Outcomes of Patients Hospitalized for COVID-19 and Cardiac Disease

Quick Takes

  • Hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease.
  • The mechanism of poorer outcomes in patients with COVID-19 and concomitant cardiac disease may be related to inflammatory activation.
  • There is a need for better prevention of COVID-19 and for better evidence-based treatment of COVID-19 in patients with cardiac conditions.

Study Questions:

What are the demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for coronavirus disease 2019 (COVID-19) in Brescia, Lombardy, Italy?

Methods:

The investigators enrolled two groups of consecutive patients (n = 99) hospitalized for COVID-19 pneumonia at Civil Hospitals of Brescia, Lombardy, Italy, between March 4-25, 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Survival curves were plotted using the Kaplan–Meier method and compared between patients with and without cardiac disease by the log-rank test.

Results:

Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and noncardiac patients except for higher values of serum creatinine, N-terminal pro–B-type natriuretic peptide, and high-sensitivity troponin T in cardiac patients. During hospitalization, 26% of patients died, 15% developed thromboembolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank p = 0.019; relative risk, 2.35; 95% confidence interval, 1.08–5.09). The rate of thromboembolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively).

Conclusions:

The authors concluded that hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease.

Perspective:

This cohort study reports a high rate of in-hospital mortality and complications including thromboembolic events, and septic shock rates in cardiac patients with COVID-19 compared with those without a history of cardiac disease. The mechanism of poorer outcomes in patients with COVID-19 and concomitant cardiac disease may be multiple and cannot be ascertained by the current study, but inflammatory activation may have a major role in the patients with heart failure and/or coronary artery disease, and may explain their susceptibility to COVID-19 and their poorer clinical course. It is apparent that better prevention of COVID-19 and possibly better evidence-based treatment of COVID-19 is warranted in these patients. Whether remdesivir or other antivirals may improve prognosis in these high-risk patients needs further prospective study.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Atrial Fibrillation, Coronary Artery Disease, Coronavirus, Coronavirus Infections, COVID-19, Creatinine, Heart Failure, Hospital Mortality, Inflammation, Natriuretic Peptide, Brain, Primary Prevention, Respiratory Distress Syndrome, Adult, Shock, Septic, Troponin T, Thromboembolism


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