A Population-Based Registry Analysis on Hospitalized COVID-19 Patients with Previous Cardiovascular Disease: Clinical Profile, Treatment, and Predictors of Death.

Eduardo Gutiérrez-Abejón,Francisco Javier Álvarez,Débora Martín-García,Eduardo Tamayo,Francisco Herrera-Gómez

doi:10.3390/jcdd8120167

Abstract

A high percentage of patients with COVID-19 (coronavirus disease 2019) have previous cardiovascular disease (CVD). The findings presented here came from an epidemiological population-based registry study (real-world data) that enrolled all in-hospital COVID-19 patients with previous CVD from 1 March to 31 May 2020. Death, other comorbidities, hospital stay variables, ventilation type, and main clinical outcomes were evaluated. In Castile and Leon, 35.83% of the 7307 in-hospital COVID-19 patients who participated in this study had previous CVD, particularly arrhythmias (48.97%), cerebrovascular disease (25.02%), ischemic heart disease (22.8%), and chronic heart failure (20.82%). Of the patients, 21.36% were men and more than 90% were over 65 years of age, and the mortality rate achieved 32.93%. The most used medicines were antibiotics (91.41%), antimalarials (73.3%), steroids (46.64%), and antivirals (43.16%). The main predictors of death were age over 65 years (OR: 5), ventilation needs (OR: 2.81), treatment with anti-SIRS (systemic inflammatory response syndrome) medicines (OR: 1.97), antivirals (OR: 1.74) or steroids (OR: 1.68), SIRS (OR: 5.75), SARS (severe acute respiratory syndrome) (OR: 2.44), or AKI (acute kidney injury) (OR: 1.63) occurrence. Chronic heart failure and cerebrovascular disease were associated with a worse clinical course of COVID-19, especially in men older than 65 years with diabetes who developed SIRS, SARS, or AKI.

Highlights

Since the beginning of the COVID-19 pandemic in China in December 2019, a significant prevalence of previous cardiovascular diseases (CVDs) amongsevere acute respiratory syndrome (SARS)-CoV-2 infected patients has been observed [1–5]
The respiratory symptoms produced by COVID-19 are more severe in patients with previous CVD, which has been related to higher secretion of angiotensin converting enzyme
In patients with previous CVD, it tivirals, tocilizumab, and other anti-systemic inflammatory response syndrome (SIRS) decreased between 1 March 2020 and 31 May was observed that patients with chronic heart failure (OR: 1.27, 1.02–1.58) and with cere2020

Summary

Introduction

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infected patients has been observed [1–5]. These patients with underlying CVD have shown a worse disease prognosis with an increasing mortality [1,6–9], especially in elderly people [3], and due to the presence of several factors such as low cardiovascular reserve, increased metabolic demand, procoagulant activity, and dysregulated immunity and inflammation due to the underlying CVD [10,11]. The respiratory symptoms produced by COVID-19 are more severe in patients with previous CVD, which has been related to higher secretion of angiotensin converting enzyme. ACE2 is related to a worse outcome in males with COVID-19 compared to females. The ACE2 gene is located on the X chromosome; the expression of ACE2 will be higher in males than in females

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