Home > Cardiology > HFA 2021 > COVID-19 and the Heart > Increased COVID-19 mortality in patients with cardiorenal comorbidity

Increased COVID-19 mortality in patients with cardiorenal comorbidity

Presented by
Dr Johan Bodegård
Conference
HFA 2021
A large Swedish registry study evaluated the likelihood of all-cause death after hospitalisation with a COVID-19 infection in patients with pre-existing cardiorenal disease. In comparison to controls, the death rate was significantly increased in this population.

Elderly patients and those with comorbidities are known to be more seriously affected by COVID-19 infections. “One particularly vulnerable patient group is those with cardiorenal disease defined as heart failure (HF), chronic kidney disease (CKD), or cardiorenal syndrome (CRS); the latter being a combination of chronic HF and CKD,” informed Dr Johan Bodegård (epidemiologist, AstraZeneca, Norway) [1]. CRS is characterised by haemodynamic interorgan crosstalk between heart and kidney but also encompasses neurohormonal changes [2].

The nationwide, observational registry study investigated the risk for all-cause mortality by comparing patients with cardiorenal disease to matched controls [1]. The 39,146 participants were divided into 4 groups: HF, CKD, CRS, and controls, and were followed for 12 months or until death after their admission to the hospital due to a COVID-19 infection. At baseline, the participants had a mean age of 80 years, 43% were women, and the median in-patient stay was 6 days (25% of patients were hospitalised for over 9 days). Many suffered from comorbidities: 40% had ischaemic heart disease, 29% diabetes, and 32% had a history of prior pneumonia. As for medication, 59% received inhibitors of the renin-angiotensin system and 26% systemic corticosteroids.

“We had 6,570 deaths, which is about 17% of the population studied, and very high event rates between 200 to 300 per 100 person-years,” Dr Bodegård stated. The highest risk for all-cause death was found in the CRS group, which was 60% higher than in the control group (HR 1.60; 95% CI 1.51–1.70; P<0.001). The hazard ratio for death was also significantly higher in the CKD and the HF groups versus control with an HR of 1.32 (95% CI 1.23–1.41; P<0.001) and 1.27 (1.21–1.33; P<0.001), respectively. Significances found for other variables within the multivariate analysis were in line with those shown in previous studies. A special assessment of all study subjects younger than 70 years exhibited similar patterns to the entire study cohort. Compared with controls, it resulted in HR values for CRS of 2.32 (95% CI 1.74–3.10; P<0.001), for CKD this was 1.83 (95% CI 1.41–2.37; P<0.001), and for HF 1.79 (95% CI 1.41–2.26; P<0.001).

“These results stress the fact that cardiorenal patients hospitalised with COVID-19 are at early high risks and should be prioritised for acute clinical awareness, improved disease management, and infection protection,” Dr Bodegård suggested in his conclusion.


    1. Bodegård J. The risk of all-cause death after COVID-19 hospital admission among patients with prior heart failure, chronic kidney disease and cardio-renal syndrome: a 12-month follow-up observational study. Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.
    2. Rangaswami J, et al. Circulation. 2019;139(16):e840–e878.

 

Copyright ©2021 Medicom Medical Publishers



Posted on