BackgroundPrior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown.ObjectiveThis study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19.MethodsCase–control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19.ResultsTotal of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011).ConclusionVascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.

Background: Heart failure with reduced ejection fraction (HFrEF) is associated with recurrent hospitalizations and high mortality. Guideline-directed medical therapy (GDMT) reduces morbidity, mortality and re-admission rates. Despite the evidence, less than 50% of patients with HFrEF are prescribed appropriate medical therapy. When hospitalized patients have these medications discontinued on admission or during hospitalization, they are less likely to have them restarted on discharge. The goal of this study was to determine the incidence of disruption of beta-blocker (BB) therapy during hospitalization for HFrEF patients admitted to an academic tertiary referral hospital. Methods:We conducted a retrospective study in a single teaching hospital over the course of 1 year, and utilized data queried from the electronic medical record (EPIC) database. Inclusion criteria were met by patients with an ICD-10 code diagnosis of heart failure, left ventricular ejection fraction less than 40% and BB prescription prior to admission. Additional information noted included age, sex, vital signs throughout the admission and dates where BB was not given for a full 24-h period. Patients in the intensive care unit (ICU) were excluded due to uncertainty of their hemodynamics. Data were extracted from the electronic medical record database and analyzed through Python, Microsoft Excel and RStudio. The incidence of BB disruption during hospitalization was defined as a 24-h period where no BB was administered. Blood pressure (BP) and heart rate (HR) levels were compared between patients who received BB and patients who had a disruption in their BB. Measurements were also obtained to assess whether a correlation exists between holding BB therapy and time of the year, age, or sex.Results: Between January 2018 and January 2019, 780 patient encounters met inclusion criteria for the study. Patients who were continued on BB therapy had an average BP of 120.8/68.7 mm Hg and an HR of 82.4 bpm on days they received their BB. Patients who had a disruption of BB therapy had an average BP of 117.7/67.6 mm Hg and an HR of 88.6 bpm on the days of the disruption (P < 0.001). There was no association between holding BB and age, sex, or time of year.Conclusions: This study showed that in an academic tertiary referral center, patients with HFrEF who are not in an ICU have a 23% chance of not receiving their recommended BB therapy for 24 h. While the differences measured for BP and HR are statistically significant, they are not clinically significant.

Blunt thoracic wall trauma can rarely lead to acute coronary artery injury and occlusion , and mostly involves the left anterior descending artery due to its vulnerable anterior anatomic positioning. Herein, we present a case of a young man who presented as a ST segment elevation MI (STEMI) with right coronary artery (RCA) occlusion after a blunt thoracic wall trauma. Clinical Vignette: A 37-year-old man with no previous medical history was brought to our ER with blunt chest wall trauma following a motor vehicle collision. Initial workup showed multiple fractures, a right pneumothorax and a pelvic hematoma. EKG performed for chest pain showed STEMI in the inferior and lateral leads. A 2D echocardiogram then showed inferolateral wall hypokinesis. Serial troponin I levels trended up sharply from 0.4 initially. After initiating intravenous heparin and cangrelor, the patient underwent emergent coronary angiography which revealed a rare, RCA occlusion with a thrombus. The patient then successfully underwent aspiration thrombectomy with restoration of TIMI grade III blood flow. Discussion: Hence, we presented a rare case of RCA occlusion resulting from blunt thoracic wall trauma. While musculoskeletal pain may mask the symptoms of myocardial hypoperfusion, a high index of suspicion for coronary artery thrombosis can lead to desirable outcomes in such patients.

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