The incidence of cardiovascular conditions in patients admitted to hospital with and without COVID-19 in the South-East of Scotland

Abstract

Abstract Background Multiple studies have reported an increased risk of acute myocardial infarction, cardiac arrhythmia, heart failure, myocarditis, and venous thromboembolism in patients admitted to hospital with COVID-19 infection. Whether the incidence of these cardiovascular conditions differ in patients hospitalised with COVID-19 compared to those who have COVID-19 excluded is not clear. Methods In a prospective, multi-centre, cohort study in secondary and tertiary care hospitals in Scotland, consecutive adults with symptoms of suspected COVID-19 were identified by the attending clinician using an electronic form integrated into the care pathway. Using linked electronic health record data, we evaluated the incidence of acute myocardial infarction, atrial fibrillation, heart failure hospitalisation, myocarditis, and venous thromboembolism during the index admission and the first 90 days following the index admission. In multivariable regression models the frequency of cardiovascular conditions at 90 days were compared in patients with confirmed COVID-19 infection defined by RT-PCR test with those in whom COVID-19 was excluded. Results Between April 2020 and May 2022, 53,644 (median age 68 [interquartile range, IQR 49-90] years, 54% women) consecutive patients were hospitalised and underwent RT-PCR for suspected COVID-19 infection. In total, 4,365 (8%) had COVID-19 confirmed and 49,279 (92%) had COVID-19 excluded. At 90 daythe myocardial infarction was less common (2% versus 5%) and venous thromboembolism was more common (6% versus 4%) in patients with COVID-19 compared to those without, but the proportion with atrial fibrillation (15% versus 14%), heart failure hospitalisation (10% versus 9%), and myocarditis (<0.1% versus <0.1%) were similar. Overall, the proportion with a cardiovascular condition at 90 days did not differ in patients with or without COVID-19 (Figure). Age (over 65 years, adjusted hazard ratio [aHR] 2.75, 95% confidence interval [CI] 2,61 to 2.89), male sex (aHR 1.35, 1.30 to 1.40), and risk factors (diabetes [aHR 1.13, 1.08 to 1.19], hyperlipidaemia [aHR 1.09, 1.01 to 1.18], hypertension [aHR 1.45, 1.39 to 1.52]) were independent predictors of cardiovascular complications, whilst COVID-19 status was not associated with increased risk (aHR 0.94, 0.88 to 1.01). Conclusion Cardiovascular conditions are common in patients hospitalised with suspected COVID-19, however the incidence at 90 days does not differ in those with or without COVID-19 and COVID-19 infection does not confer an increase in risk.