Influence of cardiovascular disease and cardiovascular risk factors in COVID-19 patients. Data from a large prospective Spanish cohort

Abstract

Introduction and objectivesCoronavirus disease 2019 (COVID-19) has become a pandemic. Retrospective data showed worse outcomes in patients with cardiovascular disease (CVD) and cardiovascular (CV) risk factors. Our aim was to evaluate the link between CVD and CV risk factors and in-hospital outcomes in COVID-19 patients. MethodsWe designed a prospective registry that included consecutive COVID-19 patients admitted at our institution. The inclusion period was from 27 February to 7 April 2020. Clinical outcomes were monitored up to 2 May 2020. ResultsA total of 876 patients were included. Mean age was 62±18 years old; 47% were > 65 years of age. A total of 69% of patients had at least one CV risk factor; 15% of the patients had previous history of CVD. Patients with previous CVD were significantly older (77±11 vs 60±18 years old; P<.01), with a higher proportion of men (64 vs 54%; P=.021) and showed a higher proportion of rise in both high-sensitivity cardiac-specific troponin-T (hs-cTnT) (78 vs 27%; P<.01) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (74 vs 29%; P<.01) on admission. Those patients with CV risk factors were also significantly older (68±16 vs 49±16 years old; P<.01), showing a higher percentage of patients fulfilling acute distress respiratory syndrome criteria (28 vs 21%; P=.021) and more need of mechanical ventilation (9 vs 4%; P<.01). Levels of hs-cTnT (44 vs 9%; P<.01) and NT-proBNP (43 vs 15%; P<.01) were more frequently elevated in patients with CV risk factors. Risk of death was significantly higher in patients with CVD (33 vs 8%; P<.01) or CV risk factors (16 vs 1%; P<.01). We found age > 65 years old (OR, 15; 95%CI, 5–43), chronic congestive heart failure (OR, 3.27; 95%CI, 1.38–7.72) and chronic kidney disease (OR, 8.55; 95%CI, 1.47–5.46) as independent predictors of death. ConclusionsIn patients admitted for COVID-19, CVD or CV risk factors are associated with an increased risk of death during hospitalization. We found that older age, history of congestive heart failure and chronic kidney disease are independent predictors of death in COVID-19.