Association between regional distributions of SARS-CoV-2 seroconversion and out-of-hospital sudden death during the first epidemic outbreak in New York.

Background Increased incidence of out-of-hospital sudden death (OHSD) has been reported during the coronavirus 2019 (COVID-19) pandemic. New York City (NYC) represents a unique opportunity to examine the epidemiologic association between the two given the variable regional distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its highly diverse neighborhoods. Objective The purpose of this study was to examine the association between OHSD and SARS-CoV-2 epidemiologic burden during the first COVID-19 pandemic across the highly diverse neighborhoods of NYC. Methods The incidences of OHSD between March 20 and April 22, 2019, and between March 20 and April 22, 2020, as reported by the Fire Department of New York were obtained. As a surrogate for viral epidemiologic burden, we used percentage of positive SARS-CoV-2 antibody tests performed between March 3 and August 20, 2020. Data were reported separately for the 176 zip codes of NYC. Correlation analysis and regression analysis were performed between the 2 measures to examine association. Results Incidence of OHSD per 10,000 inhabitants and percentage of SARS-CoV-2 seroconversion were highly variable across NYC neighborhoods, varying from 0.0 to 22.9 and 12.4% to 50.9%, respectively. Correlation analysis showed a moderate positive correlation between neighborhood data on OHSD and percentage of positive antibody tests to SARS-CoV-2 (Spearman ρ 0.506; P2= 0.645). Conclusion The association in geographic distribution between OHSD and SARS-CoV-2 epidemiologic burden suggests either a causality between the 2 syndromes or the presence of local determinants affecting both measures in a similar fashion

Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection.

Background Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. Objective This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality. Methods Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF. Results AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P \u3c .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42-1.71; P \u3c .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1). Conclusion In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality

Unveiling Relations in the Industry 4.0 Standards Landscape based on Knowledge Graph Embeddings

Industry~4.0 (I4.0) standards and standardization frameworks have been proposed with the goal of \emph{empowering interoperability} in smart factories. These standards enable the description and interaction of the main components, systems, and processes inside of a smart factory. Due to the growing number of frameworks and standards, there is an increasing need for approaches that automatically analyze the landscape of I4.0 standards. Standardization frameworks classify standards according to their functions into layers and dimensions. However, similar standards can be classified differently across the frameworks, producing, thus, interoperability conflicts among them. Semantic-based approaches that rely on ontologies and knowledge graphs, have been proposed to represent standards, known relations among them, as well as their classification according to existing frameworks. Albeit informative, the structured modeling of the I4.0 landscape only provides the foundations for detecting interoperability issues. Thus, graph-based analytical methods able to exploit knowledge encoded by these approaches, are required to uncover alignments among standards. We study the relatedness among standards and frameworks based on community analysis to discover knowledge that helps to cope with interoperability conflicts between standards. We use knowledge graph embeddings to automatically create these communities exploiting the meaning of the existing relationships. In particular, we focus on the identification of similar standards, i.e., communities of standards, and analyze their properties to detect unknown relations. We empirically evaluate our approach on a knowledge graph of I4.0 standards using the Trans$^*$ family of embedding models for knowledge graph entities. Our results are promising and suggest that relations among standards can be detected accurately.Comment: 15 pages, 7 figures, DEXA2020 Conferenc

The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection

Background - The novel SARs-CoV-2 coronavirus is responsible for the global COVID-19 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine ± azithromycin for the treatment of COVID-19. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes (TdP) and sudden cardiac death. Methods - Hospitalized patients treated with chloroquine/hydroxychloroquine ± azithromycin from March 1st through the 23rd at three hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in TdP. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation and arrhythmogenic death. Results - Two hundred one patients were treated for COVID-19 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine and 119 (59.2%) also received azithromycin. The primary outcome of TdP was not observed in the entire population. Baseline QTc intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) vs. those treated with combination group (chloroquine/hydroxychloroquine and azithromycin) (440.6 ± 24.9 ms vs. 439.9 ± 24.7 ms, p =0.834). The maximum QTc during treatment was significantly longer in the combination group vs the monotherapy group (470.4 ± 45.0 ms vs. 453.3 ± 37.0 ms, p = 0.004). Seven patients (3.5%) required discontinuation of these medications due to QTc prolongation. No arrhythmogenic deaths were reported. Conclusions - In the largest reported cohort of COVID-19 patients to date treated with chloroquine/hydroxychloroquine {plus minus} azithromycin, no instances of TdP or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made

Indications for implantable cardioverter-defibrillator placement in ischemic cardiomyopathy and after myocardial infarction

Dramatic reductions in the rate of sudden cardiac death due to use of implantable cardioverter-defibrillators (ICDs) have been well-established in several large randomized clinical trials including patients with left ventricular dysfunction after myocardial infarction. This article reviews the literature regarding ICD utilization in the postinfarction population, with a strong emphasis on recent clinical trials. The most current indications for, and timing of, ICD implantation postinfarction also are summarized. © 2011 Springer Science+Business Media, LLC

Safely Administering Potential QTc Prolonging Therapy Across a Large Healthcare System in the COVID-19 Era.

Background - The SARs-CoV-2 coronavirus has resulted in a global pandemic. Hydroxychloroquine ± azithromycin have been widely used to treat COVID-19 despite a paucity of evidence regarding efficacy. The incidence of torsade de pointes (TdP) remains unknown. Widespread use of these medications forced overwhelmed healthcare systems to search for ways to effectively monitor these patients while simultaneously trying to minimize healthcare provider (HCP) exposure and use of personal protective equipment (PPE). Methods - COVID-19 positive patients that received hydroxychloroquine ± azithromycin across 13 hospitals between March 1st and April 15th were included in this study. A comprehensive search of the electronic medical records was performed using a proprietary python script to identify any mention of QT prolongation, ventricular tachy-arrhythmias and cardiac arrest. Results - The primary outcome of TdP was observed in 1 (0.015%) out of 6,476 hospitalized COVID-19 patients receiving hydroxychloroquine ± azithromycin. Sixty-seven (1.03%) had hydroxychloroquine ± azithromycin held or discontinued due to an average QT prolongation of 60.5±40.5ms from a baseline QTc of 473.7±35.9ms to a peak QTc of 532.6±31.6ms. Of these patients, hydroxychloroquine ± azithromycin were discontinued in 58 patients (86.6%), while one or more doses of therapy were held in the remaining nine (13.4%). A simplified approach to monitoring for QT prolongation and arrythmia was implemented on April 5th. There were no deaths related to the medications with the simplified monitoring approach and HCP exposure was reduced. Conclusions - The risk of torsade de pointes is low in hospitalized COVID-19 patients receiving hydroxychloroquine ± azithromycin therapy

Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: Argument for earlier intervention

VT Ablation Treatment of Last Resort. Introduction: Despite advances in ablation of ventricular tachycardia (VT), recognized toxicity of amiodarone, and potential harm of implantable cardioverter defibrillator (ICD) shocks, there appears to be reluctance to pursue catheter ablation. Methods and Results: We tested the hypothesis that patients with structural heart disease and VT are referred late for ablation and may have worse outcomes as a result. Consecutive patients with VT and structural heart disease referred to a single center, between January 2008 and April 2009 were studied. Patients with prior VT ablations were excluded. Late referrals were defined as those with 2 or more episodes of VT, separated by at least 1 month. Ninety-eight consecutive patients were analyzed. Ninety-six percent of patients had an ICD implanted prior to ablation, 58% were in VT storm and 67% taking ≥400 mg daily of amiodarone or amiodarone intolerant (10%). Thirty-six patients fit the definition of early referral and 62 late. Overall acute procedural success was achieved in 89%. Amiodarone dose decreased from a mean and median of 559 and 400 mg daily preablation to 98 and 0 postablation (P \u3c 0.01). Mean and median VT episodes decreased from 17 and 6 in the month preceding ablation to 1 and 0 in the 6 months following ablation (P \u3c 0.01). In Kaplan-Meier analysis, the early referral group had superior 1-year VT free survival (P = 0.01). Conclusions: VT ablation is frequently reserved for patients receiving recurrent ICD shocks despite high dose amiodarone. Stronger consideration should be given to earlier referral for VT ablation in patients with structural heart disease. © 2011 Wiley Periodicals, Inc