Risk of COVID-19 mortality among patients with preexisting cerebrovascular disease

ABSTRACT

Introduction: COVID-19 is associated with incident cerebrovascular disease (CVD). We evaluated the association between preexisting CVD and COVID-19 mortality. Methods: Utilizing deidentified pooled data from 40 healthcare organizations, adult (≥ 18 years) COVID-19 patients were identified based on ICD-10 diagnostic codes and documentation of laboratory positivity for SARS-CoV-2 RNA or antibodies. Among COVID-19 patients, those with documented ICD-10 diagnoses for cerebral infarction / ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and transient ischemic attack (TIA) at least 30- days before the index COVID-19 event were classified as the CVD group. The CVD and non-CVD groups were propensity score (PS) matched on demographic and comorbidity variables. Pre and post-match risk ratios (RR) and 95% confidence intervals (CI) for 30 and 90-day mortality were calculated. Mortality rates for CVD subgroups (ICH, SAH, AIS, TIA) are also reported. Results: Among a total of 140,034 COVID-19 cases, 4,614 (3.3%) had prevalent CVD. CVD patients were significantly older and were predominantly males of either white or black race (vs. other). CVD patients also had a higher comorbidity burden (vs. non-CVD patients) (graphic). A 11 PS algorithm yielded an optimally matched sample of 8,218 COVID-19 patients (4,109 CVD and non-CVD patients each). In the matched sample, 30-day mortality was 8.4% among CVD patients and 7.0% among non-CVD patients RR (CI) 1.20 (1.03 - 1.39). 90-day mortality among CVD patients (vs. Non-CVD patients) remained significantly elevated (9.7% vs. 8.2%), RR (CI) 1.20 (1.04 - 1.37). Among CVD subgroups, 30 and 90-day mortality was higher for patients with preexisting ICH (11.8% and 13.7%, respectively) compared to IS (8.7% and 10.2%, respectively). Conclusion: Preexisting CVD significantly increases the mortality risk in COVID-19 patients. Mechanisms for poor COVID-19 outcomes among CVD patients need to be evaluated.