P014. Risk Factors for Cardiovascular Events In Hospitalized Patients with COVID-19

Background Between 25%-50% of patients hospitalized with (COVID-19) suffer cardiovascular events. Limited information is available to identify those at greatest risk for cardiac complications. Objectives Objectives were to analyze risk factors associated with cardiovascular events (CE);analyze whether risk factors and outcomes were influenced by race;and analyze survival differences among various groups. Methods This retrospective cohort study of 700 inpatients with COVID-19 was conducted at nine hospitals within a large urban midwestern city. Data was collected from March 9, 2020, to June 20, 2020. Inclusion criteria included all COVID-19 inpatients and excluded non-inpatients. Predictor variables included demographics, comorbidities, and current clinical data. The outcomes were heart failure (HF), deep-vein thrombosis, myocardial infarction, pulmonary edema, stroke, cardiomyopathy, myocarditis, reduced ejection fraction, cardiac arrhythmias, cardiogenic shock, and cardiac arrest. Pearson's correlation coefficients were used to evaluate the correlation between different variables. Multiple logistics regression analyses were conducted to examine which variables predict cardiovascular events for the entire cohort, African American patients, and white patients, respectively. Mann-Whitney U, Chi-square, or Fisher's exact tests were used to examine differences in groups with and without CE and Kaplan-Meier was conducted for survival comparisons between groups. Results Of 700 COVID-19 positive inpatients, 126 experienced cardiovascular events and 574 did not. The incidence of cardiovascular events in our sample population was 18%. As shown in Table 1, we found the following factors were highly associated with the odds of new-onset of CEs: advanced age in years, males, non-Hispanic African American, presence of comorbidities, and decreased saturation levels. Numerous laboratory values were significantly associated with the risk of CEs (Table 1). African Americans had greater odds of CEs in the presence of diabetes and cardiovascular comorbidities (p=0.008, p=0.014, respectively). However, multiple logistics analysis was used to examine the joint effect of the risk factors which suggested that lower serum albumin and neoplastic/immune compromised diseases count were highly associated with CEs for African American COVID-19 inpatients (p=0.001, p=0.044, respectively). SaO2/FiO2 ratio and cardiovascular comorbidities were significantly associated with CEs for white inpatients (p=<0.001, p=0.007, respectively). As shown in Figure 1, Kaplan-Meier survival analysis revealed inpatients with CEs had a much higher mortality rate than those without CEs (45.2% vs. 8.7%). Median survival for patients with CEs was 18 days as opposed to 100 days for those that did not experience CEs. African Americans with CEs experienced higher mortality than those without CEs (43.9% vs. 7.8%). White COVID-19 inpatients' mortality rates were 46.3% and 9.0% for those with and without CEs, respectively. Of the 126 COVID-19 inpatients who had a CE, 14.3% had cardiac arrhythmias and 8.7% had new onset of HF diagnoses, and 4.8% had acute myocardial infarctions. Conclusion Multiple risk factors for CEs and death were identified in this sample of hospitalized patients with COVID-19, and mortality was increased significantly in those inpatients who had CEs. HF, cardiac arrhythmia, and acute myocardial infarction were the most frequently cited CEs implicating the need for long-term follow-up.

Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients.

OBJECTIVE: To analyze outcomes and risk factors of cardiovascular events in a metropolitan coronavirus disease 2019 (COVID-19) database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race. DESIGN: Retrospective cohort analysis from March 9, 2020 to June 20, 2020. SETTING: Population-based study in Louisville, KY, USA. PARTICIPANTS: Seven hundred adult inpatients hospitalized with COVID-19. INTERVENTIONS: N/A. MEASUREMENTS AND MAIN RESULTS: This cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% v 8.7%, p < 0.001). There was no difference between African American and white patients regarding mortality (43.9% v 46.3%, p = 1) and length of stay for survivors (11 days v 9.5 days, p = 0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FIO2, higher serum potassium, lower serum albumin, and number of cardiovascular comorbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic and/or immune-compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FIO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients. CONCLUSIONS: Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.