Outcomes and Cardiovascular Comorbidities in a Predominantly African-American Population with COVID-19

Abstract

Importance: Racial disparities in COVID-19 outcomes have been amplified during this pandemic and reports on outcomes in African-American (AA) populations, known to have higher rates of cardiovascular (CV) comorbidities, remain limited. Objective: To examine prevalence of comorbidities, rates of hospitalization and survival, and incidence of CV manifestations of COVID-19 in a predominantly AA population in south metropolitan Chicago. Design, Setting, Participants: This was an observational cohort study of COVID-19 patients encountered from March 16 to April 16, 2020 at the University of Chicago. Deidentified data were obtained from an institutional data warehouse. Group comparisons and logistic regression modeling based on baseline demographics, clinical characteristics, laboratory and diagnostic testing was performed. Exposures: COVID-19 was diagnosed by nasopharyngeal swab testing and clinical management was at the discretion of treating physicians. Main Outcomes and Measures: Primary outcomes were hospitalization and in-hospital mortality, and secondary outcomes included incident CV manifestations of COVID-19 in the context of overall cardiology service utilization. Results: During the 30 day study period, 1008 patients tested positive for COVID-19 and 689 had available encounter data. Of these, 596 (87%) were AA and 356 (52%) were hospitalized, of which 319 (90%) were AA. Age > 60 years, tobacco use, BMI >40 kg/m2, diabetes mellitus (DM), insulin use, hypertension, chronic kidney disease, coronary artery disease (CAD), and atrial fibrillation (AF) were more common in hospitalized patients. Age > 60 years, tobacco use, CAD, and AF were associated with greater risk of in-hospital mortality along with several elevated initial laboratory markers including troponin, NT-proBNP, blood urea nitrogen, and ferritin. Despite this, cardiac manifestations of COVID-19 were uncommon, coincident with a 69% decrease in cardiology service utilization. For hospitalized patients, median length of stay was 6.2 days (3.4-11.9 days) and mortality was 13%. AA patients were more commonly hospitalized, but without increased mortality. Conclusions and Relevance: In this AA-predominant experience from south metropolitan Chicago, CV comorbidities and chronic diseases were highly prevalent and associated with increased hospitalization and mortality. Insulin-requiring DM and CKD emerged as novel predictors for hospitalization. Despite the highest rate of comorbidities reported to date, CV manifestations of COVID-19 and mortality were relatively low. The unexpectedly low rate of mortality merits further study.

Statin therapy did not improve the in-hospital outcome of coronavirus disease 2019 (COVID-19) infection

“…A total of 8350 records were obtained through systematic electronic searches and other ways. After screening titles, abstracts, and full texts, 9 studies [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ] with a total of 3449 COVID-19 patients were included in the meta-analysis. The essential characteristics of the included studies are summarized in Table 1 .…”

“…[ 8 ] 2020 50 Retrospective cohort 66.3 ± 13.3 Severity 18 (36%) 32 (64%) Nguyen et al. [ 9 ] 2020 356 Retrospective cohort 61.3 ± 17 Mortality 90 (25.2%) 266 (74.8%) Rodriguez-Nava et al. [ 10 ] 2020 87 Retrospective cohort 67 ± 12.5 Mortality 47 (54%) 40 (46%) Wang et al.…”

Protective Effects of Statins Administration in European and North American Patients Infected with COVID-19: A Meta-Analysis

“…The result of the meta-analysis of these seven studies performed in Western countries are reported in ►Fig. 2, [35][36][37][38][39][40][41] which demonstrate that COVID-19 patients taking statins had nearly 40% lower odds of progressing to the composite endpoint of severe/critical illness or death (OR: 0.59; 95% CI: 0.35-0.99; Cochran's Q p ¼ 0.02; I 2 ¼ 60%). Individually, six of these seven studies reported a reduced OR (i.e., OR < 1; protective effect of statins), [35][36][37][38][39][40] while in only one study was the OR >1 (i.e., OR: 1.60; 95% CI: 0.88-2.92).…”

The protective association between statins use and adverse outcomes among COVID-19 patients: a systematic review and meta-analysis

“…Israel et al 16 split their database into two cohorts and reported two relative risk ratios for the outcome of mortality. Two studies, Grasselli et al 14 and Rodriguez-Nava et al 20 , reported on ICU patients; the other 11 7-10,13,15-19,21,22 reported on non-ICU patients. Six studies 7,10,17,18,20,21 defined a statin user as one who used statins after a COVID-19 hospitalization; seven studies 8,9,13-16,19,22 defined a statin user as one who used statins before a COVID-19 hospitalization.…”