Rate of CV complications substantial, but lower than expected in hospitalized COVID-19 patients
Presenters: James A. De Lemos, MD and Fatima Rodgriguez, MD, MPH
While cardiovascular (CV) complications are an important problem in patients hospitalized with COVID-19, they are less common than initially feared, according to data from the American Heart Association national COVID-19 Disease Registry.
As of November 9, 2020, the registry includes 22,500 patient records from 109 US hospitals and medical centers.
But although the number of patients with in-hospital CV complications is lower than expected, given the scale of the pandemic and with almost 70,000 patients currently hospitalized in the United States, the aggregate number of cardiac complications remains substantial and vigilance is needed, according to presenter James A. de Lemos, MD, professor of medicine, the University of Texas Southwestern Medical Center, Dallas.
Data entered into the registry from 8,000 patient records collected between January 1 and July 22, 2020, showed an 8.8% occurrence of a composite of in-hospital cardiac complications that included CV death, myocardial infarction, stroke, heart failure, and cardiogenic shock.1
“COVID-19 admissions have a high prevalence of cardiac risk factors and a moderately high prevalence of prior CV disease diagnoses,” said Dr. De Lemos. “More than 20% of patients hospitalized required mechanical ventilation, and 20% died or were referred for hospice.” The dominant cause of these complications are related to acute respiratory distress syndrome and high rates of respiratory mortality, he added.
The most common in-hospital CV complication was atrial fibrillation, in 8% of patients. Rates of other complications were approximately 3% for myocardial infarction; 3.8% for deep vein thrombosis or pulmonary embolism; less than 2% for new heart failure, stroke, or cardiogenic or mixed shock; and 0.3% for myocarditis.
“The vast majority of individuals hospitalized with COVID-19 have risk factors for CV disease,” he said. “Fewer than 15% had none of the traditional risk factors.”
Through September 30, 2020, in 14,889 registry patients, CV risk factors present were hypertension in almost 60%, diabetes in 35%, obesity (body mass index [BMI] > 30 kg/m2) in 45%, and hyperlipidemia in 35%. The prevalence of various forms of CV disease at hospitalization was 5% for myocardial infarction, stroke in more than 10%, heart failure in more than 10%, atrial fibrillation in 8%, and chronic kidney disease in 13%. About 4% entered having already undergone percutaneous coronary intervention or coronary artery bypass grafting.
Death through the end of September 2020 occurred in 16.7% of hospitalizations, with another 2.8% referred for hospice; 72% of deaths were due to respiratory causes, while 10% could be attributed to cardiac disease.
The registry also revealed a higher risk of hospitalization in obese patients and minorities. Almost half (43%) of the registry patients were obese or severely obese, as determined from the 7,606 patients with BMI data available, compared with 34% of adults according to the National Health and Nutrition Examination Survey.2 Compared with their non-obese peers, severely obese patients (BMI > 40 kg/m2) patients were an average of 18 years younger and were more likely to be Black. They also had about a 30% higher relative risk of in-hospital death.
Based on 7,868 patients with race or ethnicity data to July 22, 2020, one-third (33.0%) of hospitalized COVID-19 patients were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. By comparison, census data show that Blacks represent 10.6% of the US population and Hispanics 9.0%.3
“Overall, there were no major racial or ethnic differences in mortality,” reported Fatima Rodriguez, MD, MPH, assistant professor of cardiovascular medicine, Stanford University, Stanford, CA. “Over 50% of all deaths occurred among Black or Hispanic patients.”
In fully adjusted models, no differences in mortality or major adverse cardiac events were observed for Black, Hispanics, and Asian patients compared with non-Hispanic Whites, although Asians had higher COVID-19 disease severity at presentation.
References
- https://eventpilotadmin.com/web/page.php?page=IntHtml&project=AHA20&id=2291
- Hendren NS, De Lemos JA, Ayers C, et al. Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19: results from the American Heart Association COVID-19 Cardiovascular Disease Registry. doi:10.1161/CIRCULATIONAHA.120.051936
- Rodriguez F, Solomon N, de Lemos JA, et al. Racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19: findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry. doi:10.1161/CIRCULATIONAHA.120.052278
Dr. De Lemos has disclosed the following: honoraria from Amgen, Regeneron, Novo Nordisc, Janssen, Quidel Cardiovascular, Eli Lilly, Ortho Clinical Diagnostics, and Siemen's Diagnostic, and research grants from Roche Diagnostics and Abbott Diagnostics. Dr. Rodriguez has disclosed relevant relationships (grant, research support, advisor, or review panel member) with HealthPals, NovoNordisk, Janssen , and The Medicines Company.