ABSTRACT
Background Coronavirus disease 2019 (COVID-19) mortality remains high in those with cardiovascular disease (CVD). The temporal trend in higher COVID-19 mortality due to CVD has public health implications. We assessed the association between CVD and COVID-19 mortality throughout the COVID-19 pandemic. Methods We retrospectively studied all patients who received care for COVID-19 at Rush University System for Health during the pandemic (divided into 7 waves based on predominant virus variants and vaccine rollouts). CVD was defined as congestive heart failure (CHF), myocardial infarction (MI), cerebrovascular or peripheral vascular disease (ascertained by ICD codes). Using multivariable logistic regression, we assessed independent associations of COVID-19 mortality with age, sex, race, and 17 comorbidities in the Charlson comorbidity index, overall and stratified by pandemic waves. Results Of 43876 patients (mean age 40, 56% female, 14% with CVD), 1032 (2%) died from COVID-19 between March 2020 and August 2022. Adjusted for covariables, mortality was 3.2 times as likely in those with CVD as those without (OR=3.2, 95%CI 2.7-3.9;p<0.001). There was a trend toward increasing mortality associated with co-existing CVD as pandemic progressed to later waves (where Delta and Omicron were predominant), particularly in those with CHF or MI (Figure). Conclusion We found that COVID-19 mortality associated with co-existing CVD (particularly CHF and MI) increased temporally throughout the pandemic. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
Background: The use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) in COVID-19 patients has been controversial given the role of the angiotensin-converting enzyme 2 receptor as a cellular infiltration point for the virus. Methods: Since March of 2020, data was obtained from adult patients with COVID-19 admitted to Rush University Systems for Health through automatic extraction from the electronic medical record. We looked for other factors that were associated with mortality. All variables in Figure 1 were included in a single multivariable logistic regression model with in-hospital mortality as the primary outcome. Results: Of the 3863 patients in the cohort, 1290 (33.4%) were on an ACEi/ARB during their admission. When adjusted for the other variables in Figure 1, in-hospital ACEi/ARB usage was associated with decreased risk of mortality (adjusted odds ratio [aOR] 0.52 [CI 0.38 - 0.73];p < 0.001) compared to those not taking them. In the same model, oral anticoagulation (aOR 0.25 [CI 0.17 - 0.37];p < 0.001) was also found to be protective against in-hospital mortality. Increased BMI, male sex, initial high respiratory rate, history of atrial fibrillation and valve disease increased the risk of in-hospital mortality. Conclusion: Consistent with previous findings certain factors increase mortality, but in-hospital use of ACEi/ARBs and anticoagulation were independently associated with decreased mortality during COVID-19 hospitalization. [Formula presented]
ABSTRACT
Introduction: Vasopressor use has been associated with higher mortality rates in patients with COVID-19, the association between the maximum number of concurrent vasopressors with mortality has not yet been studied. Methods: A retrospective cohort study was conducted on patients admitted with COVID-19 to the intensive care unit (ICU) at Rush University System for Health in Illinois between March and October 2020. Multivariable logistic regression, adjusted for age, BMI, history of CAD and diabetes, was used to determine if an increasing number of vasopressors is associated with higher 60-day mortality. Results: A total of 637 patients met the inclusion criteria. Composite 60-day mortality was 28.6%. Of the 637 patients who met inclusion criteria, 338 (53.1%) required the support of at least one vasopressor. When compared to patients with no vasopressor requirement, those who required 1 (adjusted OR [aOR] 3.27, p<0.01), 2 (aOR 4.71, p<0.01), 3 (aOR 26.2, p<0.01), and 4 or 5 (aOR 106.38, p<0.01) vasopressor(s) were at increased risk of 60-day mortality (Figure 1). Additionally, the incidence of mechanical ventilation, venous thromboembolism, ventricular arrhythmia, and new renal replacement therapy increased with additional vasopressor requirement (p < 0.001 for each outcome;Table 1). There was no statistical difference in the incidence of MACE between the groups (p = 0.139). Conclusion: In this cohort, each additional vasopressor added was associated with escalating 60-day mortality. Identifying these high-risk patients can help determine prognostic outcomes and guide decision-making.