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Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis
Jolanda Sabatino1,2, Salvatore De Rosa1,2, Giovanni Di Salvo3
1Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
Insights
Cardiovascular complications are common in hospitalized COVID-19 patients, especially those with pre-existing heart conditions or risk factors. These complications, along with existing risk factors, significantly increase the risk of death in COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic presents a global health emergency.
- While most COVID-19 cases are mild, severe illness necessitates better risk stratification.
- Understanding cardiovascular involvement is crucial for managing severe COVID-19.
Purpose of the Study:
- To conduct a meta-analysis of observational studies on cardiovascular complications in hospitalized COVID-19 patients.
- To evaluate the impact of cardiovascular risk factors and comorbidities on mortality in these patients.
Main Methods:
- A systematic literature search was performed on PubMed, Scopus, and ISI.
- Included studies reported clinical outcomes of hospitalized COVID-19 patients.
- Meta-regression analysis was used to assess associations between risk factors, complications, and mortality.
Main Results:
- Over 77,000 patients from 21 studies were analyzed.
- 12.86% of patients had pre-existing cardiovascular comorbidities or risk factors.
- Cardiovascular complications occurred in 14.09% of hospitalized COVID-19 patients.
- Pre-existing cardiovascular issues and complications during hospitalization significantly increased mortality risk.
Conclusions:
- Cardiovascular complications are frequent in COVID-19 patients.
- These complications, alongside pre-existing cardiovascular risk factors, contribute to adverse outcomes and mortality.
- Clinicians should identify high-risk patients by considering cardiovascular comorbidities and complications.
Background:
The ongoing pandemic of Novel Coronavirus Disease 2019 (COVID-19) infection has created a global emergency. Despite the infection causes a mild illness to most people, some patients are severely affected, demanding an urgent need to better understand how to risk-stratify infected subjects.
Design:
This is a meta-analysis of observational studies evaluating cardiovascular (CV) complications in hospitalized COVID-19 patients and the impact of cardiovascular risk factors (RF) or comorbidities on mortality.
Methods:
Data sources: PubMed, Scopus, and ISI from 1 December 2019 through 11 June 2020; references of eligible studies; scientific session abstracts; cardiology web sites. We selected studies reporting clinical outcomes of hospitalized patients with COVID-19. The main outcome was death. Secondary outcomes were cardiovascular symptoms and cardiovascular events developed during the COVID-19-related hospitalization. Extracted data were recorded in excel worksheets and analysed using statistical software (MedCalc, OpenMetanalyst, R). We used the proportion with 95% CI as the summary measure. A Freeman-Tukey transformation was used to calculate the weighted summary proportion under the random-effects model. Heterogeneity was assessed by using the Cochran Q test and I2 values.
Results:
Among 77317 hospitalized patients from 21 studies, 12.86% had cardiovascular comorbidities or RF. Cardiovascular complications were registered in 14.09% of cases during hospitalization. At meta-regression analysis, pre-existing cardiovascular comorbidities or RF were significantly associated to cardiovascular complications in COVID-19 patients (p = 0.019). Pre-existing cardiovascular comorbidities or RF (p<0.001), older age (p<0.001), and the development of cardiovascular complications during the hospitalization (p = 0.038) had a significant interaction with death.
Conclusions:
Cardiovascular complications are frequent among COVID-19 patients, and might contribute to adverse clinical events and mortality, together with pre-existing cardiovascular comorbidities and RF. Clinicians worldwide should be aware of this association, to identifying patients at higher risk.
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