Defining heart disease risk for death in COVID-19 infection

• Published in: QJM : An International Journal of Medicine Vol. 113; no. 12; pp. 876 - 882
• Main Authors: Li, J, Guo, T, Dong, D, Zhang, X, Chen, X, Feng, Y, Wei, B, Zhang, W, Zhao, M, Wan, J
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-12-2020
• Subjects: Adult; Aged; Biomarkers - blood; Cardiovascular Diseases - complications; Cardiovascular Diseases - mortality; Cardiovascular Diseases - therapy; Cause of Death; China - epidemiology; COVID-19 - mortality; COVID-19 - therapy; Female; Humans; Male; Middle Aged; Original Papers; Retrospective Studies; Risk Factors; SARS-CoV-2; China
• ISSN: 1460-2725; 1460-2393; 1460-2393
• DOI: 10.1093/qjmed/hcaa246

Summary
Background
Cardiovascular disease (CVD) was in common in coronavirus disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with or without CVD.
Methods
Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People’s Hospital, Wuhan, China, from 23 January to 14 March 2020. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD.
Results
Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 vs. 52 years) and had higher proportion of men (52.5% vs. 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs. 8.1%), malignant arrhythmias (3.7% vs. 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy(7.9% vs. 1.8%) and acute kidney injury (11.6% vs. 3.4%). The rate of glucocorticoid therapy (36.7% vs. 25.5%), Vitamin C (23.3% vs. 11.8%), mechanical ventilation (21.9% vs. 7.6%), intensive care unit admission (12.6% vs. 3.7%) and mortality (16.7% vs. 4.7%) were higher in patients with CVD (both P < 0.05). The multivariable Cox regression models showed that older age (≥65 years old) (HR 3.165, 95% CI 1.722–5.817) and patients with CVD (HR 2.166, 95% CI 1.189–3.948) were independent risk factors for death.
Conclusions
CVD are independent risk factors for COVID-19 patients. COVID-19 patients with CVD were more severe and had higher mortality rate, early intervention and vigilance should be taken.