COVID-19 pandemic: Older adults and those affected by the delta variant experienced increased cardiovascular morbidity and mortality

A study in hospitalised COVID-19 patients evaluated the impact of age and SARS-CoV-2 virus variant time period on major adverse cardiovascular events (MACE) and in-patient mortality. Patients presenting during the delta wave faced increased rates of MACE and mortality compared with alpha and omicron waves. Older adults exhibited higher probabilities of MACE and death than the young adults, irrespective of the variant.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to significant cardiovascular morbidity and mortality. A study conducted on 45,421 patients admitted to 134 hospitals and medical centres with a diagnosis of COVID-19 assessed the impact of a patient's age and time period of virus variant on MACE (new onset heart failure, myocardial infarction, stroke, or death) and in-patient mortality.

This study included patient information from the American Heart Association’s Get with the Guidelines COVID-19 cardiovascular disease registry (AHA COVID-19 CVD), which is a comprehensive national database of adult patients hospitalised with COVID-19 across the United States.

Dr Pratyaksh Srivastava (Smidt Heart Institute, Cedars-Sinai, CA) and his team divided these participants into 3 groups based on the dominant variant (wild type/alpha, delta, omicron) of the SARS-CoV-2 virus at the time of hospitalisation.

They further stratified the cohort based on the age of the individuals (young adults: 18–40 years; older adults: >40 years). The majority (85.7%) were in the older age category. The median age was 63 (50–75) years, and 47% were women.

“We compared rates of MACE and rates of in-patient mortality between the groups using logistic regression models adjusted for possible confounders such as age, sex, body mass index, race, payment source, and medical comorbidities,” Dr Srivastava explained. The rates of MACE during hospitalisation in the alpha, delta, and omicron waves were 20.8%, 23.6%, and 15.5%, respectively. In-hospital mortality rates in these periods were 14.0%, 14.8%, and 6.0%, respectively.

Patients presenting during the delta wave had increased odds of MACE and in-hospital mortality (odds ratio [OR] 1.57; 95% CI 1.42–1.73; P<0.0001 and OR 1.49; 95% CI 1.34–1.66) compared with those in the alpha wave. Patients in the omicron wave had decreased probabilities of in-hospital mortality (OR 0.6; 95% CI 0.43–0.84; P=0.003) and similar odds of MACE when compared with the alpha wave period.

An age-based analysis of the study cohort revealed that older adults had increased odds of MACE and in-hospital mortality (OR 3.08; 95% CI 2.70–3.51 and OR 3.60; 95% CI 3.06–4.23; P<0.0001) compared with those in the young adult group.

Dr Srivastava and his team concluded that COVID-19 patients had higher probabilities of MACE and mortality during the delta wave compared with the other 2 periods, particularly when they were >40 years old.

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   1. Srivastava PK, et al. Impact of age and variant on cardiovascular events among patients hospitalized with COVID-19: An analysis from the AHA COVID-19 CVD registry. EP.APS.P47. AHA Scientific Sessions 2022, 05–07 November, Chicago, USA.

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Posted on 11 January 2023