Geographical Differences in Cardiovascular Comorbidities and Outcomes of COVID-19 Hospitalized Patients in the USA

Abstract

<b><i>Introduction:</i></b> Cardiovascular comorbidities may predispose to adverse outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). However, across the USA, the burden of cardiovascular comorbidities varies significantly. Whether clinical outcomes of hospitalized patients with COVID-19 differ between regions has not yet been studied systematically. Here, we report differences in underlying cardiovascular comorbidities and clinical outcomes of patients hospitalized with COVID-19 in Texas and in New York state. <b><i>Methods:</i></b> We established a multicenter retrospective registry including patients hospitalized with COVID-19 between March 15 and July 12, 2020. Demographic and clinical data were manually retrieved from electronic medical records. We focused on the following outcomes: mortality, need for pharmacologic circulatory support, need for mechanical ventilation, and need for hemodialysis. Univariate and multivariate logistic regression analyses were performed. <b><i>Results:</i></b> Patients in the Texas cohort (<i>n</i> = 296) were younger (57 vs. 63 years, <i>p</i> value <0.001), they had a higher BMI (30.3 kg/m<sup>2</sup> vs. 28.5 kg/m<sup>2</sup>, <i>p</i> = 0.015), and they had higher rates of diabetes mellitus (41 vs. 30%; <i>p</i> = 0.014). In contrast, patients in the New York state cohort (<i>n</i> = 218) had higher rates of coronary artery disease (19 vs. 10%, <i>p</i> = 0.005) and atrial fibrillation (11 vs. 5%, <i>p</i> = 0.012). Pharmacologic circulatory support, mechanical ventilation, and hemodialysis were more frequent in the Texas cohort (21 vs. 13%, <i>p</i> = 0.020; 30 vs. 12%, <i>p</i> < 0.001; and 11 vs. 5%, <i>p</i> = 0.009, respectively). In-hospital mortality was similar between the 2 cohorts (16 vs. 18%, <i>p</i> = 0.469). After adjusting for differences in underlying comorbidities, only the use of mechanical ventilation remained significantly higher in the participating Texas hospitals (odds ratios [95% CI]: 3.88 [1.23, 12.24]). Median time to pharmacologic circulatory support was 8 days (interquartile range: 2, 13.8) in the Texas cohort compared to 1 day (0, 3) in the New York state cohort, while median time to in-hospital mortality was 16 days (10, 25.5) and 7 days (4, 14), respectively (both <i>p</i> < 0.001). In-hospital mortality was higher in the late versus the early study phase in the New York state cohort (24 vs. 14%, <i>p</i> = 0.050), while it was similar between the 2 phases in the Texas cohort (16 vs. 15%, <i>p</i> = 0.741). <b><i>Conclusions:</i></b> Geographical differences, including practice pattern variations and the impact of disease burden on provision of health care, are important for the evaluation of COVID-19 outcomes. Unadjusted data may cause bias affecting future regulatory policies and proper allocation of resources.