Heart Rate in Patients with SARS-CoV-2 Infection: Prevalence of High Values at Discharge and Relationship with Disease Severity

Abstract

The most common arrhythmia associated with COronaVIrus-related Disease (COVID) infection is sinus tachycardia. It is not known if high Heart Rate (HR) in COVID is simply a marker of higher systemic response to sepsis or if its persistence could be related to a long-term autonomic dysfunction. The aim of our work is to assess the prevalence of elevated HR at discharge in patients hospitalized for COVID-19 and to evaluate the variables associated with it. We enrolled 697 cases of SARS-CoV2 infection admitted in our hospital after February 21 and discharged within 23 July 2020. We collected data on clinical history, vital signs, laboratory tests and pharmacological treatment. Severe disease was defined as the need for Intensive Care Unit (ICU) admission and/or mechanical ventilation. Median age was 59 years (first-third quartile 49, 74), and male was the prevalent gender (60.1%). 84.6% of the subjects showed a SARS-CoV-2 related pneumonia, and 13.2% resulted in a severe disease. Mean HR at admission was 90 ± 18 bpm with a mean decrease of 10 bpm to discharge. Only 5.5% of subjects presented HR > 100 bpm at discharge. Significant predictors of discharge HR at multiple linear model were admission HR (mean increase = β = 0.17 per bpm, 95% CI 0.11; 0.22, p < 0.001), haemoglobin (β = −0.64 per g/dL, 95% CI −1.19; −0.09, p = 0.023) and severe disease (β = 8.42, 95% CI 5.39; 11.45, p < 0.001). High HR at discharge in COVID-19 patients is not such a frequent consequence, but when it occurs it seems strongly related to a severe course of the disease.

Analysis of Risk Factors for In-Hospital Death Due to COVID-19 in Patients Hospitalised at the Temporary Hospital Located at the National Stadium in Warsaw: A Retrospective Analysis

“…A study by Mudatsir et al demonstrated that high blood pressure and an increased respiratory rate were associated with severe COVID-19 [ 39 ]. Maloberti et al found that the discharge heart rate was strongly related to the evidence of severe disease and the need for intensive care unit admission and/or mechanical ventilation [ 61 ].…”

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

“…After removing duplicates, 1585 results remained and were evaluated for title and abstract check. Therefore, 65 reports were considered in the full-text review stage, and 20 of those were included in the systematic review [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48], while 45 reports were excluded: 2 papers written in Russian [49,50], 5 conference papers [51][52][53][54][55], 3 comments [56][57][58], 4 case reports or case series [59][60][61][62], 2 literature reviews [63,64], 1 study protocol [65], 12 studies that did not perform a formal evaluation of autonomic functions [66][67][68][69][70][71][72][73][74][75]…”

“…Details regarding the selection process are available in the PRISMA diagram (Figure 1). [66][67][68][69][70][71][72][73][74][75][76][77]; not acute COVID-19 population-Refs. [78][79][80][81][82][83][84][85][86][87][88][89][90]; not in English or Italian-Refs.…”

“…The PRISMA diagram of the systematic review. Reports excluded: Not formal assessment of dysautonomia-Refs [66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90]…”

The Future Evolution of the Mortality Acceleration Due to the COVID-19: The Charlson Comorbidity Index in Stochastic Setting

“…For instance, chronic kidney disease (CKD), incidence of acute kidney injury (AKI) and atrial fibrillation (AF) have been shown to represent comorbidities associated with reduced survival in patients hospitalized for COVID-19 disease. The role of the comorbidities under consideration particularly on in-hospital mortality has been well-documented in some studies as in (28,29) and others. Accordingly, it could be useful to adjust the stochastic CCI according to a correction factor based on these risk factors, for obtaining a more reliable projections.…”