Patients older than 65 years hospitalized with COVID-19 have higher rates of intensive care unit admission and death when compared with younger patients. Cardiovascular conditions associated with COVID-19 include myocardial injury, acute myocarditis, cardiac arrhythmias, cardiomyopathies, cardiogenic shock, thromboembolic disease, and cardiac arrest. Few studies have described the clinical course of those at the upper extreme of age. We characterize the clinical course and outcomes of 73 patients with 80 years of age or older hospitalized at an academic center between March 15 and May 13, 2020. These patients had multiple comorbidities and often presented with atypical clinical findings such as altered sensorium, generalized weakness and falls. Cardiovascular manifestations observed at the time of presentation included new arrhythmia in 7/73 (10%), stroke/intracranial hemorrhage in 5/73 (7%), and elevated troponin in 27/58 (47%). During hospitalization, 38% of all patients required intensive care, 13% developed a need for renal replacement therapy, and 32% required vasopressor support. All-cause mortality was 47% and was highest in patients who were ever in intensive care (71%), required mechanical ventilation (83%), or vasopressors (91%), or developed a need for renal replacement therapy (100%). Patients older than 80 years old with COVID-19 have multiple unique risk factors which can be associated with increased cardiovascular involvement and death.

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Introduction:To understand how age and other factors impacted outcomes, we examined characteristics of patients aged 65 years and older hospitalized with COVID-19. Material and methods: This was a retrospective cohort study that included all patients aged 65 years and older with laboratory-confirmed COVID-19, who were admitted to a suburban New York academic medical centre between 15 March and 13 May 2020, and discharged. Results: Of 196 patients, the median age was 76 years, with 57% male, and 66% white. A greater proportion of "older" (77-105 years) compared to "old" (65-76 years) patients were admitted with a primary diagnosis other than COVID-19 (34% vs. 15%), were afebrile (80% vs. 67%), and had a clear initial chest X-ray (19% vs. 8%). Older patients had a higher prevalence of dementia (26% vs. 1.0%), cardiac (42% vs. 28%), and vascular disease (20% vs. 9%). Overall survival was lower among older compared to old patients (55% vs. 74%, p = 0.026) and when mechanical ventilation (20% vs. 46%, p = 0.29) or vasopressors (15% vs. 41%, p = 0.46) were required (20% vs. 46%, p = 0.029) and when new hepatic dysfunction (24% vs. 65%, p < 0.001) or new renal failure (29% vs. 56%, p = 0.015) developed. Factors at presentation that were associated with significantly lower survival included hypoxaemia, elevation of total white blood cell count, procalcitonin, and d-dimer. Conclusions: Overall mortality was 34%. Survival was 2-to 3-fold higher for those aged 65-76 years compared to those aged 77 years and older who required advanced therapies such as mechanical ventilation. Improving clinical parameters were associated with significantly higher survival, regardless of age.