Fewer CV complications than expected in AHA COVID-19 Registry

The first results from the AHA COVID-19 Cardiovascular Disease (CVD) Registry revealed that in-hospital cardiovascular (CV) complications were less frequent than initially anticipated on the basis of single-centre experiences. The composite rate of CV death, myocardial infarction (MI), stroke, heart failure (HF), and shock was 8.8%.

Prof. James de Lemos (University of Texas Southwestern Medical Center, USA) explained the main objectives of the registry: 1) to accelerate the pace of COVID-19 research and improve quality, in view of the unprecedented time horizon and the need for ‘out-of the-box’ thinking for solutions; 2) to collect granular data, with over 200 unique data elements and extensive serial laboratory data; and 3) to complete case capture from the beginning of the pandemic in order to minimise selection bias and enhance generalisability. Considering the immediate need for data, the research process was disrupted and democratised, establishing a secure cloud-based environment called the AHA Precision Medicine Platform (PMP). A novel strategy for 'burst science' that has been implemented allows multiple groups of investigators to work simultaneously on the PMP using de-identified data, in the hope that the 'door-to-dissemination' time be markedly accelerated. As of 9 November 2020, records of over 22,500 patients from 109 hospitals were available.

Prof. de Lemos showed that the majority of the 14,889 patients hospitalised for COVID-19 (data cut-off: 22 July 2020) had CV risk factors, including hypertension (58%), obesity (43%), diabetes (36%), and hyperlipidaemia (34%). Prevalent disease was also common, particularly prior chronic kidney disease or end-stage renal disease (13%), HF (11%), and prior stroke (10%). In-hospital cardiac complications were less frequent than initially anticipated. The composite CVD endpoint of CV death, MI, stroke, HF, and shock was reached by 8.8% of hospitalised patients. Looking at individual complications, AF was reported in 8.0%, deep vein thrombosis/pulmonary embolism in 3.8% (substantially less than reported in single-centre experiences), MI in 2.5%, stroke, new HF, and cardiogenic or mixed shock in <2%, and myocarditis in 0.3%. Death occurred in 16.7% of patients (10% had a CV cause), with another 2.8% referred to hospice. Non-cardiac complications included ICU admission in 30%, mechanical ventilation in 20%, and new dialysis/CRRT in 4.0%.

“The COVID-19 pandemic has driven disruptive –and we believe enduring– innovation to registry research,” Prof. de Lemos concluded. “COVID-19 admissions have a high prevalence of CVD risk factors and a moderately high prevalence of prior CVD. Unfortunately, the pandemic has a depressingly high mortality and morbidity rate. CV complications are an important subset but are less common than initially feared. Given the scale of the pandemic, with currently almost 70,000 COVID-19 patients hospitalised in the US, the cumulative number of these CV events is still large.”

 

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   1. De Lemos JA, et al. The AHA COVID-19 Cardiovascular Disease Registry: Design, Implementation, and Initial Results. 08, AHA Scientific Sessions 2020, 13–17 Nov.

 



Posted on 17 February 202125 March 2024