Analysis Details CV Risk Factors and Complications, Outcomes in 70k COVID-19 Patients

Jolanda Sabatino, MD

Results of an analysis of data from more than 20 published studies examining coronavirus disease 2019 (COVID-19) patients is providing a comprehensive overview of the impact a patient’s cardiovascular risk profile can have on outcomes from the disease.

Carried out by investigators from the Universita degli Studi Magna Graecia di Catanzaro in Italy, the meta-analysis included data from more than 75,000 patients hospitalized with COVID-19.

“These findings unveil additional prognostic elements that should be taken into account, in addition to age and gender, to influence the risk prognostication and clinical management of COVID-19 patients. The association between the novel Coronavirus and cardiac complications needs further exploration,” wrote investigators.

To learn more about the impact cardiovascular risk factors can have on outcomes in patients hospitalized with COVID-19, a team led by Jolanda Sabatino, MD, designed their study to use data from PubMed, Scopus, and Google Scholar electronic databases from November 2019 through June 11, 2020. In their search, investigators sought to identify studies with a group of keywords, including coronavirus, COVID-19, cardiac, cardiovascular.

In total, 2397 records were identified in their search. Of these, 21 studies were considered eligible for the current analysis. These 21 studies included 77,317 patients and reported data related to clinical outcomes of patients hospitalized with COVID-19 from Europe, Asia, and the US. Specifically, 14 studies were conducted in Asia, 5 were conducted in the US, and 2 were conducted in Europe.

Investigators pointed out 40.4% of patients were female, the mean age of the entire cohort was 48.4±18.5 years, and 12.89% (95% CI, 8.24-18.32) of patients had a cardiovascular comorbidity. Investigators also noted hypertension was present in 36.08% (95% CI, 20.25–53.64) of patients, 19.45% (95% CI, 12.55–27.45) reported having diabetes, and 10.74% (95% CI, 5.55–17.38) were considered current smokers.

Additionally, obesity was present at anamnesis in 33.78% of patients, coronary artery disease was already known at prevention in 11.67% of patients, heart failure was present at anamnesis in 9.35% of patients, and a history of COPD was present in 5.30% of patients.

Results of the investigators’ analyses indicated cardiovascular complications were recorded in 14.09% (95% CI, 10.26-20.23) of patients. Angina was reported in 10.15% (95% CI, 3.16-20.48) of patients, arrhythmias or palpitations were reported in 18.40% (95% CI, 7.78-32.25) of patients, acute heart failure was reported in 1.96% (95% CI, 0.94-3.35) of patients, and acute myocardial infarction was reported in 3.54% (95% CI, 2.11-5.32) of patients.

Investigators highlighted preexisting cardiovascular comorbidities or risk factors were significant predictors of cardiovascular complications in hospitalized COVID-19 at meta-regression analysis (P=.026). Investigators added neither age (P=.097) nor gender (P=.224) were significant predictors at meta-regression analysis.

The observed case fatality rate among the studies was 9.6% (Arcsine of square root proportion [ASRP], 0.20; 95% CI, 0.14-0.28) with a large heterogeneity among the studies (I2=99.7%; Qp <.001). Further analysis of fatality rates revealed the case fatality rate for patients in ICUs was 41.8% (ASRP, 0.07; 95% CI, 0.03-0.13). Meta-regression analysis indicated age (P <.001), preexisting cardiovascular comorbidities or risk factors (P <.001), and the development of cardiovascular complications (P=.038) had a significant interaction with death.

“Results of the present meta-analysis strongly suggest that COVID-19 fatality is influenced by cardiovascular pre-existing conditions and/or cardiovascular risk factors,” investigators wrote.

This study, “Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis,” was published in PLOS ONE.