ABSTRACT
OBJECTIVES: Describe the incidence of cardiac complications in patients admitted to hospital with COVID-19 in Australia. DESIGN: Observational cohort study. SETTING: Twenty-one (21) Australian hospitals. PARTICIPANTS: Consecutive patients aged ≥18 years admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MAIN OUTCOME MEASURES: Incidence of cardiac complications. RESULTS: Six-hundred-and-forty-four (644) hospitalised patients (62.5±20.1 yo, 51.1% male) with COVID-19 were enrolled in the study. Overall in-hospital mortality was 14.3%. Twenty (20) (3.6%) patients developed new atrial fibrillation or flutter during admission and 9 (1.6%) patients were diagnosed with new heart failure or cardiomyopathy. Three (3) (0.5%) patients developed high grade atrioventricular (AV) block. Two (2) (0.3%) patients were clinically diagnosed with pericarditis or myopericarditis. Among the 295 (45.8%) patients with at least one troponin measurement, 99 (33.6%) had a peak troponin above the upper limit of normal (ULN). In-hospital mortality was higher in patients with raised troponin (32.3% vs 6.1%, p<0.001). New onset atrial fibrillation or flutter (6.4% vs 1.0%, p=0.001) and troponin elevation above the ULN (50.3% vs 16.4%, p<0.001) were more common in patients 65 years and older. There was no significant difference in the rate of cardiac complications between males and females. CONCLUSIONS: Among patients with COVID-19 requiring hospitalisation in Australia, troponin elevation was common but clinical cardiac sequelae were uncommon. The incidence of atrial arrhythmias and troponin elevation was greatest in patients 65 years and older.
Subject(s)
Atrial Fibrillation , COVID-19 , Pericarditis , Adolescent , Adult , Atrial Fibrillation/epidemiology , Australia/epidemiology , Female , Humans , Male , SARS-CoV-2Subject(s)
Atrial Fibrillation/epidemiology , COVID-19/complications , Cardiomyopathies/epidemiology , Heart Failure/epidemiology , Pericarditis/epidemiology , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/immunology , Atrial Fibrillation/virology , Australia/epidemiology , COVID-19/immunology , COVID-19/therapy , COVID-19/virology , Cardiomyopathies/immunology , Cardiomyopathies/virology , Female , Heart Failure/immunology , Heart Failure/virology , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Pericarditis/immunology , Pericarditis/virology , Prospective Studies , Registries/statistics & numerical data , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicityABSTRACT
During the COVID-19 pandemic there has been a reduction in hospital admissions for acute myocardial infarction. This manuscript presents the analysis of Google Trends meta-data and shows a marked spike in search volume for chest pain that is strongly correlated with COVID-19 case numbers in the United States. This raises a concern that fear of contracting COVID-19 may be leading patients to self-triage using internet searches.
Subject(s)
COVID-19 , Chest Pain , Communicable Disease Control/statistics & numerical data , Diagnostic Self Evaluation , Internet Use/statistics & numerical data , Myocardial Infarction/epidemiology , COVID-19/epidemiology , COVID-19/psychology , Chest Pain/diagnosis , Chest Pain/epidemiology , Chest Pain/psychology , Correlation of Data , Fear , Humans , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , SARS-CoV-2 , Social Isolation , United States/epidemiologyABSTRACT
INTRODUCTION: The coronavirus 2019 disease (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pre-existing cardiovascular disease (CVD) increases the morbidity and mortality of COVID-19, and COVID-19 itself causes serious cardiac sequelae. Strategies to minimise the risk of viral transmission to health care workers and uninfected cardiac patients while prioritising high quality cardiac care are urgently needed. We conducted a rapid literature appraisal and review of key documents identified by the Cardiac Society of Australia and New Zealand Board and Council members, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, and key cardiology, surgical and public health opinion leaders. MAIN RECOMMENDATIONS: Common acute cardiac manifestations of COVID-19 include left ventricular dysfunction, heart failure, arrhythmias and acute coronary syndromes. The presence of underlying CVD confers a five- to tenfold higher case fatality rate with COVID-19 disease. Special precautions are needed to avoid viral transmission to this population at risk. Adaptive health care delivery models and resource allocation are required throughout the health care system to address this need. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Cardiovascular health services and cardiovascular health care providers need to recognise the increased risk of COVID-19 among CVD patients, upskill in the management of COVID-19 cardiac manifestations, and reorganise and innovate in service delivery models to meet demands. This consensus statement, endorsed by the Cardiac Society of Australia and New Zealand, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, the National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia summarises important issues and proposes practical approaches to cardiovascular health care delivery to patients with and without SARS-CoV-2 infection.