ABSTRACT
INTRODUCTION: The majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.). These studies have often utilized definitions of myocardial injury that are not guideline-based and thus, not applicable to the U.S. METHODS: The current study is a two-part investigation of the effect of myocardial injury on the clinical outcome of patients hospitalized with COVID-19. The first part is a retrospective analysis of 268 patients admitted to our healthcare system in Toledo, Ohio, U.S.; the second part is a systematic review and meta-analysis of all similar studies performed within the U.S. RESULTS: In our retrospective analysis, patients with myocardial injury were older (mean age 73 vs. 59 years, P 0.001), more likely to have hypertension (86% vs. 67%, P 0.005), underlying cardiovascular disease (57% vs. 24%, P 0.001), and chronic kidney disease (26% vs. 10%, P 0.004). Myocardial injury was also associated with a lower likelihood of discharge to home (35% vs. 69%, P 0.001), and a higher likelihood of death (33% vs. 10%, P 0.001), acute kidney injury (74% vs. 30%, P 0.001), and circulatory shock (33% vs. 12%, P 0.001). Our meta-analysis included 12,577 patients from 8 U.S. states and 55 hospitals who were hospitalized with COVID-19, with the finding that myocardial injury was significantly associated with increased mortality (HR 2.43, CI 2.28-3.6, P 0.0005). The prevalence of myocardial injury ranged from 9.2 to 51%, with a mean prevalence of 27.2%. CONCLUSION: Hospitalized COVID-19 patients in the U.S. have a high prevalence of myocardial injury, which was associated with poorer survival and outcomes.
Subject(s)
COVID-19/complications , Myocardial Infarction/etiology , Aged , Cardiovascular Diseases/complications , Female , Hospitalization , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Ohio , Prognosis , Renal Insufficiency, Chronic/complications , Retrospective Studies , SARS-CoV-2 , Troponin I/bloodABSTRACT
BACKGROUND: The effects of cardiovascular comorbidities on outcomes in COVID-19 hospitalized patients has not been well studied. METHODS: This is a hospital-based study evaluating the effects of CVD on the outcomes in patients admitted with COVID-19. Clinical outcomes were studied in patients with and without CVD. RESULTS: Eighty-seven patients had CVD, and 193 patients had no history of CVD. Ischemic heart disease was the most common CVD (63%). When compared with patients with no CVD, those with CVD had higher mortality (29% vs 9%, p < 0.001), discharge to a skilled nursing facility (SNF) (36% vs 15%, p < 0.001), and change of code status to 'do not resuscitate' (41% vs 14%, p < 0.001). The odds for mortality were high with ischemic heart disease (OR 3.6, 95% CI 1.8-7.3, p < 0.001), and systolic heart failure (OR 3.8,95% CI 1.2-12.3, p = 0.02). Patients in the CVD group were more likely to have incident atrial fibrillation (22% vs 3%, p < 0.001), type 2 Mi (17% vs 6%, p = 0.002), high BNP (57% vs 14%, p < 0.001), acute kidney injury (64% vs 29%, p < 0.001), and any type of circulatory shock (27% vs 12%, p = 0.001). CONCLUSION: CVD is associated with increased mortality, myocardial injury, arrhythmias, and discharges to an SNF.
Subject(s)
COVID-19 , Cardiovascular Diseases , Cardiovascular Diseases/epidemiology , Hospitals , Humans , Retrospective Studies , SARS-CoV-2ABSTRACT
INTRODUCTION: The cause-and-effect relationship of QTc prolongation in Coronavirus disease 2019 (COVID-19) patients has not been studied well. OBJECTIVE: We attempt to better understand the relationship of QTc prolongation in COVID-19 patients in this study. METHODS: This is a retrospective, hospital-based, observational study. All patients with normal baseline QTc interval who were hospitalized with the diagnosis of COVID-19 infection at two hospitals in Ohio, USA were included in this study. RESULTS: Sixty-nine patients had QTc prolongation, and 210 patients continued to have normal QTc during hospitalization. The baseline QTc intervals were comparable in the two groups. Patients with QTc prolongation were older (mean age 67 vs. 60, P 0.003), more likely to have underlying cardiovascular disease (48% versus 26%, P 0.001), ischemic heart disease (29% versus 17%, P 0.026), congestive heart failure with preserved ejection fraction (16% versus 8%, P 0.042), chronic kidney disease (23% versus 10%, P 0.005), and end-stage renal disease (12% versus 1%, P < 0.001). Patients with QTc prolongation were more likely to have received hydroxychloroquine (75% versus 59%, P 0.018), azithromycin (18% vs. 14%, P 0.034), a combination of hydroxychloroquine and azithromycin (29% vs 7%, P < 0.001), more than 1 QT prolonging agents (59% vs. 32%, P < 0.001). Patients who were on angiotensin-converting enzyme inhibitors (ACEi) were less likely to develop QTc prolongation (11% versus 26%, P 0.014). QTc prolongation was not associated with increased ventricular arrhythmias or mortality. CONCLUSION: Older age, ESRD, underlying cardiovascular disease, potential virus mediated cardiac injury, and drugs like hydroxychloroquine/azithromycin, contribute to QTc prolongation in COVID-19 patients. The role of ACEi in preventing QTc prolongation in COVID-19 patients needs to be studied further.