ABSTRACT
Objectives: We aimed to evaluate the association of body mass index (BMI) with in-hospital mortality and cardiorespiratory outcomes in patients admitted with COVID-19 infection. Methods: This data was collected from an academic tertiary referral center in upstate New York. Retrospective cohort analysis was conducted on patients admitted with COVID-19 infection (n=194). BMI was calculated and patients were stratified into two categories: 'healthy' (BMI=18.5-24.5) and 'overweight' (BMI>25). Cardiorespiratory outcomes were classified as in-hospital mortality, need for vasopressors, mechanical ventilation, and hemodialysis. Transthoracic echocardiography was performed to evaluate for left ventricular (LV) ejection fraction, right ventricular (RV) systolic function and RV dilation. Cardiovascular (CV) risk factors such as history of COPD, Diabetes, HTN, CAD and cigarette smoking were analyzed. LDH, troponin, CRP and ferritin levels were also noted. Results: Out of 194 patients, 68% were overweight with a mean BMI of 29.8 +/-9.5 kg/m2 and a mean age of 66 +/-16, 75% of females and 63% of males were overweight. Mortality rate was 31% in overweight patients compared to 17% in healthy subset (p<0.04). The rate of need for mechanical ventilation was higher in overweight group as well (34% vs. 17%, p<0.02). There was no significant difference between the cohorts in terms of vasopressor and hemodialysis requirement (p=0.09 and 0.2 respectively). RV systolic function was depressed in 21% of overweight cohort vs. 8% of healthy patients (p<0.02) while RV dilatation was seen in 15% of overweight patients compared with 5% of healthy patients (p<0.03). There was no significant difference in LV ejection fraction between the groups. LDH was more frequently elevated in overweight cohort with a mean level of 346 +/-185 IU/L (p<0.01). No significant difference in rest of the laboratory analysis or CV risk factors were found. Conclusion: Elevated BMI (>25) is associated with a statistically significant increase in in-hospital mortality, need for mechanical ventilation, right ventricular abnormalities, and LDH levels in patients hospitalized with COVID-19 infection.
ABSTRACT
Background: Impact of social isolation associated with the COVID-19 pandemic on the severity and frequency of cardiac symptoms has not been well investigated. Material and methods: This was a single tertiary center cohort study of inpatients admitted with a primary diagnosis of either CHF or acute myocardial infarction. Each patient rated the extent of isolation related to the pandemic and severity and frequency of symptoms during an in-person interview. Results: The study cohort included 54 patients, 48.1% females (26 of 54), 70.2+/-13.5 years old, who reported moderate or severe isolation in 57% (31 of 54). Symptom severity worsening was reported in 48% (26 of 54) of patients and was more common in socially isolated patients (74 vs. 29%, p=0.001;17 of 23 vs. 9 of 31). Symptom frequency increase was reported in 43% (24 of 54) and was also more common in socially isolated patients (61 vs. 33%, p=0.036;14 of 23 vs. 10 of 31). There was no difference in mortality between the two groups (p=0.6971). There was a trend of increased hospitalizations, on average, among patients who reported drastic isolation than patients who maintained social contacts (0.826+/-1.614 vs. 0.484+/-0.996 admissions, p=0.349). These findings were not affected by the diagnosis (CHF vs. MI), age, gender, race, and co-morbidities including HTN, DM, atril fibrillation, COPD or asthma, and/or chronic renal insufficiency. Likewise, there was no association between symptom worsening and GDT utilization including beta-blockers, RAAS inhibitors, MRA, anticoagulants, ICD or PPM placement. Conclusions: Our findings suggest that independent of age, gender, race, LVEF, recorded comorbidities, and recorded active therapeutics, the COVID-19 pandemic resulted in a significant cardiac symptom increase in patients who reported social isolation. Interventions aimed at reducing social isolation require investigation and implementation.