Preliminary prospective cohort data from the Yale COVID-19 Cardiovascular Registry showed that at least 40% of patients hospitalised with verified COVID-19 had a high cardiovascular (CV) risk at baseline, including a high prevalence of diabetes and hypertension. Patients with CV risk in the Yale registry cohort had high mortality rates and CV complications; about 1 in 5 patients died, 2 in 5 experienced a CV event, and 1 in 5 required mechanical ventilation .
Dr Manan Pareek (Yale University School of Medicine, USA) presented the data, which was intended to supplement the sparse body of evidence suggesting that patients with a high CV risk or disease burden tend to be more vulnerable during SARS-CoV-2 infection. The aim of the analysis was to determine the prevalence of CV risk factors, established CV disease, and associated medications. Additionally, they sought to identify risk factors for incident CV events and mortality. Using the Yale New Haven Hospital COVID-19 Cardiovascular Registry, Dr Pareek and colleagues performed a prospective cohort study including 1,200 hospitalised patients positive for COVID-19 (median age 68 years; 54% male). Dr Pareek presented the analysis of the first 495 patients.
The primary endpoint was in-hospital death from any cause. Secondary endpoints were CV outcomes, such as major adverse CV event (MACE), and non-CV outcomes, such as intensive care admission, mechanical ventilation, and renal replacement therapy. Within the first 495 patients, more than 40% presented with CV risk factors, among which diabetes, hypertension, and hyperlipidaemia were the most common. In addition, 46% of the cohort had a history of any CV disease, the most prevalent being coronary artery disease (CAD), heart failure, and atrial fibrillation; accordingly, medication use by this cohort was frequent, including antihypertensives, aspirin, and statins.
In-hospital CV events included atrial fibrillation (19%), myocardial infarction (17%), and acute decompensated heart failure (14%). Non-CV related events were intensive care admission (35%), mechanical ventilation (21%), and dialysis (4%). Furthermore, 18% of patients died in hospital, and 39% experienced a MACE after admission. Applying logistic regression to determine potential predictors of MACE, independent variables were male gender, history of atrial fibrillation, use of a diuretic, oxygen therapy at admission, low albumin, and high troponin T levels. Similarly, in-hospital mortality was characterised by independent variables of age, a history of ventricular tachycardia, use of P2Y12 inhibitors, lower platelet count, higher aspartate aminotransferase, lower albumin, and high troponin T levels.
Limitations of the study included the observational nature of the study as well as the limited event rate and short follow-up. Because all participants were hospital patients, the population was generally older with more comorbidities than the non-hospitalised COVID-19 patients.
- Pareek M, et al. YNHHS-COVID-19 – Cardiac Complications Registry. COVID and Cardiovascular Disease session, ESC Congress 2020, 30 Aug.
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