COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations

Abstract

Background: A high burden of severe disease and death from the coronavirus disease 2019 (COVID-19) has been consistently observed in older patients, especially those with pre-existing medical co-morbidities. The global pandemic lockdown has isolated many patients with chronic illnesses from their routine medical care. This narrative review article analyses the multitude of issues faced by individuals with underlying medical conditions during the COVID-19 pandemic. Methods: Sources for this publication were identified through searches of PubMed for articles published between 31st December 2019 and 4th June 2020, using combinations of search terms. Guidelines and updates from reputable agencies were also consulted. Only articles published in the English language were included. Results: The volume of literature on COVID-19 continues to expand, with 17,845 articles indexed on PubMed by 4th June 2020, 130 of which were deemed particularly relevant to the subject matter of this review. Older patients are more likely to progress to severe COVID-19 disease requiring intensive care unit (ICU) admission. Patients with preexisting cardiovascular disease, especially hypertension and coronary heart disease, are at greatly increased risk of developing severe and fatal COVID-19 disease. A controversial aspect of the management of COVID-19 disease has been the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Obese COVID-19 patients are more likely to require complex ICU management. Putative mechanisms of increased COVID-19 disease severity in diabetes include hyperglycaemia, altered immune function, sub-optimal glycaemic control during hospitalisation, a pro-thrombotic and pro-inflammatory state. Patients with mental health disorders are particularly vulnerable to social isolation, and this has been compounded by the suspension of non-emergency care in hospitals around the world, making it difficult for patients with chronic mental illness to attend outpatient appointments.

Risk factors of developing critical conditions in Iranian patients with COVID-19

“…Almost all of the researches showed that there is a relation between age and developing critical condition in COVID-19 patients. The need for intensive care unit (ICU) admission is higher in older patients [ 41 ]. Many researchers indicated that patients older than 60–65 years old are at higher risk of mortality [ 13 , 36 ].…”

“…Pre-existing cardiovascular problems especially coronary heart disease put the patient at great risk of developing fatal form of novel coronavirus disease [ 41 ]. Lots of studies have mentioned cardiovascular diseases especially ischemic heart disease as a risk factor for mortality in COVID-19 patients [ 13 , 26 , 36 ].…”

Aging, Care, and Isolation in the Time of COVID-19.

“…The syndemic effects of SARS-COV-2 and cardiometabolic conditions are still being identified (Singer 2020). While relatively low death rates have been reported in populations with high rates of HIV, prompting speculation of the protective effects of ARV medication, other chronic conditions are clearly implicated in poor outcomes for COVID-19 (Flaherty et al 2020;Mahumud, Kamara, and Renzaho 2020). COVID-19, chronic conditions, and aging are linked in ways that stretch beyond clinical risk.…”

Fatty liver disease in obese patients with COVID-19: a tale of two pandemics?

“…A recently published review article discusses the challenges faced by patients with pre-existing chronic medical conditions, including CVD and diabetes, during the current global pandemic. 4 These vulnerable patients are more likely to develop severe COVID-19 requiring prolonged hospitalization and intensive care management. The clinical outcomes in obese COVID-19 patients are worse, and the fatality rate is higher in this group.…”

“…The authors recommend that the weight gain associated with prolonged societal lockdown measures be addressed by concerted efforts to promote healthy eating and physical activity. 4 This is especially important in the obese population, many of whom will also have evidence of MAFLD.…”