). Patients were stratified according to FOIS (1-5=dysphagia, 6-7= functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning and SLP evaluation were collected. Results Dysphagia was found in 71% of the patients at baseline (in total 79% male, age 61 ±12 years, BMI 30 ±8 kg/m 2 ). Median FOIS score at baseline was 2 (IQR 1) vs 5 (IQR 2.5) at hospital discharge. Patients with dysphagia were older (64 ±8.5 vs 53 ±16 years; p= 0.019), had a higher incidence of hypertension (70% vs 12%; p=0.006) were ventilated invasively longer (16 ±7 vs 10 ±2 days; p=0.017) or with tracheostomy (9 ±9 vs 1 ±2 days; p=0.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=-0.471, p=0.01), and number of days at the Intensive Care Unit (ICU) (r=-0.48, p=0.01). Conclusion Dysphagia is prevalent in COVID-19 patients post invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (p<0.001).

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IntroductionAtrial fibrillation (AF) causes ischaemic stroke and based on risk factor evaluation warrants anticoagulation therapy. In stroke survivors, AF is typically detected with short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring requires substantial resources while insertable cardiac monitors are invasive and costly. Chest and thumb ECG could provide an alternative for AF detection poststroke.The primary objective of our study is to assess the incidence of newly diagnosed AF during 28 days of chest and thumb ECG monitoring in cryptogenic stroke. Secondary objectives are to assess health-related quality of life (HRQoL) using short-form health survey (SF-36) and the feasibility of the Coala Heart Monitor in patients who had a stroke.MethodsStroke survivors in Region Gävleborg, Sweden, will be eligible for the study from October 2017. Patients with a history of ischaemic stroke without documented AF before or during ECG evaluation in the stroke unit will be evaluated by the chest and thumb ECG system Coala Heart Monitor. The monitoring system is connected to a smartphone application which allows for remote monitoring and prompt advice on clinical management. Over a period of 28 days, patients will be monitored two times a day and may activate the ECG recording at symptoms. On completion, the system is returned by mail. This system offers a possibility to evaluate the presence of AF poststroke, but the feasibility of this system in patients who recently suffered from a stroke is unknown. In addition, HRQoL using SF-36 in comparison to Swedish population norms will be assessed. The feasibility of the Coala Heart Monitor will be assessed by a self-developed questionnaire.Ethics and disseminationThe study was approved by The Regional Ethical Committee in Uppsala (2017/321). The database will be closed after the last follow-up, followed by statistical analyses, interpretation of results and dissemination to a scientific journal.Trial registration numberNCT03301662; Pre-results.

Background An implantable cardioverter defibrillator (ICD) is recommended for patients with symptomatic heart failure with ejection fraction ≤35% despite optimal medical therapy. More recently, the benefits of ICDs have been questioned in nonischemic cardiomyopathy (CM). Aim To examine the incidence of appropriate therapy, complications, mortality, and cause of death among ICD patients in an unselected validated cohort. In primary prevention, appropriate therapy in ischemic versus nonischemic CM will be evaluated. Methods A retrospective observational study of patients in Region Gävleborg, Sweden, who underwent ICD implantation or replacement between 2007 and 2017. Results In total, 438 patients (mean age at implant: 65.9 ± 11.2 years, 82.0% males, mean follow‐up: 5.2 ± 4.0 years) were included. There were 108 (24.7%) deaths (49.1% due to heart failure) and 94.9% survived the first year. Cumulative incidence of appropriate therapy at 5‐year was 31.6%. Cumulative incidence of inappropriate shock at 5‐year was 9.1%. A total of 98 complications requiring surgical intervention occurred (annual rate: 4.3%). In total, 236 patients with primary prevention due to ischemic (61.9%) or nonischemic (38.1%) CM were included. During a mean follow‐up of 3.9 ± 2.5 years, for appropriate therapy, there was no significant difference (P = .985) between ischemic (cumulative incidence at 1, 3, and 5 years: 6.4%, 17.1%, and 19.6%) and nonischemic CM (cumulative incidence at 1, 3, and 5 years: 5.6%, 13.6%, and 24.4%). Conclusion Ischemic and nonischemic CM confer similar risk of ventricular arrhythmia. This supports current guidelines regarding primary‐prevention ICD. Short‐term survival is excellent but complications remain a problem.

ObjectiveIn stroke survivors, atrial fibrillation (AF) is typically evaluated solely by short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring or insertable cardiac monitors require substantial resources. Chest and thumb ECG could provide an alternative means of AF detection, which in turn could allow prompt anticoagulation to prevent recurrent stroke. The objective of this study was to assess the yield of newly diagnosed AF during 28 days of chest and thumb ECG monitoring two times per day in cryptogenic stroke.MethodsThis study, Transient ECG Assessment in Stroke Evaluation, included patients who had a stroke from Region Gävleborg, Sweden, between 2017 and 2019. Patients with a recent ischaemic stroke without documented AF (or other reasons for anticoagulation) before or during ECG evaluation in the stroke unit were evaluated using the Coala Heart Monitor connected to a smartphone application for remote monitoring.ResultsThe prespecified number of 100 patients (mean age 67.6±10.8 years; 60% men) was analysed. In nine patients (9%, number needed to screen 11) AF but no other significant atrial arrhythmias (>30 s) was diagnosed. The mean CHA2DS2-VASc score was similar among patients with AF and no AF (4.9±1.1 vs 4.3±1.3; p=0.224) and patients with AF were older (74.3±9.0 vs 66.9±10.8; p=0.049). Patients performed on average 90.1%±15.0% of scheduled transmissions.ConclusionIn evaluation of cryptogenic stroke, 9% of patients had AF detected using chest and thumb ECG two times per day during 1 month. In many stroke survivors, this is a feasible approach and they will be potentially protected from recurrent stroke by anticoagulation treatment.Trial registration numberNCT03301662.