Cardiology patients now eligible for 4th COVID vax dose

Patients with poorly controlled hypertension and other chronic cardiac conditions should begin receiving a fourth dose of COVID-19 vaccine for winter, ATAGI says.

The advice, released on Wednesday, applies to anyone aged 16–64 and covers a range of patients deemed at increased risk of severe COVID-19.

Conditions warranting the additional dose include ischaemic heart disease, valvular heart disease, congestive cardiac failure, cardiomyopathies, pulmonary hypertension and complex congenital heart disease, according to the expert group.

Indigenous patients aged 50 and older, aged and disability care residents, those with severe immunocompromise and anyone else over 64 have already been recommended a fourth dose.

As per previous advice, the Pfizer and Moderna vaccines are preferred for boosters and patients have been advised to wait three months until after their most recent SARS-CoV-2 infection before vaccination.

Poor long-term outcomes with endovascular abdominal aortic aneurysm repair

Clinicians should take care when selecting patients for endovascular abdominal aortic aneurysm repair, US researchers warn as perioperative benefits may be eclipsed by poor long-term outcomes.

A retrospective study of 5,684 matched patients who had first-time open or endovascular abdominal aortic aneurysm repair found open surgery was associated with a significantly lower six-year mortality rate than endovascular repair (35.6% vs 41.2%; hazard ratio [HR]: 0.83, 95% CI: 0.74–0.94, P = 0.002).

The procedure also had lower 6-year rupture (5.8% vs 8.3%, HR: 0.76, 95% CI: 0.60–0.97, P < 0.001) and reintervention (11.6% vs 16.0%, HR: 0.67, 95% CI: 0.55–0.80, P < 0.001) rates but was associated with a higher risk of 30-day mortality (odds ratio: 3.56, 95% CI: 2.41–5.26, P < 0.001) and complications.

Late rupture is considered an “important cause” of long-term mortality in endovascular repair patients, and thought to be triggered by endoleak, graft migration or infection. Preventing this may require reintervention and drive up reintervention rates compared with open surgery, the authors suggested.

“Although [endovascular repair] remains a valuable option in patients ineligible for [open repair] … careful weighing of risks and benefits is warranted in patients who are candidates for either repair modality,” they wrote in JAMA Network Open.

“These findings [emphasise] the importance of careful patient selection and long-term follow-up surveillance for patients who undergo endovascular repair,” they concluded.

Long COVID cardiovascular symptoms persist up to 18 months

Most non-hospitalised COVID-19 “long-haulers” continue to experience cardiovascular symptoms an average of 15 months after disease onset, US figures show.

Scientists at the Northwestern Medicine Neuro COVID-19 Clinic evaluated 52 patients up to 18 months after their initial visit to the Neuro COVID-19 Clinic and found no significant change in the frequency of most neurologic symptoms between first and follow-up appointments.

While loss of taste (63% vs 27%) and smell (58% vs 21%) decreased overall, heart rate and blood pressure variation (35% vs 56%) and gastrointestinal symptoms (27% vs 48%) increased at follow-up.

Other symptoms reported after an average of 15 months included numbness/tingling (69% vs 65%), headache (67% vs 54%), dizziness (50% vs 54%), blurred vision (34% vs 44%), tinnitus (33% vs 42%) and fatigue (87% vs. 81%).

“We were surprised by the persistence of most of the debilitating neurologic symptoms of our patients, and by the late appearance of symptoms that suggest dysfunction of the autonomic nervous system,” said study investigator Dr Igor Koralnik chief of Neuro-infectious Diseases and Global Neurology in the Department of Neurology, who oversees the Neuro COVID-19 Clinic.

There was no difference according to vaccination status, with 77% of patients vaccinated, he noted.

“Vaccination didn’t cure long COVID symptoms, but didn’t worsen them either, which is a reason given by some long-haulers for not getting vaccinated,” Dr Koralnik said.

The findings are published in Annals of Clinical and Translational Neurology.