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1. Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Author

Hockham, Carinna ; https://orcid.org/0000-0003-2126-5350, Linschoten, Marijke, Asselbergs, Folkert W, Ghossein, Chahinda, Woodward, Mark ; https://orcid.org/0000-0001-9800-5296, Peters, Sanne AE ; https://orcid.org/0000-0003-0346-5412, Al-Ali, AK, Al-Muhanna, FA, Al-Windy, NYY, Almubarak, YA, Alnafie, AN, Alshahrani, M, Alshehri, AM, Anthonio, RL, Asselbergs, FW, Aujayeb, A, Berg, JM ten, van Boxem, AJM, Captur, G, Caputo, M, Charlotte, N, Dark, P, De Sutter, J, Delsing, CE, Dorman, HGR, Drost, JT, Emans, ME, Ferreira, JB, Gabriel, L, van Gilst, WH, Groenemeijer, BE, Haerkens-Arends, HE, van der Harst, P, Hedayat, B, van der Heijden, DJ, Hellou, E, Hermanides, RS, Ast, JF Hermans-van, van Hessen, MWJ, Heymans, SRB, van der Horst, ICC, van Ierssel, SH, Jewbali, LS, Kearney, MT, van Kesteren, HAM, Kietselaer, BLJH, Koning, AMH, Kopylov, PY, Kuijper, AFM, Kwakkel-vanErp, JM, van der Linden MMJM, Linschoten, M, Linssen, GCM, R, Macias Ruiz, Magdelijns, FJH, Martens, FMAC, McCann, GP, van der Meer, P, Meijs, MFL, Messiaen, P, Monraats, PS, Montagna, L, Moriarty, A, Mosterd, A, Nierop, PR, van Ofwegen-Hanekamp, CEE, Pinto, YM, Poorhosseini, H, Prasad, S, Redón, J, Reidinga, AC, Ribeiro, MIA, Ripley, DP, Salah, R, Saneei, E, Saxena, M, Schaap, J, Schellings, DAAM, Schut, A, Shafiee, A, Shore, AC, Siebelink, HJ, van Smeden, M, Smits, PC, Pisters, R, Tessitore, E, Tieleman, RG, Timmermans, P, Tio, RA, Tjong, FVY, Uil, CA den, Van Craenenbroeck, EM, van Veen HPAA, Veneman, T, Verschure, de Vries, JK, van de Wal, RMA, van de Watering, DJ, Westendorp, ICD, Westendorp, PHM, Weytjens, C, Wierda, E, Williams, B, Woudstra, P, Wu, KW, Zaal, R, Zaman, AG, van derZee, PM, Hockham, Carinna ; https://orcid.org/0000-0003-2126-5350, Linschoten, Marijke, Asselbergs, Folkert W, Ghossein, Chahinda, Woodward, Mark ; https://orcid.org/0000-0001-9800-5296, Peters, Sanne AE ; https://orcid.org/0000-0003-0346-5412, Al-Ali, AK, Al-Muhanna, FA, Al-Windy, NYY, Almubarak, YA, Alnafie, AN, Alshahrani, M, Alshehri, AM, Anthonio, RL, Asselbergs, FW, Aujayeb, A, Berg, JM ten, van Boxem, AJM, Captur, G, Caputo, M, Charlotte, N, Dark, P, De Sutter, J, Delsing, CE, Dorman, HGR, Drost, JT, Emans, ME, Ferreira, JB, Gabriel, L, van Gilst, WH, Groenemeijer, BE, Haerkens-Arends, HE, van der Harst, P, Hedayat, B, van der Heijden, DJ, Hellou, E, Hermanides, RS, Ast, JF Hermans-van, van Hessen, MWJ, Heymans, SRB, van der Horst, ICC, van Ierssel, SH, Jewbali, LS, Kearney, MT, van Kesteren, HAM, Kietselaer, BLJH, Koning, AMH, Kopylov, PY, Kuijper, AFM, Kwakkel-vanErp, JM, van der Linden MMJM, Linschoten, M, Linssen, GCM, R, Macias Ruiz, Magdelijns, FJH, Martens, FMAC, McCann, GP, van der Meer, P, Meijs, MFL, Messiaen, P, Monraats, PS, Montagna, L, Moriarty, A, Mosterd, A, Nierop, PR, van Ofwegen-Hanekamp, CEE, Pinto, YM, Poorhosseini, H, Prasad, S, Redón, J, Reidinga, AC, Ribeiro, MIA, Ripley, DP, Salah, R, Saneei, E, Saxena, M, Schaap, J, Schellings, DAAM, Schut, A, Shafiee, A, Shore, AC, Siebelink, HJ, van Smeden, M, Smits, PC, Pisters, R, Tessitore, E, Tieleman, RG, Timmermans, P, Tio, RA, Tjong, FVY, Uil, CA den, Van Craenenbroeck, EM, van Veen HPAA, Veneman, T, Verschure, de Vries, JK, van de Wal, RMA, van de Watering, DJ, Westendorp, ICD, Westendorp, PHM, Weytjens, C, Wierda, E, Williams, B, Woudstra, P, Wu, KW, Zaal, R, Zaman, AG, and van derZee, PM

Abstract

Objective To assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease. Design Registry based observational study. Setting 74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021 Participants All adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients). Main outcome measures Any cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease. Results Of 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 t

Published
2023

2. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries

Author

Linschoten, M, Uijl, A, Schut, A, Jakob, CEM, Romao, LR, Bell, RM, McFarlane, E, Stecher, M, Zondag, AGM, van Iperen, EPA, Hermans-van Ast, JF, Lea, NC, Schaap, J, Jewbali, LS, Smits, PC, Patel, RS, Aujayeb, A, van Smeden, M, Siebelink, HJ, Williams, S, Pilgram, L, Tieleman, RG, Williams, B, Asselbergs, FW, Al-Ali, AK, Al-Muhanna, FA, Al-Rubaish, AM, Al-Windy, NYY, Alkhalil, M, Almubarak, YA, Al Nafie, AN, Al Shahrani, M, Al Shehri, AM, Anning, C, Anthonio, RL, Badings, EA, Ball, C, Van Beek, EA, Ten Berg, JM, Von Bergwelt-Baildon, M, Bianco, M, Blagova, O, Bleijendaal, H, Bor, WL, Borgmann, S, van Boxem, AJM, van den Brink, FS, Bucciarelli-Ducci, C, Van Bussel, BCT, Byrom-Goulthorp, R, Captur, G, Caputo, M, Charlotte, N, vom Dahl, J, Dark, P, De Sutter, J, Degenhardt, C, Delsing, CE, Dolff, S, Dorman, HGR, Drost, JT, Eberwein, L, Emans, ME, Er, AG, Ferreira, JB, Forner, MJ, Friedrichs, A, Gabriel, L, Groenemeijer, BE, Groenendijk, AL, Gruener, B, Guggemos, W, Haerkens-Arends, HE, Hanses, F, Hedayat, B, Heigener, D, van der Heijden, DJ, Hellou, E, Hellwig, K, Henkens, MTHM, Hermanides, RS, Hermans, WRM, van Hessen, MWJ, Heymans, SRB, Hilt, AD, van der Horst, ICC, Hower, M, van Ierssel, SH, Isberner, N, Jensen, B, Kearney, MT, Kielstein, JT, Kietselaer, BLJH, Kochanek, M, Kolk, MZH, Koning, AMH, Kopylov, PY, Kuijper, AFM, Kwakkel-van, ERPJM, Lanznaster, J, van der Linden, MMJM, van der Lingen, ACJ, Linssen, GCM, Lomas, D, Maarse, M, Magdelijns, FJH, Magro, M, Markart, P, Martens, FMAC, Mazzilli, SG, McCann, GP, van der Meer, P, Meijs, MFL, Merle, U, Messiaen, P, Milovanovic, M, Monraats, PS, Montagna, L, Moriarty, A, Moss, AJ, Mosterd, A, Nadalin, S, Nattermann, J, Neufang, M, Nierop, PR, Offerhaus, JA, Van Ofwegen-Hanekamp, CEE, Parker, E, Persoon, AM, Piepel, C, Pinto, YM, Poorhosseini, H, Prasad, S, Raafs, AG, Raichle, C, Rauschning, D, Redon, J, Reidinga, AC, Ribeiro, MIA, Riedel, C, Rieg, S, Ripley, DP, Rommele, C, Rothfuss, K, Ruddel, J, Ruthrich, MM, Salah, R, Saneei, E, Saxena, M, Schellings, DAAM, Scholte, NTB, Schubert, J, Seelig, J, Shafiee, A, Shore, AC, Spinner, C, Stieglitz, S, Strauss, R, Sturkenboom, NH, Tessitore, E, Thomson, RJ, Timmermans, PJR, Tio, RA, Tjong, FVY, Tometten, L, Trauth, J, Van Craenenbroeck, EM, van Veen, HPAA, den Uil, CA, Vehreschild, MJGT, Veldhuis, L, Veneman, T, Verschure, DO, Voigt, I, Walter, L, vande Watering, DJ, de Vries, JK, vande Wal, RMA, Westendorp, ICD, Westendorp, PHM, Westhoff, T, Weytjens, C, Wierda, E, Wille, K, de With, K, Worm, M, Woudstra, P, Wu, KW, Zaal, R, Zaman, AG, van der Zee, PM, Zijlstra, LE, Alling, TE, Ahmed, R, Bayraktar-Verver, ECE, van Aken, K, Jimenes, Bermudez FJ, Biole, CA, Den Boer-Penning, P, Bontje, M, Bos, M, Bosch, L, Broekman, M, Broeyer, FJF, de Bruijn, EAW, Bruinsma, S, Cardoso, NM, Cosyns, B, Len, van Da DH, Dekimpe, E, Domange, J, van Doorn, JL, van DOorn, P, Dormal, F, Drost, IMJ, Dunnink, A, van Eck, JWM, Elshinawy, K, Gevers, RMM, Gognieva, DG, van der Graaf, M, Grangeon, S, Guclu, A, Habib, A, Haenen, NA, Hamilton, K, Handgraaf, S, Heidbuchel, H, Hendriks-van Woerden, M, Hessels-Linnemeijer, BM, Hosseini, K, Huisman, J, Jacobs, TC, Jansen, SE, Janssen, A, Jourdan, K, ten Kate, GL, van Kempen, MJ, Kievit, CM, Kleikers, P, Knufman, N, van der Kooi, SE, Koole, BAS, Koole, MAC, Kui, KK, Kuipers-Elferink, L, Lemoine, I, Lensink, E, van Marrewijk, V, Meijer, EJ, Melein, AJ, Mesitskaya, DF, van Nes, CPM, Paris, FMA, Perrelli, MG, Pieterse-Rots, A, Pisters, R, Polkerman, BC, van Poppel, A, Reinders, S, Reitsma, MJ, Ruiter, AH, Selder, JL, van der Sluis, A, Sousa, AIC, Tajdini, M, Sanchez, Tercedor L, Van de Heyning, CM, Vial, H, Vlieghe, E, Vonkeman, HE, Vreugdenhil, P, de Vries, TAC, Willems, AM, Wils, AM, Zoet-Nugteren, SK, Cardiovascular Centre (CVC), Restoring Organ Function by Means of Regenerative Medicine (REGENERATE), Cardiology, Intensive Care, RS: CAPHRI - R5 - Optimising Patient Care, MUMC+: MA Medische Staf IC (9), RS: Carim - H02 Cardiomyopathy, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - V04 Surgical intervention, MUMC+: MA Intensive Care (3), UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service de cardiologie, CAPACITY-COVID Collaborative Consortium, LEOSS Study Group, Rheumatology, AII - Infectious diseases, AII - Inflammatory diseases, AMS - Musculoskeletal Health, AMS - Tissue Function & Regeneration, ACS - Heart failure & arrhythmias, General practice, Epidemiology and Data Science, Graduate School, Nuclear Medicine, and ACS - Atherosclerosis & ischemic syndromes

Subjects
Male, Cardiac & Cardiovascular Systems, Epidemiology, education, Medizin, Comorbidity, AMERICAN-COLLEGE, GUIDELINES, DIAGNOSIS, Cohort Studies, Risk Factors, MANAGEMENT, Humans, AcademicSubjects/MED00200, Hospital Mortality, Aged, Heart Failure, Science & Technology, SARS-CoV-2, COVID-19, ASSOCIATION, Cardiovascular disease, EUROPEAN-SOCIETY, Hospitalization, surgical procedures, operative, Editorial, Cardiovascular System & Cardiology, behavior and behavior mechanisms, HEART-FAILURE, Female, Patient registry, Human medicine, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, psychological phenomena and processes, TASK-FORCE
Abstract

Aims Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. Methods and results We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66–75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02–1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10–1.30; P Conclusion Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.

Published
2021
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3. Intra-Individual Variability of Direct Oral Anticoagulant Levels in Frail Older Patients upon, during, and after Acute Hospitalization: the DOAC-FRAIL Study.

Author

de Jong MJ, Saadan H, van der Hooft BHM, Hellenbrand DLS, Brüggemann RAG, Ten Cate H, van Kuijk SMJ, van Geel RMJM, Henskens YMC, Winckers K, and Magdelijns FJH

Abstract

Competing Interests: Disclosure H.t.C. received research support from Bayer and Synapse, and advisory board and consultancy fees from Alveron, Galapagos, Novostia, and Astra Zeneca. He is shareholder with Coagulation Profile. All revenues are deposited at CARIM for research purposes. All other authers declare no conflicts of interest.

Published
2024
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4. The DOAC-FRAIL study, evaluation of direct oral anticoagulant-levels in acutely admitted frail older patients: An exploratory study.

Author

de Jong MJ, Saadan H, Hellenbrand DLS, Ten Cate H, Spaetgens B, Brüggemann RAG, van Kuijk SMJ, Winckers K, Henskens YMC, and Magdelijns FJH

Subjects
Humans, Male, Female, Aged, 80 and over, Aged, Anticoagulants administration & dosage, Anticoagulants therapeutic use, Administration, Oral, Hospitalization, Factor Xa Inhibitors administration & dosage, Factor Xa Inhibitors therapeutic use, Frail Elderly
Published
2024
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5. The Effect of a Smartphone App with an Accelerometer on the Physical Activity Behavior of Hospitalized Patients: A Randomized Controlled Trial.

Author

Dijk-Huisman HCV, Senden R, Smeets MHH, Marcellis RGJ, Magdelijns FJH, and Lenssen AF

Subjects
Humans, Middle Aged, Aged, Exercise, Motor Activity, Walking, Accelerometry, Smartphone, Mobile Applications
Abstract

Inactive behavior is common in hospitalized patients. This study investigated the effectiveness of using a smartphone app with an accelerometer (Hospital Fit) in addition to usual care physiotherapy on increasing patients' physical activity (PA) behavior. A randomized controlled trial was performed at Maastricht University Medical Centre. Patients receiving physiotherapy while hospitalized at the department of Pulmonology or Internal Medicine were randomized to usual care physiotherapy or using Hospital Fit additionally. Daily time spent walking, standing, and upright (standing/walking) (min) and daily number of postural transitions were measured with an accelerometer between the first and last treatment. Multiple linear regression analysis was performed to determine the association between PA behavior and Hospital Fit use, corrected for functional independence (mILAS). Seventy-eight patients were included with a median (IQR) age of 63 (56-68) years. Although no significant effects were found, a trend was seen in favor of Hospital Fit. Effects increased with length of use. Corrected for functional independence, Hospital Fit use resulted in an average increase of 27.4 min (95% CI: -2.4-57.3) standing/walking on day five and 29.2 min (95% CI: -6.4-64.7) on day six compared to usual care. Hospital Fit appears valuable in increasing PA in functionally independent patients.

Published
2023
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7. Development and internal validation of a prediction model to identify older adults at risk of low physical activity levels during hospitalisation: a prospective cohort study.

Author

van Dijk-Huisman HC, Welters MHP, Bijnens W, van Kuijk SMJ, Magdelijns FJH, de Bie RA, and Lenssen AF

Subjects
Aged, Cohort Studies, Humans, Prospective Studies, Walking, Activities of Daily Living, Hospitalization
Abstract

Background: Inactive behaviour is common in older adults during hospitalisation and associated with poor health outcomes. If patients at high risk of spending little time standing/walking could be identified early after admission, they could be given interventions aimed at increasing their time spent standing/walking. This study aims to identify older adults at high risk of low physical activity (PA) levels during hospitalisation., Methods: Prospective cohort study of 165 older adults (≥ 70 years) admitted to the department of Internal Medicine of Maastricht University Medical Centre for acute medical illness. Two prediction models were developed to predict the probability of low PA levels during hospitalisation. Time spent standing/walking per day was measured with an accelerometer until discharge (≤ 12 days). The average time standing/walking per day between inclusion and discharge was dichotomized into low/high PA levels by dividing the cohort at the median (50.0%) in model 1, and lowest tertile (33.3%) in model 2. Potential predictors-Short Physical Performance Battery (SPPB), Activity Measure for Post-Acute Care (AM-PAC), age, sex, walking aid use, and disabilities in activities of daily living-were selected based on literature and analysed using logistic regression analysis. Models were internally validated using bootstrapping. Model performance was quantified using measures of discrimination (area under the receiver operating characteristic curve (AUC)) and calibration (Hosmer and Lemeshow (H-L) goodness-of-fit test and calibration plots)., Results: Model 1 predicts a probability of spending ≤ 64.4 min standing/walking and holds the predictors SPPB, AM-PAC and sex. Model 2 predicts a probability of spending ≤ 47.2 min standing/walking and holds the predictors SPPB, AM-PAC, age and walking aid use. AUCs of models 1 and 2 were .80 (95% confidence interval (CI) = .73-.87) and .86 (95%CI = .79-.92), respectively, indicating good discriminative ability. Both models demonstrate near perfect calibration of the predicted probabilities and good overall performance, with model 2 performing slightly better., Conclusions: The developed and internally validated prediction models may enable clinicians to identify older adults at high risk of low PA levels during hospitalisation. External validation and determining the clinical impact are needed before applying the models in clinical practise., (© 2022. The Author(s).)

Published
2022
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9. Barriers and enablers to physical activity behaviour in older adults during hospital stay: a qualitative study guided by the theoretical domains framework.

Author

van Dijk-Huisman HC, Raeven-Eijkenboom PH, Magdelijns FJH, Sieben JM, de Bie RA, and Lenssen AF

Subjects
Aged, Exercise, Humans, Length of Stay, Qualitative Research, Health Personnel, Hospitals
Abstract

Background: Older adults admitted with an acute medical illness spent little time active during hospitalisation and this has been associated with negative health outcomes. Understanding which barriers and enablers influence the physical activity behaviour of hospitalised older adults is a first step towards identifying potentially modifiable factors and developing, evaluating and implementing targeted interventions aimed at increasing their physical activity behaviour. Using a theoretical framework has been found to be more successful in changing behaviour than using a non-theory driven approach. This study aimed to explore barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness, as perceived by patients and healthcare professionals, and to categorise them using the Theoretical Domains Framework (TDF)., Methods: A qualitative study was conducted at a combined university and regional hospital in the Netherlands between January 2019 and February 2020. Older adults (≥70 years) admitted with an acute medical illness, and healthcare professionals (nurses, physicians, physiotherapists) were recruited using purposive sampling. Semi-structured interviews were audiotaped, transcribed and analysed using directed qualitative content analysis. Barriers and enablers to physical activity behaviour during hospitalisation were identified and coded using the TDF., Results: Meaning saturation was determined after interviews with 12 patients and 16 healthcare professionals. A large number of barriers and enablers were identified and each categorised to 11 of the 14 domains of the TDF. The 'Environmental Context and Resources' domain in particular yielded many examples, and revealed that the hospital environment exerts an inactivating influence on patients., Conclusions: The large number of identified barriers and enablers highlights the complexity of influencing older adults' physical activity behaviour during hospitalisation. This overview of barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness represents an initial step towards developing, evaluating and implementing theory-informed behaviour change interventions to improve hospitalised older adults' physical activity levels. It can assist clinicians and researchers in selecting modifiable factors that can be targeted in future interventions., (© 2022. The Author(s).)

Published
2022
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10. Age is the main determinant of COVID-19 related in-hospital mortality with minimal impact of pre-existing comorbidities, a retrospective cohort study.

Author

Henkens MTHM, Raafs AG, Verdonschot JAJ, Linschoten M, van Smeden M, Wang P, van der Hooft BHM, Tieleman R, Janssen MLF, Ter Bekke RMA, Hazebroek MR, van der Horst ICC, Asselbergs FW, Magdelijns FJH, and Heymans SRB

Subjects
Aged, Comorbidity, Female, Hospital Mortality, Hospitalization, Humans, Male, Retrospective Studies, Risk Factors, SARS-CoV-2, COVID-19
Abstract

Background: Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown., Methods: In this multicenter retrospective cohort study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from the CAPACITY-COVID registry were included (age 69[58-77]years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with the primary outcome. The effect of comorbidities on the relation of age with the primary outcome was evaluated using mediation analysis., Results: In-hospital COVID-19 related mortality occurred in 1108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio [OR]4.68, 95%confidence interval [4.02-5.45], OR0.68[0.59-0.79], respectively;both p<  0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.65[0.55-0.75], DM OR1.47[1.26-1.72], CKD OR1.61[1.32-1.97], COPD OR1.30[1.07-1.59]). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome., Conclusions: Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities., Trial Registration: CAPACITY-COVID ( NCT04325412 )., (© 2022. The Author(s).)

Published
2022
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11. Added Value of Early Consultation of an Inpatient Palliative Care Team in Hospitalized Older Patients With High Symptom Burden: A Prospective Comparative Study.

Author

Naaktgeboren MW, Magdelijns FJH, Janssen DJA, and van den Beuken-van Everdingen MHJ

Subjects
Aged, Hospitalization, Humans, Prospective Studies, Referral and Consultation, Inpatients, Palliative Care
Abstract

Background: It is estimated that in 2050 one quarter of the population in Europe will be aged 65 years and older. Although the added value of a palliative care team is emphasized in the literature, the impact of the palliative care team on the symptom burden in older non-cancer patients is not yet well established., Objectives: To structurally measure symptoms and to investigate whether proactive consultation with a palliative care team results in improvement of symptoms., Design: This study has a prospective comparative design., Setting/participants: Older patients, admitted to a Dutch University Medical Centre for who a health care professional had a negative response to the Surprise Question, were selected., Measurements, Results: In period one, 59 patients completed the Utrecht Symptom Diary (USD) at day one of admission and after 7 days. In period 2 (n = 60), the same procedure was followed; additionally, the palliative care team was consulted for patients with high USD-scores. Significant improvement on the USD Total Distress Score (TSDS) was observed in both groups without a difference between the 2 periods. This study showed an association between consultation of the palliative care team and improvement on USD TSDS (adjusted odds ratio: 4.9; 95% confidence interval: 1.816-13.198), despite low follow-up rate of advices (approximately 50%)., Conclusions: This study emphasizes the importance of creating awareness for consulting the palliative care team. Further research should focus on assessing the reason behind the low follow-up rate of the advice given and understanding the specific advices contributing to symptom improvement.

Published
2021
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12. ['Ecstasy-light' - not as light as its name suggests: toxic effects of 4-fluoroamphetamine].

Author

Knippels MCJ, Essers IMM, Magdelijns FJH, and van Twist DJL

Subjects
Adult, Amphetamine-Related Disorders prevention & control, Female, Humans, Male, Netherlands, Seizures chemically induced, Young Adult, Amphetamine-Related Disorders epidemiology, Amphetamines adverse effects, Central Nervous System Stimulants adverse effects
Abstract

Background: The use of 4-fluoroamphetamine (4-FA) has shown a marked increase, especially because users perceive its effects to be relatively mild. 4-FA is also known as ecstacy-light, but is probably not as light as its name suggests. From April 2017 its use has therefore been forbidden in the Netherlands., Case Description: In a short time, we saw three patients at our emergency department who had signs of a severe intoxication with 4-FA. A 21-year-old male developed a tonic-clonic seizure, bruxism, mydriasis, and rhabdomyolysis. A 19-year-old female was confused and was longing for death. A 22-year-old male needed to be admitted to intensive care to be intubated, sedated and cooled due to tachycardia, hypertension and hyperthermia., Conclusion: Because of its relatively mild effects, 4-FA is gaining in popularity in the Netherlands. However, the use of this designer drug can lead to severe problems such as severe confusion, hyperthermia and tonic-clonic seizures.

Published
2017

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