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Background: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown. Methods: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19–associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay. Results: Multivariable analysis identified cancer as an independent predictor of COVID-19–associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19–associated severe disease than were those without cancer (hazard ratio [HR], 2.02; 95% CI, 1.53–2.68; PP=.02) or CVD (HR, 1.79; 95% CI, 1.21–2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone. Conclusions: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19–associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.

Patients with pre-existing cardiovascular disease and risk factors are more likely to experience adverse outcomes associated with the novel coronavirus disease-2019 (COVID-19). Additionally, consistent reports of cardiac injury and de novo cardiac complications, including possible myocarditis, arrhythmia, and heart failure in patients without prior cardiovascular disease or significant risk factors, are emerging, possibly due to an accentuated host immune response and cytokine release syndrome. As the spread of the virus increases exponentially, many patients will require medical care either for COVID-19 related or traditional cardiovascular issues. While the COVID-19 pandemic is dominating the attention of the healthcare system, there is an unmet need for a standardized approach to deal with COVID-19 associated and other traditional cardiovascular issues during this period. We provide consensus guidance for the management of various cardiovascular conditions during the ongoing COVID-19 pandemic with the goal of providing the best care to all patients and minimizing the risk of exposure to frontline healthcare workers.

Background: We aim to assess the heterogeneity of demographics, gender variability and outcomes reporting for subjects enrolled in RCTs studying the role of statins and PCSK9 inhibitors in primary and secondary prevention of CAD. Methods: RCTs and metanalyses were searched for the use of statins and PCSK9 inhibitors published in journals with impact factor > 4 between 1995 and 2020. RCT data was analyzed for gender, race and geographic location. Metanalyses were searched for the outcomes-level heterogeneity. Results: A total 31 statin-based RCTs for primary and secondary prevention of CAD were found, of which 29 were included with a total 172,871 patients (71.4% males vs. 28.6% females). In WOSCOPS trial, all 6595 subjects were males. Though most of these trials included global patient populations, 10% of the trials included exclusively North Americans. Fifteen of the RCTs (52%) did not have race data. Of the 14 RCTs which reported race: 67% White, 4% Black. The mean number of White and non-White patients were 3950 and 1768 respectively. For PCSK9 inhibitors with a total of 13 RCTs included in our study there were cumulative 85,806 patients with globally enrolled patient population and predominantly male 71% vs 29% females. Ten RCTs (77%) reported race: 82% White, 0.3% Black. The mean number of White and non-White patients were 4671 and 1058 respectively. The eleven statin metanalyses included 823,936 patients. Ten of the eleven metanalyses reported statistical heterogeneity via I 2 % (mean 53%) for different outcomes. Five of the eleven metanalyses included primary outcomes of all-cause mortality, and the rest included onset/progression of different types of cardiovascular disease. The seven PCSK9 inhibitor metanalyses pooled 376,885 patients. All 7 metanalyses reported heterogeneity via I 2 % (mean 48%) for different outcomes, of which 2 included primary outcomes of all-cause mortality. Conclusions: Significant gender and racial disparities exist in RCTs for primary and secondary prevention lipid lowering therapies. Enrollment in PCSK9 inhibitor trials was global and significant treatment effect heterogeneity existed in metanalyses. Inequalities in female and non-White participation may hamper generalizability of these crucial medications.

BACKGROUND: AKI is a significant complication of coronavirus disease 2019 (COVID-19), with no effective therapy. Niacinamide, a vitamin B3 analogue, has some evidence of efficacy in non-COVID-19-related AKI. The objective of this study is to evaluate the association between niacinamide therapy and outcomes in patients with COVID-19-related AKI. METHODS: We implemented a quasi-experimental design with nonrandom, prospective allocation of niacinamide in 201 hospitalized adult patients, excluding those with baseline eGFR

Background Tachycardia-induced cardiomyopathy (CMP) is an established cause of left ventricular (LV) systolic dysfunction and heart failure (HF). However, the variables distinguishing patients presenting with a preserved vs. reduced LV ejection fraction (EF) are not fully established. We therefore sought to characterize clinical variables of patients presenting with atrial fibrillation or flutter (AF) with HF and preserved LV ejection fraction (AFpEF) vs. those with AF and HF with reduced EF (AFrEF). Methods We examined records of 661 pts presenting with new AF and HF with preserved EF (AFpEF, LVEF >45%) or AF and HF with reduced EF (AFrEF - EF≤ 45%). Pts with clinically relevant coronary artery disease or other known or suspected cause of CMP were excluded. Clinical variables, ECG and echocardiographic parameters were recorded. Results Included in this analysis were 38 pts with AFpEF and 95 patients with AFrEF with initial LVEFs of 58.0 ± 5.3% vs. 31.7 ± 9.1%, respectively (p Conclusion Our findings demonstrate substantial gender disparities among pts presenting with rapid AF and HF with females having a preserved EF and males, reduced EF phenotype. Our data also support the novel finding that alcohol abuse is highly prevalent among pts with AFrEF and should be considered as a possible causal factor in patients presenting with rapid AF, HF and reduced LVEF.

BACKGROUND Web-based resources are commonly used by medical students to supplement curricular material. Three commonly used resources are UpToDate (Wolters Kluwer Inc), digital textbooks, and Wikipedia; there are concerns, however, regarding Wikipedia’s reliability and accuracy. OBJECTIVE The aim of this study was to evaluate the impact of Wikipedia use on medical students’ short-term knowledge acquisition compared with UpToDate and a digital textbook. METHODS This was a prospective, nonblinded, three-arm randomized trial. The study was conducted from April 2014 to December 2016. Preclerkship medical students were recruited from four Canadian medical schools. Convenience sampling was used to recruit participants through word of mouth, social media, and email. Participants must have been enrolled in their first or second year of medical school at a Canadian medical school. After recruitment, participants were randomized to one of the three Web-based resources: Wikipedia, UpToDate, or a digital textbook. During testing, participants first completed a multiple-choice questionnaire (MCQ) of 25 questions emulating a Canadian medical licensing examination. During the MCQ, participants took notes on topics to research. Then, participants researched topics and took written notes using their assigned resource. They completed the same MCQ again while referencing their notes. Participants also rated the importance and availability of five factors pertinent to Web-based resources. The primary outcome measure was knowledge acquisition as measured by posttest scores. The secondary outcome measures were participants’ perceptions of importance and availability of each resource factor. RESULTS A total of 116 medical students were recruited. Analysis of variance of the MCQ scores demonstrated a significant interaction between time and group effects (P CONCLUSIONS Medical students who used Wikipedia had superior short-term knowledge acquisition compared with those who used a digital textbook. Additionally, the Wikipedia group trended toward better posttest performance compared with the UpToDate group, though this difference was not significant. There were no significant differences between the UpToDate group and the digital textbook group. This study challenges the view that Wikipedia should be discouraged among medical students, instead suggesting a potential role in medical education.