Cardiovascular comorbidities as predictors for severe COVID-19 infection or death

Matthew Phelps*, Daniel Molager Christensen, Thomas Gerds, Emil Fosbøl, Christian Torp-Pedersen, Morten Schou, Lars Køber, Kristian Kragholm, Charlotte Andersson, Tor Biering-Sorensen, Helle Collatz Christensen, Mikkel Porsborg Andersen, Gunnar Gislason

*Corresponding author for this work

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Abstract

Aims Pre-existing cardiovascular diseases (CVDs) have been proposed to identify patients at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes, but existing evidence is conflicting. Thus, it is unclear whether pre-existing CVDs are independently important predictors for severe COVID-19.

Methods and results In a nationwide Danish cohort of hospital-screened COVID-19 patients aged >= 40, we investigated if pre-existing CVDs predict the 30-day risk of (i) composite outcome of severe COVID-19 and (ii) all-cause mortality. We estimated 30-day risks using a Cox regression model including age, sex, each CVD comorbidity, chronic obstructive pulmonary disease-asthma, diabetes, and chronic kidney disease. To illustrate CVD comorbidities' importance, we evaluated the predicted risks of death and severe infection, for each sex, along ages 40-85. In total, 4090 COVID-19 hospital-screened patients were observed as of 26 August 2020; 22.1% had >= 1 CVD, 23.7% had severe infection within 30days and 12.6% died. Predicted risks of both outcomes at age 75 among men with single CVD comorbidities did not differ in clinically meaningful amounts compared with men with no comorbidities risks for the composite outcome of severe infection; women with heart failure (28.2%; 95% CI 21.1-37.0%) or atrial fibrillation (30.0%; 95% CI: 24.2-36.9%) showed modest increases compared with women with no comorbidities (24.0%; 95% CI: 21.4-26.9%).

Conclusions The results showing only modest effects of CVDs on increased risks of poor COVID-19 outcomes are important in allowing public health authorities and clinicians to provide more tailored guidance to cardiovascular patients, who have heretofore been grouped together as high risk due to their disease status.YY

Original languageEnglish
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume7
Issue number2
Pages (from-to)172-180
Number of pages9
ISSN2058-5225
DOIs
Publication statusPublished - 2021

Keywords

  • COVID-19
  • Mortality
  • Morbidity
  • Severe outcomes
  • Cardiovascular comorbidities
  • Pre-existing conditions
  • EPIDEMIOLOGY

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