Heart Newscast: «Corticosteroids and covid, physiological pacemaker and coronacardiac damage»
Chronic treatment with corticosteroids, a risk factor for severe covid
Corticosteroids, powerful medicines, show an estimable benefit during the inflammatory phase of SARS-CoV-2 infection, but this is not the case in those covid patients who take these drugs to treat their chronic diseases: they had a worse prognosis after hospitalization , something that did not happen with those taking other immunosuppressants.
This is what emerges from the study «Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry» that the Spanish Society of Internal Medicine (SEMI) has published in the International Journal of Infectious Diseases.
The research concludes that chronic corticosteroid intake prior to hospitalization for covid is associated with a worse prognosis of the disease:
Of 14,973 patients evaluated, 868 (5.2%) were considered immunosuppressed patients and 14,105 (94.2%) were not. More than half were men (56.5%) and the mean age was 69 years.
Among the immunosuppressed, 654 had a history of immune-mediated inflammatory disease (4.36% overall) and 214 were solid organ transplant recipients (1.42% overall, with 151, 32, 16, and 15 undergoing kidney transplant, liver, lung and heart, respectively). People with cancer were not included.
All together there were 1,243 prescriptions for immunosuppressive drugs, the most frequent being glucocorticoids (68.3%), followed by antimetabolites such as mycophenolate, azathioprine and methotrexate (42.5%), calcineurin inhibitors (17.9%) and m -TOR (65 patients).
The hospital mortality rate was 19.1% (2,857 deaths); between specific treatments of chronic immunosuppressants, only the use of corticosteroids on admission was associated with higher mortality.
The study shows that solid organ transplant recipients had a higher risk of mortality, while patients with immune-mediated inflammatory disease had a risk similar to that of the general population without immunosuppression.
In addition, patients receiving chronic corticosteroid treatment before admission had more in-hospital complications, such as severe Acute Respiratory Distress Syndrome (ARDS), sepsis, septic shock, acute renal failure, and Multi-Organ Dysfunction Syndrome.
Finally, chronic treatment with systemic corticosteroids was also associated with worse outcomes among solid organ transplant recipients.
In contrast, chronic treatment with calcineurin inhibitors before hospitalization was not associated with worse outcomes, and most patients on this medication were solid organ transplant recipients.
“While corticosteroids have a well-established benefit during the inflammatory phase of COVID-19, chronic glucocorticoid therapy at admission carries a special risk of severe COVID-19, complications, and death.”
Conclusion of the researchers of the Spanish Society of Internal Medicine (SEMI)
However, they specify that “more studies are needed to clarify the profile of COVID-19 in different immunosuppressed patients and the influence of specific immunosuppressive drugs on their results.”
Pacemakers to stimulate the heart more naturally
Physiological stimulation in pacemaker implantation, a technique that allows the heart to be stimulated using natural electrical conduction pathways, is one of the latest innovations in cardiology that can benefit thousands of patients a year in countries like Spain.
This technique, which is being a success in Europe, allows correcting the weakness in the heart that can be caused by the pacemaker in certain patients.
Patients whose hearts are weakened by bundle branch block or constant pacing can be corrected by selective connection of the pacemaker inserted into the patient’s conduction system.
To implant a pacemaker in a classical way, a lead was placed at the tip of the right ventricle, where it could be, but that is not the normal conduction path and the contraction could weaken the heart muscle. What this new technique does is use the natural way, the way we are designed.
The natural path of the electrical impulse is recovered and for this reason the cables of the device are placed in a physiological zone, making a kind of electrical bypass. The heart re-contracts in a more natural way.
Cardiology considers essential any medical advance in terms of arrhythmiasa problem that affects many patients, so many that 40% of consultations in Spain in this specialty correspond to palpitations, which can often lead to arrhythmias.
One in 16 hospitalized for covid suffered cardiovascular events per year
One in 16 covid patients admitted suffered a major cardiovascular event (MACE) – such as stroke, venous thromboembolic diseaseheart failure or cardiovascular mortality- in the first year after hospitalization, one third in the first 30 days.
It is one of the conclusions of a study published in the Spanish Journal of Cardiology in which the incidence of this type of events during the first year after hospitalization for COVID-19.
Of the participants, 53.9% were male with a mean age of 66.7 years; the prevalence of vascular risk factors was high, with 17.9% smokers, 30.3% diabetics and 20.8% obese, and the most prevalent comorbidities of those analyzed were cardiological (23.1 %).
Under these premises, the first finding that the researchers found was the high incidence of cardiovascular events after admission, since one of every sixteen patients hospitalized for COVID-19 suffered some MACE in the first year after admission and a third of these, during the first 30 days.
The most frequent cardiovascular event in the follow-up, which lasted for one year until April 18, 2021, was hospitalization for heart failurewhile venous thromboembolic disease was the earliest, especially in the form of pulmonary thromboembolism.
Specifically, 75% of VTE cases occurred in the first 30 days and 62.5% were pulmonary thromboembolisms, all of them early after hospitalization.
Data that contribute to emphasizing the association of covid with cardiovascular disease and lend plausibility to the hypothesis that SARS-CoV-2 acts as a modifying factor of cardiovascular disease, in a manner analogous to how other more studied agents such as the Influenza virus.
Spanish Society of Cardiology
However, more studies are required to delve into the long-term cardiovascular impact of the virus and to characterize the underlying pathophysiological mechanisms.
Dr. Macaya summarizes the “Noticiero del Corazón” with three messages
- Patients receiving a continuing medical prescription for corticosteroids due to some chronic pathology, they must prevent, even more so, the spread of SARS-CoV-2 by maintaining all measures: vaccination recommended by their doctors, FFP2 masks outside the private home, even avoiding direct contact with people outside the family bubble , social distance, hand hygiene, etc.
- We have pacemaker technologically much more efficient and minimalist, more natural and physiological, suitable for the “electric” structure of the heart, which also allow patients to do daily physical exercise of a certain mechanical intensity.
- The coronavirus infection of the COVID-19 pandemic it is one more trigger, but not a minor one, of cardiovascular disease, so prevention, prevention and prevention must be extreme, concludes our cardiojournalist.
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