Myocarditis and pericarditis in individuals exposed to the Ad26.COV2.S, BNT162b2 mRNA, or mRNA-1273 SARS-CoV-2 vaccines

IMPORTANCE: There is a high level of public and professional interest related to potential safety issues of the COVID-19 vaccines; however, no serious adverse cardiovascular events were reported in phase 3 randomized controlled trials of their safety and efficacy. Moreover, none of the case series from the United States (US) of these potential complications have been population-based.OBJECTIVES: To estimate the reporting rates of myocarditis and pericarditis in the US using the Vaccine Adverse Event Reporting System (VAERS), and to assess if these adverse events were disproportionally reported among the different COVID-19 vaccines.DESIGN SETTING AND PARTICIPANTS: All cases of myocarditis and pericarditis from VAERS reported up to July 28, 2021.EXPOSURE: Single-dose Ad26.COV2.S, BNT162b2 mRNA, or mRNA-1273 SARS-CoV-2 vaccinations.MAIN OUTCOMES AND MEASURES: Reporting rates were computed by dividing the total number of cases of myocarditis and pericarditis (combined) by the total number of vaccine doses administered. Disproportionality analyses were performed to evaluate disproportional reporting of myocarditis and pericarditis for the Ad26.COV2.S and mRNA-1273 vaccines vs. the BNT162b2 mRNA vaccine.RESULTS: By July 28, 2021, 1392, 699, and 68 cases of myocarditis or pericarditis had been reported out of 1.91, 1.38, and 1.33 million administered doses of the BNT162b2 mRNA, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines, respectively. Median times to event were 3 days, 3 days, and 9 days for the BNT162b2 mRNA, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines. The reporting rates for myocarditis or pericarditis were 0.00073 (95% confidence interval, 95% CI 0.00069-0.00077), 0.00051 (95% CI 0.00047-0.00055), and 0.00005 events per dose (95% CI 0.00004-0.00006) for the BNT162b2 mRNA, mRNA-1273, and Ad26.COV2.S COVID-19 vaccines, respectively. Myocarditis and pericarditis were disproportionally reported following the BNT162b2 mRNA vaccine when compared with the other vaccines, using both disproportionality measures.CONCLUSIONS AND RELEVANCE: We found reporting rates of myocarditis and pericarditis to be less than 0.1% after COVID-19 vaccination. Rates were highest for the BNT162b2 mRNA vaccine, followed by the mRNA-1273 and Ad26.COV2.S, respectively. However, the reporting rates of myocarditis and pericarditis secondary to vaccination remains less common than those seen for SARS-CoV-2 infection.</p

Validity of the GAITRite Walkway Compared to Functional Balance Tests for Fall Risk Assessment in Geriatric Outpatients

This study examined the concurrent validity between gait parameters from the GAITRite walkway and functional balance test commonly used in fall risk assessment. Patients were sampled from one geriatric outpatient clinic. One physiotherapist evaluated the patients on the GAITRite walkway with three repetitions in both single- and dual-task conditions. Patients were further evaluated with Bergs Balance scale (BBS), Dynamic Gait index (DGI), Timed Up and Go (TUG), and Sit To Stand test (STS). Correlations between quantitative gait parameters and functional balance test were analyzed with Spearman&rsquo;s rank correlations. Correlations strength was considered as follows: negligible &lt;0.1, weak 0.10&ndash;0.39, moderate 0.40&ndash;0.69, and strong &ge;0.70. We included 24 geriatric outpatients in the study with a mean age of 80.6 years (SD: 5.9). Patients received eight (SD: 4.5) different medications on average, and seven (29.2%) patients used walkers during ambulation. Correlations between quantitative gait parameters and functional balance test ranged from weak to moderate in both single- and dual-task conditions. Moderate correlations were observed for DGI, TUG, and BBS, while STS showed weak correlations with all GAITRite parameters. For outpatients analyzed on the GAITRite while using walkers, correlations showed no clear pattern across parameters with large variation within balance tests

Atrial fibrillation in patients with liver disease: Recent advances

Atrial fibrillation is associated with significant morbidity and mortality, and its incidence is increasing globally. The primary complication of atrial fibrillation is ischemic stroke, whose risk may be reduced with oral anticoagulant agents, i.e., either vitamin K antagonists or direct oral anticoagulants. Patients with atrial fibrillation often have concomitant hepatic impairment, particularly because of increasing rates of non-alcoholic liver disease. However, anticoagulation in patients with liver disease is challenging due to the pathophysiological changes of the coagulation cascade and, as a result, an increased risk of major bleeding in such individuals. Furthermore, monitoring of the degree of anticoagulation is complicated in patients with liver disease due to issues such as spontaneous international normalized ratio (INR) elevation, changes in hepatic drug elimination, and thrombocytopenia. We review the current evidence on atrial fibrillation and anticoagulation in patients with liver disease. We suggest having a strong focus on risk factor management and argue that the risk of ischemic stroke often outweighs the risk of hemorrhagic events in this setting

Return to work and risk of subsequent detachment from employment after myocardial infarction:Insights from Danish nationwide registries

Background Limited data are available on return to work and subsequent detachment from employment after admission for myocardial infarction ( MI ). Methods and Results Using individual‐level linkage of data from nationwide registries, we identified patients of working age (30–65 years) discharged after first‐time MI in the period 1997 to 2012, who were employed before admission. To assess the cumulative incidence of return to work and detachment from employment, the Aalen Johansen estimator was used. Incidences were compared with population controls matched on age and sex. Logistic regression was applied to estimate odds ratios for associations between detachment from employment and age, sex, comorbidities, income, and education level. Of 39 296 patients of working age discharged after first‐time MI , 22 394 (56.9%) were employed before admission. Within 1 year 91.1% (95% confidence interval [ CI ], 90.7%–91.5%) of subjects had returned to work, but 1 year after their return 24.2% (95% CI , 23.6%–24.8%) were detached from employment and received social benefits. Detachment rates were highest in patients aged 60 to 65 and 30 to 39 years, and significantly higher in patients with MI compared with population controls. Predictors of detachment were heart failure (odds ratio 1.20 [95% CI , 1.08–1.34]), diabetes mellitus (odds ratio 1.13 [95% CI , 1.01–1.25]), and depression (odds ratio 1.77 [95% CI , 1.55–2.01]). High education level and high income favored continued employment. Conclusions Despite that most patients returned to work after first‐time MI , about 1 in 4 was detached from employment after 1 year. Several factors including age and lower socioeconomic status were associated with risk of detachment from employment. </jats:sec