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Brief report: Effect of cardiac multi-morbidity on COVID hospitalization outcomes
Fouad Chouairi1, Edward Jaffe2, Abdul Mannan Khan Minhas3
1Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America.
Insights
Patients with more cardiac comorbidities faced higher mortality and mechanical ventilation risks during COVID-19 hospitalizations. This national study highlights the critical impact of heart conditions on severe COVID-19 outcomes.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly strained healthcare systems globally.
- Limited research exists on the impact of cardiac risk factors on COVID-19 hospitalization outcomes using national data.
- Cardiac multimorbidity is a significant concern for severe COVID-19 outcomes.
Purpose of the Study:
- To investigate the effect of cardiac multimorbidity on healthcare utilization and outcomes in COVID-19 hospitalizations.
- To analyze national data for associations between cardiac comorbidities and COVID-19 severity.
- To determine if cardiac conditions independently affect mortality and mechanical ventilation rates in COVID-19 patients.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database for adult COVID-19 admissions in 2020.
- Identified cardiac comorbidities including coronary artery disease, diabetes mellitus, heart failure, and atrial fibrillation using ICD-10-CM codes.
- Employed multivariable logistic regression to assess the impact of cardiac multimorbidity on mortality and mechanical ventilation.
Main Results:
- Over 1 million COVID-19 admissions were analyzed, with a significant prevalence of cardiac comorbidities (e.g., 39.4% had diabetes mellitus).
- A clear dose-response relationship was observed: higher numbers of cardiac comorbidities correlated with increased mortality and mechanical ventilation rates (p<0.001).
- Multivariable analysis confirmed that increased cardiac multimorbidity independently predicted higher odds of mortality (ORs ranging from 1.48 to 2.43).
Conclusions:
- This is the first national study examining cardiac comorbidities' impact on COVID-19 outcomes.
- Increased cardiac multimorbidity is significantly associated with higher rates of mechanical ventilation and in-hospital mortality, independent of age.
- Further granular and longitudinal research is recommended to deepen understanding of these associations.
Background:
The COVID-19 pandemic has stretched healthcare resources thin and led to significant morbidity and mortality. There have been no studies utilizing national data to investigate the role of cardiac risk factors on outcomes of COVID hospitalizations. The aim of this study was to examine the effect of cardiac multimorbidity on healthcare utilization and outcomes among COVID hospitalizations during the first year of the pandemic.
Methods:
Using the national inpatient sample (NIS), we identified all adult hospital admissions with a primary diagnosis of COVID in 2020, using International Classification of Diseases, Tenth Revision, Clinical Modification codes (ICD010-CM). Coronary artery disease, diabetes mellitus, heart failure, peripheral vascular disease, previous stroke, and atrial fibrillation were then identified as cardiac comorbidities using ICD-10-CM codes. Multivariable logistic regression was used to evaluate the effect of cardiac multimorbidity on mortality and mechanical ventilation.
Results:
We identified 1,005,040 primary COVID admissions in 2020. Of these admissions, 216,545 (20.6%) had CAD, 413,195 (39.4%) had DM, 176,780 (16.8%) had HF, 159,700 (15.2%) had AF, 30735 (2.9%) had PVD, and 25,155 (2.4%) had a previous stroke. When stratified by number of comorbidities, 428390 (40.8%) had 0 comorbidities, 354960 (33.8%) had 1, 161225 (15.4%) had 2, and 105465 (10.0%) had 3+ comorbidities. COVID hospitalizations with higher cardiac multimorbidity had higher mortality rates (p<0.001) higher MV rates (p<0.001). In our multivariable regression, these associations remained with increasing odds for mortality with each stepwise increase in cardiac multimorbidity (1: OR 1.48 (1.45-1.50); 2: OR 2.13 (2.09-2.17); 3+: OR 2.43 (2.38-2.48), p<0.001, all).
Conclusions:
Our study is the first national examination of the impact of cardiac comorbidities on COVID outcomes. A higher number of cardiac comorbidities was associated with significantly higher rates of MV and in-hospital mortality, independent of age. Future, more granular, and longitudinal studies are needed to further examine these associations.
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