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Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Pre-existing cardiovascular disease rather than cardiovascular risk factors drives mortality in COVID-19
Kevin O'Gallagher1, Anthony Shek2, Daniel M Bean2
1Department of Cardiology, King's College London British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, London, UK.
Insights
In hospitalized COVID-19 patients, pre-existing cardiovascular disease (CVD) significantly increases mortality risk, especially in younger individuals. Cardiovascular risk factors alone were not independent predictors of death.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- The association between cardiovascular (CV) risk factors (e.g., diabetes, hypertension), established CV disease (CVD), and COVID-19 outcomes is not fully understood.
- Understanding these relationships is crucial for managing severe COVID-19 cases and mitigating CV complications.
Purpose of the Study:
- To investigate the impact of pre-existing cardiovascular disease and CV risk factors on mortality and CV complications in hospitalized COVID-19 patients.
- To determine if established CVD is a stronger predictor of adverse outcomes than CV risk factors alone.
Main Methods:
- A cohort study of 1721 adults hospitalized for severe COVID-19 between March and June 2020.
- Ascertainment of pre-existing CVD, CV risk factors, and associations with mortality and CV complications.
- Statistical analysis including adjusted hazard ratios (aHR) to assess independent associations with mortality across different age groups.
Main Results:
- Among 1721 patients, 20.3% had pre-existing CVD, 51.6% had CV risk factors without CVD, and 28.1% had neither.
- Patients with CVD had higher in-hospital mortality (37%) compared to those with risk factors (25.7%) or neither (16.5%).
- Established CVD was independently associated with mortality in patients under 70 years (aHR 2.43) but not in those 70 or older (aHR 1.14). CV risk factors alone did not independently predict mortality in either age group.
- CV complications, including venous thromboembolism (VTE), were more frequent in patients with CVD.
Conclusions:
- Pre-existing established cardiovascular disease is a significant contributor to mortality in hospitalized COVID-19 patients, more so than CV risk factors alone.
- The increased hazard associated with CVD may be partly mediated by new CV complications.
- Vigilant monitoring and optimal care for patients with established CVD are essential during COVID-19 hospitalization.
Background:
The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear.
Methods:
We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 2020. Pre-existing CVD, CV risk factors and associations with mortality and CV complications were ascertained.
Results:
Among 1721 patients (median age 71 years, 57% male), 349 (20.3%) had pre-existing CVD (CVD), 888 (51.6%) had CV risk factors without CVD (RF-CVD), 484 (28.1%) had neither. Patients with CVD were older with a higher burden of non-CV comorbidities. During follow-up, 438 (25.5%) patients died: 37% with CVD, 25.7% with RF-CVD and 16.5% with neither. CVD was independently associated with in-hospital mortality among patients < 70 years of age (adjusted HR 2.43 [95% CI 1.16-5.07]), but not in those ≥ 70 years (aHR 1.14 [95% CI 0.77-1.69]). RF-CVD were not independently associated with mortality in either age group (< 70 y aHR 1.21 [95% CI 0.72-2.01], ≥ 70 y aHR 1.07 [95% CI 0.76-1.52]). Most CV complications occurred in patients with CVD (66%) versus RF-CVD (17%) or neither (11%; p < 0.001). 213 [12.4%] patients developed venous thromboembolism (VTE). CVD was not an independent predictor of VTE.
Conclusions:
In patients hospitalised with COVID-19, pre-existing established CVD appears to be a more important contributor to mortality than CV risk factors in the absence of CVD. CVD-related hazard may be mediated, in part, by new CV complications. Optimal care and vigilance for destabilised CVD are essential in this patient group. Trial registration n/a.
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