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Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.
Hall, Eric J; Ayers, Colby R; Kolkailah, Ahmed A; Rutan, Christine; Walchok, Jason; Williams, Joseph H; Wang, Tracy Y; Rodriguez, Fatima; Bradley, Steven M; Stevens, Laura; Hall, Jennifer L; Mallya, Pratheek; Roth, Gregory A; Morrow, David A; Elkind, Mitchell S V; Das, Sandeep R; de Lemos, James A.
  • Hall EJ; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.).
  • Ayers CR; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.).
  • Kolkailah AA; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.).
  • Rutan C; Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.).
  • Walchok J; Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.).
  • Williams JH; Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.).
  • Wang TY; Duke Clinical Research Institute, Duke University, Durham, NC (T.Y.W.).
  • Rodriguez F; Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, CA (F.R.).
  • Bradley SM; Allina Health Minneapolis Heart Institute, MN (S.M.B.).
  • Stevens L; Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.).
  • Hall JL; Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.).
  • Mallya P; Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.).
  • Roth GA; Division of Cardiology, Department of Medicine, University of Washington, Seattle (G.A.R.).
  • Morrow DA; Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.A.M.).
  • Elkind MSV; Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
  • Das SR; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.).
  • de Lemos JA; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.).
Circ Cardiovasc Qual Outcomes ; 16(5): e009652, 2023 05.
Article in English | MEDLINE | ID: covidwho-2261935
ABSTRACT

BACKGROUND:

The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time.

METHODS:

We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models.

RESULTS:

A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63).

CONCLUSIONS:

Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiovascular Diseases / Stroke / COVID-19 / Myocardial Infarction Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Vaccines / Variants Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Circ Cardiovasc Qual Outcomes Journal subject: Vascular Diseases / Cardiology Year: 2023 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiovascular Diseases / Stroke / COVID-19 / Myocardial Infarction Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Vaccines / Variants Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Circ Cardiovasc Qual Outcomes Journal subject: Vascular Diseases / Cardiology Year: 2023 Document Type: Article