Effects of CVD in hospitalised COVID-19 patients

A study of >28,000 American COVID-19 patients revealed that cardiovascular disease (CVD) or CVD risk factors dramatically increase the risk of in-hospital mortality. The risk of death was particularly high for older men [1].

The current analysis utilised electronic health records from 54 health systems that use a COVID-19 database. Prof. Ann Marie Navar (University of Texas Southwestern, USA) sought to understand who is most at risk, which is especially important for deploying immunisation strategies. Overall, 28,299 hospitalised patients with COVID-19 were identified. The analysis focused on 19,584 hospitalised patients who were discharged home or died in the hospital as of 1 July 2020. The median age was 52 years, 52.3% were male, 29.4% were Hispanic, and 21.5% were Black. Comorbidities were common: 50.4% had hypertension, 31.1% had diabetes, 18.0% had coronary artery disease, 14.3% had prior heart failure, and 5.6% had end-stage renal disease (see Table).

Table: Characteristics and in-hospital mortality of patients hospitalised with COVID-19 [1]



The overall in-hospital mortality was 20.7%, rising non-linearly with age, with a sharp increase above age ~60 years (P<0.0001). Female sex, white race, and Hispanic ethnicity were associated with a lower risk of death (P<0.0001 for all). On the other hand, in patients needing mechanical ventilation (32.6%), mortality was much higher: 74.6%. Mortality rates were also higher for patients with CVD (28.8%) or CVD risk factors: hypertension (mortality 20.4%), diabetes (21.5%), and heart failure (34.2%) (P<0.0001 for all). Cardiovascular complications were uncommon: myocardial infarction 5%, pulmonary embolism 2%, and stroke 1.5%. However, they were strongly associated with increased mortality risk: 55.5%, 26.5%, and 56%, respectively. Prof. Navar also observed a significant linear increase in risk of death with a decrease in BMI. “Once hospitalised, being underweight may be as much or worse of a risk factor than being overweight.”

In a multivariable analysis looking at comorbidities, BMI, and race/ethnicity, these were the main predictors of mortality:

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   1. male sex: OR 1.46 (95% CI 1.31–1.62);
   2. Hispanic ethnicity: OR 0.71 (95% CI 0.59–0.86)
   3. diabetes: OR 1.27 (95% CI 1.13–1.42);
   4. heart failure: OR 1.29 (95% CI 1.13–1.47);
   5. chronic kidney disease: OR 1.50 (95% CI 1.32–1.69).

Prof. Navar said there is a “remarkably high risk” of death in the ~16 million Americans >80 years old with diabetes and/or hypertension when infected with COVID-19. “It seems almost impossible, then, to be advocating a strategy of focused protection or herd immunity as some in the US administration are calling for.”

 

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   1. Navar A, et al. Impact of Cardiovascular Disease on Outcomes Among Hospitalized COVID-19 Patients: Results From >14,000 Patients Across the United States. LBS.08, AHA Scientific Sessions 2020, 13–17 Nov.

 



Posted on 17 February 202125 March 2024