J Korean Med Sci.  2021 Jan;36(2):e15. 10.3346/jkms.2021.36.e15.

Impact of Cardiovascular Risk Factors and Cardiovascular Diseases on Outcomes in Patients Hospitalized with COVID-19 in Daegu Metropolitan City

• Park BE
• Lee JH
• Park HK
• Kim HN
• Jang SY
• Bae MH
• Yang DH
• Park HS
• Cho Y
• Lee BY
• Nam CW
• Lee JB
• Kim U
• Chae SC
• the Daegu COVID-19 Research Project

• KMID: 2510588
• DOI: http://doi.org/10.3346/jkms.2021.36.e15

Abstract

Background
Data regarding the association between preexisting cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs) and the outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) are limited. Therefore, the aim of this study was to investigate the impact of preexisting CVRFs or CVDs on the outcomes of patients with COVID-19 hospitalized in a Korean healthcare system.
Methods
Patients with COVID-19 admitted to 10 hospitals in Daegu Metropolitan City, Korea, were examined. All sequentially hospitalized patients between February 15, 2020, and April 24, 2020, were enrolled in this study. All patients were confirmed to have COVID-19 based on the positive results on the polymerase chain reaction testing of nasopharyngeal samples. Clinical outcomes during hospitalization, such as requiring intensive care and invasive mechanical ventilation (MV) and death, were evaluated. Moreover, data on baseline comorbidities such as a history of diabetes, hypertension, dyslipidemia, current smoking, heart failure, coronary artery disease, cerebrovascular accidents, and other chronic cardiac diseases were obtained.
Results
Of all the patients enrolled, 954 (42.0%) had preexisting CVRFs or CVDs. Among the CVRFs, the most common were hypertension (28.8%) and diabetes mellitus (17.0%). The prevalence rates of preexisting CVRFs or CVDs increased with age (P < 0.001). The number of patients requiring intensive care (P < 0.001) and invasive MV (P < 0.001) increased with age. The in-hospital death rate increased with age (P < 0.001). Patients requiring intensive care (5.3% vs. 1.6%; P < 0.001) and invasive MV (4.3% vs. 1.7%; P < 0.001) were significantly greater in patients with preexisting CVRFs or CVDs. In-hospital mortality (12.9% vs. 3.1%; P < 0.001) was significantly higher in patients with preexisting CVRFs or CVDs. Among the CVRFs, diabetes mellitus and hypertension were associated with increased requirement of intensive care and invasive MV and in-hospital death. Among the known CVDs, coronary artery disease and congestive heart failure were associated with invasive MV and in-hospital death. In multivariate analysis, preexisting CVRFs or CVDs (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.07–3.01; P = 0.027) were independent predictors of in-hospital death adjusting for confounding variables. Among individual preexisting CVRF or CVD components, diabetes mellitus (OR, 2.43; 95% CI, 1.51–3.90; P < 0.001) and congestive heart failure (OR, 2.43; 95% CI, 1.06–5.87; P = 0.049) were independent predictors of in-hospital death.
Conclusion
Based on the findings of this study, the patients with confirmed COVID-19 with preexisting CVRFs or CVDs had worse clinical outcomes. Caution is required in dealing with these patients at triage.after

Keyword

Coronavirus; SARS-CoV-2; COVID-19; Cardiovascular Risk Factors; Cardiovascular Disease; Prognosis

Figure

• 

  Fig. 1 Frequency according to the presence (“yes”) or absence (“no”) of preexisting cardiovascular risk factors or cardiovascular disease. Frequency of intensive care unit utilization (A), invasive mechanical ventilator utilization (B), and in-hospital death (C) according to the presence (“yes”) or absence (“no”) of preexisting cardiovascular risk factors or cardiovascular disease.ICU = intensive care unit, CV = cardiovascular, CVD = cardiovascular disease, DM = diabetes mellitus, HTN = hypertension, DL = dyslipidemia, CAD = coronary artery disease, HF = heart failure, CVA = cerebrovascular accidents, CCD = chronic cardiac disease, MV = mechanical ventilator.

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