Abstract Importance This is the first meta-analysis to investigate risk of death and hospitalization in individuals with comorbidities, specifically during the Omicron era. Objective To assess the risk of mortality and hospitalization from COVID-19 in individuals with comorbidities in comparison with individuals without comorbidities during the Omicron era. Data Sources A systematic search of Embase, MEDLINE, PubMed, Europe PMC, Latin American and Caribbean Health Sciences Literature, Cochrane COVID-19 Study Register, and WHO COVID-19 Database was performed to identify studies published between 1 January 2022 and 13 March 2024. Study Selection Inclusion criteria were observational studies including people (all ages) with at least 1 of the following comorbidities: cardiovascular/ cerebrovascular disease, chronic lung conditions, diabetes, and obesity. In total, 72 studies were included in the review, of which 68 were meta-analyzed. Data Extraction and Synthesis Data were extracted by one reviewer and verified by a second. Studies were synthesized quantitively (meta-analysis) using random-effect models. PRISMA guidelines were followed. Main Outcomes and Measures Evaluated outcomes were the risks of death, hospitalization, intensive care unit (ICU) admission, and any combination of these outcomes. Odds ratios, hazard ratios, and rate ratios were extracted; pooled relative risk (RR) and 95% confidence intervals (CI) were calculated. Results Minimum numbers of participants per comorbidity across included studies ranged from 328 870 for thrombosis to 13 720 480 for hypertension. Risks of death, hospitalization, and the combined outcome were increased in individuals with cerebrovascular disease, COPD, diabetes, respiratory diseases, heart disease, and heart failure versus those without (pooled RRs ranged from 1.27 [heart disease, hospitalization; 95% CI, 1.17-1.38, P < .001] to 1.78 [heart failure, death: 95% CI, 1.46-2.16, P < .001]). Individuals with diabetes and obesity had increased risk of ICU admission (RR: 1.20; 95% CI: 1.04-1.38, P = .0141 and RR: 1.32; 95% CI: 1.11-1.57, P = .00158, respectively). Conclusions During the Omicron era, risk of death and hospitalization from COVID-19 is increased amongst individuals with comorbidities including cerebrovascular/cardiovascular conditions, chronic lung diseases, and diabetes, with the highest risk in those with heart failure. Individuals with diabetes and obesity are at increased risk of ICU admission. Key Points Question What are the risks of severe outcomes from COVID-19 in individuals with comorbidities during the Omicron era? Findings This systematic review and meta-analysis found increased risk of mortality and hospitalization among individuals with a range of comorbidities, including cerebrovascular/cardiovascular conditions, chronic lung diseases, and diabetes, with the highest risk in those with heart failure, versus those without. Risk of ICU admission was higher in individuals with obesity and diabetes. Meaning This study identified comorbid populations most at risk of severe outcomes from COVID-19. Targeting these populations with public health measures, such as vaccination, may be beneficial.
Journal Article Accepted manuscript The burden of atrial fibrillation related to metabolic risks: Different countries and territories, yet the same challenges Get access Bi Huang, Bi Huang Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom Search for other works by this author on: Oxford Academic Google Scholar Meng Li, Meng Li Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom Search for other works by this author on: Oxford Academic Google Scholar Gregory Y H Lip Gregory Y H Lip Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United KingdomDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark Corresponding author: Gregory Y.H. Lip, E-mail: gregory.lip@liverpool.ac.uk https://orcid.org/0000-0002-7566-1626 Search for other works by this author on: Oxford Academic Google Scholar European Heart Journal - Quality of Care and Clinical Outcomes, qcae037, https://doi.org/10.1093/ehjqcco/qcae037 Published: 08 May 2024
Hypertension (HT) is a disease that poses a serious threat to human health, mediating organ damage such as the cardiovascular (CV) system, kidneys, central nervous system (CNS), and retinae, ultimately increasing the risk of death due to damage to the entire vascular system. Thus, the widespread prevalence of hypertension brings enormous health problems and socioeconomic burdens worldwide. The goal of hypertension management is to prevent the risk of hypertension-mediated organ damage and excess mortality of cardiovascular diseases. To achieve this goal, hypertension guidelines recommend accurate monitoring of blood pressure and assessment of associated target organ damage. Early identification of organ damage mediated by hypertension is therefore crucial. Plasma biomarkers as a non-invasive test can help identify patients with organ damage mediated by hypertension who will benefit from antihypertensive treatment optimization and improved prognosis. In this review, we provide an overview of some currently available, under-researched, potential plasma biomarkers of organ damage mediated by hypertension, looking for biomarkers that can be detected by simple testing to identify hypertensive patients with organ damage, which is of great significance in clinical work. Natriuretic peptides (NPs) can be utilized as a traditional biomarker to detect hypertension-mediated organ damage, especially for heart failure. Nevertheless, we additionally may need to combine two or more plasma biomarkers to monitor organ damage in the early stages of hypertension.
Abstract Hypertensive urgencies and emergencies occur most commonly in patients with previous hypertension, especially if inadequately managed. About 40% of cases have an underlying cause, most commonly renovascular disease, primary renal diseases, phaeochromocytoma, and connective tissue disorders. Hypertensive emergencies occur when severely elevated or sudden marked increase in blood pressure is associated with acute end-organ damage. Malignant phase hypertension is a rare condition characterized by very high blood pressure, with bilateral retinal haemorrhages and/or exudates or cotton wool spots, with or without papilloedema. Presentation is typically with visual disturbance, with or without headaches. Urinalysis may demonstrate proteinuria and haematuria, even in the absence of primary renal disease. Some patients with mild renal impairment at first presentation may improve, or even regain normal renal function, but this is unlikely to occur in those with more severe renal impairment at presentation.
The risk of developing dementia is increased in patients with atrial fibrillation (AF), with the incidence of both conditions increasing with aging. Patients with dementia frequently do not receiving adequate thrombo-prophylaxis, because of the inability to monitor INR and/or to achieve and maintain good compliance with anticoagulant treatment. Under-treatment is therefore an important contributor to the increased risk of ischemic stroke and mortality in this subgroup of AF patients. In newly-diagnosed patients with AF starting oral anticoagulation, the presence of cognitive impairment should be considered in addition to the calculation of the SAMe-TT2R2 score, as part of an integrated decision management pathway to choose the most appropriate oral anticoagulant [i.e., vitamin K antagonists (VKAs) or non-vitamin K oral anticoagulants (NOACs)]. Moreover, in patients with low or worsening time in therapeutic range during VKAs therapy, the assessment of cognitive impairment may help identify those patients who may benefit from switching to NOACs. In conclusion, patients with AF and dementia benefit from anticoagulation and should not be denied receiving adequate stroke prevention. Cognitive function assessment and social support are pivotal elements in the management of these AF patients.
