POSA420 Trends in Thrombotic and Cardiovascular Events Among Hospitalized Patients with COVID-19 in the US: Findings from a Large Electronic Health Records Database

Abstract

Patients with the coronavirus disease 2019 (COVID-19) have an increased risk of thrombotic and cardiac events. We assessed the incidence and trends in selected thrombotic and cardiac events among hospitalized COVID-19 patients from a large, geographically diverse US electronic health records (EHR) database. This retrospective study analyzed Optum® de-identified COVID-19 EHR dataset to identify patients hospitalized between 03/01/2020 and 10/31/2020 with a COVID-19 diagnosis code. Patients were members of an integrated delivery network with ≥1 encounter during the 12 months prior to admission. Events of interest, including acute coronary syndrome (ACS), venous thromboembolism (VTE), stroke and myocarditis, were identified by diagnosis codes during hospitalization. Patients with any such events in their 12-month baseline were excluded. A composite event was defined by the occurrence of any of these events. Events were reported as proportions, in total as well as by month of admission and age group. Among 25,574 hospitalized COVID-19 patients, the median age was 60 years (IQR: 44-72), and 54.5% were female. The composite event occurred in 3,052 (11.9%) patients (ACS=6.4%, VTE=4.1%, stroke=2.4%, myocarditis=0.6%) and its incidence increased with age (≤19=4.6%, 20-49=6.2%, 50-59=11.7%, 60-69=13.4%, ≥70=17.3%). In the youngest age group, myocarditis (2.2%) and VTE (1.7%) contributed to the majority of events, while in the oldest, ACS (10.9%), VTE (4.2%) and stroke (4.1%) were observed most often. Patients admitted during March had the highest incidence (20.6%), which decreased to 9.1% by July and remained steady through October (9.6%). The percentage decline in the composite event incidence during the study period was higher in younger versus older patients (≤19=77.0% 20-49=61.9%, 50-59=66.0%, 60-69=58.6%, ≥70=44.1%). The incidence of the composite event was highest among patients hospitalized early in the pandemic. The composite event occurred in almost 5% patients ≤19 years old and this group experienced the largest decline during the study period.