Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across sixteen countries
AbstractAimsPatients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.Method and resultsWe used data from the CAPACITY-COVID registry and LEOSS study. Multivariable modified Poisson regression models were fitted to assess the association between different types of pre-existent heart disease and in-hospital mortality. 10,481 patients with COVID-19 were included (22.4% aged 66 – 75 years; 38.7% female) of which 30.5% had a history of cardiac disease. Patients with heart disease were older, predominantly male and more likely to have other comorbid conditions when compared to those without. COVID-19 symptoms at presentation did not differ between these groups. Mortality was higher in patients with cardiac disease (30.3%; n=968 versus 15.7%; n=1143). However, following multivariable adjustment this difference was not significant (adjusted risk ratio (aRR) 1.06 [95% CI 0.98 – 1.15, p-value 0.13]). Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for NYHA III/IV heart failure (aRR 1.43 [95% CI 1.22 – 1.68, p-value <0.001]) and atrial fibrillation (aRR 1.14 [95% CI 1.04 – 1.24, p-value 0.01]). None of the other heart disease subtypes, including ischemic heart disease, remained significant after multivariable adjustment.ConclusionThere is considerable heterogeneity in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with severe heart failure are at greatest risk of death when hospitalized with COVID-19.