Outcomes of Covid-19 among patients with ischemic heart disease: A propensity matched analysis
Mirza Faris Ali Baig1, Aravind Dilli Babu2, Bengt Herweg3
1Department of Internal Medicine, Asante Three Rivers Medical Center, Grant Pass, OR, United States.
Insights
Patients with ischemic heart disease (IHD) have no increased COVID-19 mortality risk. However, IHD history significantly elevates the likelihood of in-hospital cardiac complications during COVID-19 infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular diseases, particularly severe heart failure, are linked to higher COVID-19 mortality and worse hospital outcomes.
- The specific impact of pre-existing ischemic heart disease (IHD) on COVID-19 outcomes requires further large-scale investigation.
Purpose of the Study:
- To investigate the effect of COVID-19 infection on in-hospital mortality and other adverse outcomes in patients with a history of ischemic heart disease (IHD).
Main Methods:
- Utilized the 2020-2021 National Inpatient Sample (NIS) database for a large patient cohort.
- Employed propensity score matching (1:1 ratio) to compare COVID-19 patients with IHD against those without IHD.
- Analyzed outcomes including in-hospital mortality, acute kidney injury (AKI), acute myocardial injury (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and hospitalization charges.
Main Results:
- After propensity matching, 4,772 COVID-19 patients with and without IHD were compared.
- IHD patients exhibited significantly higher rates of acute myocardial injury (aOR 3.75), cardiogenic shock (aOR 2.89), ventricular tachycardia (aOR 3.26), and ventricular fibrillation (aOR 2.23).
- No significant differences were observed in in-hospital mortality, AKI, PE, mechanical ventilation, tracheal intubation, or resource utilization between the groups.
Conclusions:
- A history of ischemic heart disease (IHD) does not appear to influence COVID-19 related mortality.
- Pre-existing IHD is associated with an increased risk of specific in-hospital cardiac complications during COVID-19 infection.
Background:
Prior research has linked cardiovascular diseases with higher COVID-19 mortality and worse hospital outcomes, particularly in severe heart failure. Large population-based data regarding the impact of pre-existing ischemic heart disease (IHD) on COVID-19 outcomes is not well established.
Objective:
To study the impact of COVID-19 infection on IHD hospital mortality and other outcomes.
Methods:
The study included a patient cohort from the 2020 and 2021 National Inpatient Sample (NIS) database. Propensity score matching was used to match the study cohort (COVID-19 with IHD) to controls (COVID-19 without IHD) using a 1:1 matching ratio. The outcomes analyzed were in-hospital mortality, rates of acute kidney injury (AKI), acute myocardial injury (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges.
Results:
A total of 2,532,652 patients met the inclusion criteria (1,199,008 females [47.3 %), predominantly Caucasian 1,456,203 (57.5 %); mean [SD] age 63, (5.4), including 29,315 (1.1 %) patients with a history of IHD. Following propensity matching, 4,772 COVID-19 patients with and without IHD were matched. IHD patients had higher rates of AMI (adjusted odds ratio (aOR) 3.75, 95 % CI 3.27-4.31, p < 0.001), cardiogenic shock (aOR 2.89, 95 % CI 1.60-5.19, p < 0.001), VT (aOR 3.26, 95 % CI 2.48-4.29, p < 0.001), and VF (aOR 2.23, 95 % CI 1.25-3.99, p < 0.001). The odds ratios of in-hospital mortality, AKI, PE, mechanical ventilation, tracheal intubation, and resource use were not significantly different.
Conclusion:
A history of IHD does not impact COVID-19 mortality but increases the risk of in-hospital cardiac complications.
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