Lower incidence of new-onset heart disease following covid-19 compared to viral pneumonia despite more echocardiography

Abstract

Abstract Background Studies have shown an increased risk of cardiac disease and dysfunction following COVID-19. However, it remains unknown whether infection with COVID-19 differs from other viral pneumonias with respect to subsequent incident heart disease. Purpose To determine the incidence of heart disease and use of cardiac procedures in patients following a diagnosis of COVID-19 compared to other viral pneumonias. Methods In a retrospective, observational study, we compared incidence rates for cardiac disease diagnosed after hospitalization with COVID-19 February-November 2020 versus hospitalization with viral pneumonia as the main diagnosis in 2018-2019. Data was obtained from The Norwegian Patient Registry and the Norwegian Surveillance System for Communicable Diseases, and linked with a unique national person identification number. We defined heart disease using ICD-10 codes and used Cox regression models to compare the hazard of first episodes of myocarditis, acute myocardial infarction, atrial fibrillation/flutter, heart failure, ischemic disease, other cardiac disease, and total heart disease (any of these conditions). Patients were followed until 31 December 2020, with censoring on this date or a maximum of 274 days after hospital admission. Results Patients hospitalized with COVID-19 in 2020 (n = 2,359) were younger, mean 59 (SD 18) vs 69 (19) years, had fewer comorbidities, had fewer hospitalizations prior to the index hospitalization (0.5 (1.2) vs 0.9 (1.8)), were more frequently treated with respiratory support (14.2% vs 7.8%) and had higher in-hospital mortality (6.9% vs 2.3%) than patients hospitalized with viral pneumonia in 2018-2019 (n = 9,018). Patients hospitalized with COVID-19 had a lower crude incidence of new total heart disease than those with viral pneumonia (56 [95%CI 48-65] vs 75 [95%CI 71-79] per 100,000 person-years). This difference persisted after adjusting for age, sex, Charlson comorbidity score (comprising age, sex, and 17 dichotomized comorbidities), hospital admission during the previous year, respiratory support, and a propensity score for being hospitalized for COVID-19 vs. other pneumonia: Hazard ratio (HR) 0.79 [95%CI 0.67-0.94], p = 0.006. Patients with COVID-19 more frequently underwent echocardiography: HR 1.41 [1.23-1.63], p = <0.001 (Fig. 1). Conclusion Following hospitalization for COVID-19, the incidence of total heart disease and heart failure was lower than for patients hospitalized with viral pneumonia, despite more frequent examinations with echocardiography.Figure 1