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COVID-19 / THE SPECIALTY COLLECTION

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Cardiology

63%

COVID-19 survivors had higher cardiovascular hazards than VA controls

In a comparison with VA controls, COVID-19 survivors had a 63% higher hazard of any cardiovascular outcome through 12 months. Hazards were also higher for heart failure, atrial fibrillation, heart attack and stroke.

Absolute event rates for this comparison are not available in this summary, and the study design is not recorded. The comparison with VA controls shows associations, not proof that infection caused each outcome.

Pulmonology

>90%

Most measured lung-function values were normal despite breathlessness

With breathless Long COVID, >90% of measured lung-function values were normal despite lower scores than controls. In a never-hospitalized subgroup, 14/109 (~13%) had a low lung gas-transfer measure (TLCO) and reduced xenon-MRI gas-exchange metrics.

The >90% describes measured values, not people; details of the controls are not available in this summary. The subgroup had otherwise unexplained breathlessness, and a pulmonary contribution was described as only potential.

Vaccinology

Omicron-adapted vaccines: severe-outcome benefits and a myocarditis signal

Versus no Omicron-adapted vaccination, reported effectiveness ranged 16.6% to 67.8% for COVID-19 hospitalization and 26.6% to 75.2% for all-cause mortality. A myocarditis incidence signal was also reported.

Rapid review of adults who were neither pregnant nor immunocompromised. The myocarditis signal involved adults aged 50 years or older. Its uncertainty range was wide and included no increase; its reference group and absolute rate are unavailable here.

Hematology

21%lower relative risk

Nebulized heparin lowered mortality in acute respiratory failure

Across randomized trials of adults with acute respiratory failure, nebulized heparin had a 21% lower relative risk of death from any cause than standard care or placebo.

Mortality was 17.1% with nebulized heparin and 22.1% with standard care or placebo. The major-bleeding analysis found no clear difference versus control; the supplied evidence does not specify the control regimen, and the estimate was imprecise.

Rehabilitation

MD 102.34 m; p<0.0001

Rehabilitation improved short-term walking, breathlessness and anxiety

Compared with usual care, rehabilitation increased short-term 6-minute walking distance, with a mean difference of 102.34 m, and reduced modified Medical Research Council breathlessness scores and Hospital Anxiety and Depression Scale anxiety scores.

A systematic review and meta-analysis studied people with long COVID. The outcomes were short-term; the exact follow-up duration is not available in this summary.

Reproductive Health

Prior vaccination was linked to lower preterm-birth hazard after infection

In the Swedish register-based cohort, women infected during pregnancy who had prior vaccination had lower preterm-birth hazard than infected women without previous vaccination. Both groups had higher hazard than non-infected women.

This was an observational comparison, so it does not establish a causal vaccine effect. The reported measures were relative hazards against non-infected women, not absolute risk differences.

Research Methodology

78% (1,591 results)

Most reviewed Omicron vaccine results had serious bias concerns

In a living systematic review of observational Omicron vaccine-effectiveness studies, 78% (1,591 results) were judged at serious risk of bias; confounding was the principal concern.

The appraisal covered 79 studies, over 53 million individuals and 2,032 vaccine-effectiveness estimates; 18% (361 results) were at moderate risk. These percentages concern study credibility, not the amount of vaccine effectiveness.

Therapeutics

No primary day-90 benefit was established for nirmatrelvir-ritonavir

For established Long COVID, neither the 15-day nor 25-day regimen established a benefit versus placebo on primary patient-reported autonomic, cognitive, or exercise outcomes.

The USA trial was randomized, double-blind, and placebo-controlled. Across all 963 participants, 42 (4%) experienced 52 serious adverse events, and there were no deaths; events were not reported as a between-group comparison.

Vascular Medicine

48.8% vs 33.4%; risk difference 15.4%

Death or cardiovascular hospitalization was more common after COVID-19 than influenza

Among US Medicare beneficiaries aged 65 or older, death from any cause or hospitalization for specified heart and circulation problems within 1 year occurred in 48.8% after Omicron-era COVID-19 hospitalization versus 33.4% after historical 2017-2018 influenza hospitalization.

The combined outcome included death from any cause or hospitalization for heart attack, ischemic stroke, transient ischemic attack, blood clots in the lungs or deep veins, heart failure or cardiac arrest. The influenza group was historical; other design details are not recorded in this summary.

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