Background: Severe coronavirus disease 2019 (COVID‐19) is characterized by a proinflammatory state with high mortality. Statins have anti‐inflammatory effects and may attenuate the severity of COVID‐19. Methods and Results: An observational study of all consecutive adult patients with COVID‐19 admitted to a single center located in Bronx, New York, was conducted from March 1, 2020, to May 2, 2020. Patients were grouped as those who did and those who did not receive a statin, and in‐hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting were used in survival models to examine the association between statin use and death during hospitalization. A total of 4252 patients were admitted with COVID‐19. Diabetes mellitus modified the association between statin use and in‐hospital mortality. Patients with diabetes mellitus on a statin (n=983) were older (69±11 versus 67±14 years; P <0.01), had lower inflammatory markers (C‐reactive protein, 10.2; interquartile range, 4.5–18.4 versus 12.9; interquartile range, 5.9–21.4 mg/dL; P <0.01) and reduced cumulative in‐hospital mortality (24% versus 39%; P <0.01) than those not on a statin (n=1283). No difference in hospital mortality was noted in patients without diabetes mellitus on or off statin (20% versus 21%; P =0.82). Propensity score matching (hazard ratio, 0.88; 95% CI, 0.83–0.94; P <0.01) and inverse probability treatment weighting (HR, 0.88; 95% CI, 0.84–0.92; P <0.01) showed a 12% lower risk of death during hospitalization for statin users than for nonusers. Conclusions: Statin use was associated with reduced in‐hospital mortality from COVID‐19 in patients with diabetes mellitus. These findings, if validated, may further reemphasize administration of statins to patients with diabetes mellitus during the COVID‐19 era.

Purpose: To determine if a cannulation method for venovenous extracorporeal membrane oxygenation (V‐V ECMO) is related to patient outcome.Methods: A retrospective, multicenter study of adult patients (≥18 years old) placed on V‐V ECMO for severe respiratory failure due to COVID‐19 between March 1, 2020, to April 30, 2021. Patients were divided into the following three groups based on the initial cannulation method: (1) femoral vein‐femoral vein or femoral vein‐internal jugular vein (dual‐site, C‐DS), (2) single, dual‐lumen cannula in internal jugular vein with tip positioned in the pulmonary artery (C‐PA), and (3) single, dual‐lumen cannula in internal jugular vein with tip positioned in the inferior vena cava (C‐IVC). The primary outcome was in‐hospital mortality assessed by a time‐to‐event analysis.Results: Overall, 435 patients from 17 centers comprised the study cohort. C‐DS was performed in 247 (57%, age: 49, IQR:39–57 years; 30% female) cases, 99 (23%, age: 53, IQR: 42–59 years; 26% female) received C‐PA, and 89 (20%) patients got C‐IVC (age: 46, IQR 35–54; 33% female). At 90‐days, in‐hospital mortality was 60% (C‐DS), 41% (C‐PA), and 61% (C‐IVC), p = 0.06. After adjustment for clinical characteristics, the likelihood of in‐hospital mortality in comparison to C‐DS, was lower with C‐PA (aHR: 0.52, 95%CI 0.32–0.85, p = 0.009) and similar with C‐IVC (aHR: 0.96, 95%CI 0.63–1.47, p = 0.86).Conclusion: Catheter‐directed flow into the PA bypassing the right ventricle with a single dual‐lumen cannula is associated with reduced mortality during V‐V ECMO for COVID‐19. These findings are limited by residual confounding and site‐clustering. Further investigation is urgently warranted with randomized studies.

Background: Functional mitral regurgitation (FMR) has emerged as a therapeutic target in patients with chronic heart failure and left ventricular systolic dysfunction. The significance of FMR in acute decompensated heart failure remains obscure. We systematically investigated the prevalence and clinical significance of FMR on admission in patients admitted with acute decompensated heart failure and left ventricular systolic dysfunction. Methods and Results: The study was a single‐center, retrospective review of patients admitted with acute decompensated heart failure and left ventricular systolic dysfunction between 2012 and 2017. Patients were divided into 3 groups of FMR: none/mild, moderate, and moderate‐to‐severe/severe FMR. The primary outcome was 1‐year post‐discharge all‐cause mortality. We also compared these groups for 6‐month heart failure hospitalization rates. Of 2303 patients, 39% (896) were women. Median left ventricular ejection fraction was 25%. Four hundred and fifty‐three (20%) patients had moderate‐to‐severe/severe FMR, which was independently associated with 1‐year all‐cause mortality. Moderate or worse FMR was found in 1210 (53%) patients and was independently associated with 6‐month heart failure hospitalization. Female sex was independently associated with higher severity of FMR. Conclusions: More than half of patients hospitalized with acute decompensated heart failure and left ventricular systolic dysfunction had at least moderate FMR, which was associated with increased readmission rates and mortality. Intensified post‐discharge follow‐up should be undertaken to eliminate FMR amenable to pharmacological therapy and enable timely and appropriate intervention for persistent FMR. Further studies are needed to examine sex‐related disparities in FMR.