Cardiac auscultation predicts mortality in elderly patients admitted for COVID-19

COVID-19 has had a great impact on the elderly population. All admitted patients underwent cardiac auscultation at the Emergency Department. However, to our knowledge, there is no literature that explains the implications of cardiac auscultation at the Emergency Department.

Data collection from our hospital records. Our cohort consists of 300 admissions with a mean age of 81.6 years and 50.7% men.

Pathological cardiac auscultation at the Emergency Department was a risk factor for in-hospital mortality (RR = 1.9; 95% CI 1.3-2.8), heart failure (RR = 3.2; 95% CI = 1.8-5.6), respiratory failure (RR = 1.8; 95% CI = 1.3-2.5), acute kidney injury (RR = 2.6; 95% CI = 2-3.2), and ICU admission (RR = 3.3; 95% CI = 1.3-8.2). The findings in patients with pathological cardiac auscultation were that oxygen saturation in the Emergency Department, arterial pH, and HCO3^- were significantly lower, and the ALT/GPT, LDH, and lactate determinations were significantly higher, which is compatible and correlates with the fact that the main variable is indeed a risk factor for a more severe clinical course. Among the findings from pathological auscultation, arrhythmic tone/arrhythmia was the most frequent (50%) and a risk factor for in-hospital mortality (RR = 2.3; 95% CI = 1.6-3.4). Logistic regression was performed from a multivariate analysis that showed that the initial ex novo arrhythmia correlated with pathological cardiac auscultation is an independent risk factor for in-hospital mortality.

Continuous rhythm monitoring makes it possible to detect ex novo arrhythmias and act proactively, and to offer greater care and attention to these patients who have a higher risk of in-hospital mortality and a worse prognosis. Cardiac auscultation can alert us in order to perform more electrocardiograms in these patients and thus have better monitoring.