Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries
CAPACITY-COVID Collaborative Consortium and LEOSS Study Group; Linschoten, Marijke; Zondag, Anna; Asselbergs, Folkert
(2022) European heart journal, volume 43, issue 11, pp. 1104 - 1120
(Article)
Abstract
AIMS: Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS: We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable
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Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION: Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Keywords: COVID-19, SARS-CoV-2, Cardiovascular disease, Comorbidity, Epidemiology, Patient registry, Journal Article
ISSN: 0195-668X
Publisher: Oxford University Press
Note: Funding Information: R.L. Anthonio: reports a grant from Biotronic Teaching, a CTCue licence by Sanofi and personal fees from Abiomed and Amgen. Funding Information: P.Y. Kopylov: Sechenov University received funding from the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Center ‘Digital Biodesign and Personalized Healthcare’ no. 075-15-2020-926. Funding Information: The CAPACITY-COVID registry is supported by the Dutch Heart Foundation (2020B006 CAPACITY), the EuroQol Research Foundation, Novartis Global, Sanofi Genzyme Europe, Novo Nordisk Nederland, Servier Nederland, and Daiichi Sankyo Nederland. The Dutch Network for Cardiovascular Research (WCN), a partner within the CAPACITY-COVID consortium, received funding from the Dutch Heart Foundation (2020B006 CAPACITY) for site management and logistic support in the Netherlands. LEOSS is supported by the German Centre for Infection Research (DZIF) and the Willy Robert Pitzer Foundation. Marijke Linschoten is supported by the Alexandre Suerman Stipend of the University Medical Center Utrecht. Folkert W. Asselbergs is supported by CardioVasculair Onderzoek Nederland 2015-12 eDETECT and, along with Bryan Williams and Robert Bell, is supported by the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre. The work of Angela Shore was supported by the NIHR Exeter Clinical Research facility during the conduct of the study. The work of Gerry McCann was supported by grant funding by the United Kingdom Research and Innovation (UKRI) for the COVID Heart and PHOSP COVID research studies Funding Information: and by the NIHR Leicester Biomedical Research Centre for data collection. The work of Sanjay Prasad was supported by grant funding for COVID Heart from UKRI. The work of Philippe Kopylov and Daria Gognieva was financed by the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Center Digital Biodesign and Personalized Healthcare no. 075-15-2020-926. The work conducted at the King Fahd Hospital of the University was supported by the King Abdulaziz City for Science & Technology grant number (10-BIO1342-46). Funding Information: S. Heymans: reports an unrestricted research grant from Pfizer; funding from the European Union Commission’s Seventh Framework Funding Information: programme under grant agreement no. 305507 (HOMAGE); support from the Netherlands Cardiovascular Research Initiative, an initiative with support of the Dutch Heart Foundation, CVON2016-Early HFPEF, 2015-10, CVON She-PREDICTS, grant 2017-21, CVON Arena-PRIME, 2017-18. S. Heymans has reported additional consulting fees from Roche, NovoNordisk, CSL Behring (besides those reported earlier i.e. AstraZeneca, Cellprothera and Merck). Funding Information: C. Bucciarelli-Ducci received grant funding as co-applicant for COVID Heart. Funding Information: We want to express our gratitude and appreciation to all participating sites and researchers forming part of the CAPACITY-COVID collaborative consortium and LEOSS. CAPACITY-COVID gratefully acknowledges the following organizations for their assistance in the development of the registry and/or coordination regarding the data registration in the collaborating centres: partners of the Dutch CardioVascular Alliance (DCVA), the Dutch Association of Medical Specialists (FMS), and the British Heart Foundation Centres of Research Excellence. In addition, the consortium is grateful for the endorsement of the CAPACITY-COVID initiative by the European Society of Cardiology (ESC), the European Heart Network (EHN), and the Society for Cardiovascular Magnetic Resonance (SCMR). Furthermore, the consortium appreciates the endorsement of CAPACITY-COVD as a flagship research project within the National Institute for Health Research (NIHR)/British Heart Foundation (BHF) Partnership framework for COVID-19 research. Part of this work is supported by the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 joint undertaking under grant agreement no. 116074. This joint undertaking receives support from the EU's Horizon 2020 research and innovation programme and EFPIA. Furthermore, we want to thank the LEOSS study infrastructure group: Jörg Janne Vehreschild (Goethe University Frankfurt, University Hospital of Cologne), Lisa Pilgram (Goethe University Frankfurt), Carolin E.M. Jakob (University Hospital of Cologne), Melanie Stecher (University Hospital of Cologne), Max Schons (University Hospital of Cologne), Susana M. Nunes de Miranda (University Hospital of Cologne), Annika Claßen (University Hospital of Cologne), Sandra Fuhrmann (University Hospital of Cologne), Bernd Franke (University Hospital of Cologne), Nick Schulze (University Hospital of Cologne), Fabian Praßer (Charité, Universitätsmedizin Berlin), and Martin Lablans (University Medical Center Mannheim). The CAPACITY-COVID registry is supported by the Dutch Heart Foundation (2020B006 CAPACITY), the EuroQol Research Foundation, Novartis Global, Sanofi Genzyme Europe, Novo Nordisk Nederland, Servier Nederland, and Daiichi Sankyo Nederland. The Dutch Network for Cardiovascular Research (WCN), a partner within the CAPACITY-COVID consortium, received funding from the Dutch Heart Foundation (2020B006 CAPACITY) for site management and logistic support in the Netherlands. LEOSS is supported by the German Centre for Infection Research (DZIF) and the Willy Robert Pitzer Foundation. Marijke Linschoten is supported by the Alexandre Suerman Stipend of the University Medical Center Utrecht. Folkert W. Asselbergs is supported by CardioVasculair Onderzoek Nederland 2015-12 eDETECT and, along with Bryan Williams and Robert Bell, is supported by the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre. The work of Angela Shore was supported by the NIHR Exeter Clinical Research facility during the conduct of the study. The work of Gerry McCann was supported by grant funding by the United Kingdom Research and Innovation (UKRI) for the COVID Heart and PHOSP COVID research studies and by the NIHR Leicester Biomedical Research Centre for data collection. The work of Sanjay Prasad was supported by grant funding for COVID Heart from UKRI. The work of Philippe Kopylov and Daria Gognieva was financed by the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Center Digital Biodesign and Personalized Healthcare no. 075-15-2020-926. The work conducted at the King Fahd Hospital of the University was supported by the King Abdulaziz City for Science & Technology grant number (10-BIO1342-46). Funding Information: We want to express our gratitude and appreciation to all participating sites and researchers forming part of the CAPACITY-COVID collaborative consortium and LEOSS. CAPACITY-COVID gratefully acknowledges the following organizations for their assistance in the development of the registry and/or coordination regarding the data registration in the collaborating centres: partners of the Dutch CardioVascular Alliance (DCVA), the Dutch Association of Medical Specialists (FMS), and the British Heart Foundation Centres of Research Excellence. In addition, the consortium is grateful for the endorsement of the CAPACITY-COVID initiative by the European Society of Cardiology (ESC), the European Heart Network (EHN), and the Society for Cardiovascular Magnetic Resonance (SCMR). Furthermore, the consortium appreciates the endorsement of CAPACITY-COVD as a flagship research project within the National Institute for Health Research (NIHR)/British Heart Foundation (BHF) Partnership framework for COVID-19 research. Part of this work is supported by the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 joint undertaking under grant agreement no. 116074. This joint undertaking receives support from the EU’s Horizon 2020 research and innovation programme and EFPIA. Furthermore, we want to thank the LEOSS study infrastructure group: Jörg Janne Vehreschild (Goethe University Frankfurt, University Hospital of Cologne), Lisa Pilgram (Goethe University Frankfurt), Carolin E.M. Jakob (University Hospital of Cologne), Melanie Stecher (University Hospital of Cologne), Max Schons (University Hospital of Cologne), Susana M. Nunes de Miranda (University Hospital of Cologne), Annika Claßen (University Hospital of Cologne), Sandra Fuhrmann (University Hospital of Cologne), Bernd Franke (University Hospital of Cologne), Nick Schulze (University Hospital of Cologne), Fabian Praßer (Charité, Universitätsmedizin Berlin), and Martin Lablans (University Medical Center Mannheim). Funding Information: N. Isberner: reports a grant from the Hector Foundation II, Fond: STIF-99. B. Jensen: reports personal fees from GILEAD. Funding Information: G.P. McCann: received grant funding as co-applicant for COVID Heart and PHOSP COVID research studies from United Kingdom Research and Innovation (UKRI). Funding Information: S. Prasad: received grant funding for COVID Heart from the British Heart Foundation/National Institute of Health Research (NIHR). Funding Information: L. Pilgram: received grant funding from the Willy Robert Pitzer Foundation during the conduct of the LEOSS registry study. Funding Information: F. Hanses: reports a grant from the Federal Ministry of Education and Research (BMBF); consulting fees from MSD and GSK; and personal fees from Basilea and Correvio. Funding Information: The following authors disclose relationships/activities/interests outside the submitted work. sF.W. Asselbergs: reports grants from CardioVasculair Onderzoek Nederland 2015-12 eDETECT and National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre. Publisher Copyright: © The Author(s) 2021
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