Cardiovascular comorbidities as predictors for severe COVID-19 infection or death

Abstract

Background Pre-existing cardiovascular diseases (CVDs) have been proposed to identify patients at higher risk of adverse COVID-19 outcomes, but existing evidence is conflicting. Thus, it is unclear whether pre-existing CVDs are independently important predictors for severe COVID-19. Methods and results In a nationwide Danish cohort of hospital-screened COVID-19 patients aged > =40, we investigated if pre-existing CVDs predict the 30-day risk of (1) composite outcome of severe COVID-19 and (2) all-cause mortality. We estimated 30-day risks using a Cox regression model including age, sex, each CVD comorbidity, COPD-asthma, diabetes, and chronic kidney disease. To illustrate CVD comorbidities’ importance, we evaluated the predicted risks of death and severe infection, for each sex, along ages 40 - 85. 4,090 COVID-19 hospital-screened patients were observed as of August 26, 2020; 22.1% had ≥ 1 CVD, 23.7% had severe infection within 30 days and 12.6% died. Predicted risks of both outcomes at age 75 among men with single CVD comorbidities did not differ in clinically meaningful amounts compared to men with no comorbidities risks for the composite outcome of severe infection; women with heart failure (28.2%; 95% CI 21.1%-37.0%) or atrial fibrillation (30.0%; 95% CI: 24.2%-36.9%) showed modest increases compared to women with no comorbidities (24.0%; 95% CI: 21.4%-26.9%). Conclusions The results showing only modest effects of CVDs on increased risks of poor COVID-19 outcomes are important in allowing public health authorities and clinicians to provide more tailored guidance to cardiovascular patients, who have heretofore been grouped together as high-risk due to their disease status.

A national analysis of trends in COVID-19 infection and clinical management in Veterans Health Administration medical facilities

“…11,19,33,34 In addition to older age, prior work has documented evidence of increased risk for COVID-19 infection, severity, and/or fatality among patients with certain symptoms, preexisting medical conditions, and abnormal laboratory findings. 4,7,13,14,28 Although the significance and magnitude of associations varied between studies, our finding of declining mortality seems to support the idea of greater risk for severe or fatal disease among patients that have these risk factors. In our study, patients hospitalized in March compared to later months had more exacerbating symptoms (e.g., fever, dyspnea, cough) and evidence of biomarkers on inflammation, infection, cardiac and muscle injury, decreased liver and kidney function.…”

“…In our study, patients hospitalized in March compared to later months had more exacerbating symptoms (e.g., fever, dyspnea, cough) and evidence of biomarkers on inflammation, infection, cardiac and muscle injury, decreased liver and kidney function. 4,7,13,14,28 Additionally, we found that both hospitalized and deceased patients had more underlying comorbidities in March compared to later months including severe cardiovascular diseases, diabetes, renal disease, and obesity. However, deceased patients had a higher frequency of such comorbidities.…”

“…Many prior studies have worked to identify risk factors for COVID-19 infection, severity, and fatality. 1, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Literature published early on in the pandemic, as well as more 356 recent studies, have consistently reported an elevated risk of both testing positive and 357 severe or fatal disease among older populations (age 65 years) after adjusting for 358 sociodemographic characteristics and comorbidities. 4,9,13,16 In our study, we found that the majority of patients hospitalized with COVID-19 were older.…”

“…1, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, the results of these studies are largely 129 conflicting, especially among those conducted during the initial onset of the pandemic 130 compared to more recent literature, as well as among those that were regional or local 131 compared to national in scope. 1, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Conflicting findings from "real-world" studies may be at least partially due to lack of consideration for the temporal and regional distribution of COVID-19 burden across the U.S., secular trends in clinical practice, or potential systemic differences in the characteristics of patients requiring hospitalization or treatment. 9,13,15,16,18,19 Moreover, the aggregation of this information at one time point and short-term assessment (e.g., one month) may not accurately account for the influence of rapidly deployed and changing mitigation efforts including government restrictions and policies.…”

Clinical Characteristics and Outcomes of COVID-19 in West Virginia

“…The poor outcomes for COVID 19 related to the cardiovascular co-morbidities may be a direct result of the condition itself or attributed to other conditions [ 34 ]. Some authors have found rather modest associations of adverse outcomes and hypertensive comorbidities like Atkins JL et.al.…”