Aims The coronavirus disease‐2019 (COVID‐19) pandemic has changed the landscape of medical care delivery worldwide. We aimed to assess the influence of COVID‐19 pandemic on hospital admissions and in‐hospital mortality rate in patients with acute heart failure (AHF) in a retrospective, multicentre study. Methods and results From 1 January 2019 to 31 December 2020, a total of 101 433 patients were hospitalized in 24 Cardiology Departments in Poland. The number of patients admitted due to AHF decreased by 23.4% from 9853 in 2019 to 7546 in 2020 ( P < 0.001). We noted a significant reduction of self‐referrals in the times of COVID‐19 pandemic accounting 27.8% ( P < 0.001), with increased number of AHF patients brought by an ambulance by 15.9% ( P < 0.001). The length of hospital stay was overall similar (7.7 ± 2.8 vs. 8.2 ± 3.7 days; P = not significant). The in‐hospital all‐cause mortality in AHF patients was 444 (5.2%) in 2019 vs. 406 (6.5%) in 2020 ( P < 0.001). A total number of AHF patients with concomitant COVID‐19 was 239 (3.2% of AHF patients hospitalized in 2020). The rate of in‐hospital deaths in AHF patients with COVID‐19 was extremely high accounting 31.4%, reaching up to 44.1% in the peak of the pandemic in November 2020. Conclusions Our study indicates that the COVID‐19 pandemic led to (i) reduced hospital admissions for AHF; (ii) decreased number of self‐referred AHF patients and increased number of AHF patients brought by an ambulance; and (iii) increased in‐hospital mortality for AHF with very high mortality rate for concomitant AHF and COVID‐19.

Background According to 2019 ESC guidelines for management in patients with the pulmonary embolism (PE), the computed tomographic pulmonary angiography (CTPA) is the diagnostic method of choice in suspected high-risk PE defined as patients with hemodynamic instability. In stable cases, it is recommended to assess the pre-test probability of the PE. However, CTPA with its great accuracy and wide availability in most medical centers is used as often to confirm as to exclude the diagnosis in PE suspected patients, despite the fact that it is linked with the risk of radiation and iodine-containing contrast exposure. Purpose The aim of the study was to assess the validity of CTPA use in patients with suspected PE form the perspective of multidisciplinary clinical center. Methods We retrospectively analyzed the data of from 52,474 hospitalized patients between 01.2018 and 12.2019. A total of 261 (0.5%) consecutive patients with suspected PE (in the emergency department or during hospitalization) were included into the study. Due to suspicion of PE all patients underwent the CTPA. In this group, we analyzed all available clinical data, results of laboratory and diagnostic tests (before and after CTPA) including estimated glomerular filtration rate (eGFR), creatinine level, transthoracic echocardiography (TTE) and planar ventilation/perfusion (lung scintigraphy) scan (V/Q SPECT) if performed. Results The CTPA confirmed PE in 28.9% of patients. The most common final diagnoses, established in the group with negative CTPA result, include heart failure (33.9%), pneumonia (14.4%) exacerbation of chronic obstructive pulmonary disease or asthma (9.3%) and acute coronary syndrome (5.9%). Acute PE was the cause of in-hospital death in 2.4% of patients and the rate of all cause in-hospital death was 11.4%. In 54.2% of patients we observed the eGFR decline and creatinine level increase, meeting the criteria of the acute contrast-induced nephropathy in 33 of them of them (19.8%). In the group with excluded PE, mean eGFR before CTPA was 70.9ml/min/1.73m2 with the decline to mean 60.4ml/min/1.73m2 during the hospitalization (p&lt;0.01). In patients with negative CTPA result and the worsening of the renal function mean eGFR decline was 17.8ml/min/1.73m2 (p&lt;0.01) and mean creatinine level increase was 38.6μmol/l (p&lt;0.01). CONSLUSIONS The initial data collected show the overuse of CTPA in suspected PE, as the diagnosis was confirmed in less than one-third of them. Although CTPA allows to exclude or confirm PE unambiguously, its use is associated with risk of acute contrast-induced nephropathy. Additionally, in patients with exacerbation of heart failure established as final diagnosis after excluding PE, intensive diuretic treatment is crucial and may cause further accompanying renal function worsening. Therefore, optimizing the diagnostic pathway in patients with suspected PE into less aggravating procedures such as TTE or V/Q SPECT is justifiable. Funding Acknowledgement Type of funding source: None

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